1/25/15. Equicare Health. Patient Management & Retention: Clinical And Financial Implications. Clinical Implica+ons of Pa+ent Management

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1 Equicare Health Patient Management & Retention: Clinical And Financial Implications By the end of a day sitting in meetings. 2 Clinical Implica+ons of Pa+ent Management Screening Diagnostics Workup Tx Plan Treatment Care Planning Communicate Increased patient satisfaction with care Increased patient engagement Improved attendance at appointments (both during and after treatment) Ability to detect side and late effects of treatment, as well as recurrences earlier Follow-up Survivor Management Assess ULTIMATELY: Improved clinical outcomes for patients 3 1

2 Pa+ent Management Op+ons How to manage patients? Good old fashioned paper Excel spreadsheet based Enterprise level software (eg. HIS) Dedicated software Who manages the program? Oncologists Nurses or Nurse Navigators Other? 4 Systemic Pa+ent Leakage Can Occur at Several Points Systemic leaks can have a significant impact on revenue for Oncology as well as the imaging department. Screening Diagnostics Treatment Follow-Up 5 Overview Patient loss or leakage often occurs at three points in the continuum of care, from screening through follow up: Patient loss following a positive screen Patient loss after a definitive diagnosis Patient loss after treatment 6 2

3 Model and Assump+ons A simple model is provided to estimate the encounter value for a cohort of breast cancer patients with positive screen (mammogram), and assigns revenue values for: Diagnostic workup Treatment, & Follow-up for five years 7 Assump+ons - Con+nued Our example center has the following characteris+cs: 2500 patients screened per year 275 (11%) screen positive 55 (20%) receive a definitive diagnosis % Reten+on for two scenarios by stage % Retention No Program Strong Program +ve screen to diagnostic workup 20% 80% +ve diagnosis to treatment 80% 90% Treated patients who stay in follow up Yr. 1 80% 90% Patients who stay in follow-up as a % of prior year, yrs. 2 -> 5 60% 80% 8 Assump+ons Con+nued 2 Revenue by Stage Estimate Diagnostic workup $ 5000 Treatment $40000 Follow-up $ 728 Breast Follow-up Revenues by Site Type Low Risk* High Risk* Wtd. Average Free standing, no imaging $ 355 $ 388 $ 367 Free standing, with imaging $ 404 $ 556 $ 456 Hospital service line, no imaging $ 671 $ 965 $ 772 Hospital service line, with imaging $ 860 $ 2,184 $ 1,317 Typical case mix 66% 34% Overall Average $ 728 *Risk of Recurrence 9 3

4 10 Pa+ents Receiving Treatment Patients needing Patients with Patients in follow up Patients in follow up Patients in follow up Patients in follow up Patients in follow up diagnostic workup definitive diagnosis 1st yr post 2nd yr post 3rd yr post 4th yr post 5th yr post that proceed to treatment treatment treatment treatment treatment treatment Patients - no program Patients - strong program 11 Where Does The Revenue Come From? $10,000,000 $ 9,455,344 $9,000,000 $435,344 $8,000,000 $7,000,000 Revenue $6,000,000 $5,000,000 $4,000,000 $3,000,000 $ 2,094,696 $7,920,000 $2,000,000 $59,696 $1,000,000 $- Revenue- no program $1,760,000 $275,000 Revenue - strong program $1,100,000 Patients needing diagnostic workup Patients with definitive diagnosis that proceed to treatment Total follow up patients 12 4

5 Pa+ent Leakage Following a Posi+ve Screen Post +ve screen is the most financially damaging place to lose patients from the network o All downstream revenue opportunity is lost o From the model, the average downstream revenue lost per patient is approximately $44,000 Possible Causes o Weak follow up post screen o No direct contact with patient immediately following o Providing results only and not offering follow up appointment 13 Challenges Dealing With Screening Pa+ents Post screening leakage can be challenging to address because: o Oncology may not own the screening program o Gaps in information flow may mean positive screen reports are not available to oncology navigators o Screening program may not have a budget for a navigator 14 Minimizing Post Screening Leakage Consider staffing an oncology funded navigator in the screening facility if separate Consider a dedicated navigator role (depending on volume) so you can: o Follow up with patients within 48 hours of results available o Offer follow up appointment as part of contact o Provide relevant education as part of or immediately post the follow up call 15 5

6 Leakage Following Diagnos+c Work Up Diagnostic work up currently receives the most attention Highest dollar value All activities occur within the service line 16 Leakage Following Diagnos+c Work Up Areas for consideration Track patients leaving the network o Referred out because service not available o Opted for treatment elsewhere A quality navigation program to build trust Effective education to clarify treatment choices Understand and deal with barriers to care for that patient 17 Leakage Following Treatment Post-treatment follow up as an activity produces the lowest revenue per period of the three areas under consideration, however: o 5 yr. revenues for breast cancer follow up on average range from $1800 to $6500 per patient depending on the facility type. o Patients that are being followed in accordance with best practices are more likely to have a recurrence or a new primary detected earlier, and o Are more likely to remain in the network for treatment 18 6

7 Minimizing Post Treatment Leakage Some steps to consider: Per CoC, implement a robust survivorship program o Care plans including A recommended surveillance schedule A treatment summary Care team contact information o Comprehensive post treatment education o Appointment reminders General Comments Leakage following a positive screen is the most challenging to address, but offers the best ROI on a per patient retained basis - $44K Screening is typically limited to Breast, Lung and (in some locations) Skin sites Leakage following treatment, while offering less revenue per patient on average, offers the opportunity to build a program offering significant ROI across the majority of the treated population. 21 7

8 Why Worry About Leakage? In the example here reducing the post screen leakage by 10% yielded approximately $1.5MM in additional revenue over the 5 year period modeled Better patient care Compliance with CoC Continuity of Care requirements (Sections 3.1, 3.2, 3.3) Did I say more revenue? 22 Questions? 23 8