The Dartmouth Symposium on Health Care Delivery Science March 26-27, 2018 Health Care Transformation Playbook: How to Implement Organizational Change in an Uncertain Environment Symposium on Health Care Delivery Science, 2018. Dartmouth College. Agenda Policy Update. Overview of recent policy changes at the federal level relating to value-based payment. Hope Plavin’16 Session 1: Where Are We Now? Opportunities and challenges facing OneCare Vermont, a state-wide ACO, as it relates to a Next Generation ACO model. Linda Cohen’16 Norman Ward’15 Stephen Leffler’16 Session 2: Leading Change – How to Evaluate Change Opportunities and Differentiate Good Ideas from Bad Ones Panel of Executive Officers discuss decision-making around areas of transformation; including evaluating change opportunities, deciding which ideas to pursue, and determining when to abandon initiatives. Joanne Conroy Janice Nevin Austin Pittman’13 Session 3: Medici Method Innovation Workshop Utilizing diverse perspectives and experiences to generate and refine innovative ideas on health system transformation. Facilitated by The Medici Group Session 4: Elements of Change Management Discussion among Mt. Sinai Beth Israel’s CMO, COO and VP-HR about the operational, human resources, and managerial strategies involved in the transformation of Mt. Sinai Beth Israel and its subsequent reduction in total bed capacity from 799 licensed beds to 220, of which 70 are medical/surgical. Barbara Barnett’13 Christopher Berner Elizabeth Sellman Session 5: Transformative Partnerships Four tactics for creating transformative partnerships. Robert Eubanks’19 Session 6: Transformers - Transformation Learning Stations Five presentations about transformative work. David Robson’16 Benjamin Anderson’16 Gregory Makoul’13 Surya Bhatta’18 and Kathryn Becker Van Haste’18 Kevin Bader’18 and John Benson Session 7: Dimensions of Implementing Change Panelists share strategies for implementing change and creating value at the physician, departmental and organizational levels. Suellen Griffin’15 Alok Sharan’15 Andrew Sorenson’16 2018 Symposium Keynote Speaker Rushika Fernandopulle is the co-founder and CEO of Iora Health, an innovative primary care clinical organization. He is a physician who has spent more than ten years involved in efforts to improve the quality of healthcare delivered to patients. He was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement, and served as a Managing Director of the Advisory Board Company. He serves on the faculty and earned his AB, MD, and MPP from Harvard University. He completed his clinical training at the Massachusetts General Hospital. Video: http://dartgo.org/symhcds18 Symposium on Health Care Delivery Science, 2018. Dartmouth College. Policy update. Hope Plavin provided an overview of key changes in the contours of the US health policy landscape. This included the roles of federal and state governments, private payers, and newer entrants to the marketplace such as Amazon, and Google. Changes in federal policy leadership, and Medicare and Medicaid payment and priorities were described. Potential trends for the near future were laid out, including growth in value-based payment and purchasing models, cross-sector partnerships and continued interest in accountable care organizations. “Do strong financial incentives coupled with better Hope Plavin ‘16 patient engagement and care management improve outcomes & lower costs?” Video: http://dartgo.org/symhcds18 Slides: http://dartgo.org/symslide18 Session 1. Where are we now? The State of Vermont is conducting a 5-year Key levers for change are hospital payment experiment with CMS around 1) controlling reform, primary care support, community- healthcare spending growth to 3.5% over 5 years, based services support, and population 2) getting Vermonters into the OneCare Vermont health management. Payment reforms are ACO (70% of commercially insured Vermonters creating new capitated care payment models and 90% of Medicare beneficiaries in Vermont) and all-payer rate setting. Their population through bringing in providers, 3) critically model segments patients into healthy and examining if the model is improving health well (44%), early onset chronic illness quality in Vermont. (40%), complex/high cost/acute care (6%), and chronic illness and rising risk (10%) and focuses resources on acute and high- cost segments. OneCare ACO’s community-based care aims to address social determinants of health, focusing resources on high-cost, high-risk patients, screening for social Linda Cohen ‘16 Norm Ward ‘16 Steve Leffler ‘16 supports in primary care. Symposium on Health Care Delivery Science, 2018. Dartmouth College. Session 2. Leading change: How to “whole-person” care model that includes evaluate change opportunities & addressing social determinants of health. differentiate good ideas from bad Joanne Conroy shared her emphasis on engaged listening, communication, and ones. continually scanning the environment for opportunities for change. She explained the Speakers shared examples of and best practices importance of addressing hearts and minds for organizational change. Janice Nevin described and removing barriers to change. Other Christiana’s work to understand and affirm strategies discussed included: how to create organizational values by engaging her entire staff an operating system for continuous in the process and by considering the role of love improvement; prioritizing innovation by in healthcare. Austin Pittman described UHC’s allocating time for it; and the importance of iterative and very large-scale move towards a listening to the customer. “It starts with just listening. Not for what you want to hear, just listening.” Janice Nevin Joanne Conroy Austin Pittman ‘13 Video: http://dartgo.org/symhcds18 Slides: http://dartgo.org/symslide18 Session 3. Medici Method innovation workshop. This session explored how participants can use the diverse perspectives and experiences present in their teams to generate and refine innovative ideas on health system transformation. It was facilitated by Sharang Biswas D’12 Th’13, the Experience Designer at The Medici Group. Key takeaways from the experience: • Form teams as diverse as possible to leverage a variety of perspectives and experiences. • When ideating, aim to generate a large number of ideas, using intersections and connections between seemingly unrelated concepts. • When selecting which ideas to move forward with, use passion and surprise as a guide. • Acquire feedback from non-experts, and use the power of short, focused meetings. • Remember the Smallest Executable Step (SES): test ideas as cheaply and quickly as possible, and don’t be afraid to pivot away from the original idea. The Medici Group is a global strategy consulting firm that works with clients to innovate by harnessing the diversity their organizations. Based on the work of CEO, Frans Johansson (author of the Bestselling THE MEDICI EFFECT and THE CLICK MOMENT), The Medici Group engages with clients in the C-Suite to drive sustainable and meaningful progress in innovation culture, leadership model, or frontier growth. https://www.themedicigroup.com/ Symposium on Health Care Delivery Science, 2018. Dartmouth College. Session 4. Elements of change With a new facility under construction, they management. are rethinking care patterns and processes. Old wards have been relocated to available space in existing buildings in other facilities The Mount Sinai health system is reducing beds and specialty hospitals within their system, in their primary facility from 799 beds in 2018 to organized as centers of excellence. 220 beds in 2021 (70 for medical/surgical, the rest for other needs) while reorganizing the system Critical elements of success include around ambulatory care and centers of excellence. continued relationship building with the community, rethinking care models for Key drivers for the reduction are: flexibility, and interpersonal relationship • A move to coordinated care in outpatient building among staff and leadership. settings • Right-sizing an aging facility with 60% occupancy rate in need of $1.3 billion worth of renovation • Shifting patient and payer needs. Barb Barnett ‘13 Christopher Berner Elizabeth Sellman Video: http://dartgo.org/symhcds18 Slides: http://dartgo.org/symslide18 Session 5. Transformative partnerships. The four tactics are: Robert Eubanks shared four tactics for creating 1. Invest in relationships before partnering transformative partnerships and explained how 2. Discover a compelling story they relate to two projects he completed in 3. Align leadership priorities Hawaii: using video decision aids for advance 4. Exercise compassion and resilience. care planning and building a home-based palliative care program. For Tactic 1, Robert highlighted listening; Marshall Ganz’s insights on relationships; and the “Strategic Doing Process” from Purdue. For Tactic 2, Robert highlighted the “Transformation always importance of transparency around values and involves loss for someone. a compelling story such as “resist being Compassion and resilience average.” For Tactic 3, Robert stressed are essential responses.” emptying one’s beliefs and listening without judgment as well as four leadership levers that focus on emotions and systems. For Tactic 4, Robert Eubanks ‘19 he shared five practices emphasizing empathy, forgiveness, and self-care. Symposium on Health Care Delivery Science, 2018. Dartmouth College. Session 6. Transformation learning