Connecting Care Sites through Enterprise-wide Care Redesign George Mayzell, M.D, MBA Kathleen Ferket, APRN-BC Alexian Brothers Health System and Adventist Midwest Health affiliation Six acute care hospitals across northwest and western suburbs, metropolitan Chicago Freestanding behavioral health hospital Freestanding Inpatient Rehabilitation hospital, affiliated with Rehab Institute of Chicago Palliative care, freestanding hospice Home health care across system AMITA medical Group-600 physicians Primary service area- 139 sip codes Second largest system in Chicagoland area Ascension and Adventist corporate parents Objectives Explain the tenets of a population-health approach to integrating care Identify key cultural elements that shift within system re-design Develop strategies for their organization to better integrate care across the continuum Apply tips and tools to enhance outcomes. 1
We know there are more difficult days ahead 4 Healthcare Facts Value-Based Care 5 System Disruptors Current Healthcare System is unsustainable Payment models are changing Care models must continue to evolve Consumerism 2
U.S. Healthcare Costs Rising Faster Value-Based Care 7 So we must be getting something for it, right WRONG: Much lower life expectancy per dollars spent than other industrialized nations Value-Based Care 8 Health Spending: Aging Population Driving Deficit/Debt Value-Based Care 9 3
Well, it s probably an inflation problem, right Cumulative Increases from 1999-2013: Health Insurance Premiums Workers Contributions to Premiums Workers Earnings Overall Inflation WRONG: Healthcare premiums far outpace inflation and earnings Value-Based Care 10 New CMS Merit-Based Incentive Payment System (MIPS) Greater Push Towards Value-Based Payment New law enacts minor changes now, major changes later In 2020, 15% payment swing (winners and losers) Significant increase in Medicare payer mix Participation will move to performance AMITA preparing now to be ahead of the curve Value-Based Care Current Law MIPS 11 Healthcare Transformation: First Curve to Second Curve Value-Based Care 12 4
Care is Moving Towards Accountability & Value (ACO s) Outcomes (quality) Efficiency (cost) Patient Experience (Patient Centric) Projected Growth in Chronic Diseases Value-Based Care 14 What is Population Health? A sophisticated care delivery model that involves a systematic effort to assess the health needs of a target population and proactively provides services to maintain and improve the health of that population Value-Based Care 15 5
Healthcare Spending Value-Based Care 16 Elements of Population Health Stratification CIN Interoperability Data 2014: 40% of Costs Attributed to 5% Population Medicare ACO Distribution of Costs by Population - Adventist Division 2014 Critical 1% 4% 15% % of Costs 14% 14.0x High 26% 6.4x Moderate 80% 37% 2.5x Low 23% 0.3x Risk Category % of Patients Ratio of Costs Value-Based Care 18 6
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Failings of a Visit-Centric System Value-Based Care 22 The Old Paradigm Care Management Silos 8
Definition of Discharge To relieve of a charge, load or burden To release from an obligation Merriam-Webster Dictionary Enterprise Care Redesign Contributing Success Factors Organizational commitment Physician engagement Population Health leadership Optimize deployment of existing staff Leverage regional resources Align care management across sites of care Staff engagement Patient engagement Strategies for Integration Central leadership-inpatient inpatient & outpatient care management No more discharge planning-it s it s OUR patient Transitional care-clinician clinician responsible for patient s care across the full continuum Alignment of previously unaligned partners Universal Transition Form Centralized communication hub Technology 9
Imperatives to Achieve Care Continuity Support clinicians to provide continuous care Promote ownership for cross-continuum continuum care Instill patient & family ownership for self-care Scale up support for vulnerable patients 10
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Where We Need To Be in the Future Integrated Delivery Model Community Based-Population Health Sports Bariatric & Surgery Center Medicine Weight JV PCP-(PCMH) Specialists Urgent Retail RX (PCSP) Care Spec. Clinics- Wound, Sleep, Residency Infusion, Optometry, Dentistry Clinics Care Transitions Discharge Clinics Communication Center Care Mgmt Acute Care Hospitals AHH, ALMH, ABH, AGH Inpatient & ED Post Acute Care IP Rehab Outpatient. Rehab, Rad, Lab Wellness Prevention Elder Care Day PACE Programs Wellness Disease Disease Education Registry Management Ask a RN/DOC Appt. Scheduling Pt./Payor Help Line LTAC SNF Telemedicine Home DME Home Care Hospice 37 New Philosophy Transitions of Care (not D/C planning) Specific actions designed to ensure the coordination and continuity of care as patients transfer between different locations and levels of care within the same care continuum Collaborative Model Model of care that includes all care givers fully engaged in each patients care and transitions through the continuum. 3 Building a System that never Discharges the Patient 13
Enterprise Wide Investment ROI Silo Costs Technology Data Analytics Caremanagers across enterprise Acute care ED ACO Skilled facilities Office based Employee health & wellness Enterprise-Wide Returns Interoperability Utilization Gaps in care Stratification Qualitymetrics Reductions in: Unnecessary hospitalizations Avoidable readmission InappropriateED use Costs Improvement in Increase in primary care visits Employee engagement in health promotion Post-acute and community partners Resources& collaboration The AMITA Experience 2015 Joint Operating venture Two regions Philips Heath Consulting Strategy Observations across system Stakeholder involvement Co Create sessions Vision statement across system Prototype pilot in each region Stakeholders Physicians Care managers & Social Workers- acute, ACO, office based Nursing Behavioral health Palliative care Home health Community Senior Services Residency program SNF partners 14
Prototype Components Universal transition form- staff designed One care plan-staff designed Patient cohort- medically fragile ACO or AMITA medical group patients Communication hub Patient tracker lists patients in pilot Pilot medical units-one in each region Care managers, social workers & nursing Staggered regional pilot launch AMITA Lessons Learned Silos breaking down Rapid cycle design is hard Good vs. perfect perspective Improved understanding of the continuum of care Engagement through prototype design Seeing a bigger picture Improved patient experience-tracking Improved clinician communication across all settings Phase 2 completes in December What is your Organizational Readiness for the new Paradigm? Value-Based Care 45 15
Healthcare Continues to Change Value-Based Care 46 So you have to trust that the dots will somehow connect in your future. Steve Jobs, 2005 Breakdown the silos & connect the dots The Time is NOW Questions? Thank you! rxhealthpartners@comcast.net kathleen.ferket@ahss.org 16