planning a course to population health management · planning a course to population health...
TRANSCRIPT
Slide Deck: http://goo.gl/1W119jWebex Support 1-866-229-3239
Event #662 267 589
“Planning a Course to Population Health Management”
A Complimentary Webinar From healthsystemCIO.com
Your Line Will Be Silent Until Our Event Begins at 12:00 ET
Thank You!
Slide Deck: http://goo.gl/1W119jWebex Support 1-866-229-3239
Event #662 267 589
Housekeeping
• Moderator – Anthony Guerra, editor-in-chief, healthsystemCIO.com
• Ask A Question• We will be holding a Q&A session after the formal presentations.
• You may submit your questions at any time by clicking on the QA panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as “All Panelists.”
• Download the Deck • Go to Download today's deck at:
http://healthsystemcio.com/presentation/pophealth-webinar.pdf
• Shortened URL at bottom of slides
• View the Archive• You will receive an email when our archive recording is ready.
• Separate registration is required.
Slide Deck: http://goo.gl/1W119jWebex Support 1-866-229-3239
Event #662 267 589
Agenda — Approximately 45 Minutes
• 30-35 minutes: Tressa Springmann, VP/CIO, LifeBridgeHealth
• 10-15 minutes: Q&A w/Tressa Springmann
Planning a Course to Population
Health Management
January, 2015
Introducing LifeBridge Health
5
Sinai Hospital
Levindale Hebrew
Geriatric Center
Northwest Hospital
LifeBridge
Health & Fitness
LifeBridge Health
Physician Enterprise
LifeBridge Health
Commercial Division
$1.4 Billion in
Gross Patient
Revenues
1,400 Physicians
1,285 Licensed
Beds
8,000 Employees
So much more than hospitals……
6
PRIMARY
CARE,
PREVENTION,
and
WELLNESS
AMBULATORY
CARE
ACUTE CARE,
TERTIARY
CARE
POST-ACUTE
CARE
Maintain and improve health
● Favored by the greatest number of patients and physicians
● Compassionate, high quality, cost-effective health services
● Provide undergraduate and graduate medical education
● Regardless of age, race, ethnicity, emphasizing community
concern for all
Mission Statement
• Changes to private insurance, e.g.,
Young adults on parents’ policies to age 26
Prohibit lifetime monetary caps
Minimum medical loss ratio (i.e. 80% of Premium must be on
claims)
• Closes the Medicare prescription “doughnut hole” (i.e. out of pocket
at 100% between about 3K and 6K of medication costs)
• Expands coverage + imposes individual mandate in 2014
Expands Medicaid to 138%* of FPL from Maryland’s 116%
Exchanges
• Promotes the transition from volume to value
Bundled payments, Value based purchasing, ACOs
Most relevant to us as a health system
ACA High Level Impacts
8
• Source: Marketing and Planning Leadership
Council interviews and analysis.
Transition from Volume to Value
Key AttributesBundled
PaymentsValue-BasedPurchasing
Accountable Care Organizations (ACOs)
Definition
• Single payment to cover hospital, physician and post-acute needs
• Providers gainshare on savings
Rewards or punishes hospitals based on performance
• Network of providers collectively accountable for the cost and quality of care for a population
• Reimbursed through shared savings or capitation
Purpose
Incent all providers to coordinate care
Create link between reimbursement and clinical quality, patient satisfaction
Reward providers for reducing total cost of care
Change From Today
Small Small Big
9
ACOs Have Three Main Levers To
Manage Costs
10
• Source: Health Care Advisory Board interviews and analysis.
Retain Care Within Your NetworkPopulation Health
Manager
Prevent Utilization through Medical Management
1
2
3
Strategies for Risk-Bearing Providers
Example:
High-risk patient care
management (e.g., medication
management, care transitions
management)
Example:
Retaining care for employees
within your hospital
Example:
Lowest cost nursing home
Direct Care to Low-Cost
Partner
• Maryland’s new waiver has many of the same goals as the ACA
• The basic constructs of the Modernized Waiver are: (STATE GOALS)
– Limit growth in Hospital Revenue (inpatient and outpatient) to
3.58% per Capita through a Global Budget
– $330 million in Medicare savings over 5 years
– Reduce MHACs by 30% over 5 years
– Reduce rate of readmissions to the National average
• Renewal after 5 years with favorable performance and expansion to
include physician and post acute services; if not renewed, revert to
the national system
• Maryland only state with Medicare Waiver
• Hospital rates set by Healthcare Cost Review Commission (HSCRC)
Maryland Modernized Medicare Waiver
11
The key aspects of the Global Revenue
Budget are as follows:– Fixed revenue base
– Age and population adjustments as determined by
HSCRC policy
– Adjustments for market share changes as
determined by HSCRC policy
– Adjustments for Potentially Avoidable Volume
(PAUs)
Global Budget Model
12
Maryland’s Waiver is Focusing Health
Systems on Strategy 1
13• Source: Health Care Advisory
Board interviews and analysis.
Retain Care Within Your NetworkPopulation Health
Manager
Prevent Utilization through Medical Management
1
2
3
Strategies for Risk-Bearing Providers
Example:
High-risk patient care
management (e.g., medication
management, care transitions
management)
Example:
Retaining care for employees
within your hospital
Example:
Lowest cost nursing home
Direct Care to Low-Cost
Partner
Improve Quality & Reduce Costs Delivering High Value Care
• Core Measures
• MHACs
• Prevention Quality Indicators (PQIs)
• Prevent Readmissions
Build Centers of Excellence
Advance Population Health While Addressing the Social
Determinants of Health
• Ensure right level of services based on acuity
• Improve access to preventive care, including primary and
chronic care management
• Enhance community programs and social services
connections in our community to support our
neighborhood’s health development
LifeBridge Strategy
Program Care Delivery Initiatives
Admission /
Discharge
Revamp our patient education & discharge program ensuring patients are covered until connecting with their
PCP; coordinate with chronic care centers and FQHCs; increase the number of patients that are discharged
with their medications
Ensure completion of Present on Admission testing including urinalysis on every patient to clearly identify UTIs,
etc and ensure accurate present on admission documentation
HospitalistsComplete hospitalist redesign and require best practice care across the inpatient care continuum
(Implementing accountable care unit model)
IntensivistsComplete intensivist redesign and require best practice care across the inpatient care continuum (house-wide
on-call coverage implemented)
Medication
Reconciliation
Engage pharmacy team throughout the continuum from ED to inpatient units to ensure medication
reconciliation and education as well as bedside and home delivery of medication (Bedside and home delivery
programs, med education program, new ED pharm tech)
Nurse Rounding Continue nurses rounding hourly on every patient and performing shift report at the patient’s bedside
Observation
Status
Use observation status to focus on appropriateness of admissions and prevention of 30-day readmissions (14-
bed REU)
Palliative CareComplete the recruitment of the palliative care team and ensure hospice coordination (palliative care
coordinator and palliative risk assessment)
Chronic Care
Clinics
Initiate Chronic Care Clinics at Sinai and Northwest for CHF, COPD/Asthma, Diabetes, HIV, and Sickle Cell
Disease using multi-disciplinary teams
Urgent CareFully engage with Express Care in referrals for lower cost of care delivery and efficient reception of patients
needing more care
Over 20 Initiatives Currently Underway
Program Care Coordination Initiatives
Hospital
Network
Aggressively leading the way on creating Advanced Learning Collaborative to explore partnerships around
population health initiatives across a network of hospitals.
Clinical
Integration
Submitted our application for MSSP ACO with final decision pending by end of CY2014.
LifeBridge Physician Network (LBPN) created to engage over 400 loyal physicians around delivering clinically
integrated care.
Home CareExpand home care resources to address a significant increase in visits and invest in unfunded care to minimize
avoidable readmissions
Sub Acute/
SNF
Ensure Sub Acute and continuum care partners have a care coordinator to assist in pulling patients through the
system and preventing bounce back (Provider of Choice network, Adult Day Care)
FQHC
Engage our FQHC partners to reroute unnecessary ED visits and provide increased access to primary care
Ensure Sinai’s FQHC partner, Park West, meets LBH requirements for patient care or replace with another FQHC
partner
Strengthen Chase Brexton relationship at Northwest Hospital to ensure care coordination
Care
Coordination
Target high utilizers of services with more effective care management and outpatient navigation
Ensure that a care navigation team follows up on discharged patients, focusing on frequent utilizers and seniors
Implement ED Navigation programs to address care 24/7
Population
AnalyticsUnderstand and segment high utilizers of healthcare services
Cont’d
CRISP – Maryland’s HIE
18
CRISP is a regional health information exchange (HIE)
serving Maryland and the District of Columbia. We are a
not-for-profit organization advised by a wide range of
stakeholders who are responsible for healthcare
throughout the region. CRISP has been formally
designated as Maryland’s statewide health information
exchange by the Maryland Health Care Commission.
Chesapeake Regional Information Systems for our Patients
Technology Supporting Our Global Budget
19
High Utilizers
Potentially Avoidable Utilization
Care CoordinationQuery PortalEvent Notification
Utilization by Census Tract Map
All Payer All Patients Medicare Medicare % High Users% of Total
Charge Category
Patients 81,058 78 0.1% 1,686 2.1%$50,000-$100,000 Visits (IP+OP) 180,189 701 0.4% 9,810 5.4%
Charges (IP+OP) $551.5 M $17.3 M 3.1% $114.9 M 20.8%
• Limited to Patients with > 2 IP encounters for the last 12 months
• Limited to Total Charges (IP + OP) and excludingAmbulatory Surgery encounters
394 0.5%$100,000 -$150,000 3,780 2.1%
$47.1 M 8.5%
181 0.2%
≥ $150,000 1,786 1.0%
$40.9 M 7.4%
Identifying High Utilizers
Cross-Facility Super-Utilizer
Analysis
22
Inter-Hospital Readmissions
23
Care Coordination
HIE Integration with EMR
Encounter Notification Service
26
ENS enables CRISP participants to
receive real-time notifications when one of
their patients or members is hospitalized.
The alerts are generated from the “ADT”
messages CRISP receives from all
Maryland hospitals.
There are currently over 3,000,000
patients subscribed to with in ENS resulting
in over 6,000 notifications per day
If an individual has opted out of the HIE,
an alert will not be triggered.
Also:
Document Routing through
ENS - recipients can choose to
receive structured documents
upon patient discharge.
Auto-subscription – hospitals
can choose to automatically
subscribe (CRISP will use the
ADT discharge message) for a
window of time.
Population Health Tools – Broad Strokes
End of CY 2014-Decision on IT vendor
0-6 months Build Platform and Acquire Data
6-12 months Health Information Exchange (HIE)
9-12 months Smart Registries Solution
12-15 months Care Management Solutions/ Population Health Analytics Capabilities
Timeline for Population Health Information Technology
Implementation
**Already assuming risk of our employed population and families (10,315) delivering more effective care delivery and incorporating on-line risk assessment**MSSP effective January 1, 2015
Population Health Tools –LBH near term
Connect
Hiding in the department won’t make these mandates go away
Collaborate
If you’re engaged you’re aware
Control
Lead
The Role of the CIO
29
Where we DON’T want to land!
31
Slide Deck: http://goo.gl/1W119jWebex Support 1-866-229-3239
Event #662 267 589
Q&A
Click on the Q&A panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as “All Panelists.”
Slide Deck: http://goo.gl/1W119jWebex Support 1-866-229-3239
Event #662 267 589
Thank You!
• Thanks to our featured speaker: Tressa Springmann!
• You will receive an email when our archive recording is ready. (Separate registration is required)
• CHIME CHCIO Credits – Attending our Webinars = 1 CEU
• Questions/Comments – Anthony Guerra [email protected]
Go to www.healthsystemCIO.com/webinars to view our upcoming schedule and see the last 12 months of archived events.