Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21
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Population Health Management is in its early stages of maturity, suffering from inconsistent definitions and understanding, and is overhyped by vendors and ill-defined by the industry. And yet, many systems are moving forward in innovative pioneering ways to address this growing trend. In this session, you will hear from two very different, successful health systems: a physician-led group and a large integrated delivery system. They will share their best practices, learnings, and different approaches to population health management.
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Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21
- 1. Session #21 Key Principles and Approaches to PHM Sreekanth Chaguturu, MD Vice President for Population Health Management, Partners HealthCare 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. David A. Burton, MD Former Chairman and CEO, Health Catalyst, Former Senior Executive, Intermountain Healthcare 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) 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. Gregory Spencer MD FACP Chief Medical Officer Crystal Run Healthcare
- 4. 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
- 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. Crystal Run Healthcare Physician owned MSG in NY State, founded 1996 300+ 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. 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. 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. Dashboards 10
- 11. 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. 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. 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. Crystal Run EDW Roadmap
- 16. Improving the patient experience • Web Portal • Care Managers • Shadow Coaching • Choosing Wisely • Practicing Excellence 16
- 17. 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
- 19. Variation Reduction Improves Access • 41,823 fewer visits • 30,206 more patients • “Created” 12 physicians
- 20. Reducing Pharmaceutical Costs PEG Filgrastrim cost per patient before and after breast cancer pathway
- 21. Total cost difference (equalized as cost per patient treated) PEG-filgrastim use in Breast cancer patients 2012 pre-pathway 791 patients $595,920 2013 post-pathway 817 patients $368,160 TOTAL COST SAVINGS $227, 760
- 22. 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. Sreekanth Chagaturu, MD Medical Director for Population Health Management Partners HealthCare
- 24. Chapter 2: Innovations in Population Health Management Sree Chaguturu, MD Vice President, Population Health Management, Partners Health Care Division of Population Health Management September, 2014
- 25. 25 My goals for today • Describe Massachusetts health reform efforts • Provide overview of Partners Healthcare • Review select programs
- 26. Patient Protection and Affordable Care Act
- 27. My fair city…
- 28. Chapter 58 of the Acts of 2006: An Act Providing Access to Affordable, Quality, Accountable Health Care
- 29. 2 9 Increasing health care spend in Mass crowded out all other areas
- 30. Health care reform part two
- 31. 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 Non Acute Care • Spaulding Rehabilitation Network Mental Health Care • McLean Hospital • Partners Community Health Care • Community Health Centers Community Provider Network 31
- 32. 32 Partners HealthCare across eastern Massachusetts 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 Partners Home Care Branches RHCI
- 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) 33 What we do
- 34. Partners currently covers over 500,000 lives in an accountable care contract 1 2 3 4 Medicare Commercial Self 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. 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. And why these programs? 36 Primary Care •Patient Centered Medical Home (PCMH) Develop team based care •High risk care management (palliative care) •Mental health integration •Virtual visits Promote Medical Neighborhood Specialty Care •Active referral management (eConsults/curbsides) •Virtual visits • Procedural decision support (appropriateness) •Patient reported outcomes •Episodes of care (bundles) Demonstrate value in procedures Care Continuum •SNF care improvement (network/waiver/SNFist) •Home care innovation (mobile observation/telemonitoring) •Urgent care Reduce post acute variation Patient Engagement •Shared decision making Empower patients in their care •Customized decision aids and educational materials Infrastructure •Single EHR platform with advanced decision support Information -> Insight -> Action •Data warehouse, analytics, performance metrics
- 37. 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. Significant opportunity in integrating mental health services into primary care Mental Health Disorder Chronic Condition Mental Health Key Elements Examples [Current and Future] Patients with a mental health disorder have 40% higher chronic condition costs 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 Embedded mental health resources, consulting psychiatrist IT tools tracking longtitudinal progress, Patient reported outcomes measurement 38 Primary Care
- 39. Virtual visits allow us to connect to patients in more convenient ways (and avoids unnecessary office visits) Asynchronous Visits exchanges between students and teachers ar e frequently enacted asynchronously face conversations. This type of communication taking place at dif ferent times learning, auction, and business web services. W ith RelayHealth, a provider of Practice is testing a tool that conducts asynchr onous exchanges between phy-sicians visits. V isits are available for about 100 non-ur gent symptoms and conditions Synchronous Models that allow people and providers to connect in real time practice. Patients login to the RelayHealth website and complete a r elevant online organizational and financial support to enable virtual 39 Virtual Visit Asynchronous Models that deliver care to people without requiring real-time interaction Specialty 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. 40 Functional Status time Surgery Tier 3: Sustainability of Recovery Tier 1: Health status achieved Tier 2: Process of Recovery Specialty Care
- 41. We can improve a patient’s surgical journey (and avoid unnecessary or unwanted surgeries) Patient with a Surgical Problem 41 PROMs PrOE (Procedure Decision Support) PROMs Assess Appropriateness Criteria Shared Decision Making Physician Schedule Procedure Recovery Encounter OR Possible Need for Procedure Pre- Procedure Testing Short-term Outcome Measures Long-term Outcome Measures Personalized Risk (Consent Form) Informed Consent PROs Survey(s) 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): 202-204 Specialty Care
- 42. 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. 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 Decision submitted to Admitting Admitting submits PA PA reviewed by third party Patient undergoes procedure Admitting enters auth # in PATCOM Authorization submitted to Admitting Manually appeal claim 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 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. We can do a better job in helping our patients understand their healthcare encounters…. 4 Problem Redundant, inconsistent, and perishable educational encounters in healthcare Outcome Reduced provider productivity and patient satisfaction Patient Eng.
- 45. … by providing a non-perishable, personalized solution to patient education 4 Problem Redundant, inconsistent, and perishable educational encounters in healthcare Outcome Improved provider productivity and patient satisfaction Solution Provider-generated, video-based education prescribed to patients before, during, and after clinical encounters. Patient Eng.
- 46. 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. Thank you! Thoughts or questions? 47
- 48. Appropriateness Results: Diagnostic Cath Catheterization for Suspected CAD at MGH vs. NY 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Appropriateness Scores for Diagnostic Cardiac Database* MGH NY Cardiac Database Median hospital-level inappropriateness rate is 28.5%* Rarely Appropriate Maybe Appropriate Appropriate Appropriateness Scores for Diagnostic Catheterization by Month (all AUC Indications) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Aug Sept Oct Nov Dec n=156 n=8986 *Hannan, EL, et al. Appropriateness of Diagnostic Catheterization for Suspected Coronary Artery Disease in New York State. CIRC INTERVENTIONS. January 28, 2014. 113.000741
- 49. PrOE: Inputs and outputs INPUTS OUTPUTS 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) Personalized EMR EHR note created Copy of appropriateness results placed in LMR and CDR Existing consent form registries LMR, OnCall Data storage Appropriateness Indications & Decision support Measurement & analysis of appropriateness and outcomes inform guidelines and indications in real-time Data passback to registries (Web service) 49
- 50. Analytic Insights Questions & A Answers
- 51. 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 2. What feedback or suggestions do you have? 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
- 52. 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
Notes de l'éditeur
- Ambulatory discovery apps Cohort Builder Key Process Analysis Regulatory Explorer Risk Stratification and Predictive Analytics Ambulatory foundation apps 8 registries Ambulatory Population Explorer Practice Management Explorer Ambulatory advanced apps Population modules Population Health Dashboard Others IDEA data entry
- This 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.
- 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.
- Variation between physicians has to do with patient populations and stage of disease treated and percentages of patients on pathway and off pathway
- 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 products
- Follow up group participation 1Would 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)
- Follow up group participation 1Would 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)