JJ Parsons

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Total Quality Management in Health Care
Marketing How the Markets Demand for Quality is
Changing!

• JJ Parsons
• Presbyterian Healthcare Services
• Vice President, Business Development
  Contracting
• jparsons_at_phs.org
• [phone]

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Americans are more likely to want a new direction
in health care even compared to the situation in
Iraq!
Health care

Iraq

Immigration

Foreign policy in places other than Iraq

Family values issues

Global Warming

Trade
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22
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Source Public Opinion Strategies (2007)
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Healthcare Needs a Quality Focus

• The current healthcare system is economically
  unsustainable and negatively impacting our
  nation's ability to compete globally. Craig
  Barrett, Intel Chairman, 2006.

• The Institute Of Medicine estimates
  that44,000-98,000 deaths occur annually in
  American Hospitals due to medical errors.

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Market Implications

• National and local healthcare reform and
  legislation
• Market transparency of quality outcomes
• Changes in Reimbursement
• Increase focus by regulators
• Increased competition by healthcare travel
  companies
• Healthcare corporations focused on balanced
  scorecards

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Dont Try this at Home

Why are they always pushing quality on us?
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1. National Local Healthcare Reform
Legislation

• Massachusetts
• 2006 - First state to require health insurance
  and provide universal coverage
• California
• Governor introduced 12B universal coverage plan,
  but failed in Legislature in 2008
• New Mexico
• Governor Richardson seeking healthcare coverage
  expansion but outlook in Legislature is uncertain

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Insurance National Scene

• Rising healthcare costs
• Evolving consumer role interests
• Importance of technology
• Increasing government involvement
• Increasing focus on quality customers
• Consolidation

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Insurance New Mexico Market - Overall

• Increasing role of government including
  legislative bill and restrictions on profit
  levels of health plans
• Higher percentage of individuals covered under
  government programs lower reimbursement for
  these programs increase rate for Commercial market

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Source US Census Bureau Center for Health
Workforce Studies
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2. Market transparency of quality outcomes

• Who are the audiences for health performance
  information?
• Consumersuse this information at various points
  of interaction with the health system, from the
  time they choose a health plan to the point of
  selecting a health care provider for a specific
  service.
• Employers/Purchaserswant information to use in
  selecting from among various health plans,
  including the cost and outcomes of providers and
  quality standards.

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Transparency (continued)

• Health Planswant to evaluate the price and
  quality of all physicians, hospitals, and other
  providers. May also want to benchmark their
  performance on service and quality measures to
  their competitors.
• ProvidersHospitals, physicians, and other health
  care providers would benefit from more
  transparent price and quality information as a
  feedback loop for improved performance efficient
  or effective referrals.
• PolicymakersFederal/state officials for
  oversight and monitoring of provider and health
  plan performance.

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Quality in Healthcare Performance Scores
(continued)
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Response Demand for Increased Transparency

• Cost (IRS Form 990)
• Collection practices
• Community benefit
• Tax-exempt status
• Quality
• IHI 5 Million Lives Campaign
• Leapfrog 27 Safe Practices
• Never Events
• Regulatory

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3. Changes in Reimbursement CMS Halts Payments
for Never Events

• CMS The right care, for every patient, every
  time.
• October, 2007 1st step toward preventing
  Medicare from paying hospitals for costs of
  treating a patient who acquires specific
  conditions during hospitalization.
• Never Event Examples
• Objects left in surgery
• Catheter-associate urinary tract infections
• Decubitus ulcers

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4. Increased focus by regulators Transparency
of Patient Satisfaction Data
Hospital Consumer Assessment of Healthcare
Providers and Systems

• As stated by CMS and AHRQ
• HCAHPS is a tool to be used for public reporting
  of major areas of hospital performance to
  support consumer choice
• HCAHPS is not a stand-alone quality improvement
  tool
• HCAHPS presents the symptomsadditional
  measurement is needed to make a diagnosis and
  improve.

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Transparency of Patient Satisfaction Data

• Consumers will have access to the data
• Consumers will relate more easily to HCAHPS than
  to clinical data
• Some will use HCAHPS data to choose hospitals
• Will have volume, revenue, and reputation
  implications
• HCAHPS will be in the public eye
• Media coverage
• Promotion by hospitals themselves
• Reported for consumers on Hospital Compare Web
  site (www.hospitalcompare.hhs.gov)
• Typical public report data are shown as
  frequencies
• Hospital performance frequencies
• National and state average performance
  frequencies

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Transparency of Patient Satisfaction Data

• Public reporting will include the following six
  domains (March 2008)
• Communication with Doctors
• Communication with Nurses
• Responsiveness of Hospital Staff
• Pain Control
• Communication about Medicines
• Discharge Information
• The following four questions will also be
  reported
• Cleanliness of Hospital Environment
• Quietness of Hospital Environment
• Overall Rating of Hospital
• Recommend Hospital

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Dont Speak in Quality-ese

Its a vice-president thing, Berger.You
wouldnt understand.
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5. Increased competition by healthcare travel
companies

• Medical Tourism Plans Blossoming Around the
  country
• Why?
• Reduced costs
• Ex Open Heart Surgery in US 100,000
• Wockhardt, India 7,500
• Way in which patient Treated
• Care outside medical services includes gourmet
  meals laundry services quality of room hotel
  suite like room
• Access to physician call phones
• - Opportunity to see new part of the world
  vacation
• - Access to procedures not yet approved by FDA
• 
  Source ForbesLife

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6. Healthcare corporations focused on balanced
scorecards
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Baldrige Criteria Framework A Systems Perspective
Leadership Triad
Results Triad
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MBNQA Applicants by Stage
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PresEssentials Clinical Outcomes Financial
Outcomes Customer Loyalty Staff
Focus Growth and Mission Results
PHS Board Measures
2007 Vital Few Create process and information
infrastructure changes to Objectives
Improve outcomes of the Patient Care Process
(access,
throughput, satisfaction, safety)
Reduce cost per member and
cost per unit of service
2007 Theme Every Patient, Every Member,
Every Time
Hire Right Bundle Behavioral Interviewing
Pre-Interview Assessment Peer
Interviewing
Customer Loyalty Bundle Key Words at Key
Times (AIDET) Rounding on Customers Pre, Post
and Welcome Calls Service Recovery
(Advocate)
Must Haves How We Work
Employee Retention Bundle Rounding Thank You
Notes 30/90 Day Meetings
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• To benefit patients and members, Presbyterian is
  dedicated to national excellence by the
  achievement of 3 Things
• Malcolm Baldrige Quality Award - continuously
  improve processes to produce nationally excellent
  clinical, service and business results.
• Top 10 in Patient Safety - create the safest
  possible environment for those who place their
  trust in us.
• AA Rating - control expenses while growing our
  business to sustain positive financial
  performance and to fund excellence.

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PHS Baldrige Journey Timeline
Training Define customers and requirements Key
core process identification Organizational
Profile Self Assessment Four areas of focus
Achieve MBNQA Consensus Stage NMQA Zia Award
Recipient 40 QNM Examiners One MBNQA Examiner
MBNQA Site Visit Two MBNQA examiners One
senior 26 QNM Examiners
2007
2006
2002
2003
2004
2005
Focused on Key Learnings 49 QNM Examiners 1
MBNQA Examiner
Plan from self-assessment Zia application
completion QNM Roadrunner Recipient 49 QNM
Examiners
MBNQA Site Visit 25 QNM Examiners One MBNQA
Examiner
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Looking Ahead (The journey is challenging but we
are better prepared)
Presbyterian Annual Rhythm
2nd Quarter People
1st Quarter Celebration/Kickoff

• Staff reviews
• Leadership evaluations
• People summit

• Annual Theme
• Vital Few Objectives

March MPR
April MPR, QPR, ELF, LDI, QEF
February MPR
May MPR
January MPR, QPR, ELF, LDI, QEF
June MPR
Start
SHAPING THE FUTURE CYCLE 2009 - 2011
PERFORMANCE MANAGEMENT IMPROVEMENT CYCLE 2007
PERFORMANCE MANAGEMENT IMPROVEMENT CYCLE

• Performance Reviews
• Monthly Leadership (MPR)
• Quarterly Leadership (QPR, LDI, ELF)
• Quarterly All Employees (QEF)

Stop
MPR, QPR, ELF, LDI, QEF July
MPR December
MPR August
3rd Quarter Strategy
MPR, QPR, ELF, QEF October
MPR November
4th Quarter Preparation
MPR, LDI September

• Project Prioritization
• Strategic Plan
• Tactical Plan
• Capital Plan
• IT Plan
• Budget assumptions

• Budget
• Work Plan
• Measures
• Incentives
• Theme

LDI Leadership Development Institute QPR
Quarterly Performance Review MPR Monthly
Performance Review QEF Quarterly
Employee Forums ELF Extended Leader Forum
Process link
Revision 1/11/2008
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PHS Work System
Presbyterian Healthcare Services EST and EOT

Annual Rhythm Process
Patient Care Process/Council
Support
Customer Service Process/Council
Selection Engagement Process/Council
Customer Financial Experience/Council
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Good
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Presbyterians Commitment to Quality

• Earned two consecutive site visits from National
  Malcolm Baldrige Quality program. Earned QNMs
  Zia in 2004.

• Health Plan one of 14 in nation with
  threeexcellent accreditations for managed
  care.

• Medical Group setting the benchmark for care of
  patients with diabetes.

• Investing millions in patient safety, reduced
  hospital medication errors by 80 percent.

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Perspective on the Future

• Healthcare will continue to be front page news
• It will be painful for those not prepared
• All stakeholder's of the healthcare arena will
  demand data to make decisions
• The value equation quality over cost
• Will under go many cycles of change
• Every service will be faster
• Those who dont accelerate on the technology
  journey will not be around
• Very soon there will be no payment for mistakes
• Consumer will own their own healthcare data