Dr. Arnold Milstein's presentation from "Changing How We Pay for Care," a ReportingOnHealth.org webinar, 3.19.15

1. March 19, 2015
USC Annenberg Webinar
Arnold Milstein MD
Professor and Clinical Excellence Research Center Director
Stanford University
Care Delivery Innovations
Providing More with Less
© 2015 A. Milstein/Stanford Univ

2. Desired Gain in the Value of Healthcare
(Pursued 2012-2018 by 2 Policy Engines)
 >2% annual growth in US quality composite
 30% lower baseline spending
 2.5 pp slower long-term annual spending growth
1© 2015 A. Milstein/Stanford Univ

3. Visualizing ~30% Gain in Affordability of
Good Care Via “Bright Spot” Replication
Source: IHA 2012
2
Performance of 200+ California Physician Groups Accountable for Value
Positive
value
outliers
Annual Risk-Adjusted Total Healthcare Spending Per Patient
QualityCompositeScore
© 2015 A. Milstein/Stanford Univ

4. 3
Findings from the First National Study
of Most Valuable PPO Primary Care
 Deeper relationship with patients
 Expanded width of clinical responsibility
 Leverage via team, not physical assets
 Associated with 14% better quality
and ~20% less annual total spending
 Validation and learning next
© 2015 A. Milstein/Stanford Univ

5. Scaling Complex Best Practices is Hard;
Cognitive Appliances & Individuation Help
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 ICU mortality 25%
 Hospital mortality 15%
 ICU & hospital LOS 15%
Lilly CM, McLaughlin JM, Zhao H, et al. A Multicenter
Study Of ICU Telemedicine Reengineering Of Adult Critical
Care. Chest. 2014;145(3):500-507.
© 2015 A. Milstein/Stanford Univ

6. Closing Thoughts
 Better, cheaper care is a national imperative
 Positive outlier research is one of four value
improvement inputs
 Behavioral and computer sciences required
© 2015 A. Milstein/Stanford Univ 5