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1 Click to edit Master title style Transition Support Program (TSP) The Business Case for Patient Navigation Michael Swarzman, Vice President, System Growth, Advocate Health Care; Faculty, UIC School of Public Health Mervin Dino, Project Leader, Advocate Illinois Masonic Medical Center April 14, 2018 Becker s Hospital Review 9 th Annual Meeting

2 Click to edit Master Agendatitle style 1. Welcome! 2. Our Third Frame level of Reference: Advocate Health Care 3. The Burning Platform 4. Transition Support Program 2

3 Click to edit Master title style Advocate Health Care Sites Of Care 13 Hospitals 9 acute care hospitals 1 children s hospital 3 major teaching hospitals 5 Level I Trauma Centers 2 specialty hospitals 2 physician groups 1,500 employed physicians Home Care Company 3.4 million patients served 34,000 associates Total Revenue: $4.6 billion AA Rating December 2017: Announced merger with Wisconsin-based Aurora Health Care 3

4 Click Pluralistic to edit Physician Master title Approach style Active physicians on medical staffs (est. 6,000) Total APP physicians (5,000) 25% PCPs 75% specialists 71% in private practice Employed/affiliated (1,460) Independent APP (3,540) Independent non-app (1,000) Note: As of March Clinical Integration effective with private and employed specialists. 4 4

5 Click to edit Master title style The Burning Platform 5

6 Current Environment Key Takeaways Click to edit Master title style 1. Click Accelerated to edit transition Master text from styles volume to value (3-5 years) 2. Net operating income lags at business units and system level 3. New channels of patient distribution: zero-sum game 4. Local patient navigation is differentiating 5. New competencies for Business Development professionals 6

7 Is this your day? Click to edit Master title style It was the best of times, it was the worst of times, it was the age of Second wisdom, level it was the age of foolishness, it was the epoch of belief, Third it was level the epoch of incredulity, it was the season of Light, it was Fourth the season level of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way. it s often mine. ~ A Tale of Two Cities 7

8 Click The Natural to edit Master Complement title style Click To other to edit speakers Master and text myriad styles health care reform discussions and articles Because health care reform will define U.S. health care delivery for years to come (as provider systems increasingly assume traditional insurance risk) Because Business Development is a transitional key to market share, and critical influencer of net income performance, in an ACO world 8

9 Today s Lexicon Addition: Backfill Defined Click to edit Master title style What it s NOT Backfill, in Business Development parlance, is: new business brought into a health care system as a result of immediately available capacity due to health care reform implementation, plummeting utilization and/or other health care payor reform initiatives. Without backfill, even with newly earned shared savings revenue, net income will (very likely) be off budget targets Add Channels of Patient Distribution to your work world view 9

10 A Transformative Moment Click to edit Master title style Business Development is my expressive health care professional Click to edit choice Master text styles ACO s implicit intention:dramatic, transformative directional Fourth change: level the hospital will become an expense, rather than» profit, Fifth levelcenter but not yet realized Immediate clinical paradigm shift: from volume to value (yet budget performance lags) Immediate new competencies required for success How does health care manage this transition? 10

11 The Burning Platform Click to edit Master title style It s a New Day Insurers acknowledge inability to manage rising costs Population is aging 10,000 new Medicare beneficiaries per day Medicare finances are not sustainable Previously uninsured reenter the system with no utilization history Medicaid, despite marginal revenue opportunity, remains uncertain in Illinois and in AHC 11

12 The Burning Platform Provider Click to edit System Master Collision title style Course Decreasing Click to edit Revenues Master text styles Volitional Declining Utilization Medicare Medicaid Insurers/employers Squeezed Net Income Increasing Expenses Shrinking Margins Wages and Benefits Supplies Who pays for differentiated quality Technology or more effective utilization management? 12

13 The Burning Platform Click to edit Master title style Advocate Health Care s Response SIGNIFICANT Cost Reduction Willingness to examine/change everything Merger with Aurora Health Care Economies of scale Reduced cost of capital Attempted buyer-seller MCO equality Accelerate speed in implementing change Agility and Focus Nimble/Flexible Academic Medical Center competitors Regionalization, matrix organizations However, these initiatives may not be enough 13

14 Click to edit Master title style Transition Support Program: A Story of Fourth Patient level Navigation and Quality Growth 14

15 Transition Support Program (TSP) Click to edit Master title style Navigation service that assists patients with coordination of follow-up care, regardless of insurance Inpatient Program: serving readmitted and high-risk patients 1 Outpatient Program: serving all patients referred for follow-up care Combination of in-person visits at bedside/site of care and follow-up phone outreach by TSP Navigator Assists patients with non-clinical barriers: language, transportation, insurance, medication access, smoking cessation, and more Transition Support improves overall patient experience, advances population health, and yields quality growth and ROI 2 1 Jackson, et al. (2015). Timeliness of Outpatient Follow-up: An Evidence-Based Approach for Planning After Hospital Discharge. Annals of Family Medicine. 2 Balderson, D. and Safavi, K. (2013). How Patient Navigation Can Cut Costs and Save Lives. Harvard Business Review. 15

16 Transition Support Program Model Click to edit Master title style Navigation Primary Care Physician Specialists TSP Patient and Family Non- Clinical Resources Care Mgmt and Social Work Hospital Services Wrap-around support model and strength-builder for patients and families In-person visits at site of care and phone follow-up outreach Navigators are both Associates and International Medical Graduate (IMG) Volunteers Safety Tools and Motivational Interviewing Health IT: Crimson, CareNet, I- Connect Health Information Technology 16

17 Click to edit Master title style Transition Support Program Benefits For Patients Navigation of health care system Expedited appointments Empowerment of patients and families Addressing health equity For Providers Ease of access» Fifth Improved level coordination within Advocate Increased support with postdischarge coordination For Associates Improved referral process/transitions within Advocate Improved access to medical records Reduced administrative burden For Hospitals Patient-First perception to referring providers Reduced readmissions Improved Network Integrity 17 17

18 Click to TSP edit Navigation Master title Team style TSP Navigation Team (from left to right): Mervin Dino (Project Leader), Jey Duraisingam (Volunteer Navigator), Christiana Agyakwah (Volunteer Navigator), and Christian Martinez (Coordinator). Not pictured: Anna Magsino(Coordinator). TSP Navigators practicing bedside communication skills for inpatient program in AIMMC s Simulation Center. From left to right: JeyDuraisingam, Nataliya Borysenko, and MyuraniSathyanarayanan. 18

19 Transition Support Program Click to edit Master title style 2017 Financial Impact: AIMMC $3,000,000 $2,500,000 $2,000,000 $1,500,000 Net Revenue Yielded by TSP Net Revenue ($) 2,169 Patient Referrals 1,889 Fourth Unique level Patients Served $5.39 Million in Net Revenue 9:1 ROI $1,837,374 $2,847,790 $1,000,000 $500,000 $- $49,271 $404,209 $134,350 $149,002 Growth largely attributed to STAT/ASAP patient navigation Q Q Q Q Q Q Source: AHC Decision Support and APP CI Program Total Program Costs = $557,

20 Click to edit Patient Master Win title style September 29, 2017 A patient with untreated breast cancer was seen at three different Chicagoarea hospitals Third and level frequently no-showed to critical appointments. The primary care provider Fourth redirected level the patient to AIMMC in September 2017, where TSP and our» Cancer Fifth level Center provided immediate navigation support for the patient and obtained all previous medical records. The patient received support in scheduling all her testing and treatment and also received free smoking cessation counseling, transportation to her appointments, and social services support. The patient has not missed one appointment since establishing care at AIMMC, and will be able to return to work. 20

21 Click to edit Master title style Transition Support improves overall patient experience, advances population health, and yields quality growth and ROI. 21

22 Click to edit Master title style The faithful person perceives nothing less than opportunity in difficulties. ~Criss Jami 22

23 Click to edit Master title style Thank You