The Memphis Model: Building Webs of Trust at Community Scale Rev. Bobby Baker: Director of Faith and Community Partnerships & Dr. Teresa Cutts : Director of Research for Innovation The White House Sept. 20, 2011
Memphis: Land of Disparity and Assets... Egregious disparity: Income, Education, Heart Disease, Diabetes, Cancer, Suicide/Homicide, Limb Amputation BUT TONS OF ASSETS: Faith/Church and Blues
Anchors Memphis Model 7 Hospital system $1.5 Billion budget Provides high percentage of all indigent care in Tennessee Owned by the UMC Arkansas, Memphis, and Mississippi Conferences
What is the CHN? The CHN is a partnership between the 376 congregations, the hospital and community health assets developed collaboratively by all the partners. A shared mission to improve access and advance health status at community scale.
What it is not Not disease specific Not targeted for poor people or rich people Not time limited Not a pilot Not a research project Not the hospital s serving the community.
Congre 33 11,479 m regis 503 membe congregation through V Train 226 persons the Care fo train 234 persons Mental Hea train 109 persons Aftercare 182 39 90 500 traine
Access Goals Regardless of payer. 1. Right door (not usually ER) 2. Right time (early, not late) 3. Ready to be treated 4. Not alone (Note that the hospital by itself has almost no way to affect the decisions that achieve these.)
Four Opportunities to Advance Health Frail Elderly and end of life Mental Health Chronic Conditions Pathways Infants and Vulnerable Mothers
The CHN Covenant Agreement A signed document that spells out the partnership developed with clergy.
Five Phases in the Person s Journey of Education (in the Health congregation) Prevention (more targeted) Intervention (heading toward care) Treatment (medical setting) Aftercare (blend all the care assets)
Liaisons are Unpaid Volunteers With Very Specific Roles
Liaison Roles (500) Integrates individual members into the network Tracks congregational activity for constant improvement Alerts CHN navigators of developments/changes Follows their members into and out of the inpatient setting Coordinates transition from hospital to aftercare Channels community resources to congregation Provides information and referral services to congregation Facilitates wellness activity participation Shares creative leadership of CHN with Liaison Council
Member Registration: 11,479
CHN Congregational Levels of Engagement Level I - Signed Covenant Level II Trained, Active Liaisons Level III Individual members enrolled, participating in CHN education Level IV Congregational Testimony
Navigator Roles (9) Know the congregations around the hospitals Develop a network of community resources Coordinate outpatient care of CHN members Assist members with navigating the service systems Facilitate prevention and education activities in congregation Maintain program documentation and participates in ongoing program evaluation and reporting Participate in team and program staff meetings Make appropriate patient notes in Electronic Medical Record
Navigator Consult Screen
Core Educational Trainings offered by CHN: Seven Weeks/Two Hours Hospital Visitation Training (503) Alliance Aftercare Training (226) Caring For the Dying (109) Mental Health First Aid (234) Total of People Trained in Series: 1,072 Total of People Trained in all Four Courses: 122
CHN vs. Non-CHN Member Data: NOT Research per se 473 CHN patients seen at MLH from Nov. 2007-Nov. 2009 tracked through EMR and compared to Controls matched on age, ethnicity, gender and DRGs Mean Age: 60 years Ethnicity: 87% African American Gender: 64% Female Top DRG: Congestive Heart Failure (23%) Payor: 62% Medicare A and B
CHN vs. Non-CHN Patient Data 3.00% 2.50% 2.00% 1.50% 1.00% 0.50% 0.00% Mortality Rate CHN Non-CHN LOS-No Differences Readmits and Mortality Rates Differ 45 40 35 30 25 20 15 10 5 0 LOS total Readmits
CHN vs. Non-CHN Charges: DRG and Total Sum $160,000.00 $140,000.00 $120,000.00 $100,000.00 $80,000.00 $60,000.00 $40,000.00 $20,000.00 $0.00 CHF Renal Failure Stroke DM Other Cardiac $25,000,000 $20,000,000 $15,000,000 $10,000,000 $5,000,000 $0 Sum of Charges Aggregate savings of charges for the CHN patients that accrue to both payers and hospital.
Savings to Patients on Readmits*: CHN vs. Non-CHN *Based on Medicare Inpatient Deductible, net savings of $110,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 CHN Net Savings Non-CHN $0 Readmit Cost to Pt Net Savings
CHN Pre-Post Data Compared Pre-Post Utilization Patterns in subset of 50 (N=473) CHN patients 27 months before CHN started and first 27 months of CHN (within subject design) Sample Demographics Mean age=65; 58% Female; 86% African- American; top DRG: Congestive Heart Failure; 68% Medicare A&B
Hospital Metrics Pre-CHN Post-CHN Total admissions 159 101 Admits/patient** 3.2 2.0 Total readmits 37 17 Readmits/patient* 0.74 0.34 Total patient days 1,268 772 Days/admit 8.0 7.6 Days/patient** 25.4 15.4 Total charges $6,396,111 $3,740,973 Average charge/admit $40,277 $37,409 Average charge/patient** $127,922 $74,819 ER admissions 84.9% 80.2% *Significant at the p<0.05 level, by t-test **Significant at the p<0.02 level, by t-test
What s moving the data? In this sample, CHN implementation decreased overall utilization of services, particularly decreased average number of admissions (not due to inpatient clinical management differences) Which leads us OUTSIDE of the hospital. Logic Behind the Work: Blended Intelligence What the hospital knows about disease What the clergy and liaisons know about life (boots and brains on the ground) Constant Participatory Analyses, Sharing Transparently and Truthtelling Generous Sharing of Already Existing Resources Invitation, not Prescription Integration of Clinical Care with Community-Based Caregiving Aligned Assets Leveraging Trust Faith-driven treatment system (reimbursed) Faith-driven healing system (non-reimbursed) Constant data-driven innovation
HCAHPS Comparisons of CHN and non-chn July 2010-June 2011 Comparison of CHN Members Hospital Consumer Assessment Survey (HCAPS) scores with non-chn Overall Rating of Hospital Score (System) Score N Non-CHN 75% 3766 CHN 76% 138 Score difference is significant at p value =0.01, 2 proportions test
Memphis: Rowdy River Town