With the industry’s focus on value-based care, musculoskeletal service line leaders responsible for transforming processes and programs must be responsive both to payment reform and to the increasing expectations of healthcare consumers for ease and convenience. Everyone’s sights are set on delivering better outcomes, greater patient satisfaction, and lower costs.
The 2018 Musculoskeletal Leadership Summit brings orthopedic and spine thought leaders together to share best practices and lessons learned, presenting a unique opportunity to provide orthopedic and spine program excellence without the need to reinvent the wheel.
In Part Four of our series, we spoke with Shawna Zabkiewicz, Director, Value-Based Care Management at OrthoIllinois, about her top strategies for patient-centered care.
Tell us about your background in nursing and care management. How has the shift to value-based care and the increasing expectations of healthcare consumers influenced the work that you do?
Nursing is my second career. After my tour in the US Navy I worked in the electronics manufacturing industry on the business side. Nursing was always calling to me in the background, and after some personal loss and soul searching I began my nursing program. In the Twin Cities at the time of graduation, there were massive nursing layoffs. They had a wide variety of very experienced nurses to pick from, so many of us went into alternative nursing jobs, versus the traditional start on a medical/surgical floor.
I started my nursing career in pediatric home care, and then I transitioned to a field-based homecare nurse position, as a Medicare specialist. In that job I was tasked with increasing the Medicare census for the agency. My success in increasing the census and streamlining our admissions process led to me being promoted to the Director of Nursing, after spending some time in the field working directly with patient care.
In 2012, I came to Illinois, working for a large pharmaceutical company in occupational health. A large percentage of my role was dedicated to workers’ compensation case management for 73 plasma centers across the country.
In March 2015, a few years after becoming a Board Certified Case Manager, I transitioned to OrthoIllinois as a Nurse Case Manager, for their new BPCI program in the Eastern Division, and shortly after that, in August, I was promoted to Manager of the BPCI Program. As a military veteran, this position really spoke to me in terms of being conscientious about our taxpayer dollars, and it was another way for me to be able to provide service, if you will.
In working with the program, working with the physicians and our downstream providers, it became very apparent that standardizing care was leading to unbelievable outcomes and that was super exciting to me. OrthoIllinois has been very successful in the BPCI program. We currently have one commercial bundle and we’re looking to expand that, as well as participate in the new BPCI Advanced program in October.
As you know, the 2018 Musculoskeletal Leadership Summit presents an opportunity for service line leaders to connect and participate with surgeons and other clinicians. Why is this type of collaboration important for clinical transformation?
Value-based care is certainly the buzzword right now, but it is far from being mainstream. Even in my circles, I see a need for education around the concept. It’s a constant learning curve and we are always trying to move the needle. From that perspective, giving real world examples and telling the story of what it’s been like to change culture and get engagement through all levels of the healthcare delivery system is important.
This experience has probably been one of the most rewarding and one of the most challenging things I’ve done in my career. I am very passionate about the success of these programs. Being able to measure our performance as the data that comes in shows that the work we’re doing is paying off – in increased positive outcomes (and in turn to financial incentives), in the healthcare delivery team working together in a more cohesive way, and also for the promotion of the field of case management, in general.
I think the value of case managers is going to be increasing as we move towards more expansion of value-based care programs, even outside of orthopedics. They’re really the glue that holds everything together.
Can you tell us a bit about your speaking topic, “Developing Data Driven Post-Acute Networks”? Why is this topic important to you personally?
I’m going to be talking about how we can take our claims data and look at what would constitute a high-performing facility. I’ve developed scorecards in each of the vendor partnerships that we have. We meet on monthly basis to review their performance and talk about any patient issues, of course, but we also talk about their data. This leads to the occasional tough conversation, as we hold our network accountable for exceptional performance.
The data really speaks for itself, not only in the post-acute development area, but even working with our physicians. Transparency is a critical element to our success, and we continue to be transparent with the data and our openness to learning from each other.
We review the data with our downstream providers on a regular basis. That data consists of how many patients that facility has had, their length of stay, what the cost is, and readmission rates. Then on our own, we’re actually capturing patient experience data related specifically to that facility or to that vendor. This can be applied to home health or any other downstream providers you may have, as well.
Can you share some examples of the work you’ve done to improve experience, outcomes and value through the value-based care initiatives at OrthoIllinois?
I think one of the biggest things is really educating the patient and their family on the importance of trying to recover at home as much as possible, if medically it’s safe to do so.
At one point, our inpatient acute rehab numbers were pretty high. In doing a deep dive to identify the problem, I took a look at each discharge disposition—inpatient acute rehab, skilled nursing, home health and directly home—and I looked at the readmission rates for each of those discharge areas. It was quite telling. The inpatient acute rehab was somewhere upwards of 30-40%, the skilled nursing rate of readmission was about 20%, and if you discharge to home it’s in the 2-4% range. Your likelihood to be readmitted to the hospital is significantly decreased if we can get you home with the right support.
In regards to experience, for some patients it’s a mindset thing. It took quite some time to shift their mindset away from the experience they had expected. Speaking back to the cultural change – it was not only a culture change internally for us, it was a culture change and an expectation change for the patient.
When you’re in a community—a retirement community, for example—patients talk to each other and the word spreads like wildfire. It has taken us some time to get to the point where we’re no longer hearing comments like, “I want to go to the nursing home, and I’m going to have my dinners made for me and visit with my friends.” Changing those expectations, and providing that education as to why discharging to home is the best-case scenario, has been challenging; but it has definitely resulted in good outcomes.
What I see and what I feel is that if you have good outcomes, the finance piece just follows. If you’re being a good steward of the healthcare dollars, those outcomes and the financial incentive, they naturally just follow.
What about the Summit are you most looking forward to?
I was looking at the lineup of the speakers, and I am extremely honored to be presenting. I can’t thank Kathryne enough for the opportunity. But I’m really looking forward to hearing from all the other speakers that are there and doing some additional networking.
Like I said earlier, I am very passionate about this program. I think it’s almost taking a step back to simplicity. Not to say that it’s simple or easy to do. But it really comes down to the simple things that make the big difference – in being good stewards of our healthcare dollars and having unbelievable outcomes for patients.