Maryland Association of Healthcare Executives presents:

Transcription

1 Maryland Association of Healthcare Executives presents: 1

2 Today s Expert Panel Moderator: Michael Cetta, MD FACEP, Chief Strategy Officer US Acute Care Solutions Charles W. Callahan, DO, Vice President Population Health, University of Maryland Lynell Medley, Vice President Programs Healthcare Access Maryland (HCAM) Joseph Meyers, Chief Strategy Officer St. Agnes Healthcare 2

3 Overview of the issue by Dr. Callahan 3

4 Maryland Association of Healthcare Executives presents: Population Health The Third Revolution: Capital and Lower Case P Chuck Callahan, DO, FAAP Vice President, Population Health University of Maryland Medical Center Baltimore MD

5 Basic assumptions:: Health is a human right.

6 Basic assumptions:: Population health is a strategic problem.

7 Basic assumptions:: Medicine is intrinsically tactical.

8 Basic definitions:: Public health: efforts to assure conditions where people can be healthy. Population health: the health outcomes of a group of individuals. (Includes the distribution of outcomes within the group.)

9 What is the optimal balance of investments (e.g., dollars, time, policies) in the multiple determinants of health (e.g., behavior, environment, socioeconomic status, medical care, genetics) over the life course that will maximize overall health outcomes and minimize health inequities at the population level? Kindig D. Understanding Population Health Terminology. Milbank Q ;85:

10 Basic questions:: Why now?

11 Value = Outcome / Cost Need for Population Perspective World Health Organization 2000 USA Global Ranking: 37th Behind Colombia, Chile, Costa Rica & Cyprus

12 2013

13 Life Expectancy at Birth 84 years Under One Mortality 1.5 / 1,000 Life Expectancy at Birth 68.4 years Under One Mortality 15.4 / 1,000 Poppleton vs. North Baltimore/Guilford 2015 Data 7 miles apart

14 All models are wrong but some are useful. George E. F. Box

15 First Revolution: Communicable Disease Breslow Third Revolution in Health Lester Breslow, MD

16 First Revolution: Communicable Disease

17 Second Revolution: Non-communicable Disease Lester Breslow, MD

18 Second Revolution: Non- Communicable Chronic Disease

19 Second Revolution: Affluence and Chronic Disease

20 Third Revolution: Building health* *More than just the absence of disease. Lester Breslow, MD

21 Am I well?

22 Assure Insure Restore Well-being

23 Ecology of Health Care: The patients aren t in the hospital 9 inpatients vs. 330 outpatients 1000/month Where Health Decisions Happen Baltimore: ER: 60/1000/month Hospitalization: 15/1000/month Green LA et al. The ecology of health care revisited. New Engl J Med 2001;344:

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25 UMMC Approach to Patient Populations Updated HSCRC Risk Definitions December 2016 BED D ENC Bedded Encounter (Inpatient or observation hospital stay.) Midtown Campus University Campus 22

26 A Simultaneous Approach: small p and capital P Population health population health (small p ) Peak of the pyramid Health & well-being of population affects healthcare institution Short-term imperatives and ROI Requires investment in the healthcare system Healthcare system-based interventions and metrics Seen through the lens of the healthcare provider Tendency to be pejorative Population health (capital P ) Base of the pyramid Healthcare institution affects health & well-being of population Long-term imperatives and ROI Requires investment in community Community-based interventions and metrics Seen through the lens of the healthcare recipient Tendency to be restorative 23

27 Population Health and the Three Block Medical Neighborhood 1. hospital Care Inpatient / Emergency Care 2. Specialty Care Patient-Centered Specialty Care Practice 3. Primary Care Patient-Centered Primary Care Medical Home Connect & coordinate Transitional Care Coordination (TCC) Home Family Community Schools Congregations home 24

28 The Cross Sectional Approach Tendency to Focus on the Capital P hospital Care Inpatient & Transitional Care Coordination Specialty Care Complex Specialty-Based Chronic Disease Management Primary Care Primary Care Well-Care Chronic Disease Management

29 The Universal Approach Approaching the Lower Case p Housing Health literacy Transportation Employment Communication

30 Impact of the Social Determinants Approaching the Lower Case p

31 Prenatal Good parenting Fair Housing Trauma-Free Drug-Free Home Access to Nature Safe Neighborhood Tobacco Free Home Communication/Internet The Chance to Serve Vocational Training Healthcare Access Financial Acumen Adequate Income Higher-Education Meaningful Work Employment Civic-Sense Vocation Emotional Intelligence Problem Solving Skills Video Moderation Good Body Image Self-Discipline True Friends Literacy Study Skills Hobbies Music Sport Integrity Honor Faith Ability to Dialogue Living Wage Educational Success Family Relaxation Good Sleep Healthy Weight Health Literacy Marital Support Aerobic Exercise Parenting Mentors EtOH in Moderation Health and Well-Being Reproductive Health Rest To love and be loved High School Diploma Equal Opportunities Developmental Milestones Fruits & Vegetables 30 Million Words Preschool Reading Play 0-3 Programs Culture Immunizations Well-child visits Secure Attachment Violence Prevention Healthy Delivery Community Good Public Policy Nutritious Food Environmental Safety Fresh Food Parenting Classes Water Safety Smoking Cessation Housing Vitamins Support Systems Greenspace Visits Transportation Hope Justice longitudinal approach Baltimore

32 Basic assumptions:: Population health is a strategic problem.

33 No definite formula No stopping rule Many players Solutions good or bad not true or false Unpredictable Unique Problem symptom of another problem Complex Ambiguous Uncertain Horst Rittel, 1973

34 Basic conclusions:: Population health is a strategic problem: Solution requires: coordinated, integrated care, one person at a time.

35 to leave the world a better place, whether by a healthy child, a garden patch or a redeemed social condition; to know even one life has breathed easier because you have lived, this is to have succeeded. Ralph Waldo Emerson

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37 Introduction by Lynell Medley 5

38 HealthCare Access Maryland Lynell Medley, RN, VP, Programs Facebook: /HealthCareAccessMaryland Website:

39 HCAM s History 501-C3 established in 1997 Overseen by a committed, diverse board of directors HCAM plays a critical role in strengthening Maryland s health care delivery system Funding from both Public and Private Sector 200 Total Employees/ $18M Budget Serve 145,000 people per year Experienced and Tenured Management Team/Staff Experience with health insurance enrollment and system navigation Care coordination focused on social determinants of health

40 Core Services Eligibility/Enrollment System Navigation Case Management/Care Coordination Public Policy and Advocacy

41 Social Determinants of Health Job Readiness Health Insurance Recovery Support Legal Assistance Mental Health Services GED PCP TCA, Food Stamps Transportation

42 Our Model Assess Identify Develop Care Plan Refer Follow up

43 Programs Connector: Baltimore City/County, AA County, Howard, Carroll, Frederick Eligibility Unit for Baltimore City LHD Behavioral Health Outreach Programs Care Coordination (State, MDRN, BBI, Pregnant Women) Information and Referral Line Care Coordination Program (ACCU) Managed Care Organizations/PCP/OB providers Baltimore City Foster Care: MATCH Population Health Programs 911/Operation Care Hospitals : St. Agnes and West Baltimore Collaborative: University of Maryland, Midtown, Bon Secours and St. Agnes

44 Client Impact The client is a 56 year old woman who often came to the ED for nonemergency reasons, such as a stomach ache. The Coordinator met with her in the ED and the client agreed to program services. Her goals were to obtain a new PCP and a home aide. After initial enrollment, the client was unresponsive to follow up. The coordinator was able to reestablish contact and the client now has a new PCP, receives pain management, and has a therapist. HCAM is in the process of obtaining a home aide. The client has been compliant with her appointments so far. Prior to enrollment, the client visited Sinai s ED 14 times within a 4- month period. Since development of a care plan, the client has returned to the ED only once. Baltimore City

45 Thank You! Lynell Medley, VP Programs HealthCare Access Maryland 201 E. Baltimore St., 12 th floor Baltimore, MD Phone:

46 Introduction by Joesph Meyers 14

47 Saint Agnes HealthCare F. Joseph Meyers Chief Strategy Officer POPULATION HEALTH JOURNEY 15

48 Business Proposition for Large P Population Health Profile of Medicare Spending in Maryland Phase 2 of Maryland s CMS Waiver will place hospital industry at financial risk for Total Cost of Care (TCOC). 16

49 Business Case for Saint Agnes for Population Health Global Revenue Budget (GBR) = $440M Major volume increases in Bedded Care and ED following GBR. Potentially Avoidable Utilization (PAU) = 5,000+ admits (readmission & ambulatory sensitive conditions) and $60M+ charges. PAU Penalties = $4-7M annually. Waiver Progression Plan and shift to Total Cost of Care.

50 Degree of Financial Risk Population Health Journey for Little p to Big P Total Cost Of Care Strategic Partnership Community-based Organizations Patient Center Medical Home Community-based Care Management Transitions of Care Programs Strategic Partnership Post Acute Providers Fee For Service Care Managers Utilization Review Discharge Planning RN Navigators 30-Day Readmits Degree of Patient/Provider/Community Engagement 18

51 Strategic Direction Vision Map Creation of Integrated System of Care Current State Community-Based Care Acute Care Saint Agnes Hospital Gibbons Commons UMMS Acuity Post-Acute Care Transportation Skilled Nursing Facilities E-visits Seton Imaging Center Home Care Home *Saint Agnes Medical Group Community-Based Physicians *Some care management in PCP practices Transitional Care Programs (CCC, COPD, CHF) Complex Care Management Global Revenue Budget (GBR)

52 Strategic Direction Vision Map Creation of Integrated System of Care Community-Based Care Acute Care Saint Agnes Hospital UMMS Acuity Gibbons Commons Ambulatory Surgery Center Retail Pharmacy Post-Acute Care Wellness and Fitness Transportation Community-based Care Management Ambulatory Care Center(s) Behavioral Health Preferred SNF Network E-visits Seton Imaging Center Home Care Home Saint Agnes Medical Group Community-Based Physicians Transitional Care Programs (CCC, COPD, CHF) Complex Care Management Total Cost of Care

53 Moderated questions. 21

54 Question #1 Patient attribution how do we track and manage the at risk population? There are often several care providers who is ultimately responsible? What technology has been successful? 22

55 Question #2 What is the role of the health care systems in populations health? Should we expect our hospitals to address housing and education needs? 23

56 Question #3 What is a high utilizer? Who are we to say that a patient is using too many resources. Do we need to change our definition? 24

57 Question #4 Integration of Baltimore City what have we learned? How does East and West Baltimore differ? 25

58 Pearls of Wisdom 26