Presentation is loading. Please wait.

Presentation is loading. Please wait.

#HASummit14 Sreekanth Chaguturu, MD Vice President for Population Health Management, Partners HealthCare Session #21 Key Principles and Approaches to PHM.

Similar presentations


Presentation on theme: "#HASummit14 Sreekanth Chaguturu, MD Vice President for Population Health Management, Partners HealthCare Session #21 Key Principles and Approaches to PHM."— Presentation transcript:

1 #HASummit14 Sreekanth Chaguturu, MD Vice President for Population Health Management, Partners HealthCare Session #21 Key Principles and Approaches to PHM Dr. Sreekanth Chaguturu is Vice President for Population Health Management at Partners HealthCare. He provides clinical oversight to population health management clinical programs, assists in management of clinical relationships for risk contracts with commercial and government payers, as well as oversight for Partners’ self-insured health plan. In these roles, he leads the assessment and development of information technology and analytic solutions to support population health programs. Dr. Chaguturu is also an Instructor in Internal Medicine at the Harvard Medical School and an attending physician at Massachusetts General Hospital. 1 Greg Spencer, MD Chief Medical & Chief Medical Information Officer, Crystal Run Healthcare Dr. Greg Spencer is the Chief Medical Officer and Chief Clinical Information Officer at Crystal Run Healthcare. He graduated from the Medical College of Wisconsin and completed residency training in Internal Medicine at Wilford Hall US Air Force Medical Center in San Antonio, TX, where he was chief resident and assistant director of the Internal Medicine Residency program and attained the rank of major. He is board certified in Internal Medicine and a Fellow of the American College of Physicians. Dr. David A. Burton is the former Executive Chairman and CEO of Health Catalyst, and currently serves as a Senior Vice President, future product strategy. Before his first retirement, Dr. Burton served in a variety of executive positions in his 23-year career at Intermountain Healthcare, including founding Intermountain’s managed care plans and serving as a Senior Vice President and member of the Executive Committee. He holds an MD from Columbia University, did residency training in internal medicine at Massachusetts General Hospital and was board certified in Emergency Medicine. David A. Burton, MD Former Chairman and CEO, Health Catalyst, Former Senior Executive, Intermountain Healthcare

2 #HASummit14 Poll Questions (1-3) Does your organization sponsor or participate in a population health management/shared accountability initiative (e.g., ACO or commercial) a. Yes b. No c. Not sure d. Not applicable What percent of your patients are covered by your organization’s population health/shared accountability initiative? a) Less than 5% b) 5-10% c) More than 10% d) No idea e) Not applicable In your opinion, how successful has your organization’s population health/shared accountability initiative been to date? a) Not at all successful b) Slightly successful c) Somewhat successful d) Successful e) Very successful f) Unsure or not applicable

3 #HASummit14 Gregory Spencer MD FACP Chief Medical Officer Crystal Run Healthcare

4 #HASummit14 Our Approach Triple Aim as an organizational outline  Better care, better health, lower cost Analytics: multisource, scalable platform Provider involvement Care managers, CARETEAM, Telehealth Monitor the data 4

5 #HASummit14

6 NY Healthcare Environment Massive consolidation and mergers Bankruptcies Larger systems and groups Optum Venture capital Mostly unmanaged Urgent care centers and retail medicine 6

7 #HASummit14 Crystal Run Healthcare Physician owned MSG in NY State, founded providers, 20 locations Joint Venture ASC, Urgent Care, Diagnostic Imaging, Sleep Center, High Complexity Lab, Pathology Early adopter EHR (NextGen®) 1999 Accredited by Joint Commission 2006 Level 3 NCQA PCMH Recognition 2009, 2012

8 #HASummit14 Crystal Run Healthcare ACO Single entity ACO April 2012: MSSP participant December 2012: NCQA ACO Accreditation 35,000 commercial lives at risk MSSP  11,000 attributed beneficiaries  82% primary care services within ACO 8

9 #HASummit14 Business Intelligence Past Initially BI = business only, reports Quality, safety measures and clinical performance later Basic tools: SQL, SSRS, Excel Manual and time consuming Report generation > analysis Lack of scalability and extensibility Mostly tabular / numeric 9

10 #HASummit14 Dashboards 10

11 #HASummit14 Business Intelligence Now Central EDW- many sources, fewer joins Scalable More analysis, less reporting Self-service and drill down Consume and deliver information Visual 11

12 12

13 #HASummit14 Basic System Needs Common integrative platform  Pull together disparate data Cost: claims where available, internal costs A way to implement change “Leakage” and network  Where are patients going, are needs being met? Lean  Waste reduction, everywhere 13

14 #HASummit14 How we chose our EDW Our bias: controlled by us Avoiding “black boxes” Prior healthcare experience Modern technology Established track record Teach us how to fish 14

15 #HASummit14 Crystal Run EDW Roadmap

16 #HASummit14 Improving the patient experience Web Portal Care Managers Shadow Coaching Choosing Wisely Practicing Excellence 16

17 #HASummit14 Variation Reduction Specialty and division sponsored  Best practice review  Buy-in at the physician level Provider projects  Innovation contest National: Choosing Wisely Improved access - backfill and market share 17

18 #HASummit14 Variation Reduction

19 #HASummit14 Variation Reduction Improves Access 41,823 fewer visits 30,206 more patients “Created” 12 physicians

20 #HASummit14 Reducing Pharmaceutical Costs PEG Filgrastrim cost per patient before and after breast cancer pathway

21 #HASummit14 Total cost difference (equalized as cost per patient treated) 2012 pre-pathway 791 patients $595, post-pathway 817 patients $368,160 TOTAL COST SAVINGS $227, 760 PEG-filgrastim use in Breast cancer patients

22 #HASummit14 Summary Triple Aim, core values as a guide Unified analytics platform that integrates disparate systems is required Quality, safety and performance programs that are tracked Physician involvement, variation reduction Patient experience Leakage, where and why Systematically find and reduce waste 22

23 #HASummit14 Sreekanth Chagaturu, MD Medical Director for Population Health Management Partners HealthCare

24 Division of Population Health Management September, 2014 Chapter 2: Innovations in Population Health Management Sree Chaguturu, MD Vice President, Population Health Management, Partners Health Care

25 #HASummit14 25 My goals for today Describe Massachusetts health reform efforts Provide overview of Partners Healthcare Review select programs

26 #HASummit14 Patient Protection and Affordable Care Act

27 #HASummit14 My fair city…

28 #HASummit14 Chapter 58 of the Acts of 2006: An Act Providing Access to Affordable, Quality, Accountable Health Care

29 #HASummit14 29 Increasing health care spend in Mass crowded out all other areas

30 #HASummit14 Health care reform part two

31 #HASummit14 Who We Are: Partners HealthCare Massachusetts General Hospital Brigham and Women’s Hospital Teaching Hospitals Newton Wellesley Hospital North Shore Medical Center Martha’s Vineyard and Nantucket Hospitals Community Hospitals Spaulding Rehabilitation Network Non Acute Care McLean Hospital Mental Health Care Partners Community Health Care Community Health Centers Community Provider Network 31

32 #HASummit14 32 Towns With PCHI Primary Care Care Physician Practices MGH McLean Salem & Shaughnessy Kaplan Union BWH Faulkner Newton- Wellesley Spaulding Partners Acute Hospitals Partners Specialty Hospitals RHCI Partners Home Care Branches Partners HealthCare across eastern Massachusetts

33 #HASummit14 33 Our Employees ~ 60K employees – the largest non-government employer in the state ~13K are MDs, RNs and direct care givers ~5K are primarily involved in research Our Patients ~1.6M ambulatory visits ~168K discharges ~4K licensed beds ~$205M investment in community benefits Teaching 28 residency programs provide training to ~1,400 residents ~$ 167M investment in teaching Clinical Research ~$1.6B in academic/research revenue ~2,800 paid researchers (MDs & PhDs) What we do

34 #HASummit14 Partners currently covers over 500,000 lives in an accountable care contract MedicareCommercialSelf Insured Example: Pioneer ACO Covered lives: ~74k Example: Alternative Quality Contract Covered lives: ~350K Example: Partners Plus Covered lives: ~100k 34 Medicaid Example: NHP Covered lives: ~30k

35 #HASummit14 Partners is implementing over a dozen PHM Programs 35 Primary Care Patient Centered Medical Home (PCMH) High risk care management (palliative care) Mental health integration Virtual visits Specialty Care Active referral management (eConsults/curbsides) Virtual visits Procedural decision support (appropriateness) Patient reported outcomes Episodes of care (bundles) Care Continuum SNF care improvement (network/waiver/SNFist) Home care innovation (mobile observation/telemonitoring) Urgent care Patient Engagement Shared decision making Customized decision aids and educational materials Infrastructure Single EHR platform with advanced decision support Data warehouse, analytics, performance metrics

36 #HASummit14 And why these programs? 36 Primary Care Patient Centered Medical Home (PCMH) High risk care management (palliative care) Mental health integration Virtual visits Specialty Care Active referral management (eConsults/curbsides) Virtual visits Procedural decision support (appropriateness) Patient reported outcomes Episodes of care (bundles) Care Continuum SNF care improvement (network/waiver/SNFist) Home care innovation (mobile observation/telemonitoring) Urgent care Patient Engagement Shared decision making Customized decision aids and educational materials Infrastructure Single EHR platform with advanced decision support Data warehouse, analytics, performance metrics Develop team based care Demonstrate value in procedures Reduce post acute variation Empower patients in their care Information -> Insight -> Action Promote Medical Neighborhood

37 #HASummit14 Successful ACOs will use predictive analytics to launch a high risk care management program High risk patients - those at risk of being high cost Not Chronically Ill, Medically Complex Medically Complex 37 Primary Care

38 #HASummit14 Chronic Condition Mental Health Disorder Patients with a mental health disorder have 40% higher chronic condition costs Significant opportunity in integrating mental health services into primary care Mental Health Primary Care Better identify patients Increased screening Better triage of patients Phone access line with referral support Better use of protocols IMPACT for depression, SBIRT for substance abuse Better self-management Online patient-directed therapy (iCBT) Better access to services Better tracking outcomes IT tools tracking longtitudinal progress, Patient reported outcomes measurement Examples [Current and Future]Key Elements Embedded mental health resources, consulting psychiatrist 38 Primary Care

39 #HASummit14 Virtual visits allow us to connect to patients in more convenient ways (and avoids unnecessary office visits) 39 Asynchronous Models that deliver care to people without requiring real-time interaction Synchronous Models that allow people and providers to connect in real time Specialty Care

40 #HASummit14 Patient Reported Outcome Measures are outcomes that matter (and demonstrates value to market) 40  Direct collection of information from patients regarding symptoms, functional status, and mental health. Functional Status time Surgery Tier 1: Health status achieved Tier 2: Process of Recovery Tier 3: Sustainability of Recovery Specialty Care

41 #HASummit14 We can improve a patient’s surgical journey (and avoid unnecessary or unwanted surgeries) 41 Patient with a Surgical Problem Assess Appropriateness Criteria Schedule OR ProcedureRecovery Physician Encounter Possible Need for Procedure Shared Decision Making Pre- Procedure Testing Short-term Outcome Measures Long-term Outcome Measures Personalized Risk (Consent Form) Informed Consent PROs Survey(s) PROMsPrOE (Procedure Decision Support) PROMs Milford CE, Hutter MM, Lillemoe KD, Ferris TG. (2014). Optimizing appropriate use of procedures in an era of payment reform. Annals of Surgery 206(2): Specialty Care

42 #HASummit14 Nationally, these 7 procedures account for $56.6 billion, or 55% of the total costs of the 20 most costly procedures in the US: Spine fusion Spine laminectomy Knee arthroplasty Hip replacement PCI CABG Heart valve repair Nationally, these 7 procedures account for $56.6 billion, or 55% of the total costs of the 20 most costly procedures in the US: Spine fusion Spine laminectomy Knee arthroplasty Hip replacement PCI CABG Heart valve repair 42 We target the most costly procedures Specialty Care

43 #HASummit14 Clinical Office MGH Admit- ting Payer Patient visits surgeon and lumbar laminectomy is indicated Surgeon schedules procedure Admin knows procedure requires PA? Admin faxes form to admitting Admitting checks for form Admitting submits PA PA reviewed by third party Decision submitted to Admitting Manually appeal claim Admitting enters auth # in PATCOM Patient undergoes procedure Admitting checks for form Admitting calls clinic to work through PA form No Yes Denied PrOE completed PrOE PA form sent to Admitting PA is granted without third party review Authorization submitted to Admitting Potential savings: Current process: o 4-5% denial rate, o <1% ultimately denied PrOE process: o Produces same result (<1% denial rate) o Reduces administrative burden Potential savings: Current process: o 4-5% denial rate, o <1% ultimately denied PrOE process: o Produces same result (<1% denial rate) o Reduces administrative burden 43 Ultimately, we have created a more efficient prior authorization Specialty Care

44 #HASummit14 We can do a better job in helping our patients understand their healthcare encounters…. 44 Redundant, inconsistent, and perishable educational encounters in healthcare Problem Reduced provider productivity and patient satisfaction Outcome Patient Eng.

45 #HASummit14 … by providing a non-perishable, personalized solution to patient education 45 Redundant, inconsistent, and perishable educational encounters in healthcare Problem Improved provider productivity and patient satisfaction Outcome Provider- generated, video- based education prescribed to patients before, during, and after clinical encounters. Solution Patient Eng.

46 #HASummit14 We believe personalized non- perishable education will improve outcomes and satisfaction 46 Series of short, single- topic videos featuring a patient's own healthcare provider. Improve provider efficiency, increase patient engagement, and improve clinical outcomes Patient Eng.

47 #HASummit14 Thank you! Thoughts or questions? 47

48 #HASummit14 Appropriateness Scores for Diagnostic Catheterization by Month (all AUC Indications) *Hannan, EL, et al. Appropriateness of Diagnostic Catheterization for Suspected Coronary Artery Disease in New York State. CIRC INTERVENTIONS. January 28, n=156 n=8986 Median hospital-level inappropriateness rate is 28.5%* Appropriateness Scores for Diagnostic Catheterization for Suspected CAD at MGH vs. NY Cardiac Database* Appropriateness Results: Diagnostic Cath

49 #HASummit14 Appropriateness Data Repository Procedure Scheduling PrOE Appropriateness tool Public Reporting PCI, CABG, Vascular, Harris Joint Internal Performance Dashboards Billing and Prior Authorization RPM, RPDR, CDR, EMPI Pre- populated data fields (NLP search) INPUTSOUTPUTS Personalized consent form Existing registries LMR, OnCall Data storage EMR Appropriateness Indications & Decision support Measurement & analysis of appropriateness and outcomes inform guidelines and indications in real-time Data passback to registries (Web service) Copy of appropriateness results placed in LMR and CDR EHR note created PrOE: Inputs and outputs 49

50 #HASummit14 Analytic Insights A Questions & Answers

51 #HASummit14 Session Feedback Survey 51 1.On a scale of 1-5, how satisfied were you overall with this session? 1)Not at all satisfied 2)Somewhat satisfied 3)Moderately satisfied 4)Very satisfied 5)Extremely satisfied 3.On a scale of 1-5, what level of interest would you have for additional, continued learning on this topic (articles, webinars, collaboration, training)? 1)No interest 2)Some interest 3)Moderate interest 4)Very interested 5)Extremely interested 2.What feedback or suggestions do you have?

52 #HASummit14 Upcoming Keynote Sessions 2:20 PM – 3:10 PM 23.Predictive and Suggestive Analytics Dale Sanders Senior Vice President, Health Catalyst 3:25 PM – 4:25 PM 24.From The Heart: Healthcare Transformation From India To The Cayman Islands Dale Sanders Senior Vice President, Health Catalyst Chandy Abraham, MD Chief Executive Officer, Director of Medical Services Health City, Cayman Islands Gene Thompson, Health City Director, Director of Thompson Development, Ltd. 4:15 PM – 4:45 PM 25.Closing Keynote Dan Burton, Chief Executive Officer, Health Catalyst 52 Location Main Ballroom


Download ppt "#HASummit14 Sreekanth Chaguturu, MD Vice President for Population Health Management, Partners HealthCare Session #21 Key Principles and Approaches to PHM."

Similar presentations


Ads by Google