Disruptive Innovations to Achieve Right Specialty Care February 24, 2017 Hal F. Yee Jr., M.D., Ph.D. Chief Medical Officer Los Angeles County Department.

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Presentation transcript:

Disruptive Innovations to Achieve Right Specialty Care February 24, 2017 Hal F. Yee Jr., M.D., Ph.D. Chief Medical Officer Los Angeles County Department of Health Services

Disclosure I do not have relevant financial relationships with commercial interests.

GME/CE Learning Objectives Recognize the critical importance of disruptive innovations in health care delivery. Demonstrate how health information technology can genuinely improve the effectiveness and efficiency of health care delivery. Recommend how the health care safety net represents a unique model for creating and testing disruptive innovations.

LA County DHS (ca. 2011): Some Challenges Scale 88 cities, 10M residents, 2M uninsured Infrastructure Absence of unique patient/provider IDs, EHR, real primary care, standards, or coordination Governance Bureaucracy, politics, civil service, silos Disparity between demand & capacity

Los Angeles County: Scale Houston Chicago Los Angeles County: Scale New York City San Francisco Philadelphia (Optional slide): With over 4,000 square miles, Los Angeles County is larger than San Francisco (City and County), The District of Columbia, Philadelphia, Houston, Chicago, and all 5 boroughs of New York City combined. District of Columbia Data Source: U.S. Census Bureau, Topologically Integrated Geographic Encoding and Referencing system, 2009. Maps Drawn at 1:750,000 scale. 5 5

The Problems Disruptive Innovations: Patient-Centered Medical Neighborhood PCMH Specialty Home PCP Specialist Clear Consistent Coordinated Timely Efficient Cost effective Ambiguous Inconsistent Discoordinated Untimely Inefficient Costly Disruptive Innovations: Specialty-primary care work groups Expected clinical practices Electronic consultations

The Solutions Disruptive innovations: implement novel processes that greatly increase access through simplicity and cost reduction Address key barriers to change: technical (i.e., policies and procedures) adaptive (i.e., culture and behavioral)

Specialty-Primary Care Workgroups What is the disruption? How does it address the technical and adaptive barriers? Improves consistency, coordination, efficiency, and cost effectiveness.

Expected Clinical Practices What is the disruption? How does it address the technical and adaptive barriers? Improves clarity, consistency, efficiency, and cost effectiveness.

Specialty-Primary Care Expected Practices Developed by Specialty-Primary Care Work Groups composed of specialists and primary care providers Guided by 1) real-life practice conditions, 2) available clinical evidence, and 3) the principle that we must provide equitable care for entire patient population In individual situations a provider’s clinical judgment may vary from an Expected Practice, but in such cases compelling documentation for the exception should be provided.

Expected Practices: Examples Cancer screening (e.g., breast, colon) Evaluation and management of specific conditions Specialty care co-management recommendations Standard logistical information (e.g., ‘how to do X’)

Electronic Consultations What is the disruption? How does it address the technical and adaptive barriers? Improves clarity, consistency, coordination, timeliness, efficiency, and cost effectiveness.

Electronic Consultation

Impact Ability to track, triage, advise, avoid Wait times/Access to care Dialog and relationship building Elimination of illegible faxes Improved specialist efficiencies User experience and education

Bibliography Chen, A Hm, Murphy, EJ, Yee HF Jr, eReferral - A new model for integrated care, New Engl J Med, 368:2450-3, 2013. Yee, Jr HF, The Patient-Centered Medical Home Neighbor: A Sub Specialty Physician’s View, Ann Int Med, 154:63-4, 2011. Soni, SM, Giboney, P, Yee, HF Jr, Development and implementation of expected practices to reduce inappropriate variations in clinical practice, JAMA, 315:2163-64, 2016. Barnett, ML, Yee, Jr HF, Mehrotra, A, Giboney, P, Widespread adoption of electronic consultations in a large safety-net system enables rapid access to specialty care, Health Affairs, in press, 2017.