Presentation on theme: "Session #21 Key Principles and Approaches to PHM"— Presentation transcript:
1 Session #21 Key Principles and Approaches to PHM Greg Spencer, MD Chief Medical & Chief Medical Information Officer, Crystal Run HealthcareDr. 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.Sreekanth Chaguturu, MD Vice President for Population Health Management, Partners HealthCareDavid A. Burton, MD Former Chairman and CEO, Health Catalyst, Former Senior Executive, Intermountain HealthcareDr. 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.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.
2 Poll Questions (1-3)Does your organization sponsor or participate in a population health management/shared accountability initiative (e.g., ACO or commercial)YesNoNot sureNot applicableWhat percent of your patients are covered by your organization’s population health/shared accountability initiative?Less than 5%5-10%More than 10%No ideaIn your opinion, how successful has your organization’s population health/shared accountability initiative been to date?Not at all successfulSlightly successfulSomewhat successfulSuccessfulVery successfulUnsure or not applicable
3 Gregory Spencer MD FACP Chief Medical OfficerCrystal Run Healthcare
4 Our Approach Triple Aim as an organizational outline Better care, better health, lower costAnalytics: multisource, scalable platformProvider involvementCare managers, CARETEAM, TelehealthMonitor the data
6 NY Healthcare Environment Massive consolidation and mergersBankruptciesLarger systems and groupsOptumVenture capitalMostly unmanagedUrgent care centers and retail medicine
7 Crystal Run Healthcare Physician owned MSG in NY State, founded 1996300+ providers, 20 locationsJoint Venture ASC, Urgent Care, Diagnostic Imaging, Sleep Center, High Complexity Lab, PathologyEarly adopter EHR (NextGen®) 1999Accredited by Joint Commission 2006Level 3 NCQA PCMH Recognition , 2012
8 Crystal Run Healthcare ACO Single entity ACOApril 2012: MSSP participantDecember 2012: NCQA ACO Accreditation35,000 commercial lives at riskMSSP11,000 attributed beneficiaries82% primary care services within ACO
9 Business Intelligence Past Initially BI = business only, reportsQuality, safety measures and clinical performance laterBasic tools: SQL, SSRS, ExcelManual and time consumingReport generation > analysisLack of scalability and extensibilityMostly tabular / numeric
13 Basic System Needs Common integrative platform Pull together disparate dataCost: claims where available, internal costsA way to implement change“Leakage” and networkWhere are patients going, are needs being met?LeanWaste reduction, everywhere
14 How we chose our EDW Our bias: controlled by us Avoiding “black boxes” Prior healthcare experienceModern technologyEstablished track recordTeach us how to fish
15 Crystal Run EDW Roadmap Ambulatory discovery appsCohort BuilderKey Process AnalysisRegulatory ExplorerRisk Stratification and Predictive AnalyticsAmbulatory foundation apps8 registriesAmbulatory Population ExplorerPractice Management ExplorerAmbulatory advanced appsPopulation modulesPopulation Health DashboardOthersIDEA data entry
16 Improving the patient experience Web PortalCare ManagersShadow CoachingChoosing WiselyPracticing Excellence
17 Variation Reduction Specialty and division sponsored Best practice reviewBuy-in at the physician levelProvider projectsInnovation contestNational: Choosing WiselyImproved access - backfill and market share
18 Variation ReductionThis table shows the reduction in visits per patient for the initial 15 diagnoses evaluated. Through adherence to best practice guidelines, approximately 13,000 visits were eliminated, creating capacity to care for additional patients.
19 Variation Reduction Improves Access Creating a culture of efficiency has improved access in our organization. Assuming that the average physician sees 3,612 visits/year (MGMA), we have “created” 12 “new” physicians. Widespread adoption will mitigate the projected physician shortage.41,823 fewer visits30,206 more patients“Created” 12 physicians
20 Reducing Pharmaceutical Costs PEG Filgrastrim cost per patient before and after breast cancer pathwayVariation between physicians has to do with patient populations and stage of disease treated and percentages of patients on pathway and off pathway
21 Total cost difference (equalized as cost per patient treated) PEG-filgrastim use in Breast cancer patients2012 pre-pathway 791 patients $595,9202013 post-pathway 817 patients $368,160TOTAL COST SAVINGS$227, 760
22 Summary Triple Aim, core values as a guide Unified analytics platform that integrates disparate systems is requiredQuality, safety and performance programs that are trackedPhysician involvement, variation reductionPatient experienceLeakage, where and whySystematically find and reduce waste
23 Sreekanth Chagaturu, MD Medical Director for Population Health ManagementPartners HealthCare
24 Chapter 2: Innovations in Population Health Management Sree Chaguturu, MD Vice President, Population Health Management, Partners Health Care
25 My goals for today Describe Massachusetts health reform efforts Provide overview of Partners HealthcareReview select programs
26 Patient Protection and Affordable Care Act THREE POLICIES MAKE THIS EASIER-- Payment reform that rewards better outcomes and forces differentiation-- HITECH ACT to get computers in the office so we have capability-- HDI to liberate data to fuel innovative productsPatient Protection and Affordable Care Act
31 Who We Are: Partners HealthCare Teaching HospitalsMassachusetts General HospitalBrigham and Women’s HospitalCommunity HospitalsNewton Wellesley HospitalNorth Shore Medical CenterMartha’s Vineyard and Nantucket HospitalsNon Acute CareSpaulding Rehabilitation NetworkMental Health CareMcLean HospitalCommunity Provider NetworkPartners Community Health CareCommunity Health Centers
32 Partners HealthCare across eastern Massachusetts Salem &ShaughnessyPartners Acute HospitalsKaplanUnionMcLeanPartners Specialty HospitalsSpauldingTowns With PCHI Primary CareNewton-MGHBWHCare Physician PracticesWellesleyFaulknerPartners Home Care BranchesRHCI
33 What we do Our Employees Our Patients Teaching Clinical Research ~60K employees – the largest non-government employer in the state~13K are MDs, RNs and direct care givers~5K are primarily involved in researchOur Patients~1.6M ambulatory visits~168K discharges~4K licensed beds~$205M investment in community benefitsTeaching28 residency programs provide training to ~1,400 residents~$ 167M investment in teachingClinical Research~$1.6B in academic/research revenue~2,800 paid researchers (MDs & PhDs)
34 Partners currently covers over 500,000 lives in an accountable care contract 1234MedicareCommercialMedicaidSelf InsuredExample: Pioneer ACOCovered lives: ~74kExample: Alternative Quality ContractCovered lives: ~350KExample: NHPCovered lives: ~30kExample: Partners PlusCovered lives: ~100k
35 Partners is implementing over a dozen PHM Programs Primary CarePatient Centered Medical Home (PCMH)High risk care management (palliative care)Mental health integrationVirtual visitsSpecialty CareActive referral management (eConsults/curbsides)Procedural decision support (appropriateness)Patient reported outcomesEpisodes of care (bundles)Care ContinuumSNF care improvement (network/waiver/SNFist)Home care innovation (mobile observation/telemonitoring)Urgent carePatient EngagementShared decision makingCustomized decision aids and educational materialsInfrastructureSingle EHR platform with advanced decision supportData warehouse, analytics, performance metrics
36 And why these programs? Develop team based care Primary CarePatient Centered Medical Home (PCMH)High risk care management (palliative care)Mental health integrationVirtual visitsSpecialty CareActive referral management (eConsults/curbsides)Procedural decision support (appropriateness)Patient reported outcomesEpisodes of care (bundles)Care ContinuumSNF care improvement (network/waiver/SNFist)Home care innovation (mobile observation/telemonitoring)Urgent carePatient EngagementShared decision makingCustomized decision aids and educational materialsInfrastructureSingle EHR platform with advanced decision supportData warehouse, analytics, performance metricsDevelop team based carePromote Medical NeighborhoodDemonstrate value in proceduresReduce post acute variationEmpower patients in their careInformation -> Insight -> Action
37 High risk patients - those at risk of being high cost Successful ACOs will use predictive analytics to launch a high risk care management programHigh risk patients - those at risk of being high costMedically ComplexNot Chronically Ill, Medically ComplexPrimary Care
38 Significant opportunity in integrating mental health services into primary care Mental Health DisorderChronic ConditionKey ElementsExamples [Current and Future]Better identify patientsIncreased screeningBetter triage of patientsPhone access line with referral supportPatients with a mental health disorder have 40% higher chronic condition costsBetter use of protocolsIMPACT for depression, SBIRT for substance abuseBetter self-managementOnline patient-directed therapy (iCBT)Better access to servicesEmbedded mental health resources, consulting psychiatristBetter tracking outcomesIT tools tracking longtitudinal progress, Patient reported outcomes measurementPrimary Care38
39 Virtual visits allow us to connect to patients in more convenient ways (and avoids unnecessary office visits)SynchronousModels that allow people and providers to connect in real timeAsynchronousModels that deliver care to people without requiring real-time interactionSpecialty Care
40 Patient Reported Outcome Measures are outcomes that matter (and demonstrates value to market) Direct collection of information from patients regarding symptoms, functional status, and mental health.SurgeryTier 3: Sustainability of RecoveryFunctional StatustimeTier 1: Health status achievedTier 2: Process of RecoverySpecialty Care
41 We can improve a patient’s surgical journey (and avoid unnecessary or unwanted surgeries) PROMsPrOE (Procedure Decision Support)PROMsAssess Appropriateness CriteriaShared Decision MakingShort-term Outcome MeasuresLong-term Outcome MeasuresPersonalized Risk (Consent Form)PROs Survey(s)Patient with a Surgical ProblemPhysician EncounterPossible Need for ProcedureInformed ConsentSchedule ORPre-Procedure TestingProcedureRecoveryMilford 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 Care41
42 We target the most costly procedures 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 fusionSpine laminectomyKnee arthroplastyHip replacementPCICABGHeart valve repairSpecialty Care
43 Ultimately, we have created a more efficient prior authorization Clinical OfficePatient visits surgeon and lumbar laminectomy is indicatedAdmin faxes form to admittingYesPatient undergoes procedureAdmin knows procedure requires PA?Admitting calls clinic to work through PA formPrOE completedSurgeon schedules procedurePotential savings:Current process:4-5% denial rate,<1% ultimately deniedPrOE process:Produces same result (<1% denial rate)Reduces administrative burdenMGH Admit-tingAdmitting enters auth # in PATCOMNoPrOE PA form sent to AdmittingAdmitting checks for formAdmitting checks for formDecision submitted to AdmittingDeniedAuthorization submitted to AdmittingManually appeal claimPayerAdmitting submits PAPA is granted without third party reviewPA reviewed by third partySpecialty Care
44 Redundant, inconsistent, and perishable educational We can do a better job in helping our patients understand their healthcare encounters….ProblemOutcomeRedundant, inconsistent, and perishable educationalencounters in healthcareReduced provider productivity and patient satisfactionPatient Eng.
45 Improved provider productivity and patient satisfaction … by providing a non-perishable, personalized solution to patient educationOutcomeSolutionProblemImproved provider productivity and patient satisfactionProvider-generated, video-based educationprescribed to patients before, during, and afterclinical encounters.Redundant, inconsistent, and perishable educationalencounters in healthcarePatient Eng.
46 We believe personalized non-perishable education will improve outcomes and satisfaction Series of short, single-topic videos featuring a patient's own healthcare provider.Improve provider efficiency, increase patient engagement, and improve clinical outcomesPatient Eng.
48 Appropriateness Results: Diagnostic Cath Appropriateness Scores for Diagnostic Catheterization by Month (all AUC Indications)Appropriateness Scores for Diagnostic Catheterization for Suspected CAD at MGH vs. NY Cardiac Database*Median hospital-level inappropriateness rate is 28.5%*n=156n=8986*Hannan, EL, et al. Appropriateness of Diagnostic Catheterization for Suspected Coronary Artery Disease in New York State. CIRC INTERVENTIONS. January 28,
49 PrOE: Inputs and outputs PrOE Appropriateness toolProcedure SchedulingAppropriateness Indications & Decision supportPre-populated data fields (NLP search)Internal Performance DashboardsLMR, OnCallEMRPublic ReportingAppropriateness Data RepositoryEHR note createdData storageRPM, RPDR, CDR, EMPIBilling and Prior AuthorizationCopy of appropriateness results placed in LMR and CDRMeasurement & analysis of appropriateness and outcomes inform guidelines and indications in real-timePersonalized consent formExisting registriesPCI, CABG, Vascular, Harris JointData passback to registries (Web service)
51 Session Feedback Survey On a scale of 1-5, how satisfied were you overall with this session?Not at all satisfiedSomewhat satisfiedModerately satisfiedVery satisfiedExtremely satisfiedWhat feedback or suggestions do you have?On a scale of 1-5, what level of interest would you have for additional, continued learning on this topic (articles, webinars, collaboration, training)?No interestSome interestModerate interestVery interestedExtremely interestedFollow up group participation1Would you like to participate in a follow up group on this topic that would meet 2-3 times next year to share progress, challenges and best practices? (Yes, No)
52 Upcoming Keynote Sessions LocationMain Ballroom2:20 PM – 3:10 PMPredictive and Suggestive AnalyticsDale SandersSenior Vice President, Health Catalyst3:25 PM – 4:25 PMFrom The Heart: Healthcare Transformation From India To The Cayman IslandsChandy Abraham, MDChief Executive Officer, Director of Medical Services Health City, Cayman IslandsGene Thompson, Health City Director, Director of Thompson Development, Ltd.4:15 PM – 4:45 PMClosing KeynoteDan Burton, Chief Executive Officer, Health CatalystFollow up group participation1Would you like to participate in a follow up group on this topic that would meet 2-3 times next year to share progress, challenges and best practices? (Yes, No)
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