The Crescent City Beacon Community program in New Orleans is working to improve healthcare quality, coordination of care, and consumer engagement through health information technology. The program aims to reduce chronic disease burden and healthcare costs by improving clinical care for patients, strengthening care coordination between providers through a health information exchange, and engaging consumers using technologies like text messaging. It has connected many primary care practices and hospitals, implemented population health management strategies, and seen reductions in emergency department and hospital use for participating patients. The program is also collaborating with the BioDistrict initiative to further innovation in research, education, and translational medicine.
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Raising the Bar: Innovative Healthcare Program Fosters Collaboration, Education
1. RAISING THE BAR
Innovative Healthcare Program Fosters
Collaboration & Education
2. Big Data, Big Discoveries
HOST: GUEST: GUEST:
Eric Kavanagh Dr. Anjum Khurshid Jim McNamara
Sponsored by:
3. It’s a Complex Situation
Regulations in the Affordable Care Act (ACA)
Uninsured Americans
Legal challenges to the ACA
4. Emerging Solutions
Health Information Exchanges (HIEs)
Collaboration among health care institutions
Social Media for analysis, outreach and
education
6. Anjum Khurshid, PhD, MD, MPAff
Director, Health Systems Division
Director, Crescent City Beacon Community
Louisiana Public Health Institute
February 27, 2013
7. Outline
• Crescent City Beacon Community (CCBC)
Goals
– Clinical Quality Improvement
– Transitions of Care through Greater New
Orleans Health Information Exchange
(GNOHIE)
– Consumer Engagement and txt4health
• CCBC-BioDistrict Collaboration and Future
Opportunities
8. 17 Beacon Communities Bangor Beacon
Community
Western New York Brewer, ME
Beacon Community
Buffalo, NY
Southeastern
Beacon Community of Rhode Island Beacon
Minnesota Beacon
Inland Northwest Southeast Michigan Community
Community
Spokane, WA Beacon Community Providence, RI
Rochester, MN
Detroit, MI
Central Indiana Keystone Beacon
Beacon Community
Community Danville, PA
Utah Beacon
Indianapolis, IN Greater Cincinnati
Community
Beacon
Salt Lake City, UT Colorado Beacon
Community
Community
Cincinnati, OH
Grand Junction, CO
Southern Piedmont
Great Tulsa Health Beacon Community
Access Network Beacon Concord, NC
San Diego Beacon
Community
Community
Tulsa, OK
San Diego, CA Delta BLUES Beacon
Community
Hawaii County
Crescent City Beacon Stoneville, MS
Beacon Community
Hilo, HI Community
New Orleans, LA
9. Crescent City Beacon Community Goals
Reduce the burden of chronic diseases, mainly diabetes and
cardiovascular disease by :
o Improving the quality of care for chronic disease
patients in patient-centered medical homes, enabled by
HIT
o Reducing healthcare costs by decreasing preventable
emergency department and inpatient visits through better
coordination of care
o Engaging consumers in the healthcare process by
using innovative technologies and strategies
10. 3 Cs of CCBC
Clinical Care Consumer
Transformation Coordination Engagement
Build &
Improve Quality Innovate
Strengthen HIT
11. Dynamic Framework for a Coordinated System of Care
Population
Patient Education/ Patient Engagement/
Risk Reduction Disease Management
At-risk -- Low risk -- High risk -- Chronic -- Complex
Specialty/
ED Visits
Preventable
Admissions
Preventable
Diagnostics
Patient-Centered
Medical Home Emergency
(Primary Care System)
Inpatient
12. Dynamic Framework for a Coordinated System of Care
Population
Innovations/Consumer
Patient Education/ Patient Engagement/
Engagement Management
Risk Reduction Disease
At-risk -- Low risk -- High risk -- Chronic -- Complex
Specialty/
ED Visits
Preventable
Admissions
Preventable
Chronic Care Diagnostics
Management
Transitions
Patient-Centered
Medical Home
of Care
Emergency
(Primary Care System)
Inpatient
13. Clinical Transformation
Improved quality of clinical care for chronic disease patients
through improved workflow and health IT
population-based disease registries, risk stratification, care
management/care team strategies, clinical decision support
Clinical
Practice Learning EMR QI
Seminar
Coaching Collaborative Optimization Innovations
Series
14. Positive Trends on Adoption & Outcomes
Number of Sites Using Care Management Processes - 2012
Total ED/IP Encounters at ILH
5000
14 14 14 4311 7/2/12 - 1/31/13
January July
12 4000 Sum of ED
11 Sum of IP
10 2842 2826
9 9 9 3000
7 7
2000 1593
1384
4
998
1000 789 720 619 645 575
581
238 295 304 243 148
110 45 67
0
Clinic Clinic Clinic Clinic Clinic Clinic F Clinic Clinic Clinic I Clinic J
Care Management Individual Care Registries Stratify DM Care Management Care Management A B C D E G H
Staff Plans Patients for DM Patients for CVD Patients
Number of Unduplicated Lives in CDR Across the Community Q6 to Q7
Data as of 2/11/2013 Quality Outcomes (October
200,000
2012)
184,796
177,790 179,693
172,733 173,651 Diabetes: A1C testing
180,000 171,293
177,790 181,306
176,118
160,000 171,950 173,073
Diabetes: A1C control (<8.0%)
140,000 126,808
125,887
130,597
Diabetes: Lipid testing
120,000
127,008
# of Lives
124,509 126,341
100,000 Diabetes: Lipid control (<100mg/dL)
80,000
Diabetes: Blood Pressure Control (<130/80)
60,000
40,000 Ischemic Vascular Disease: Blood Pressure Control (<140/90)
20,000
Ischemic Vascular Disease: Complete Lipid Profile
0
Coronary Artery Disease: Drug Therapy for Lowering LDL-C
* All data from QI Outcome Measure Reports
15. Care Coordination
GNOHIE
Mirth Mirth Mirth Mail Mirth Care Mirth
Results Match (Secure (Care Analytics
(CDR) (EMPI) Mail) Mgmt.) (EDW)
Electronic Behavioral
ED/IP Birth
Specialty Health Analytics
Notification Outcomes
Care Referral Integration
17. Data Security
• Encrypted data
• HIPAA compliant
protocols
• Role-based access
Central security
Data
Repository
• Restricted administrative
access
• Patient consent needed
• Extensive Auditing
capabilities
18. Transitions of Care
o Emergency Department/Inpatient Notification: Alerts
and clinical information are sent to primary care
providers about patient visits to emergency departments
and hospital admissions.
o Electronic Specialty Care Referral: Referral requests
and supporting documentation of the referring primary
care provider are sent electronically to the specialist.
Specialist’s consult summaries are, in turn, provided
electronically to the primary care provider.
19. Pre-ED/IP Notification
9/15/12
Diabetic
Ketoacidosis HOSPITAL Discharged HOME
Debbie
Debbie
Type 2 Diabetes
Type 2 Diabetes
9/25/12
Hypoglycemia HOSPITAL Discharged HOME
Debbie
Debbie PRIMARY
Type 2 Diabetes
Type 2 Diabetes
CARE
10/2/12
PRACTICE
Foot infection HOSPITAL Discharged HOME
Debbie
Debbie
Type 2 Diabetes
Type 2 Diabetes
10/20/12
Kidney
Infection HOSPITAL Discharged HOME
Debbie
Debbie
Type 2 Diabetes
Type 2 Diabetes
20. ED/IP Notification System
9/15/12
Diabetic
Ketoacidosis HOSPITAL Discharged HOME
Debbie
Debbie
Type 2 Diabetes
Type 2 Diabetes
9/25/12
Hypoglycemia HOSPITAL Discharged HOME
GREATER NEW
Debbie
Debbie
Type 2 Diabetes
Type 2 Diabetes ORLEANS PRIMARY
10/2/12 HEALTH CARE
INFORMATION PRACTICE
Foot infection HOSPITAL Discharged HOME EXCHANGE
Debbie
Debbie
Type 2 Diabetes
Type 2 Diabetes
10/20/12
Kidney
Infection HOSPITAL Discharged HOME
Debbie
Debbie
Type 2 Diabetes
Type 2 Diabetes
21. Number of Unduplicated Patients in CDR
as of 2/11/2013
200,000 184,796
177,790 179,693
172,733 173,651
180,000 171,293
176,118 177,790 181,306
160,000 171,950 173,073
140,000 125,887
126,808
130,597
120,000
# of Lives
127,008
124,509 126,341
100,000
80,000
60,000
40,000
20,000
0
22. Total ED/IP Encounters at ILH Sum of ED Sum of IP
Since
5000 July ’12 7/2/12 - 1/31/13
– 3 sites
4500 4311
4000
Since Since
3500 Sept. ’12 July ’12
– 3 sites – 1 site
3000 2842 2826
2500 Since
Since
Sept. ’12
Nov. ’12
2000 – 2 sites
– 3 sites
1593
Since 1384 Since
1500 Dec. ’12 Since Sept. ’12 Since
– 1 site 998 Nov. ’12 – 1 site July ’12
1000 789 – 1 site Since – 1 site
720 645
581 Nov. ’12 619 575
500 304 – 1 site
238 295 243
110 148 67
45
0
Clinic A Clinic B Clinic C Clinic D Clinic E Clinic F Clinic G Clinic H Clinic I Clinic J
Total ED Encounters = 15,769 Total IP Encounters = 3,564
23. Telemedicine Specialty Care
Psychiatry Rheumatology Cardiology
Dermatology
Pulmonary 1 hospital – 11 General
telemedicine
Endocrinology
Physical
specialties with Diabetes
Medicine & designated
Rehab appointment slots Hepatitis C
Pain Management Neurology Nephrology
Total Specialty Consults in Q4, 2012 = 1,394
2
24. Patient Consent
OPT-IN MODEL
Exception = break the glass
1 consent form – applies across all GNOHIE
participants
PATIENT
ENGAGEMENT PROVIDER PROVIDER
AND ENGAGEMENT WORKFLOW
EDUCATION
26. Community Engagement
Consumer
Engagement Other CCBC
Model Interventions
Txt4health Campaign
Integration of
Other Settings
Community Targeted to Actualize
Provider “Health Home”
Advisory Community
Engagement Concept
Group Engagement
27. Building Blocks: Text4Health Modules
User sends
HEALTH
to 311 411
System collects: System categorizes:
HEIGHT HIGH RISK
WEIGHT (BMI) MEDIUM RISK
AGE LOW RISK
GENDER Enrollment -------------------------------
FAMILY HISTORY UNDERWEIGHT
DIABETES DIAGNOSIS AT WEIGHT
SMOKING STATUS OVERWEIGHT
Development of Profile OBESE
(Risk Categorization)
Goal Setting/Tracking Education/Motivation Local Connections
(Weight & Exercise) (According to Risk) (Care & Activities)
Enrolled participants in 12 months ~ 1,400
28. Solution Offering and Value Proposition
Care Management & Coordination System
Solution Offering Value Proposition
• Patient- • Chronic Care Improve Quality
Centered Management
Medical Home System •HEDIS measures for diabetes and cardiovascular
People Process
Improve Efficiency
•Reduce hospital readmissions
Data Analysis
•Reduce Emergency Room Visits
Technology & Information •Reduce Avoidable Hospital Admissions
(EMR/HIE) Management
•Reduce duplicate testing (e.g. imaging)
• Health •Medication management
•Engagement
Information (Consumer, Prov
Exchange ider,) Bend the Medical Cost
Bend the Medical Cost Trend
Trend
• Reduction in per member per month cost
29. Advanced Analytics
Use predictive modeling, propensity score matching,
and other statistical techniques to investigate:
• High use of Emergency Department
Prescriptive • Avoidable hospital readmissions
How can we achieve the best outcomes?
• Duplicate procedures and tests
Predictive modeling
What will or could happen?
• Preventable hospital admissions
• High-cost patients
• Variation in care
Descriptive
What happened?
• Root cause analysis
30. CCBC-BioDistrict Collaboration
• To promote research-community-industry
collaboration
• To develop a real-time, real-
world, intelligent, learning system that connects
researchers and clinicians
• To provide a laboratory for innovation, social
entrepreneurship, and translational medicine
• To measure and demonstrate impact on patient
outcomes and population health
31. Opportunities for Future
• Use state-of-the-art health IT infrastructure to
coordinate care and evaluate results
• Involve leading research institutions and medical
centers to use data to inform clinical practice
• Develop Public-private partnerships to test new
ideas, effective treatments, and innovative
technologies
• Promote economic development and job
creation through workforce training and new
business ventures
32. Strength of the System
Ownership &
Engagement
Accountability
Leveraging
Trust
Networks
Stakeholder-defined use cases and
provider-led design
34. CCBC Receives 2013 “Healthcare
Informatics Innovators Award”
“A massive effort to improve the health status of the
entire New Orleans metropolitan area”
“What makes this collaboration worthy of Innovator
Awards recognition is the combination of vision and
scope on the one hand, and the successful
leveraging of HIT to achieve those visionary
goals, on the other”
-- Mark Hagland
Editor-in-Chief, Healthcare Informatics
35. Contact:
Anjum Khurshid, PhD, MD, MPAff
Director Health Systems Division
Director Crescent City Beacon Community
Louisiana Public Health Institute
1515 Poydras St, 1200
New Orleans, LA 70112
Phone: 504-301-9800
Email: akhurshid@lphi.org
www.lphi.org www.crescentcitybeacon.org
39. Vision
BioDistrict New Orleans will become a thriving and
highly livable business, education, science and
healthcare destination, regarded throughout the City
and the nation as the premier revitalized urban district of
choice. The BioDistrict will be known for its walkable
scale, new and historic neighborhoods, excellent
schools and ecosystem support services, vibrant
retail, accessible open space and transit, as well as a
range of stable and well paying bioscience and
healthcare industry jobs. The BioDistrict will become a
national model for urban revitalization, job creation and
economic and industry development.
40. An Amazing Collaboration working TOGETHER!
Economic Development
Jobs and training
Sustainably Built Environment
10/12/12
Civic Leadership
41. Research with Industry value
Bioscience Centers of Excellence
Peptides
HIV/AIDS
Infectious Diseases
Cancer
Diabetes and Cardiovascular
Biodefense
Neuroprotection and
Rehabilitation
Nano-particle Drug Delivery
Health IT
Emerging Centers
Translational Medicine
BioBanking
43. • Economic Impacts
— Over 20 years, the BioDistrict will
generate:
• 34,000 direct and indirect jobs created
• 3600 annual construction jobs
• $4 Billion in Capital Activity
• $24 Billion in Economic Activity
• $2.45 Billion in years 1-5
• $26.185 Billion in Personal Earnings
• $2 Billion in increased Personal
Earnings
44. • Economic Impacts
— In 20 years, the BioDistrict will generate:
• $3.352 Bn in Sate and Local Tax
Generated, ($167 m per year)
• $1.91 Bn -- State tax - $95 Million
annually
• $1.44 Bn -- Local tax - $72 Million
annually
• 11.6 Million Square Feet of
New, Absorbed or Renovated Buildings
• 2,000+ Housing Units