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Designing the Laboratory of the Future Today:

Preparing to Serve Medical Homes and ACOs

Designing the Laboratory of the Future Today:

Preparing to Serve Medical Homes and ACOs

May 3, 2011May 3, 2011presented by:presented by:

Rick Panning, MBA, MLS(ASCP)Rick Panning, MBA, MLS(ASCP)CMCM

Vice President, Allina Hospitals and ClinicsVice President, Allina Hospitals and ClinicsMinneapolis, MNMinneapolis, MN

AllinaAllina--atat--a a GlanceGlance

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Laboratory Business ModelLaboratory Business Model•• Allina Medical LaboratoriesAllina Medical Laboratories

–– System business unit System business unit -- 4 metro hospital laboratories and 4 metro hospital laboratories and external reference laboratory businessexternal reference laboratory business

•• 6 Regional hospitals and 60 clinics added to model in 20116 Regional hospitals and 60 clinics added to model in 2011--20122012–– Allina entities are charged based on a fully allocated cost/testAllina entities are charged based on a fully allocated cost/test–– HospitalHospital--basedbased–– HPA pathology group (32 pathologists, 9 HPA pathology group (32 pathologists, 9 PAsPAs, 2 NPs) , 2 NPs) –– Technology, policy and procedures, IT and processes Technology, policy and procedures, IT and processes

standardized across all sitesstandardized across all sites–– Model:Model:

•• Stat/immediate response labs at all hospitals and clinicsStat/immediate response labs at all hospitals and clinics–– Hospitals: What is needed by clinicians within 4 hoursHospitals: What is needed by clinicians within 4 hours–– Clinics: What is needed by the clinician during the visitClinics: What is needed by the clinician during the visit

»» Includes A1C testing to meet strict diabetes outcomesIncludes A1C testing to meet strict diabetes outcomes•• Full service, central laboratory at Abbott Northwestern HospitalFull service, central laboratory at Abbott Northwestern Hospital

–– Includes consolidated and specialty departments: microbiology, Includes consolidated and specialty departments: microbiology, histology, cytology, Immunology/Special Chemistry, special histology, cytology, Immunology/Special Chemistry, special chemistry, special coagulation, molecular, chemistry, special coagulation, molecular, cytogeneticscytogenetics, flow , flow cytometrycytometry, , immunohistochemistryimmunohistochemistry, , andrologyandrology

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AML Test Volumes (2009)AML Test Volumes (2009)(ability to spread hospital fixed costs over larger test volume)(ability to spread hospital fixed costs over larger test volume)

External Outreach

(7%)

Internal Outreach –Regionals, Allina Clinics

(26%)

AML – 4 metro hospitalsCore testing base

(67% of testing volume))

The case for changeThe case for change•• The core central laboratory facility must be replacedThe core central laboratory facility must be replaced

–– Quality and patient safetyQuality and patient safety–– Employee safety and work environmentEmployee safety and work environment–– 40+ year old asset designed to serve one hospital now serves 40+ year old asset designed to serve one hospital now serves

10 hospitals and 70 clinics10 hospitals and 70 clinics–– Regulatory and accreditation issuesRegulatory and accreditation issues

•• Expanded central facility to realize financial benefitsExpanded central facility to realize financial benefits–– productivity and efficiency (reduce operating costs)productivity and efficiency (reduce operating costs)–– Expand outreach business Expand outreach business –– Decrease outsourced testing Decrease outsourced testing –– add virology and toxicologyadd virology and toxicology

•• Complete remaining opportunities for consolidation Complete remaining opportunities for consolidation –– Microbiology (discontinue testing at 4 sites)Microbiology (discontinue testing at 4 sites)–– Flow Flow cytometrycytometry–– Histology Histology –– Clinic chemistry at 4 sitesClinic chemistry at 4 sites

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Strategic capital recommendationStrategic capital recommendation•• Build out 72,000 square feet of space in Build out 72,000 square feet of space in

the 10the 10thth Avenue Building for an Allina Avenue Building for an Allina central laboratory (on main hospital central laboratory (on main hospital campus)campus)–– Free up prime clinical real estate in the Free up prime clinical real estate in the

hospitalhospital–– Compared to off campus locationCompared to off campus location

•• Maximizes opportunities to improve productivity Maximizes opportunities to improve productivity and lower testing costsand lower testing costs

•• Minimizes duplication of lab functions between Minimizes duplication of lab functions between Abbott Northwestern Hospital and Central Lab Abbott Northwestern Hospital and Central Lab (when compared to off(when compared to off--site)site)

Laboratory Facility/Strategy HistoryLaboratory Facility/Strategy History(10 years (10 years -- 7 proposals 7 proposals -- 7 consultants)7 consultants)

•• Proposals developed between 1998 and 2008Proposals developed between 1998 and 2008•• 7 consultants7 consultants•• 4 laboratory vice presidents4 laboratory vice presidents•• 3 3 ““nono--decisiondecision”” and 4 and 4 ““not endorsed by not endorsed by

leadershipleadership””•• 3 joint ventures 3 joint ventures –– many with a component of many with a component of

oursourcingoursourcing•• Proposed central laboratories of 40Proposed central laboratories of 40--62K square 62K square

feetfeet•• All proposals were All proposals were ““offoff--sitesite”” except oneexcept one

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Goal with Allina LeadershipGoal with Allina Leadership(2009(2009--2010)2010)

•• We needed to put this issue to rest once and for We needed to put this issue to rest once and for allall–– As we say in Minnesota, As we say in Minnesota, ””Fish or cut bait!Fish or cut bait!””–– How clinically significant is laboratory services in a How clinically significant is laboratory services in a

large integrated health system and a future large integrated health system and a future accountable care organization?accountable care organization?

•• Choices:Choices:–– Invest in a new facility and expand businessInvest in a new facility and expand business–– Remodel current facility and maintain current Remodel current facility and maintain current

businessbusiness–– Outsource testingOutsource testing–– Partner with another organizationPartner with another organization

Allina Strategic project approval Allina Strategic project approval processprocess

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A fresh start A fresh start -- the personal approachthe personal approach•• New systemNew system--wide laboratory leaderwide laboratory leader

–– Informed by history and able to bring new Informed by history and able to bring new perspectiveperspective

–– Keep issue in front of leadersKeep issue in front of leaders•• Over half of the Allina leadership team was Over half of the Allina leadership team was

relatively new to the organizationrelatively new to the organization•• Opportunity to educate the leadership team.Opportunity to educate the leadership team.

–– Value of the laboratoryValue of the laboratory–– The laboratoryThe laboratory’’s role in improving outcomess role in improving outcomes–– The need for investment in a new central laboratory The need for investment in a new central laboratory

facility and replacement LISfacility and replacement LIS•• Started with introductory meeting to provide Started with introductory meeting to provide

background for the entire group.background for the entire group.

The personal approachThe personal approach•• Scheduled 1Scheduled 1--onon--1 tours of the current laboratory 1 tours of the current laboratory

facilities with each member of the Allina facilities with each member of the Allina Executive Leadership Team (ELT) Executive Leadership Team (ELT) –– 9 members, 9 members, and key board membersand key board members–– The tours made a huge difference in the individual The tours made a huge difference in the individual

leaderleader’’s comprehension and perception of what the s comprehension and perception of what the issues were.issues were.

–– ““Seeing trumped hearingSeeing trumped hearing””•• The quality, safety, regulatory and The quality, safety, regulatory and

environmental issues became real as opposed to environmental issues became real as opposed to abstract.abstract.

•• The business case ultimately was the easy part.The business case ultimately was the easy part.

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NonNon--core lab servicescore lab services -- Impact if outsourcedImpact if outsourced•• CytogeneticsCytogenetics::

–– 50% of current business is outreach which is profitable (37% mar50% of current business is outreach which is profitable (37% margin) gin) –– Most of the remaining hospitalMost of the remaining hospital--based work is related to based work is related to AllinaAllina’’ss oncology oncology

business business –– Ability to share specimens is important. Ability to share specimens is important. –– Outsourcing cost would be higherOutsourcing cost would be higher

•• Flow Flow cytometrycytometry::–– Routine component of oncology/Routine component of oncology/hematopathologyhematopathology–– Time constraints for testing Time constraints for testing –– need quick turnaround timeneed quick turnaround time–– Would lose business from large oncology clinics and other hospitWould lose business from large oncology clinics and other hospital clientsal clients

•• Molecular:Molecular:–– A primary growth opportunity for the laboratory. A primary growth opportunity for the laboratory. –– Internal sharing of specimens and integrated reporting is importInternal sharing of specimens and integrated reporting is important.ant.

•• GYN cytology (pap smears):GYN cytology (pap smears):–– Significant investment in automated screening already madeSignificant investment in automated screening already made–– Cost and turnaround time would suffer if outsourced.Cost and turnaround time would suffer if outsourced.–– Correlation with biopsies would be impacted.Correlation with biopsies would be impacted.

Financial impact of outsourcing nonFinancial impact of outsourcing non--core core testingtesting

•• Reduction in project square footage: 11,000 SFReduction in project square footage: 11,000 SF•• Reduction in capital project cost = $4.4 millionReduction in capital project cost = $4.4 million•• Operating costs would increase $3.6M/year.Operating costs would increase $3.6M/year.

–– Comparing current operating costs to proposed Comparing current operating costs to proposed outsourcing costsoutsourcing costs

–– Outsourcing of these specialty labs would be 39% Outsourcing of these specialty labs would be 39% higher than performing inhigher than performing in--househouse

•• Loss of net outreach revenue = $3.5 millionLoss of net outreach revenue = $3.5 million

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ProductivityProductivity(assumes flat Allina growth, only growth from Outreach)(assumes flat Allina growth, only growth from Outreach)

Allina Medical Laboratories Productivity

6000

7000

8000

9000

10000

11000

12000

13000

14000

15000

1997

1999

2001

2003

2005

2007

2009

2011

2013

Year

Bill

ed T

ests

/FTE

/Yea

r

Proforma - new facility

w /o new facility, no FTE reduction, nooutreach grow th

Proforma plus current internal grow thand outreach grow th

SendoutsSendouts (AMS benchmark = 3(AMS benchmark = 3--5%)5%)We have a goal to get to 3.5% within 2 years.We have a goal to get to 3.5% within 2 years.

•• Note: 2008: Vitamin D Note: 2008: Vitamin D sendoutsendout volume increased. volume increased. •• 2009: Vitamin D brought in2009: Vitamin D brought in--househouse

Percent of Send Out Tests

5.00%

6.00%

7.00%

8.00%

9.00%

10.00%

2005Actual

2006Actual

2007Actual

2008Actual

2009Proj

2010Bud

2011Est.

2012Est.

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……and in our spare time replace our LISand in our spare time replace our LIS•• Current LIS lacked functionality needed to Current LIS lacked functionality needed to

support laboratory operations and to support an support laboratory operations and to support an outreach program. Difficult to make timely outreach program. Difficult to make timely changeschanges

•• Current vendor Current vendor sunsettingsunsetting product in July 2013product in July 2013•• Have selected EPIC BeakerHave selected EPIC Beaker

–– To be implemented in 4 phases between April 2012 To be implemented in 4 phases between April 2012 and May 2013and May 2013

–– Joint development agreement for anatomic pathologyJoint development agreement for anatomic pathology–– Total integration with EPIC EMRTotal integration with EPIC EMR

•• In addition, need to consider new EPIC affiliate In addition, need to consider new EPIC affiliate hospitals and clinicshospitals and clinics

Summary Financials for Scenario OptionsSummary Financials for Scenario Options

10 yrs10 yrs5.6 yrs5.6 yrs$8.9M$8.9M22.6%22.6%

$3.3M$3.3M

$6.3M$6.3M

$29.1M$29.1M$24.8M$24.8M$4.3M$4.3M

62,62762,627

OffOff--CampusCampus

20 yrs20 yrs8.3 yrs8.3 yrs$15.1M$15.1M20.9%20.9%

$(.5)M$(.5)M

$1.8M$1.8M

$27.7M$27.7M$27.7M$27.7M

$0$0

51,62751,627

Core Core OnlyOnly

OffOff--Campus increases to operating costs Campus increases to operating costs due to a larger lab footprint at ANW & due to a larger lab footprint at ANW & operational inefficiencies.operational inefficiencies.

$8.5M$8.5MEBIDA EBIDA (Full impact (Full impact of net revenue & cost of net revenue & cost savings in year 4)savings in year 4)

5.4 yrs5.4 yrsPayback PeriodPayback Period

Includes Annual Depreciation ExpenseIncludes Annual Depreciation Expense

Core only excludes Core only excludes CytogeneticsCytogenetics, Flow , Flow CytometryCytometry and Molecular lab and Molecular lab deptsdepts

CommentsCommentsOnOn--CampusCampus

20 yrs20 yrsProject LifeProject Life

$48.0M$48.0MNPVNPV29.7%29.7%ROIROI

$6.1M$6.1MContribution Contribution MarginMargin

$32.1M$32.1M$32.1M$32.1M

$0$0

Capital RequestedCapital RequestedCash SpentCash SpentRent/Lease NPVRent/Lease NPV

62,62762,627New Facility sq. ft.New Facility sq. ft.

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Questions posed to Questions posed to AllinaAllina’’ss Executive Executive Leadership CouncilLeadership Council

1.1. Do we agree that laboratory services are Do we agree that laboratory services are a core component of clinical care in an a core component of clinical care in an integrated health system like Allina?integrated health system like Allina?

2.2. Is outsourcing of Is outsourcing of ““nonnon--corecore”” laboratory laboratory services an acceptable solution or services an acceptable solution or alternative?alternative?

3.3. Do we see any viable alternatives to Do we see any viable alternatives to mitigate the significant risks that mitigate the significant risks that currently exist?currently exist?

Facility Project ToFacility Project To--datedate•• $29M project approved in March 2010$29M project approved in March 2010

–– Includes $5.6M for new equipmentIncludes $5.6M for new equipment•• Selected RSP Architects in June 2010Selected RSP Architects in June 2010

–– Previous work with Mayo (Rochester) and Previous work with Mayo (Rochester) and MedFusionMedFusion (Dallas)(Dallas)

•• Selected Ortho Selected Ortho ValuMetrixValuMetrix as Lean consultantsas Lean consultants–– HPA pathology also contracted with OrthoHPA pathology also contracted with Ortho

•• Design: August Design: August –– December 2010December 2010•• Selected contractor in November 2010Selected contractor in November 2010•• Construction began March 28, 2011Construction began March 28, 2011•• Construction complete December 1, 2011Construction complete December 1, 2011•• Planned movePlanned move--in: February 2012in: February 2012

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Lean Process ImprovementLean Process Improvement

•• Selected and trained 8 laboratory Selected and trained 8 laboratory professionals as permanent lean process professionals as permanent lean process improvement teamimprovement team

•• Worked with architects to lead design Worked with architects to lead design efforteffort

•• Completing workflow assessment and Completing workflow assessment and redesign with each departmentredesign with each department

•• Lean team is part of 34 different teams Lean team is part of 34 different teams designing new LISdesigning new LIS

Other current active Lean projectsOther current active Lean projects•• TrainingTraining

–– Advanced Lean training, 1 week (Central laboratory leaders and Advanced Lean training, 1 week (Central laboratory leaders and pathology leaders)pathology leaders)

–– Champion training Champion training –– 2 days (all Allina laboratory leaders)2 days (all Allina laboratory leaders)–– Lean awareness trainingLean awareness training-- 3 hours (400 lab staff and pathologists 3 hours (400 lab staff and pathologists

so far. Remaining 600 in late 2011)so far. Remaining 600 in late 2011)•• Redesign specimen management (went live on April 18)Redesign specimen management (went live on April 18)

–– Immediate improvement in cycle time.Immediate improvement in cycle time.•• Inpatient phlebotomy redesignInpatient phlebotomy redesign•• Courier optimizationCourier optimization•• Materials management /inventory projectMaterials management /inventory project•• Facility redesign at 3 other metro hospitalsFacility redesign at 3 other metro hospitals•• Many other projects being prioritizedMany other projects being prioritized

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AutomationAutomation•• Hematology:Hematology:

–– SysmexSysmex HST LineHST Line–– 2 instruments2 instruments–– SlidemakerSlidemaker and and stainerstainer–– WAM softwareWAM software

•• Chemistry/ImmunochemistryChemistry/Immunochemistry–– 2 final vendors 2 final vendors –– selection very soonselection very soon–– PrePre--analyticanalytic–– Instrument lineInstrument line–– DecapperDecapper and and RecapperRecapper–– Specimen StorageSpecimen Storage

So why is this important for patient care and So why is this important for patient care and the new world of healthcare reform and the new world of healthcare reform and ACOsACOs ??

……and to be able to continue to operate in a and to be able to continue to operate in a reality where state budget reconciliation will reality where state budget reconciliation will result in $81result in $81--188M in cuts to Allina over the 188M in cuts to Allina over the

next 3 years.next 3 years.

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What is an ACO?What is an ACO?ACOs are providerACOs are provider--based based organizations that take responsibility organizations that take responsibility for meeting the health care needs of a for meeting the health care needs of a defined population with the goal of defined population with the goal of simultaneously improving health, simultaneously improving health, improving patient experience, and improving patient experience, and reducing per capita costs. reducing per capita costs. (NCQA(NCQA))

We can all describe what they should look We can all describe what they should look like but no one has ever seen one.like but no one has ever seen one.

Dr. Don Berwick Feb 4, 2011 ACO Dr. Don Berwick Feb 4, 2011 ACO CommentsComments……

•• The aim is to The aim is to reward value instead of volumereward value instead of volumeand intensityand intensity by making providers eligible to by making providers eligible to share in the savings and riskshare in the savings and risk if they are able to if they are able to take steps that take steps that reduce health care costsreduce health care costs while while improving quality of care.improving quality of care.

•• ACOs are intended to ACOs are intended to provide better supportprovide better supportfor things that we donfor things that we don’’t do well in our health t do well in our health care system today: care system today: –– coordination and integrationcoordination and integration of care, of care, –– health information technologyhealth information technology, ,

–– goal of goal of better healthbetter health and lower costsand lower costs..

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Federal Health Reform Creating ACO Federal Health Reform Creating ACO Momentum Momentum

Courtesy of BDC Advisors, 2010

Improved Inpatient Care Efficiency

Use of Lower Cost Treatments Reduction

in Adverse Events

Reduction in Preventable Readmissions

Improved Prevention & Early Diagnosis

Improved Practice Efficiency

Reduction in Unnecessary Testing & Referrals

Reduction in Preventable ER Visits & Admissions

Improved Management of Complex Patients

Use of Lower-Cost Settings & Providers

Lower TotalHealth Care

Cost

AND

Improved Care

Lower TotalHealth Care

Cost

AND

Improved Care

All ProvidersAll Providers

Hospitals & Specialists

Hospitals & Specialists

Primary Care Practices

Primary Care Practices

PatientsPatients

Engaged, Shared Decision Making

• Changes in health care delivery are what actually create greater value

• Changes in health care delivery are what actually create greater value

Source: Center for Healthcare Quality & Payment Reform, September 7, 2009

The Opportunities for ACOThe Opportunities for ACO(Lab professionals can make a difference)(Lab professionals can make a difference)

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What will it take to be an ACO?What will it take to be an ACO?Key Components Include:Key Components Include:•• Having an effective Primary Care coreHaving an effective Primary Care core

•• Integration with specialty care Integration with specialty care

•• Coordinating care across all care settingsCoordinating care across all care settings

•• Incentive alignment with payers and physicians Incentive alignment with payers and physicians

•• Clinical excellence, Clinical excellence, consistency, and efficiencyconsistency, and efficiency

•• Skills and technical support systems to measure, Skills and technical support systems to measure, report, and manage the quality of care and cost of carereport, and manage the quality of care and cost of care

Allina’s strategy is based on this anyway

AllinaAllina’’ss strategy is based on this strategy is based on this anyway anyway

Highest quality of care and experience Highest quality of care and experience at the lowest appropriate cost to a at the lowest appropriate cost to a

growing portion of our community growing portion of our community with affiliated independent providerswith affiliated independent providers

StrategicPricing & Cost ofCare Mgt

PatientCare Model

Re‐design

NewPatient 

& Pre‐PatientChannels

ClinicalServiceLines

CommunityEngagement

HealthNetwork

Operating Excellence

Strategic Areas of Focus

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How ACO Criteria Map to How ACO Criteria Map to AllinaAllina’’ss Current StrategyCurrent Strategy

StrategicPricing & Cost ofCare Mgt

PatientCare Model

Re‐design

NewPatient 

& Pre‐PatientChannels

ClinicalServiceLines

CommunityEngagement

HealthNetwork

Operating Excellence

Clinical Excellence

& Consistency

PatientEngagement

NetworkDevelopment

Payment Reform/

Contracting

Effective Primary Care

Care Management &Navigation

Clinical Excellence & Consistency

PatientEngagement

PatientEngagement

Measurement & Reporting Systems

Examples of AllinaExamples of Allina’’s ACO Strategys ACO Strategy

EffectivePrimary

Care

CareManagement

&Navigation

Clinical Excellence

& Consistency

EffectivePrimary

Care

CareManagement

&Navigation

Clinical Excellence

& Consistency

Team Care

Pilot started in 2010 at eleven clinic sites to find new ways to work to address changing environment in our clinics.

Phase 1 - Added clinical support staff to improve productivity and efficiency for care teams (including lab)3 models: Scribe, RN, or Clinical Assistant/MLTPhase 1 results measured increase in productivity, teams reported improved quality and service, considerable time savings and improved work-life balance.

Aim is to increase both quantity and quality of the patient visit in the most cost effective way. Will continue to refine workflow, expand to ob/gyn, add clinic sites, and include more complex patient visits.

Team Care

Pilot started in 2010 at eleven clinic sites to find new ways to work to address changing environment in our clinics.

Phase 1 - Added clinical support staff to improve productivity and efficiency for care teams (including lab)3 models: Scribe, RN, or Clinical Assistant/MLTPhase 1 results measured increase in productivity, teams reported improved quality and service, considerable time savings and improved work-life balance.

Aim is to increase both quantity and quality of the patient visit in the most cost effective way. Will continue to refine workflow, expand to ob/gyn, add clinic sites, and include more complex patient visits.

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Examples of AllinaExamples of Allina’’s ACO Strategys ACO StrategyEffectivePrimary

Care

CareManagement

&Navigation

Clinical Excellence

& Consistency

EffectivePrimary

Care

CareManagement

&Navigation

Clinical Excellence

& Consistency

Team CareTeam CareCare Guides (Navigation)

Non-clinical Care Guides work with patients and the primary care team.• Do not provide clinical advice• Provide basic patient education.• Provide information about finding low-cost

medications, pharmacies, clinic hours, bus routes, and parking.

• Help with health maintenance reminders.• Review doctor instructions and ensuring all follow-up is prearranged (Lab information is key).• Call patients and consistently review their care goals, results, etc.• Relay important information from the patient to the

care team.Piloted in one clinic with 3 Guides and 333 patientsExpanded to seven total clinics with 15 guides and over 1500 patients

Care Guides (Navigation)

Non-clinical Care Guides work with patients and the primary care team.• Do not provide clinical advice• Provide basic patient education.• Provide information about finding low-cost

medications, pharmacies, clinic hours, bus routes, and parking.

• Help with health maintenance reminders.• Review doctor instructions and ensuring all follow-up is prearranged (Lab information is key).• Call patients and consistently review their care goals, results, etc.• Relay important information from the patient to the

care team.Piloted in one clinic with 3 Guides and 333 patientsExpanded to seven total clinics with 15 guides and over 1500 patients

Examples of AllinaExamples of Allina’’s ACO Strategys ACO StrategyEffectivePrimary

Care

CareManagement

&Navigation

Clinical Excellence

& Consistency

EffectivePrimary

Care

CareManagement

&Navigation

Clinical Excellence

& Consistency

Team CareTeam Care

Medical Homes

Began in 2009 with goal to fully implement a model that addresses internal, state and payer requirements.

Initial focus includes patients with chronic disease(i.e. heart failure) who are at high-risk for hospital re-admission and ED utilization. Long term goal is to improve overall patient population health through preventive and proactive patient care.

Medical Home utilizes an RN care manager to provide additional support to the care team versus non-clinical support through Care Guides.

Medical Homes

Began in 2009 with goal to fully implement a model that addresses internal, state and payer requirements.

Initial focus includes patients with chronic disease(i.e. heart failure) who are at high-risk for hospital re-admission and ED utilization. Long term goal is to improve overall patient population health through preventive and proactive patient care.

Medical Home utilizes an RN care manager to provide additional support to the care team versus non-clinical support through Care Guides.

Care Guides Care Guides

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Examples of AllinaExamples of Allina’’s ACO Strategys ACO StrategyEffectivePrimary

Care

CareManagement

&Navigation

Clinical Excellence

& Consistency

EffectivePrimary

Care

CareManagement

&Navigation

Clinical Excellence

& Consistency

Clinical Service Lines (CSL)A vehicle to assure consistent quality and operational efficiencies throughout Allina.A way to organize and integrate care across the care continuum--prevention, chronic illness, acute care, and end of life care.

Initial CSL focus on CV, Neurosciences, Cancer (pathologist and lab management staff on each team)

• Reduced elective inductions <39 weeks • Reduced HF and AMI readmissions• Improved optimal care scores for rehab patients• Implemented Allina Telehealth stroke network

Clinical Service Lines (CSL)A vehicle to assure consistent quality and operational efficiencies throughout Allina.A way to organize and integrate care across the care continuum--prevention, chronic illness, acute care, and end of life care.

Initial CSL focus on CV, Neurosciences, Cancer (pathologist and lab management staff on each team)

• Reduced elective inductions <39 weeks • Reduced HF and AMI readmissions• Improved optimal care scores for rehab patients• Implemented Allina Telehealth stroke network

Team CareTeam Care

Medical Homes Medical Homes Care Guides Care Guides

Quality MethodologyQuality MethodologyQuality Methodology•• Quality Metrics (Allina measures 80% now)Quality Metrics (Allina measures 80% now)

–– 65 Measures proposed (mix of current & new)65 Measures proposed (mix of current & new)•• Actually 87 measuresActually 87 measures•• Laboratory can impact at least 21 of the physician Laboratory can impact at least 21 of the physician

measuresmeasures–– 5 Domains identified5 Domains identified

•• Patient/Caregiver Experience (7)Patient/Caregiver Experience (7)•• Care Coordination (16)Care Coordination (16)•• Patient Safety (2)Patient Safety (2)•• Preventive Health (9)Preventive Health (9)•• AtAt--Risk Population/Frail Elderly Health (31)Risk Population/Frail Elderly Health (31)

–– No explicit cost or resource use measuresNo explicit cost or resource use measures……yetyet–– Reporting all measures in year oneReporting all measures in year one

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Some Key Questions for AllinaSome Key Questions for AllinaSome Key Questions for Allina•• If the benchmark to which we are being If the benchmark to which we are being

compared is our own, doesncompared is our own, doesn’’t that continue to t that continue to penalize high performing systems and regions?penalize high performing systems and regions?

•• How can we feel comfortable with taking How can we feel comfortable with taking financial risk without ability to identify financial risk without ability to identify participants?participants?

•• The average ACO start up will incur $1.8M and The average ACO start up will incur $1.8M and the opportunity for Allina may not be very big the opportunity for Allina may not be very big compared to the risk. Would we be better off in a compared to the risk. Would we be better off in a CMS Innovation pilot on bundles or partial CMS Innovation pilot on bundles or partial capitation? We need to choose.capitation? We need to choose.

ACOsACOs are the perfect opportunity for the are the perfect opportunity for the laboratory to be seen in the role of laboratory to be seen in the role of integrator of information and data.integrator of information and data.

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The LaboratoryThe Laboratory’’s Role in s Role in ACOsACOs and and Medical HomesMedical Homes

•• Raise awareness of your value in the coordination of care Raise awareness of your value in the coordination of care and integration of services.and integration of services.

•• Develop outreach. Meet the needs of the continuum.Develop outreach. Meet the needs of the continuum.•• Understand and manage blood and test utilizationUnderstand and manage blood and test utilization•• Improve all processes Improve all processes –– LeanLean•• Make your service accessible and convenient.Make your service accessible and convenient.•• This is a clinical initiative This is a clinical initiative –– engage your pathologistsengage your pathologists•• Be a part of financial, strategy and ACO planningBe a part of financial, strategy and ACO planning•• Electronic connectivityElectronic connectivity•• Be aware and understand what your competition is doing.Be aware and understand what your competition is doing.

How do we prepare?How do we prepare?•• By doing what we should have been doing all along.By doing what we should have been doing all along.•• Be at the table Be at the table –– every table. Be an active member of every table. Be an active member of

the care teamthe care team–– Medical laboratory scientists, lab management, pathologistsMedical laboratory scientists, lab management, pathologists

•• Strong partnership between laboratory Strong partnership between laboratory administration and pathologistsadministration and pathologists

•• Ongoing representation in system quality structure.Ongoing representation in system quality structure.•• Significant integration with clinical information Significant integration with clinical information

systemssystems•• Standardized technology and clinical protocols across Standardized technology and clinical protocols across

all sites within your system all sites within your system •• Ability to integrate data from owned hospitals, Ability to integrate data from owned hospitals,

clinics, and home care agency and other physician clinics, and home care agency and other physician practices, nursing homes, and affiliate hospitals in practices, nursing homes, and affiliate hospitals in your network. your network.

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Final Thought: The Final Thought: The ““Roller Coaster Roller Coaster RideRide”” is acceleratingis accelerating……enjoy the ride!enjoy the ride!

For more information:For more information:

Rick Panning, MBA, MLS(ASCP)Rick Panning, MBA, MLS(ASCP)CMCM

612612--262262--50125012rick.panning@allina.comrick.panning@allina.com