Rural Health Care Leadership Conference From Cardboard to Concrete and Beyond Medical Home Sweet Home February 10, 2015
PLEASE NOTE: The views expressed by the conference speakers do not necessarily reflect the views of the American Hospital Association and Health Forum. 2
Commitment to Community 3
Population of 26,948 Demographics: 52% African American 48% Caucasian Community Profile Median income of $29,849 20% of the population is below the poverty line Overall health ranking is 89 th out of 100 counties in North Carolina 4
Top Five Causes of Death in Anson County 1. Heart disease 2. Cancer (primarily trachea, bronchus and lungs) 3. Cerebrovascular disease (brain blood clot or hemorrhage) 4. Chronic lower respiratory disease 5. Diabetes 5
Obesity and Diabetes Focus 36% of the adults in Anson County are obese Defined as having a Body Mass Index [BMI] of 30 or more Public Health Survey Priorities Obesity and Diabetes 23% have Heart Disease 27% have Hypertension (High Blood Pressure) 26% have High Cholesterol 25% have Diabetes 6
Leadership Vision This community is counting on us to help them. We have an opportunity to greatly improve population health with our new model of care where we blend 21 st century analytics with 21 st century innovations. Joe Piemont, Carolinas HealthCare System President and COO 7
What is a Patient Centered Medical Home? The Agency for Healthcare Research and Quality (AHRQ) defines a medical home not simply as a place, but as an approach to primary care whereby patient treatment is team based and coordinated to ensure patients receive the necessary care in the right place, at the right time, and in the manner that best meets their needs 8
Features of the Medical Home Patient Centered Comprehensive Coordinated Accessible Committed to Quality and Safety 9
Conceptualization and Design of New Facility 10
Lean 3P: People - Preparation - Process Objective of 3P event: Create a detail level facility design that best enables the flow of patients, clinicians, medication, supplies, equipment, information, and processes (7 flows) Using Lean principles, subject matter experts who do the work define process flow first; physical layout is then designed to support workflow Over 5 day event, Surgery, Patient Care, ED/Medical Home, Patient Navigation, Imaging, and Overall Layout teams developed and ranked multiple designs based on how well each met core design criteria 11
Core Design Criteria 1. Patient travel distance 2. Nurse travel distance 3. Physician travel distance 4. Patient handoffs 5. Floor space (square footage) 6. Staffing requirements 7. Capacity for growth 8. Access 12
Day 1 - Developing and Selecting Designs 13
Final Overall Layout 14
Day 2 - Building the Selected Design
Days 3 and 4 - Simulations/Revising Layout 16
Days 3 and 4 Flow Simulation Examples Inpatient Where do we store cribs? Family member space: need to locate chairs away from patient care area Operating Room Patient going south! Ambu bag on headboard? Where is crash cart? Where would EMS pick this patient up for transfer? Registration Patient arrives for scheduled surgery need escort; where is pre-op? Wheelchair storage close to front lobby? ED/Medical Home Agitated patient screaming in lobby; where is security? Clinical staff? Safe room and sitter space available? Patient presents with stroke symptoms; where is rapid triage area? 17
Day 5 Design Approval and Report Out 18
From Cardboard to Concrete and Beyond 19
True North To significantly improve the health status of Anson County by offering an innovative, community-focused delivery model. 20
Anson Service Mix Patient-Centered Primary Care Practice Emergency Department Inpatient and Observation Unit Surgery Digital Imaging Pharmacy Laboratory Behavioral Health Personal Care Services / CAP / Home Health Community Meeting Space 21
Power of the System Committee Structure System-wide collaboration and teamwork to create change Legal and Regulatory Transition Operations Committee Medical Home Committee Anson Executive Committee Construction Committee Teammate Committee Community Relations Committee Increased emphasis on providing value to the customer 22
Innovative Care Model Outcomes focused Wellness and prevention Triple Aim: transforming to provide value (cost/quality/access) Virtual Care Health Advocate Coaches Rotating Specialist Providers New Facility Design Improving the Health of Anson County Highly Engaged Community Medical Screening Exam Process Resource and Skill Mix 23
Our New Model Patient Flow Patient seeks medical care Community health advocates update primary providers Provider screens for needs Care Team follows up with patient Patient is treated in the most appropriate setting Health Coach coordinates care and connects patient to community services 24
Our Commitment Enhance patient and community outcomes through personal, virtual and collaborative connectivity of Carolinas HealthCare System s network of specialized services, supplemented by existing community services provided by local faith-based and other organizations Provide and support a team of healthcare professionals for primary and preventive care, including a family practice residency program Enhance the number and breadth of specialist physicians practicing in Anson County Provide improved access to appropriate services, through telemedicine applications and other services Develop a flexible, cost-effective new facility that encourages collaboration among health professionals and provides an adaptable design for the evolving care needed to service the community 25
Care Coordination Team 26 Virtual Care Transport Assistance Wellness Coach Home Health (CAP) Personal Care Acute Care Hospital Clinical Pharmacist Behavioral Health CCNC Mobile Clinic Faith Based Services (Advocate) Dietician Patient Navigators Social Workers Advanced Care Practitioner (ACPs) Family Practice Physicians Tele Monitoring Health Quest Pharmacy Assistance Registered Nurses Care Coordinator
21 st Century Analytics with 21 st Century Innovations Community Health Management Identify population and create registry Perform analytics Create segments Top 3% of population with high use and cost (1 st Tier) Next 7% of population with high use and cost (2 nd Tier) Target interventions Measure and monitor Select and Stage Programs to Implement Effects within months Effects within 1 2 years Effects within 3 5 years or more 27
Measuring Progress and Success - Leading Short Term Initiatives 2015 2016 Increase % of Anson County population utilizing Anson Primary Care Medical Home once every 18 months Baseline Performance 2015 Target 2016 Target State Benchmark National Benchmark 19% 30% 35% N/A N/A Decrease % of inappropriate ED utilization for existing patients Increase # of Wellness Visits for Care Coordination of High Risk/High Cost patients 45% 40% 35% 44.1% 42.8% 0 260 500 HSR HSR Increase # of Community Engagement Activities - Screening Events - Pre-D and Diabetes - Mental Health 4 40 60 N/A N/A - Educational Offerings - Nutritional Classes - Smoking Cessation 0 15 25 N/A N/A 28
Measuring Progress and Success - Lagging Long Term Initiatives 2019 2020 Baseline Performance 2019 Target 2020 Target State Benchmark National Benchmark Increase % of Anson County population utilizing Anson Primary Care Medical Home once every 18 months 19% 50% 55% N/A N/A Decrease ED Utilization Per Capita 51.0 46% 41% 44.1 42.8 Decrease Adult Diabetes Incidence Rate Decrease Adult Obesity Incidence Rate 14% 9% 8% 9.8 8.7 33% 28% 25% 28.6% 27.6% Decrease Heart Disease Hospitalization Rate 72.1 per 1,000 60 per 1,000 55 per 1,000 58 per 1,000 56.9 per 1,000 Decrease Medicare Spend Per Beneficiary (MSPB) 0.97 0.94 0.90 0.94 0.98 29
Integrated Partnerships Carolinas HealthCare System and the Anson Community 30
Community Support
73 years old female Lifetime smoker Chronic conditions include hypertension and diabetes Battles depression Elderly patient Myrtle Lives alone with little support from friends or family Historically a non-compliant patient 14 Visits to the Emergency Room last year 32
Myrtle s Care Is Now Coordinated Visited Anson s ER in late July for a non- emergent condition After medical screening exam was transitioned to Carolinas Primary Care Hasn t been to the ER in 90 days, and her chronic conditions are being treated by her PCP Has utilized Anson transportation services for her PCP visits Has utilized HealthQuest Pharmacy Assistance program Has a weekly call from a Nurse/Social Worker, and is also being seen by our Psychotherapist 33
Improving Outcomes In Summary Access to Care Mobile unit and outreach efforts Medical Home with 3 additional providers and extended hours Specialists rotating to Anson County Transportation assistance Care Coordination Comprehensive Team Defined care plans and goals Data Analytics Disease Registry Risk Stratification of patients Engage patients and families to be part of the Care Team Promotes Health Advocates to help educate the Community 34
Improving Outcomes In Summary Lowering the Cost of Care Medical screening process in the ER Virtual Care Care Coordination Predictive data analytics Outreach efforts to drive patients to Medical Home Community Outreach Health screenings Pre D, Cholesterol, Blood Pressure, etc. Community Education Health Advocates Mobile Unit HEALTHWORKS 35
Emergency Dept Utilization 36
Medical Screening Exams 37
Trends in Patient Volume 38
Doing Different Things in Different Ways Innovative Mobile/Virtual Collaborative Data Informed Patient Engagement 39
Thank You