Radically Reforming ER Super Utilizers with Health Information Exchange

Transcription

1 Radically Reforming ER Super Utilizers with Health Information Exchange Corey Waller MD, MS, Medical Director, Center for Integrative Medicine, Spectrum Health Doug Dietzman, Executive Director, Great Lakes Health Connect

2 Corey Waller, MD MS Medical Director, Center for Integrative Medicine SUD Medical Director, Lakeshore Medical Partners Chief of Pain Medicine, Spectrum Health MS, Neuromolecular Biology, Southwest Texas State University MD, University of Texas Medical School

3 Douglas Dietzman Executive Director, Great Lakes Health Connect 25 Years Experience in HIT Leadership Leadership Counsel, ehealth Initiative Board Member, Strategic Health Information Exchange Collaborative BS, Business Management, Biola University

4 Conflicts Corey Waller, MD, MS Has no real or apparent conflicts of interest to report. Douglas Dietzman Has no real or apparent conflicts of interest to report.

5 Agenda Define Super Utilizers / Complex Patients and analyze the unique burden they place on the health care system Explain the approach to care of the Center for Integrative Medicine Understand the health care delivery landscape and the role of Health Information Exchange in Michigan Outline the unique challenges presented for communication and care coordination in managing Super Utilizers

6 Agenda Continued Describe the value that Health Information Exchange provides Present data to support the integrative approach to care supported by HIE Offer lessons learned, best practices, and recommendations

7 Learning Objectives Analyze the characteristics of Super Utilizers, and the burden they place on the health care system Explain the approach to care applied by the Center of Integrative Medicine and the unique challenges presented for provider communications and care coordination Demonstrate the value contributed to the Center for Integrative Medicine through the use of Health Information Exchange technology

8 STEPS Value Reduced Unnecessary ED Utilization by an avg. of 68.5% between 2011 and

9 Super Utilizers Defined 5% of patient population responsible for 50% of overall cost Multiple medical, behavioral, psycho-social, and/or substance abuse comorbidities Lack access to primary care or complex care management resources

10 Seven Subsets of Super Utilizers Pre-Complex Patient (P-C) ED Complex Patient (ED-C) Ambulatory Complicated Medical Complex Patient (AC-C) Non-ambulatory Complicated Medical Complex Patient (NAC-C) Patients Requiring Long Term Care (LTC-C) Primary Care Sensitive ED Utilizers (PCS-C) Patients with a Rare Disease (RD-C)

11 Challenges in Treating Super Utilizers Poor communication among providers and fragmented delivery models across health systems Lack of consistent and accurate evaluation, diagnosis, and followup Multiple comorbidities exacerbated by sub-optimal social dynamics ED is designed to address emergent needs, not complex care Dissatisfaction with accessibility, expediency, and quality of primary care

12 Center for Integrative Medicine Established to address extreme ED utilization in West Michigan Designed to provide intensive wraparound services for medically complex patients Combines physicians, RN case managers, pain/addiction therapists, social workers, and community health professionals into Care Teams Team identifies all Bio-Psycho-Social Issues, is ranked according to complexity of care, and begins treatment

13 Making the Connection The CIM s practice area encompasses 4 hospitals owned by 3 competing health systems, as well as numerous community-based behavioral and social service agencies Super Utilizers rarely seek services from the same hospital consistently Gaining collaborative buy-in from ALL stakeholders was key to demonstrating the efficacy of the integrated care approach The means to seamlessly and securely facilitate communications and care coordination among all participating providers was essential

14 Health Information Exchange Ecosystem Pharmacies Community Health & Social Services Integrated Networks/ACOs Diagnostic Centers MIHIN State of Michigan Health Plans Onramp to State Services Physician Offices GLHC Intelligent Network Onramp to Federal Services Employer Clinics Labs Creating Connected Care Communities Emergency Medical Services Home Care Rehab Skilled Nursing Provider Organizations Hospitals

15 Connected Care Communities Interoperability is not primarily a technical problem Our end goal should not be connected systems our end goal should be Care-Connected Communities HIE is a personal story for each of us August 2013

16 Connected Care Communities Connected Care Communities require: - Neutral community asset/organization representing all stakeholders - Deep understanding of each stakeholder s needs and workflows - Appropriate application of technology to support individual stakeholder needs

17 HIE Infrastructure

18 Supporting CIM Identification of Super Utilizers Community-wide clinical record to support optimal care management and delivery Inside CIM Outside CIM Notifications when external events occur Closed loop referral coordination and communication across community stakeholders: PH, BH, Social

19 Use Case Examples: Illustrating the direct impact of real time access to patient data via Health Information Exchange on care quality: Bob Makayla

20 STEPS Value Reduced Realized Unnecessary savings of ED Utilization 35% pm/py by from XX% 2012 between to XX and 20XX

21 Questions R. Corey Waller, MD, MS Medical Director Center for Integrative Medicine Spectrum Health Douglas Dietzman Executive Director Great Lakes Health Connect