11 Kansas Heart & Stroke Collaborative September 22 and 23, 2014

2 Health Care Innovation Award Grants to applicants to test innovative care delivery and payment models KUH awarded $12.5 million to work with HaysMed, 10 CAHs, primary care providers, and specialists to form a rural clinically integrated network Target population for interventions = residents of Northwest Kansas counties at risk of heart attack or stroke

3 The Kansas Heart & Stroke Collaborative is a care delivery and payment model to improve rural Kansans’ heart health and stroke outcomes and reduce total cost of care for that population.

4 Outcomes Measures Reduce total cost of care for target population by $13.8 million (1.9 percent savings) Reduce deaths from heart and cerebrovascular disease by 20 percent Project sustainability beyond 3-year grant period

5 Overarching Strategies Integration (Teamwork) Incentives (Rewards for Teamwork + fieldwork) Interventions (Fieldwork)

6 Integration Teamwork Form collaborative governance structure Strengthen care continuum for rural Kansans Pursue clinical integration among providers to provide accountability for population health

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8 First Six Months Establish grant administration processes Engage participants Implement governance structure Recruit staff Explore technology solutions Secure data sources

9 Kansas Heart and Stroke Collaborative Summit: Envisioning the Future of Rural Health Building a Foundation For Collaboration Tuesday, October :00 to 8:30 pm Clinical Committee Wednesday, October 15 – 9:00 am to 2:30 pm Technology Committee Education and Outreach Committee Finance and Administration Committee

10 Intervention Field Work Collaboratively adapt guidelines and pathways to reflect the community and its resources Expand use of telehealth Leverage IT and data analytics Develop regional/local plans for care management and patient engagement

11 Incentives Rewards for Teamwork & Field Work Transitional payment model – Direct payment for care management services – Upward payment adjustments for participating rural physicians and mid-level providers – Disease-specific shared savings program Transformational payment model – Build shared analytic infrastructure to identify and evaluate alternatives to cost-based reimbursement to preserve local access to care

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13 Year 1 – Interventions Second 6 months = initiate interventions Target population – Acute care admissions for ischemic heart disease and cerebrovascular disease 3 key components – STEMI regional system – Stroke regional system – Transitional care management

14 Year 1 – STEMI Regional System Issue and System Solution No KS hospitals perform PCI within 90 minutes when patient transferred from non-PCI facility System solution – Standardized protocols and personalized training for CAHs and EMS – Supportive telehealth through KUH – Immediate access to patient data through HIE – Integrated transfer system with HaysMed

15 STEMI Regional System Key Participants KUH team leads – Matthew Earnest, MD – Barbara MacArthur, RN, MN HaysMed team – Cardiologists – Emergency Services First Responders CAH teams – Physicians and mid-level practitioners – Directors of Nursing and Emergency Services

16 STEMI Regional System Key Interventions Early Recognition of Signs and Symptoms Activation of Emergency Medical Services Point of Entry Protocols – Acquisition and transmission of ECGs – Transporting to the facility best-suited to providing needed care Application of AHA and ACC Treatment and Transfer Guidelines *Deliverable: Improved Patient Outcomes

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18 Year 1 – Stroke Regional System Expansion of Existing Initiatives Expansion of Kansas Initiative for Stroke Survival – Supported by KUH’s Advanced Comprehensive Stroke Center – Emergent Stroke Readiness System solutions – Standardized protocols and personalized training EMS transport and CAH receipt of potential stroke patients Use of tPA – Telehealth – Immediate access to patient data through HIE – Integrated transfer system with HaysMed

19 Year 1 – Stroke Regional System Key Participants KUH team leads – Colleen Lechtenberg, MD – Marilyn Rymer, MD HaysMed team – Neurologist – Emergency Services CAH teams – Physicians and mid-level practitioners – Directors of Nursing and Emergency Services

20 Year 1 Intervention - Transitional Care Management Post-discharge follow-up care for Medicare + Medicaid acute care admissions with discharge diagnosis of ischemic heart disease or cerebrovascular disease – Coordination with PCP – Provision of resources and personnel for patient engagement and community involvement

21 Year 2 – Interventions Expand Transitional Care Management Expand TCM to include acute care admissions with discharge diagnosis of hypertensive disease, disorders of lipid metabolism and tobacco use but without a diagnosis of heart attack or stroke.

22 Year 2 – Interventions Introduce Local Health Coaches Patient engagement – Using physician referrals and data analytics, identify and engage high-risk/rising risk patients in local communities – Collaborative staff residing in local communities reach out to these individuals using patient engagement tools

23 Health Coach Opportunities Identifying qualified individuals in local communities – Health department staff, EMS, retired nurses, etc. Developing training materials Designing effective patient engagement tools Navigating patient privacy issues

24 Year 3 – Interventions Expand Transitional Care Management Expand TCM to include acute care admissions with discharge diagnosis of diseases of the circulatory system

25 Year 3 – Interventions Chronic Care Management and Health Homes Collaborative staff to provide Medicare chronic care management (CCM) services and Medicaid health home services to target population – Care plan – Medication management – Coordination of healthcare services – Engage community resources

26 Incentives Providers continue to bill and collect for services Payment to Collaborative for TCM, CCM, and health home services Enhanced payments on Medicare Physician Fee Schedule Disease-Specific Shared Savings Program Proposal for transformational payment model

27 WE HAVE THE OPPORTUNITY TO CHANGE HEALTH AND HEALTHCARE – KANSAS CAN LEAD THE NATION

28 The project described was supported by Funding Opportunity Number CMS- 1C from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.