CRITICAL ACCESS HOSPITAL NETWORK OF EASTERN WASHINGTON Applying Health Information Technology to Impact Rural Population Health Sue Deitz, MPH February 9, 2015 Please note that the views expressed by the conference speakers do not necessarily reflect the views of the American Hospital Association and Health Forum
Outline of Today s Presentation Background of CAHN Our Evolution to measure population health. Live demo of population health tool The impact of capacity to population health on rural facilities. Alignment of Population Health initiatives at state and local level. Leveraging Population Health data to strengthen the rural infrastructure.
Rural Network in Eastern Washington Established in 2002 with HRSA Network Development Grant Program. Recently grew from 7 to 13 Public Hospital Districts. Located in 8 contagious counties that share a common referral with Spokane, Washington. Organized as a 501c3 with a Board of Directors comprised of Members CEOs.
What is a Public Hospital District (PHD)? Public hospital districts are governmental entities authorized by state law to deliver heath services. Each public hospital district is governed by a board of publicly elected commissioners. CAHN includes 13 PHDs. Comprised12 Critical Access Hospitals, 1 Rural Hospital, 19 rural health clinics. GREAT infrastructure for innovation
CAHN s Common Rural Health Disparities Older, sicker, less educated, lower income, less access In percent WA Lincoln Pend Oreille Grant Garfield Columbia Adams Asotin Whitman Spokane (urban) 65 or older 13.6 22.9 22.3 12.4 23 25.5 10.2 20.3 9.8 14.3 Median Age 37 47.6 47.8 32.1 49 48.3 29 43.5 24.4 36 Bachelor degree 31 19 17 14.6 24.6 18.7 12 16 48 29 Persons below FPL 13.4 14.2 20.4 20.3 12.1 17.1 22.9 13.6 32.6 15.4 Diabetes 8 12 9 8 17 16 14 13 9 9 Heart disease 5 9 8 7 10 9 8 6 4 6 Obesity (BMI >30) 27 32 31 38 31 38 37 31 26 28 High cholesterol 40 47 45 43 50 48 44 49 36 39 HPSA - Y Y Y Y Y Y Y Y N Data Sources: County Rankings, WA Department of Health, and US Census
Purpose of the CAHN Our Purpose: To advocate for rural health care delivery and to develop program funding and resources to support and strengthen CAHN Member care systems. What do we do: Secure resources and develop systems that support CAHN Members to meet their local and regional program targets.
CAHN s Services Essential categories of services: Rural advocacy Patient Centered Medical Home/care coordination Health information technology Members participate in: Professional peer groups Quality improvement initiatives Aggregate data sharing
CAHN Organizational Chart Board of Directors CEOs Executive Director Physician Champions HIT/IS Leadership Team CFO/Finance Leadership Team Clinical Care Coordinator Leadership Team
CAHN s Evolution Todays Topic: Health Information/Data Analytics to Impact Rural Health how did we get here? Our Milestones: 2007 2008-11 My job interview- I want my data 2011 2012 HRSA Rural Health Information HRSA Small Technology Healthcare Provider Development Grant Quality Improvement Grants 2013 Board agrees to be NCQA Patient Centered Medical Homes Hot Spotters Grant from Cambia Foundation
CAHN Seeks to Aggregate Data in 9 Rural Health Clinics Pend Oreille Lincoln Garfield Grant Odessa Hospital IS system Meditech Meditech Dairyland Meditech Meditech EMR Vendor GE Centricity Allscripts Soapware Hosted GE Centricity Hosted GE Centricity # Rural Health Clinics 2 3 1 2 1 Disparate Health Information Systems No central data repository to aggregate data No tool to measure population base health data Write a Grant.
Rural Health Information Technology Network Development Grant Program Awarded grant - 2011-2014 Implement a common disease registry Chronic disease management of the patient Local registry for management of a population Aggregate our data across sites Secure health information exchange Track outcomes over time Supports Patient Centered Medical Home NCQA recognition
CAHN Architecture Local Central Data Repository and De-Identified Aggregated
CAHN Analytics Web based and paper Chronic Disease Management tools
Diagnoses and Meds are prioritized to highlight chronic conditions Goals Not Met are highlighted for quick reference and visibility Labs, Calculations and Diagnostic Procedures pertinent to the Action Items are displayed for easy reference Targeted reminders for nursing staff allow better leverage of provider time and more efficient workflow
CAHN Analytics: Population Health Tool
Live Demo https://praedxlogin.com
Local and Regional Dashboards Measures Lipid Control ACE or ARB Therapy Med Reconciliation Fall Risk Screening A1c Poor Control High BP Control LDL Control A1c Control Aspirin or Antiplatelet Tobacco Non-use Beta Blocker for LVSD Controlling High BP Lipid Panel & LDL-C Cervical Cancer Screening Aspirin or Antiplatelet Breast Cancer Screen Colorectal Cancer Influenza Immunization Pneumococcal Vaccination BMI Screening Tobacco Use Screening High BP Depression Screening Diabetes: Low-level - Lipoprotein Diabetes: Foot Exam Filter by Demographics : Age, gender, race Practice Location Provider Payer Timeframe Benchmarks
By the end of the HRSA grant 7 of 9 rural health clinics data De-identified Aggregated in a central data repository; Apply >2000 clinical rules and 30+ NQF-endorsed quality measures to deliver actionable information; Stratify entire patient population by risk; Assist with workflow redesign, practice optimization, and business alignment to achieve clinical integration and maximize care team productivity.
Data Impacts Rural silos Data is a common thread between agencies Population health data disseminated to in PHD: Hospital Admin, Providers, Boards Data resource for Community Needs Assessments Shared data with behavioral health providers Shared data with public health Shared data with EMS Shared data with school system
Impact of Population Health Data Population based benchmark/goals chronic disease management (e.g. LDL, BP, A1c) Inpatient admission rates/ed visits for high utilizers (hot spotter project) Per visit revenue from increase in preventive procedures, labs and screenings triggered by tools Identified service delivery gap of behavioral health that supported integration/co-locations Prompted Rural County Coalitions
Rural County Coalitions taking form Optometry Public Safety Substance Abuse/ Treatment Centers Mental Health Dental Hospitals
CAHN Challenges Lack of IT/health informatics resources Lack of clinic staff expertise in data analytics Data quality garbage in garbage out Documentation variation among providers/clinic staff EMR Upgrades impact on mapping On-site Training vs webinars Reliance on Vendors/external IT consultants
Simultaneously.on the other side of the state Washington State s Health Innovation Plan CMS awarded $64.9 Million Awarded to Washington s Health Care Authority December 2014 Fully implemented, the Innovation Plan will achieve an estimated $730 million ROI in the first 3-5 years
WA State s Triple Aim Strategies Supported by HB 2572 and SB 6312 Build healthy communities and people through prevention and early mitigation of disease throughout the life course. Drive value-based purchasing by rewarding quality heath care over quantity, with state government leading by example as Washington's largest purchaser of health care First Mover. Improve chronic illness care through better integration of care and social supports, particularly for individuals with physical and behavioral health co-morbidities. (more than 1 illness) 24
State VBP Strategy First Mover
VBP Activities already underway
Regionalization: RSAs/ACHs State to create an Accountable Community of Health (ACH) in each Regional Service Area (RSA) Partner in Medicaid purchasing Develop a region-wide health assessment and regional health improvement plan Drive accountability for results Act as a forum for harmonizing payment models, performance measures and investments Health coordination and workforce development
Sept 2014 CAHN Regional Expansion Today CAHN s Aggregate Population Estimate: 216,802 Aggregate County Population 2013 Estimate: 216,802 6 9 5 2 8 14 12 1 13 7 3 4 10 11 2002 1. Lincoln Hospital 2. Odessa Memorial Hospital 3. Garfield Hospital 4. Newport Hospital 5. Coulee Medical Center 6. Samaritan Hospital 7. Dayton General Hospital 2014 8. East Adams Hospital 9. Othello Hospital 10. Pullman Regional Med Ctr 11. Tri State Hospital 12. Columbia Basin Hospital 13. Whitman Hospital 14. Ferry Hospital
Well, now what do we do? Should we be an ACO? Should we be an CCO (similar to Oregon)? Should we use data to negotiate with Payers? Should we create our CAHN Employee Health Plan? Should we partner with the HCA s Value-Based Payment demonstrations outlined in SIM grant? Should we partner with the ACH? Sue
Simultaneously.back on our side of the state CAHN awarded HRSA Network Development Grant (2 nd round)
HRSA Grant Goals Improve the quality and delivery of both behavioral eight and primary care health services in four rural counties in eastern Washington. Strengthen the rural health care system by establishing local public-private partnership organizations in four rural counties in eastern Washington. Expand impact with shared best practices and results Use Population Health tools/strategies to transition to value based purchasing
Stepwise Approach: Build capacity at CAHN to support volume to value transitions Data Population health analytics in all member sites Regional data aggregation /central data repository Integrate Care Mgmt. Each member establish Rural County Coalition Public Hospital District: CAHs, RHCs Behavioral Health Providers Local Health Departments / Public Health PCMHs use analytics to better manage patient care to improve outcomes and patient health Identify high utilizers (Hot Spotting)
Data Analytics: Build a better mouse trap?
Stepwise Approach: Build infrastructure to manage transitional payment models Payers Claims Develop capability to contract with third party payers including actuarial expertise. Acquire and analyze third party payer claims targeting high cost users. Shared Savings Develop payment/measurement system to attribute value and distribute shared savings.
Population Health Population health may be defined as any provider arrangement with a payer in which the provider agrees to provide specified care to a defined group of people (the population) in which the provider must accomplish three things: 1. Improve the group s medical outcomes 2. Reduce the group s per-capita costs 3. Contractually capture the savings from the value you ve created in 1 & 2
Rural Population Health Historically, rural providers have not served local markets of sufficient size to provide the essential requirements for population health: actuarial credibility to allow providers to accept financial risk; and market attractiveness to payers to collaboratively engage with the providers. CAHN aggregated their 13 member rural service areas into a larger population (approximately 215,000 covered lives) to facilitate payer engagement in population health.
Preliminary Strategic Planning
The End What we have before us are some breathtaking opportunities disguised as insoluble problems. - JOHN W. GARDNER - SECRETARY OF HEALTH, EDUCATION, AND WELFARE - UNDER PRESIDENT LYNDON JOHNSON
Questions. Sue Deitz, MPH Director, Critical Access Hospital Network (208) 610-0937 suefox@sandpoint.net http://www.cahnetwork.org