Development of an integrated practice unit: Utilizing a lean approach to impact value of care for brain tumor patients.

99 Background: Lack of care coordination across subspecialty departments involved in the treatment of brain tumor patients at our institution has negatively impacted patient outcomes, patient experience, and costs. Meanwhile, value-based health care has become increasingly relevant as a means to respond to changing payment structures and improve quality. With the aim to increase value, we restructured medical practice across the continuum of care for brain tumor patients by developing a virtual (non co-located) Integrated Practice Unit (IPU). Methods: From June 2014 to August 2015, we engaged a core team of physicians and administrators from Neurosurgery, Neuro-Oncology, Radiation Oncology, Neuroradiology and Neuropathology to re-design care pathways for the following diagnoses: glioma, metastatic cancer to the brain, and meningioma. We applied lean methodology to map out current state, identify root causes, and develop an implementation plan based on our analyses. Results: Root causes uncovered included:...