Redesigning Health Care in an Accountable Care World Jack Cox, MD: Chief Quality Officer Hoag Memorial Hospital Presbyterian, Newport Beach CA Diane Laird, MPH: Chief Executive Officer Greater Newport Physicians, Newport Beach CA Orange County Employee Benefits Council October 14 th, 2010
Overview The Impetus for Change Introduction to Continuum of Care A Case Study on Orthopedic Care The Evolution of Outcome Measurements Closing Comments: Accountable Care
The Impetus for Change Unsustainable growth in health care expenses High variability in quality and cost >50 Million uninsured Fundamental changes to employer provided health coverage
Health Insurance Premiums Outpace Inflation
What s Wrong with our System? Historical reimbursement models reward inefficiency, excess utilization and illness Customers (patients) have historically had limited sensitivity to cost of care or lifestyle impact on their health Health care is practiced in silos Industry has been slow to adopt/embrace IT solutions No accountability since Quality is difficult to measure Significant variation in care
Introduction to Continuum of Care Definitions: A range of services developed and organized to address the variety of needs individuals have as they age The provision of comprehensive care from the hospital to the home, which advocates the pooling together of medical and social services within the community and the creation of linkages between community care initiatives at all levels of the health care system Health care services provided either during inpatient hospitalization or for multiple diagnoses over a lifetime to give a basis for evaluating effectiveness, quality and cost of care
Continuum of Care
Historical Silo Approach to Re design Ambulatory Inpatient Future Group Practices Destination Facilities Inpatient to OP Shift ASCs Urgent Care vs ER Diagnostic Services Evidence based guidelines Specialty specific soln s Physician extenders Fracture clinic Improve throughput Supply chain improvements: Improved pricing Standardize implants Clinical Pathways Build sufficient volume to support infrastructure Re evaluate job descriptions specialty staff vs cross training Develop patient care teams Engage physicians Coordination across the continuum of care Joint review of best practices IP/OP Benchmark MD best practices Eliminate duplication of effort IT connectivity to increase efficiency and reduce errors, data sharing Build Trust
A Case Study in Orthopedics Center of Excellence: Joint Replacement Alan Beyer, MD, Exec Medical Director ~ Dori Holnagel, Exec. Operations Director Area Old Paradigm New Paradigm Focus Where Hospital Setting Education Outcomes Payment Patient Satisfaction Admission Hospital focus Inpatient Hoag Main Campus Pre Op only SCIP measures, Inpatient Varies Hospital/MDs separate Post Hospital calls of selective patients (Press Ganey) Registration Desk Continuum of Care focus OP: same day hip replacements Hoag Orthopedic Institute, Irvine SkyLight pre, during, post surgery Functional Outcomes SF36 @ pre op, 3, 6, 12 month post op Bundle All inclusive In hospital service recovery (SkyLight) Navigator
A Patient Case Study Mr. Smith is a 50 y/o otherwise healthy, active male with degenerative knee disease. Plays golf, rides bikes. Increasing pain & dysfunction in right knee. Therapeutic options: Lose weight Physical therapy Steroid Injections Knee replacement
A Patient Case Study (cont d) Decision made to replace knee in 1 month. Assigned a navigator who assists with all pre op preparations as well as answers questions Email address registered with SkyLight Streaming pre op, during hospitalization, post op education SF36 sent pre op & at 3, 6, 12 months post op Day of surgery all forms filled out, met by navigator & taken to floor Has surgery, in hospital 2.5 days; progressive physical therapy In hospital asked about pain control, food & room several times a day Home progressive activity, navigator checks in daily for 1 st week & then regularly depending on his need 6 mo post op pain free, playing golf & riding bikes again
Evolution of Outcome Measurement Traditional Infection Rates Antibiotics within 1 hour surgery DVT prophylaxis Pain control Complications/Return to OR Mortality Hospital Cost per stay New Focus All of the Traditional plus Pain at 3, 6, 12 month post surgery Activities of daily living Other activities (golf, etc.) Re admission rates (any reason) Total Cost of Care (physicians, pre acute, hosp, and post acute) Return to Work with no limitations
Accountable Care is a Team Effort The patient must be an engaged participant What can an employer do to support the Team effort? Employee incentives for preventive care Employee incentives for healthy behaviors Vending machines, fitness, wellness programs, stress reduction, smoking cessation, etc.
Questions?