Promoting the Spread of Health Care Promoting the Spread of Health Care InnovationsInnovations

Web SeminarWeb Seminar

April 9, 2013April 9, 2013

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What is the Health CareWhat is the Health CareInnovations Exchange? Innovations Exchange?

Publicly accessible, searchable database of health policy Publicly accessible, searchable database of health policy and service delivery innovationsand service delivery innovations

Searchable QualityToolsSearchable QualityTools Successes and attemptsSuccesses and attempts Innovators’ stories and lessons learnedInnovators’ stories and lessons learned Expert commentariesExpert commentaries Learning and networking opportunitiesLearning and networking opportunities New content posted to the Web site every two weeks New content posted to the Web site every two weeks

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Next EventsNext EventsThursday, April 25, 2013 1-2 pm ETThursday, April 25, 2013 1-2 pm ET

Payment Models that Support Medical Home and Payment Models that Support Medical Home and Accountable Care Organization Principles: Maryland’s Accountable Care Organization Principles: Maryland’s Experience Experience

Thursday, May 9, 2013 1-2 pm ETThursday, May 9, 2013 1-2 pm ETA Close Look at Care Coordination: West Virginia’s A Close Look at Care Coordination: West Virginia’s

Experience Experience 5

Today’s Event ModeratorToday’s Event Moderator

Ronie Nieva, PhDRonie Nieva, PhD

Vice President, Westat and Editor-in-Chief of the Vice President, Westat and Editor-in-Chief of the AHRQ Health Care Innovations ExchangeAHRQ Health Care Innovations Exchange

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Essentia HealthEssentia HealthLinda Wick, RN, CNPLinda Wick, RN, CNP

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Manager, Heart Failure ProgramManager, Heart Failure Program

RespondentRespondent

Janell Moerer, MBAJanell Moerer, MBA

Group Vice President, Strategy and Group Vice President, Strategy and Business Development, Centura HealthBusiness Development, Centura Health

Essentia Health Essentia Health Heart Failure ProgramHeart Failure Program

First visit 5-7 days after discharge Cardiology oversight – once per year Patients managed in clinic: 4-7 office visits

the first year Registered nurses do case management: use

protocols, manage home telescale data, follow up on lab/test data, and triage phone calls

Program ComponentsProgram Components

CoachingCoaching EducationEducation SupportSupport Consistency of care providerConsistency of care provider Immediate feedback on health choicesImmediate feedback on health choices Prescheduled follow-up appointmentsPrescheduled follow-up appointments Relationship building with patient/familyRelationship building with patient/family Multidisciplinary team approach to careMultidisciplinary team approach to care Engaged/passionate staffEngaged/passionate staff

TripleTriple Aim

OutcomesOutcomes – Use of guideline directed medications/devices

– Total yearly admissions/30 day readmissions

Patient SatisfactionPatient Satisfaction Reduced Cost of CareReduced Cost of Care

– Total yearly admissions/30 day readmissions

– Reduce duplication of testing

– Using the right provider at the right time for the right diagnosis

SHOW ME THE MONEY!SHOW ME THE MONEY!

Readmission RatesReadmission Rates

Note: 6 month rates for heart failure patients N=294-229 FY2005-2010

Essentia Health St. Mary’s Hospital Readmissions

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10

20

30

40

2010 2011 2012

Nat'l Avg

All Cause

HF

“Times They are a Changing”

Essentia Health is an Accountable Care Organization

CMS Bundled Payments for Care Improvement Initiative

Primary care is using health care home model: stable Heart Failure Program patients discharged to primary care physician

Challenges: Challenges: Administrative Buy-InAdministrative Buy-In

Ongoing challenge of administrative buy-in

Dialog changed once organization became an Accountable Care Organization: risk/benefit

Demonstrate how model fits Triple Aim Markets within the organization have

different priorities NCQA accreditation process fits model

Challenges: Provider Buy-InChallenges: Provider Buy-In

Progress with physician and provider buy in: show data on outcomes

Culture changing from physician- centered to patient-centered

Culture changing from individual provider-based to team-based care

Other chronic disease programs changing to Heart Failure Model within Essentia

Challenges: WorkforceChallenges: Workforce

Sustaining workforce with potential nursing shortage

Clear staffing roles Inclusion/exclusion criteria for patients Using Telehealth technology

Scale Up and SpreadScale Up and Spread

Added Telehealth video visits to remote sitesAdded Telehealth video visits to remote sites Added program staff to neighborhood clinics Added program staff to neighborhood clinics Developed interface with primary care case Developed interface with primary care case

managers: shared care planmanagers: shared care plan Integrated home scale data into electronic Integrated home scale data into electronic

medical records with options for coverage from medical records with options for coverage from other sitesother sites

Closing ThoughtsClosing Thoughts

If everything seems under control, you’re not going fast enough –

– Mario Andretti

RespondentRespondent

Janell Moerer, MBAJanell Moerer, MBA

Group Vice President, Strategy and Group Vice President, Strategy and Business Development, Centura HealthBusiness Development, Centura Health

Comments and ConsiderationsComments and Considerations

Continuity of leadership and passion for Continuity of leadership and passion for the service has assisted growth and the service has assisted growth and adoptionadoption

Data beginning to reflect intended Data beginning to reflect intended impact to new value equationimpact to new value equation

Impact of Changing EnvironmentImpact of Changing Environment

Transformation and disruption of the norm Transformation and disruption of the norm has accelerated adoption and scalehas accelerated adoption and scale

Fee-for-service payment to Fee-for-service payment to bundle/Accountable Care Organization bundle/Accountable Care Organization

Change in value equation: outcomes/costChange in value equation: outcomes/cost

Shift to Team-Based CareShift to Team-Based Care

Emphasis on team-based care: patient-Emphasis on team-based care: patient-centered medical homes/health homescentered medical homes/health homes

Heart Failure Program and team are Heart Failure Program and team are more “part of” the delivery vs. “separate more “part of” the delivery vs. “separate from” due to emphasis on team-based from” due to emphasis on team-based care.care.

Overarching QuestionsOverarching Questions

Where does this program need to reside in the Where does this program need to reside in the short term, mid-term, and long-term?short term, mid-term, and long-term?

Who should “own” it? Accountability?Who should “own” it? Accountability? How are the physician champions engaged in How are the physician champions engaged in

development and adoption with peers?development and adoption with peers? How will guardrails for compliance within the How will guardrails for compliance within the

delivery system be addressed?delivery system be addressed?

Key ConsiderationsKey Considerations

How will the challenges and opportunities change due How will the challenges and opportunities change due to the transformation of payment and care delivery?to the transformation of payment and care delivery?

Administrative buy-inAdministrative buy-inPhysician adoptionPhysician adoptionDelivery system needs and compositionDelivery system needs and compositionData gathering to data aggregation and segmentationData gathering to data aggregation and segmentationNew competitors New competitors

Key ConsiderationsKey Considerations

How and what will the Heart Failure Program How and what will the Heart Failure Program need for innovation and to accelerate need for innovation and to accelerate adoption with sustainable value?adoption with sustainable value?

Community partnerships i.e. parish nursing, Community partnerships i.e. parish nursing, community emergency medical servicescommunity emergency medical servicesTelehealth to clothing with monitoring devices; Telehealth to clothing with monitoring devices; iHeart FailureiHeart FailureTechnology partnershipsTechnology partnershipsRetail competitors and opportunitiesRetail competitors and opportunitiesPatient/consumer experience and literacyPatient/consumer experience and literacy

Transformation to ValueTransformation to Value

SHOW ME THE MONEY!

Questions?Questions?

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