access and innovation · 4/12/2017 · why do we spend so much ? 11 0.0 2.0 4.0 6.0 8.0 10.0 12.0...
TRANSCRIPT
Access and InnovationChanging the System for Vulnerable People
Lauran Hardin MSN, RN-BC, CNL
Mercy Health Saint Mary’s
National Center for Complex Health and Social Needs
Senior Director Cross Continuum Transformation
§The Mercy Health Story
Mercy Health Saint Mary’s
An integrated health care system in West Michigan:
2nd largest integrated health care system in Kent county
with $450M annual net revenue
Achieved Magnet® designation on May 15, 2013
Top Hospitals for Leapfrog 2013 - 2015
Teaching hospital - 371 beds with ~ 4,500 colleagues - -
including 116 psychiatric, and 15 neonatal ICU beds
Progressive leader in cancer care, neurosciences,
orthopedics, kidney transplant, diabetes and endocrine
care, and behavioral health
Comprehensive clinical integration model aligning more
than 500 employed and independent providers into
Clinically Integrated System with at risk contracts
Care for Vulnerable Populations – Community Benefit
clinics serving different populations, Psychiatric services
c) 2016 Trinity Health Michigan dba Mercy Health Saint Mary’s. All
Rights Reserved. No Reproduction Without Prior Authorization
It started with one patient and one phone call…
Demographics of High Frequency Patients
(>10 ED Visits &/or >4 Inpatient Admissions)
0
10
20
30
40
50
60
Primary Care Status
FY 2011
FY 2012
FY 2013
Primary Care Status
•60% have a medical
home
Insurance Status
•30% Uninsured
•40% are Dual Eligible
Age
•70% are <60 yrs old
54/12/2017
Root Cause Analysis
PSYCHIATRIC• Mental Illness
• Addiction
• Trauma
SOCIAL• Housing
• Transportation
• Health Literacy
• Competency
SYSTEM• System Design Issues
• EMR Issues
• Policy
• Access
339 Patients - 24 Months
Net Revenue Reduction 42%
Direct Expense Reduction 47%
Operating Margin Increase $632k
High
Frequency
Population
Management
Outpatient Visit
Reduction
199
17%
Emergency Visit
Reduction
1,498
43%
Admissions
Reduction
195
44%
Hospital Utilization
Patient Economics
c) 2016 Trinity Health Michigan dba Mercy Health Saint Mary’s. All
Rights Reserved. No Reproduction Without Prior Authorization
Camden Coalition of Healthcare Providers
§The Cost of Poor Access
196065 70 75 80 85 90 95 2000 05 10
2012
6%
5%
is 60 times what it was
in 1960, consuming one fifth
of personal income and 17% of
GDP
20%
17%
21%
National Health Spending Per Capita
Why do we spend so much ?
11
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0T
urk
ey
Esto
nia
Mexic
o
Pola
nd
Luxem
bo
urg
Kore
a
Czech R
ep
ublic
Hu
ng
ary
Chile
Isra
el
Slo
va
k R
epublic
Ire
lan
d
United K
ingd
om
Fin
land
Slo
ve
nia
Icela
nd
Italy
Austr
alia
OE
CD
AV
ER
AG
E
Norw
ay
Spain
Port
ugal
Gre
ece
New
Zea
lan
d
Austr
ia
Can
ada
Belg
ium
Japan
Den
mark
Fra
nce
Germ
any
Sw
ed
en
Sw
itzerland
Neth
erland
s
United S
tate
s
%GDP Healthcare Spending for OECD Countries
From book by Elizabeth Bradley and Lauren Taylor- The American Health
Care Paradox: Why Spending More is Getting Us Less
§ About theCamden Coalition
Camden Coalition of Healthcare Providers
Healthcare hotspotting is the strategic use of data to target evidence-based services to complex patients with high utilization.
These patients are experiencing a mismatch between their needs and the services available.
Camden Coalition of Healthcare Providers
Camden Hospital Cost Curve
ED visits2011
Inpatient visits 2011
0 1 2 3 to 4 5+
0 44,728 (85%) patients• 5,210 Inpatient visits• 63,489 ED visits
• $28,000,000 (50%) IP payment• $25,800,000 (59%) ED payment
985 (2%) patients
• 1,856 IP visits• 4,129 ED visits
• $10,000,000 (17%) IP payment
• $1,700,000 (4%) ED payments
503 (1%) patients
• 2,026 Inpatient Visits• 4,144 ED Visits
• $10,900,000 (20%) in IP payment
• $1,700,000 (4%) in ED payment
1
2 to 3
4 to 54,961 (9%)
patients
• 28,447 ED visits
• $11,500,000 (27%) in ED
payment
1,563 (3%) patients
• 1,239 IP visits• 6,962 ED visits
• $6,700,000 (18%) in IP payment
• $2,800,000 (6%) in ED payment
6 to 7
8 to 9
10 +
ED & Inpatient Utilization Matrix
§ Innovation in Intervention
Education & Employment
Official ID & Vital Records
Food & Nutrition
Reproductive Health
MentalHealth
Medication & Medical Supplies
Provider Relationships
Health Maintenance
Substance Use Disorder
Other
Benefits & Entitlements
Shelter
Legal
Transport
Advocacy & Activism
Family, Personal & Peer Relationships
16 Domains of Care
Student Hotspotting
Over 30 participating teams in 2016
§ Beyond Healthcare
Hotspotting
Meet Peter• 51-year old African
American male
• COPD exacerbation, Acute Asthma Exacerbation, Hypertension
• Generalized Anxiety Disorder, Major Depressive Disorder
• In remission from Substance Disorder Dependence form Alcohol
• Homeless (1+ year in shelter)
• Limited income (~$200/month)
• History of incarceration
Peter’s Hospital Utilization
Peter & Sheryl Moving In
November 23, 2015
226 Dual-System High Utilizers(16+ ED visits & 7+ police encounters over five years).
ED V
isit
s
Police Encounters
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50
§4 Partnering for Complex People
Inter-organizational Collaboration – Case Conferencing
sdasT
To
work togetherwith shared dataand public input
DeliverBetter care atLower costs
Encourages a group of stakeholders in a community
A Community collaborative isan innovative community based model of delivery that…
§ Connecting to the Movement
Faculty for National Center
Shelly Virva, LMSW, CSW Lauran Hardin, MSN, RN-BC, CNL
Corey Waller, MD
Conference for the National Center for Complex Health & Social Needs
Wednesday-Friday, November 15 – 17
Los Angeles, CA
https://www.camdenhealth.org/national-center/
complex.care
• Hardin, L., Kilian, A., & Spykerman, K. (2016). Competing health systems and complex patients: An interprofessionalcollaboration to improve outcomes and reduce healthcare costs. Journal of Interprofessional Education and Practice, 7, 5 – 10. http://jieponline.com/article/S2405-4526(16)30103-3/pdf
• Hardin, L., Kilian, A., Muller, L., Callison, K., & Olgren, M. (2016). Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users. The Western Journal of Emergency Medicine, 18(2), 189–200. doi:10.5811/westjem.2016.11.31916
• Hardin, L., Kilian, A., & Olgren, M. (2016). Perspectives on Root Causes of High Utilization that Extend Beyond the Patient. Population Health Management. doi:10.1089/pop.2016.0088
• Hardin, L. (2016). Restoring Dignity for Vulnerable Populations: Changing the System for Complex Patients. Health Progress, January-February, 28-32.
The project was undertaken as a Clinical QI initiative at Mercy Health and as such was not formally supervised by the Mercy Health Institutional Review Board per their policies.
Publications
• National Center for Complex Health and Social Needs
https://www.camdenhealth.org/national-center/
• Camden Coalition of Healthcare Providers
https://www.camdenhealth.org/
• Student Hotspotting Program
https://www.camdenhealth.org/programs/student-hotspotting/
Lauran Hardin MSN, RN-BC, CNL
Senior Director Cross Continuum Transformation
National Center for Complex Health and Social Needs
For More Information