Planning a Course to Population Health Management

Transcription

1 Planning a Course to Population Health Management A Complimentary Webinar From healthsystemcio.com Your Line Will Be Silent Until Our Event Begins at 12:00 ET Thank You! Slide Deck: Webex Support Event #

2 Housekeeping Moderator Anthony Guerra, editor-in-chief, healthsystemcio.com Ask A Question We will be holding a Q&A session after the formal presentations. You may submit your questions at any time by clicking on the QA panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists. Download the Deck Go to Download today's deck at: Shortened URL at bottom of slides View the Archive You will receive an when our archive recording is ready. Separate registration is required. Slide Deck: Webex Support Event #

3 Agenda Approximately 45 Minutes minutes: Tressa Springmann, VP/CIO, LifeBridge Health minutes: Q&A w/tressa Springmann Slide Deck: Webex Support Event #

4 Planning a Course to Population Health Management January, 2015

5 Introducing LifeBridge Health Sinai Hospital Northwest Hospital Levindale Hebrew Geriatric Center LifeBridge Health Physician Enterprise $1.4 Billion in Gross Patient Revenues 1,400 Physicians 1,285 Licensed Beds 8,000 Employees LifeBridge Health & Fitness LifeBridge Health Commercial Division 5

6 So much more than hospitals PRIMARY CARE, PREVENTION, and WELLNESS AMBULATORY CARE ACUTE CARE, TERTIARY CARE POST-ACUTE CARE 6

7 Mission Statement Maintain and improve health Favored by the greatest number of patients and physicians Compassionate, high quality, cost-effective health services Provide undergraduate and graduate medical education Regardless of age, race, ethnicity, emphasizing community concern for all

8 ACA High Level Impacts Changes to private insurance, e.g., Young adults on parents policies to age 26 Prohibit lifetime monetary caps Minimum medical loss ratio (i.e. 80% of Premium must be on claims) Closes the Medicare prescription doughnut hole (i.e. out of pocket at 100% between about 3K and 6K of medication costs) Expands coverage + imposes individual mandate in 2014 Expands Medicaid to 138%* of FPL from Maryland s 116% Exchanges Promotes the transition from volume to value Bundled payments, Value based purchasing, ACOs Most relevant to us as a health system 8

9 9 Transition from Volume to Value Source: Marketing Payments and Purchasing Planning Leadership Organizations (ACOs) Single payment to cover Rewards or punishes Network of providers Council interviews and analysis. Key Attributes Definition Purpose Change From Today Bundled hospital, physician and post-acute needs Providers gainshare on savings Incent all providers to coordinate care Value-Based hospitals based on performance Create link between reimbursement and clinical quality, patient satisfaction Small Small Big Accountable Care collectively accountable for the cost and quality of care for a population Reimbursed through shared savings or capitation Reward providers for reducing total cost of care

10 ACOs Have Three Main Levers To Manage Costs Strategies for Risk-Bearing Providers 1 Prevent Utilization through Medical Management Example: High-risk patient care management (e.g., medication management, care transitions management) Population Health Manager 2 Retain Care Within Your Network Example: Retaining care for employees within your hospital 3 Direct Care to Low-Cost Partner Example: Lowest cost nursing home Source: Health Care Advisory Board interviews and analysis. 10

11 Maryland Modernized Medicare Waiver Maryland s new waiver has many of the same goals as the ACA The basic constructs of the Modernized Waiver are: (STATE GOALS) Limit growth in Hospital Revenue (inpatient and outpatient) to 3.58% per Capita through a Global Budget $330 million in Medicare savings over 5 years Reduce MHACs by 30% over 5 years Reduce rate of readmissions to the National average Renewal after 5 years with favorable performance and expansion to include physician and post acute services; if not renewed, revert to the national system Maryland only state with Medicare Waiver Hospital rates set by Healthcare Cost Review Commission (HSCRC) 11

12 Global Budget Model The key aspects of the Global Revenue Budget are as follows: Fixed revenue base Age and population adjustments as determined by HSCRC policy Adjustments for market share changes as determined by HSCRC policy Adjustments for Potentially Avoidable Volume (PAUs) 12

13 Maryland s Waiver is Focusing Health Systems on Strategy 1 Strategies for Risk-Bearing Providers 1 Prevent Utilization through Medical Management Example: High-risk patient care management (e.g., medication management, care transitions management) Population Health Manager 2 Retain Care Within Your Network Example: Retaining care for employees within your hospital 3 Direct Care to Low-Cost Partner Example: Lowest cost nursing home Source: Health Care Advisory Board interviews and analysis. 13

14 LifeBridge Strategy Advance Population Health While Addressing the Social Determinants of Health Ensure right level of services based on acuity Improve access to preventive care, including primary and chronic care management Enhance community programs and social services connections in our community to support our neighborhood s health development Improve Quality & Reduce Costs Delivering High Value Care Core Measures MHACs Prevention Quality Indicators (PQIs) Prevent Readmissions Build Centers of Excellence

15 Program Admission / Discharge Hospitalists Intensivists Medication Reconciliation Nurse Rounding Observation Status Palliative Care Chronic Care Clinics Urgent Care Over 20 Initiatives Currently Underway Care Delivery Initiatives Revamp our patient education & discharge program ensuring patients are covered until connecting with their PCP; coordinate with chronic care centers and FQHCs; increase the number of patients that are discharged with their medications Ensure completion of Present on Admission testing including urinalysis on every patient to clearly identify UTIs, etc and ensure accurate present on admission documentation Complete hospitalist redesign and require best practice care across the inpatient care continuum (Implementing accountable care unit model) Complete intensivist redesign and require best practice care across the inpatient care continuum (house-wide on-call coverage implemented) Engage pharmacy team throughout the continuum from ED to inpatient units to ensure medication reconciliation and education as well as bedside and home delivery of medication (Bedside and home delivery programs, med education program, new ED pharm tech) Continue nurses rounding hourly on every patient and performing shift report at the patient s bedside Use observation status to focus on appropriateness of admissions and prevention of 30-day readmissions (14- bed REU) Complete the recruitment of the palliative care team and ensure hospice coordination (palliative care coordinator and palliative risk assessment) Initiate Chronic Care Clinics at Sinai and Northwest for CHF, COPD/Asthma, Diabetes, HIV, and Sickle Cell Disease using multi-disciplinary teams Fully engage with Express Care in referrals for lower cost of care delivery and efficient reception of patients needing more care

16 Cont d Program Hospital Network Clinical Integration Home Care Sub Acute/ SNF FQHC Care Coordination Population Analytics Care Coordination Initiatives Aggressively leading the way on creating Advanced Learning Collaborative to explore partnerships around population health initiatives across a network of hospitals. Submitted our application for MSSP ACO with final decision pending by end of CY2014. LifeBridge Physician Network (LBPN) created to engage over 400 loyal physicians around delivering clinically integrated care. Expand home care resources to address a significant increase in visits and invest in unfunded care to minimize avoidable readmissions Ensure Sub Acute and continuum care partners have a care coordinator to assist in pulling patients through the system and preventing bounce back (Provider of Choice network, Adult Day Care) Engage our FQHC partners to reroute unnecessary ED visits and provide increased access to primary care Ensure Sinai s FQHC partner, Park West, meets LBH requirements for patient care or replace with another FQHC partner Strengthen Chase Brexton relationship at Northwest Hospital to ensure care coordination Target high utilizers of services with more effective care management and outpatient navigation Ensure that a care navigation team follows up on discharged patients, focusing on frequent utilizers and seniors Implement ED Navigation programs to address care 24/7 Understand and segment high utilizers of healthcare services

17 CRISP Maryland s HIE Chesapeake Regional Information Systems for our Patients CRISP is a regional health information exchange (HIE) serving Maryland and the District of Columbia. We are a not-for-profit organization advised by a wide range of stakeholders who are responsible for healthcare throughout the region. CRISP has been formally designated as Maryland s statewide health information exchange by the Maryland Health Care Commission. 18

18 Technology Supporting Our Global Budget High Utilizers Potentially Avoidable Utilization Care Coordination Query Portal Event Notification 19

19 Utilization by Census Tract Map

20 Identifying High Utilizers All Payer All Patients Medicare Medicare % High Users % of Total Charge Category Patients 81, % 1, % $50,000- Visits (IP+OP) 180, % 9, % $100,000 Charges (IP+OP) $551.5 M $17.3 M 3.1% $114.9 M 20.8% Limited to Patients with > 2 IP encounters for the last 12 months Limited to Total Charges (IP + OP) and excluding Ambulatory Surgery encounters % $100,000-3, % $150,000 $47.1 M 8.5% % 1, % $150,000 $40.9 M 7.4%

21 Cross-Facility Super-Utilizer Analysis 22

22 Inter-Hospital Readmissions 23

23 Care Coordination

24 HIE Integration with EMR

25 Encounter Notification Service ENS enables CRISP participants to receive real-time notifications when one of their patients or members is hospitalized. The alerts are generated from the ADT messages CRISP receives from all Maryland hospitals. There are currently over 3,000,000 patients subscribed to with in ENS resulting in over 6,000 notifications per day If an individual has opted out of the HIE, an alert will not be triggered. Also: Document Routing through ENS - recipients can choose to receive structured documents upon patient discharge. Auto-subscription hospitals can choose to automatically subscribe (CRISP will use the ADT discharge message) for a window of time. 26

26 Population Health Tools Broad Strokes

27 Population Health Tools LBH near term Timeline for Population Health Information Technology Implementation End of CY Decision on IT vendor 0-6 months Build Platform and Acquire Data 6-12 months Health Information Exchange (HIE) 9-12 months Smart Registries Solution months Care Management Solutions/ Population Health Analytics Capabilities **Already assuming risk of our employed population and families (10,315) delivering more effective care delivery and incorporating on-line risk assessment **MSSP effective January 1, 2015

28 The Role of the CIO Connect Hiding in the department won t make these mandates go away Collaborate Control If you re engaged you re aware Lead 29

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30 Where we DON T want to land! 31

31 Q&A Click on the Q&A panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists. Slide Deck: Webex Support Event #

32 Thank You! Thanks to our featured speaker: Tressa Springmann! You will receive an when our archive recording is ready. (Separate registration is required) CHIME CHCIO Credits Attending our Webinars = 1 CEU Questions/Comments Anthony Guerra aguerra@healthsystemcio.com Go to to view our upcoming schedule and see the last 12 months of archived events. Slide Deck: Webex Support Event #