L3: Comprehensive Care: Principles and Practice of Responsible Insourcing

Transcription

1 L3: Comprehensive Care: Principles and Practice of Responsible Insourcing Melora Simon Director, Adult Demonstration Programs Health Plan of San Mateo Stephen Martin Associate Professor University of Massachusetts Medical School these presenters have nothing to disclose Annual IHI Summit Learning Lab (L3) April 21, :30 12:30 1

2 Learning Objectives Describe Responsible Insourcing and its place in routine practice Understand how Responsible Insourcing supports the Quadruple Aim Identify practice areas that are a priority and could be insourced, and develop action plans to successfully implement insourcing in these areas Barre Family Health Center Care Close to Home 2

3 Wound Care Expertise at Barre allows us to care for most chronic and complex wounds on site until healed Urgent Care We provide care for patients until midevening and on weekends, including procedures such as suturing and fracture care 3

4 IV Fluids & Antibiotics Home Elastomeric IV Care 4

5 Integrated Behavioral Health 3 psychologist faculty and 1 fellow Dual visits with resident and patient Full part of educational program Attention to urgent mental health needs Opioid Use Disorder Care 250+ patients in care Often combined with on-site counseling Including prenatal and OB care Partnership with community 5

6 Hepatitis C Care Over 100 patients with chronic HCV Over the past 3 years, Project ECHO involvement allows full spectrum of care, from diagnosis to cure Graduated residents now treating patients in Alabama and Maine 6

7 When expectations do not meet with reality 7

8 Retinopathy Screening A non-dilated retinal camera allows us to screen and monitor diabetic eye disease on site, requiring only 5-10 minutes per patient but Global Health at Home Harvesting innovations from around the world to improve American medical care Global Health at Home: Harvesting innovations from around the world to improve American medical care By Howard Hiatt, Charles Kenney, and Mark Rosenberg November-December

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10 Bright Spots: Identify and Replicate Positive Results over Diverse Contexts Positive Deviants: Opportunities to Learn How to Improve Mean 10

11 High Level Results Quality and cost are very poorly correlated Identifying Bright Spots: Double Top-Quartile National Ranking Unit of analysis: Medical practices with more than one physician providing at least primary care Cost: Top quartile performance on observed to expected measure of risk adjusted total per capita payer-allowed spending for patients attributed to the practice Quality: Top quartile performance on a weighted composite of observed to expected measures of performance on 41 HEDIS and similar measures; higher weighting of measures with more clinical significance Big data: 3 years of data, 40 million covered lives, ~10,000 scorablemedical practices across the country Approach informed by consultation with diverse panel of experts in clinical performance assessment. 11

12 Rare But Powerful 10,000 scorable sites <5% in top quartile on both quality and cost Risk-adjusted per capita total cost of care > 20% lower than average >10% higher on quality composite Bright Spots found in both high and low cost labor markets 12

13 Bright Spot Sites are Diverse Independent, primary care only Fee-for-service (FFS) Greater Minneapolis, MN Greater Rochester, NY Capitated Greater Orlando, FL Independent, multispecialty Capitated Greater Tampa, FL Part of a health system Fee-for-service Phoenix, AZ Memphis, TN Greater Dayton, OH Greater Cincinnati, OH Capitated Orange County, CA Other Workplace clinic: San Antonio, TX Federally Qualified Health Center: Greater Boston, MA Shared Features of Most Valuable Care Sites Deeper patient relationships Wider scope of responsibility Team-based practice organization 26 13

14 Responsible insourcing Incision and drainage Joint and dental injections Durable medical equipment Wound care Long-active reversible contraception Diabetic pump care Intravenous fluid, diuretics, antibiotics Home INR devices for anticoagulation Vision refraction Hearing assistive devices Behavioral health Project ECHO 14