The Sheba Journey Towards Value
Measurement
Eyal Zimlichman MD, MSc
Ahuva Weiss-Meilik PhD
Ari Shamiss MD, MPA
Delegation of North America Hospital CEOs to Israel
February 5, 2012
Sheba Road Map
 Sheba Medical Center has developed since 2002 a
balanced-score-card management systems – CHESS
(“Clinical and Health Economy and Satisfaction
Simulator”) measuring:
 Clinical process
 Clinical outcome
 Patient level activity based costing
 To allow for correlation between process and outcomes
– both clinical and costs, SMC has been developing an
approach that would allow through case-mix and
correlation algorithms to optimize total value
(Medilogica).
Measuring Cost…
• To create value we need to relate quality to cost
• Measuring cost using claims as proxies is
insufficient
• The $ value of an outcome is essential for
comparative effectiveness or more accurately
“comparative efficiency”
• Therefore Patient-Level Costing is an important
denominator
The Challenge
• It is difficult to correlate between outcomes and
process variability
• Clinical leaders and clinicians are minimally
involved in the efforts to maximize value
Sheba Medical Center
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Medilogica: Measuring
and Optimizing Value
What is Medilogica?
• A value (quality and cost) measurement and
optimization system that allows redesigning care to
maximize health care value
• Allows clinicians and managers to identify process
steps that would increase value (reducing costs of
care while improving clinical outcomes) on a
procedure/diagnosis level
• Patient level costing data as well as clinical process
and outcomes need to feed the Medilogica engine
• Engine algorithms have been developed and tested
individually. Sheba Medical Center is about to
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launch the full solution for the first time.
Sheba Medical Center
CHESS:
Sheba’s Organizational Value Compass
ORGANIZATIONAL
GOALS
Clinical
Financial
Patient oriented
8 Work
Groups
CRM/academic
Senior
Steering
Committee
MEASURES
Balanced
Score Card
ORGANIZATIONAL
VALUE COMPASS
“Clinical and Health
Economy and
Satisfaction Simulator”
Sheba Medical Center
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CHESS: IT Architecture
Overall – 86 quality
indicators:
EMR
PACS
IRB
Academic
Lab
CPOE
HR
Safety/RM
ADT
Infec. Dis.
Financial
Training
Case-mix
adjustment
Data
analytics
43 – clinical perspective
18 – financial perspective
11 – patient perspective
CHESS measures
9 – Crew resource and
academic perspective
5 – Case-mix measures
DATA
WAREHOUSE
Nursing
dashboard
SQL data
General
dashboard
Dashboard
presented on an
organizational web
portal (Microsoft
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office SharePoint)
Sheba Medical Center
Where does Medilogica fit?
CHESS VALUE
COMPASS
MEDILOGICA
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Principles of Medilogica
• Measuring process and outcome alone is not sufficient to
maximize health care value
• Medilogica provides a correlation engine that allows clinical
leaders to drive care processes according to expected clinical
and financial outcomes
• Medilogica’s case-mix clustering principle allows to group
patients sharing similar clinical profiles – thus adjusting for
case-mix
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Sheba Medical Center
Case-mix Clustering
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The Medilogica Platform
Data collection:
 Clinical, financial and administrative information systems
 Smart pop-up dialogue boxes
 Enterprise data warehouse
Grouping of patients using the case-mix cluster algorithm
 Segment similar cases leveraging case mix adjustment algorithm
 Real time predictive modeling tools for clinicians
 Assess the variation in outcomes and identify areas of potential
improvement
 Correlate financial and clinical outcomes
 Optimize total value of the clinical product
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Sheba Medical Center
Data Platform and Solutions
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Sheba Medical Center
Patient Level Costing
• Financial outcome data feeding
the Medilogica system has to
on a patient level, be activity
based and time derived in as a
real-time fashion as possible
• Sheba Medical Center is
operating an information
technology – real time - activity
based patient level costing
system (TMR by Gomla).
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Sheba Medical Center
DEMO
Sheba Medical Center
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Dashboard: Clinical Orientation
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Dashboard: Financial Orientation
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Financial and Clinical Outcome
Fracture of Hip
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Correlating Outcome to Process:
Defining Best Practice
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Value Optimization Engine
Fracture of Hip
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Value Optimization Engine
Fracture of Hip
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Value Optimization Engine
Fracture of Hip
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Current Status
• Case-mix and correlation algorithms have been
developed during the last 10 years at Sheba
Medical Center (Dr. Ahuva Meilik-Weiss and Dr.
Eyal Zimlichman). SMC owns the intellectual
property for the algorithms
• Sheba Medical Center is about to launch a full
implementation of the system. Colon surgery was
chosen as a pilot condition.
• Sheba will be looking for partners to jointly develop
the operational system.
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Sheba Medical Center
Planned Medilogica Pilot
Develop and implement a fully operational value
(quality and cost) measurement and optimization
system for colon surgery patients, setting the stage
for measurement and optimization of other
conditions and procedures across the hospital.
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Sheba Medical Center
Piloting at other hospitals
• Defining: process maps, clinical
outcomes
• Enhancing costing system
• Validate case-mix cluster
algorithm
• Develop preliminary dashboard
 Data collection in real-time
(manual plus IS)
 Report to managers
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Sheba Medical Center
Looking ahead…
• How many conditions do we need to cover?
Pareto rule, top 10-20 in terms of variation in costs and clinical
outcomes would account for the vast majority of potential
improvement
• Looking across the continuum of care
(did someone say ACO?...)
Cross providers-patient level costing systems
Patient centered longer-term outcomes (patient reported)
Optimizing process across the continuum, following the patient
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Sheba Medical Center
THANK YOU
MEDILOGICA
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Sheba Medical Center