Population Health Management: A U.S. Experience
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1 Population Health Management: A U.S. Experience William W. Feaster, MD, MBA Chief Medical Information Officer CHOC Children s Hospital Orange County, California
2 An embarrassment of riches The U.S. is a very rich country like our European colleagues We have a similar number of doctors per capita We have the world s most prolific medical research We spend the most money on health care Why aren t we the healthiest country?
3
4 If you want to truly understand something, try to change it. - Kurt Lewin, PhD
5 The US has been trying to reduce rising health care spending for years Focus has historically been on payment reform 1983 introduction of DRG reimbursement for hospitals under Medicare Late 1980 s - expansion of insurance-based managed care Primary care established as a gatekeeper Pre-authorization for procedures Per diem reimbursement to hospitals Still FFS to providers 1990 s shift to capitated payments Insurers shifted risk to the providers Health systems unable to manage that risk Arbitrary allocations of $$ without data 2000 Managed care rejected by physicians and health systems return to FFS payments to physicians, heavily discounted of course Hospital back to discounted FFS or per diem reimbursement But we made up for lost revenues in volume!
6 Just paying less wasn t the long-term solution Capitation DRGs
7 The problems we need to address are more structural than just what we re paying for services We spend too much money on treating disease and not enough on preventing disease Spending tends to be governed by the volume of healthcare delivered, not by the quality or efficacy of that care If someone pays us less for a procedure, we have to make it up in volume! Concept of Supply-sensitive care David E. Wennberg MD, MPH Dartmouth
8 28% spent in last 6 months of life
9 Supply-sensitive Care Our provider systems are designed to get the results they get Fee-for-service incentivizes more procedures and more care The more hospital beds in a region, the more hospitalizations The more providers you have in an area, the more care people receive Is this supply-sensitive care better? Is more care better? Does it lead to better outcomes?
10 With more care, are outcomes better? Fisher, ES, et. Al. Ann Intern Med. 2003;138(4):
11
12 Insanity: doing the same thing over and over again and expecting different results. - Albert Einstein
13 Enter the Patient Protection and Affordable Care Act (aka Obamacare ) 2010 Great intentions Increase access to healthcare coverage for uninsured Mandates and insurance exchanges End abusive health insurance practices Transform the health care delivery system Shift to value-based reimbursement Encourage the development of new patient care models Prevention of chronic disease and improving public health But a bit overcomplicated 1,000 other pages in the law outlining improvements and 15,000 pages of regulations to implement these
14 The uninsured While the % are improving, there are currently 38,000,000 Americans without healthcare insurance coverage (plus another 11 million illegal immigrants)
15 Healthcare Transformation: The shift to value-based reimbursement (Quality and Satisfaction)
16 The dominant model enabling this shift is the Accountable Care Organization (ACO) Established by the ACA as a new payment model under Medicare one of many Over 420 ACOs are part of Medicare s Shared Savings Program and Pioneer Program (both began in 2012) 7.8 million enrollees 2014 results overall, organizations showed improvements in quality scores by 87% Less than 30% of ACOs were actually rewarded for that good work. Several penalized. What Medicare starts, others follow
17
18 Let s shift to Orange County, California In 1993, during the period when managed care shifted to capitated payments, OC formed a county health system (CalOptima) to manage the care of low income women, children and adults previously insured under California s FFS Medicaid program. CHOC Children s Hospital is the primary provider of inpatient and specialty pediatric care in Orange County thus was the county s primary partner in this program.
19 Current State We ve been at this for 22 years! We have an independent practice association (CHOC Health Alliance) Provides patient management for utilization and referrals Minimizes out-of-system care Physicians are in everything from solo to large multispecialty practices Provider network established among these physicians (CHOC Physician Network)
20 Current State (cont.) We are now at full-risk capitation for 150,000 low income children in that program. California typically pays less than cost for the care of Medicaid patients (49 of 50 states) A huge potential loss for the hospital unless we can improve the health of this population and more appropriately utilize our resources When asked, the CFO couldn t give me any data on the profitability of this population!
21 How have we managed these populations in the past? Until recently, our performance metrics on this population have utilized the old fashion techniques of claims data analysis (how we do HEDIS reporting) and individual performance assessments. While we have heavily leveraged our EHR within our hospital and specialty clinics to implement care guidelines, we haven t pushed these out to the majority of clinicians caring for these patients.
22 PPACA Several reasons to change this statusquo were recognized Value-based reimbursement is here to stay and will be extended to new populations that we depend upon for profitability. We are entering into a commercial ACO with our neighboring adult hospitals and we will take on full-risk for those patients as well
23 CHOC Children s Hospital Orange, California 279 Inpt beds in Orange 30 PICU 12 CVICU 67 NICU 28 Heme/Onc 82 M/S 24 Neuroscience 3 shelled floors for future development Surgical service with 7 ORs, 2 endo, 3 procedure rooms 48 Inpt beds in Mission Viejo PICU, NICU and M/S 34 bed ED Up to 320 patients per day being seen Now a level 2 trauma center 5 primary care clinics 30 Orange specialty clinics 5 satellite specialty clinics UCI affiliation 500 residents, fellows, med students 375 active research studies
24 We ve been organized to provide care under a FFS environment Hospital thrives when we have lots of patients Most of the care within the hospital is specialty based Affiliated multispecialty group run in a foundation model (Pediatric Specialty Faculty PSF) Large numbers of community-based specialists Unaffiliated pediatricians referring patients to specialists of their choice Employed primary care pediatric group (only manages 26,000 of the 150,000 CalOptima patients and not well)
25 We can keep doing business as usual, but
26 Change is mandated We have to create a system of care (facilities and providers) that most efficiently provides care to populations of patients We have to direct our care to providers who do the best job caring for our patients We have to develop models of care to support this system We have to support this care model with technology not previously available
27 CHOC Pediatric System of Care To manage these populations CHOC is looking to affiliate with pediatric practices throughout Orange County Different levels of affiliation based on practice desires Practices joining our Foundation will be switched to Cerner Ambulatory to take full advantage of a common Millennium platform. Move community specialists into our Foundation practice Importance of this move now recognized by community-based specialists
28 CHOC Pediatric System of Care Other affiliations will focus on communication and exchange of data between CHOC and the practices, as well as extension of our population health infrastructure within existing EHRs whenever possible. Care model supporting this system of care being refined Technology should be driven by the care model, not the care model being driven by technology
29 Our four pillars of technology supporting population health Patient Engagement Care Communications Analytics Care Management
30 Care communications Care communications Push Traditional: Fax, snail mail, telephone New: Direct , secure texting Direct data feeds into care partner s EMR or HIE Pull Connection to our local HIE, OCPRHIO Data pulls bidirectional Parsing into the EHR
31 Patient engagement Patient engagement Patient portal a primary tool for engaging patients in their care Useful features but not very engaging in it s current form Other needed engagement functionality Secure live video for home housecalls Push of patient education based on identified need Pre-visit questionnaires Integration with home monitoring, personal fitness and other devices Full support for portable devices Dilemma of multiple portals serving an ACO population
32 Care management Care management Must support all encounters with the patient wherever or however that care is delivered Patient data and cross-encounter care plans available to all using system Supports multiple roles: Care managers Care navigators Health coaches Benefit from risk adjustment methodology appropriate to the population
33 Analytics In the past, we ve relied on assessment of individual clinicians, sourced data from chart reviews or out-of-date administrative claims data to measure utilization and performance. The new era is built on quality and performance analytics derived from the Electronic Health Record and many disparate data sources (big data?)
34 Analytics (cont.) This data needs to be presented in real-time to the point of care Data reporting must support improved quality and outcomes, patient and provider satisfaction demonstrate that to payers and patients
35 Why did we choose the Cerner Healthe Intent Platform We looked at several other vendors in the marketplace None had the potential of the Healthe Intent platform We have a very successful long-term relationship with the vendor Many successful development partnerships Certainly there are advantages of loading Cerner data into a Cerner product However, the platform is vendor agnostic Big data front end allows collection of data from disparate sources, normalization of that data and serves as a technology base for all of our population health tools
36 CHOC has been a Cerner client since Cerner live (ADT, results from St. Joes) Patient Accounting 2003 Pharmacy 2005 IP Nursing and Ancillary Documentation 2007 CPOE 2008 Ambulatory EHR development begun 2011 Positive Patient ID Medication Scanning 2011 Document Scanning 2011 Mobile MD HIE 2012 NICU MD Documentation - Neodata Quest Results Interface 2013 Tower Opening Cerner applications SurgiNet PathNet RadNet FirstNet PACS Fuji Synapse Siemens Syngo Timeless Breast Milk erx outpatient GE Muse Nuance Dragon Dictation Cerner Depart Process, erx inpatient 2014 Advanced Medication Reconciliation Cerner Clinical XR 2014 Dynamic Documentation rolled-out in first clinics CCD Patient Portal 2014 MU 2 compliant, HIMSS Stage 7 Recognition 2015 Resonance 2015 Healthe Intent Platform Data platform implemented Seven registries designed, five in production Healthe Care pediatric development underway
37 The Healthe Intent Platform Know Engage & Manage Data Acquisition Healthe Intent Platform Programs Solutions Workflow
38 What are we referring to as a registries? A registry provides data, visible at the point of care, to track compliance with published or mutually accepted care guidelines (ADA, AAP, etc). A team of experts advise registry development to include: Exclusion criteria (e.g. age>=1, certain diagnoses, etc.) Inclusion criteria (diagnoses, resource utilization, etc.) Process measures (lab test obtained, patient seen per schedule, etc.) Outcome measures (lab test result, ED visits, etc.) Registry data will be visible within PowerChart workflow and will also be available to practice managers, care managers, and others to assess patient outcomes and track compliance with care guidelines. Registry reporting will be rolled out to all providers within CHOC s Pediatric System of Care.
39 Cerner HealtheRegistries Cerner has developed >20 registries for the adult population We are their development partner for pediatric registries First five we have developed are: Asthma (persistent, severe) Diabetes Seizures Cardiomyopathy (CHF) Inflammatory Bowel Disease We are now working on an update to Cerner s current well child care registry developed elsewhere Starting work on a Sickle Cell Disease registry with Children s National Medical Center Also hope to partner with other children s hospitals on: Scoliosis, complex care, cystic fibrosis, cerebral palsy, autism, obesity, psychiatric disease, etc.
40 CHOC asthma registry
41 CHOC asthma registry measure
42 CHOC asthma registry measure
43 Organizer view
44 Measure detail
45 Person-level MPage view
46 Measure supporting facts
47 Registry value framework
48 Maria 9 year old girl who lives with asthma
49 HEALTH TEAM Maria Cortez PATIENT Cristina & Julio MOTHER AND FATHER Lisa SCHOOL NURSE Dr. Tupas POPULATION HEALTH MEDICAL DIRECTOR Brenda LVN CARE COORDINATOR Dr. Fortades PEDIATRICIAN
50 Dr. Fortades PEDIATRICIAN Automatic alerts, or text messages, are sent to Mom, Dad, and the School Nurse to notify Maria s care team of the poor air quality (AQI > 230) BREATHMOBILE EMR EMR HealtheIntent Lisa SCHOOL NURSE Cristina & Julio MOTHER AND FATHER Brenda LVN CARE COORDINATOR Maria Cortez PATIENT Dr. Tupas MEDICAL DIRECTOR
51 +1 (714) Air Quality Alert: Air Quality is critical due to fires in your area. Please consult your Asthma Action Plan. Maria uses her spirometer at school
52 Maria Cortez Home Home School School Christina (Mum) logs into Maria s member portal and see her daughter s peak flow readings 52 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information belonging to Cerner Corporation and/or its related affiliates which may not be reproduced or transmitted in any form or by any means without the express written consent of Cerner.
53 Dr. Fortades PEDIATRICIAN BREATHMOBILE EMR EMR HealtheIntent Lisa SCHOOL NURSE Cristina & Julio MOTHER AND FATHER Brenda LVN CARE COORDINATOR Maria Cortez PATIENT Dr. Tupas MEDICAL DIRECTOR Brenda (care manager) automatically notified that Maria is at risk
54 Brenda, drills down to look at Maria s asthma action plan
55 Brenda Cortez, Maria MRN: y 9y DOB: 1/14/2005 F Next Appointment: In 7 Days Address: N Bush Bush Street Street Santa Ana, Santa CA Ana, CA (714) Phone: (714) Patient in yellow zone. Please have an evaluation completed and appointment within the next 24 hours. School today 180 School today Maria s asthma action plan that Brenda would have access to
56 Dr. Fortades PEDIATRICIAN BREATHMOBILE EMR EMR HealtheIntent Lisa SCHOOL NURSE Cristina & Julio MOTHER AND FATHER Brenda LVN CARE COORDINATOR Brenda sends Cristina a text message Maria Cortez PATIENT Dr. Tupas MEDICAL DIRECTOR
57 At the mobile clinic, the nurses are using the EMR for scheduling Dr. Fortades PEDIATRICIAN BREATHMOBILE EMR EMR HealtheIntent Lisa SCHOOL NURSE Cristina & Julio MOTHER AND FATHER Brenda LVN CARE COORDINATOR Maria Cortez PATIENT Dr. Tupas MEDICAL DIRECTOR
58 and management
59 Note sent automatically to Dr. Fortades and the member portal Dr. Fortades PEDIATRICIAN BREATHMOBILE EMR EMR HealtheIntent Lisa SCHOOL NURSE Cristina & Julio MOTHER AND FATHER Brenda LVN CARE COORDINATOR Maria Cortez PATIENT Dr. Tupas MEDICAL DIRECTOR
60 Scenarios Cost of ED & hospitalizations Cost of two mobile asthma clinics $2,328,000* ` $1,000,000* Traditional scenario *only 35% of asthmatic children with persistent asthma have controlled asthma within a one year period Breathmobile scenario *over 75% of patients with persistent asthma achieve asthma control after three visits on the van within a one year period *Financial information based on 1,200 patients being seen per year
61 The devil is in the details Registry development and validation is an iterative process Mapping of measures to data in the HealtheIntent platform Modifying Millennium build to collect necessary data Acquiring data from less than eager sources Attribution HI set up to attribute patients to individual physicians Within our system, they may be identified with a clinic rather than a specific MD more a pediatric issue. Identity management Patient matching Provider id and access (SCIM and SAML)
62 Some next steps in our journey to population health Adoption of the HealtheIntent platform as our EDW Development of our standardized reporting Secure new data feeds from community practice EHRs, our satellite hospital (Meditech),LabCorp, etc. Possibly also pushes of data from OCPRHIO and rivate ACO partner s private HIE Work with Cerner to develop a more pediatricspecific risk stratification model within the HealtheCare application. Develop/implement new methodologies for patient engagement.
63 Technology is necessary, but Changing behavior will take time We have to redesign our provider systems, as they are perfectly designed to get the results they get in a FFS environment Health plans designed around the FFS environment Regulatory environment needs to evolve Focus on anti-trust, Stark
64 Failure is not an option Apollo 13 the movie
65
66 Dr. William Feaster Chief Medical Information Officer, Children s Hospital of Orange County wfeaster@choc.org
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