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

lhardin@camdenhealth.org

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

lhardin@camdenhealth.org

For More Information