atlanticare - special care center
DESCRIPTION
TRANSCRIPT
SPECIAL CARE CENTER
A SERVICE OF
AtlantiCare: Special Care Center
• Faced with escalating care costs, especially for employees with chronic conditions, AtlantiCare and the Welfare Fund adopted the AIC-U model (Special Care Center) and opened the center July 2007 (based on the original white paper)
• Although the Special Care Center originally served
only participants of the Local 54 Fund and AtlantiCare employees, it has subsequently been opened up to other patient populations
Time to Innovate
• Care was fragmented• Chronic conditions were not managed• Payers needed to be partners• Healthcare needed to be done differently
Source: Sg2
THE 80-20 RULE of Chronic Care
• 80 % of Healthcare Spend • 20% Patients with Chronic Conditions
SOLUTION
Care while Costsfor patients with Chronic Conditions
Innovative Healthcare for Chronic Conditions
• Partnered on solutions• National innovations/best practices • Piloted the “SCC” - a patient-centered medical
home for individuals with chronic conditions • Invitation Only Enrollment (screening form)• Opened the doors in the summer of 2007• Enrolled 2,600 patients to date
Three Aspects of Care
• High motivated Health Coaches (medical assistant, LPN)
• High performing medical providers
• High Value specialist network
Specialist Network
Medical Providers
Health Coaches
Task at Hand
• Attract Chronic Care Patients to the Practices– Patients with the highest spend (MedAi 4-5)
OR
• Provide chronic care in their existing practices– Hot sack services in primed practices - locations
• Give Patients what they WANT and NEED
– Relationship with their Doctor– Health Coach support– Care they can Access– Provide Pharmacy Services– Care of the highest Quality– Reduced Costs– Electronic care that is Connected– Care that is Integrated– Driven by the patient Experience
Special Care Principles
SPECIAL CARE CENTER IMPERATIVES
emergency room usagehospital ization ratesacute care length of stay
Improve care management to decrease over utili zation of unnecessary services, admissions and length of stay while improvi ng care outcomes.
Effective management of pati ent care throughout the continuum- inpatient to am bulatory and services al ong the care route.
CONTINIUM MANAGEM ENT
open access to co-located behavioral healthPh-Q 9 scores- decreased symptomshealth outcom es with reduced symptoms
Increase access, decrease st igma and im prove care and outcomes.
Provide on-site behavioral health servi ces.INT EGRATED BEHAVIORAL HEALT H
util ization of generic medicat ionsdrug costs
Reduce over utilizat ion of brand medicat ions which results i n cost savi ngs.
Effective management of on-site pharmaceut ical services.
PROACTIVE THERAPEUTIC MEDICATION PROG RAM
sam e day sick visitssam e day/next day hospital discharge visit semergency room visit s - non-em ergent cases
Reduce barriers to the right care at the right time and at the right place.
Provide open access schedulingOPEN ACCESS
ambulatory care vis itsRx Compliance to 99% fi ll rate
Reduce barriers to the right care at the right time and at the right place.
To reduce barriers to care and medications.WAIVED CO-PAYS
pat ient educationcare engagem enthealth i ndicators through ef fective self and team management
Increase patient educati on, engagement and self-management goal attainment .
Provide relat ionship based health education and navigation.-He lp p eop le clar ify t heir he alth go als, a nd imple me nt an d su stain be havio rs, lif estyle s, a nd attit ude s th at ar e co ndu cive to o ptim um hea lth -G uide pe ople in t heir per son al ca re an d he alth -ma inte nan ce a ctivities -Assist pe ople in r edu cing the ne gat ive im pact ma de on the ir lives by c hr onic c ond itions suc h as car diov ascula r d iseas e, c ance r, and dia bet es.
HEALT H COACHES
OUTCOM EGOALROLE
- Tools for Replication
Barrier Reduction
• Personal health coach for each patient• Waive visit co-pays • Waive prescription co-pays when members use the SCC
pharmacies• Open Access for Sick Call• Same Day/Next Day Hospital Discharge Appointments • Access to the care team 24 hours a day, 7 days a week• Utilize a robust electronic medical record to increase
efficiencies and safety- that could communicate throughout the continuum of care- reduce unnecessary testing- provide medication reconciliation
Relationship with Doctor
• The Patient-Doctor relationship is paramount to improving care while reducing costs by instilling:– Focus on each and every patient/family need– Expertise– Trust– Proven methods to improve health outcomes– Key to hire right staff who understand model
Health Coach Navigating Care
• The Health Coach Principle is a staffing model that assigns each patient a personal educator (also known as a health mentor or navigator) who shepherds the patient through their care with:– Continuous contact– Health literate patient education– Real life practical support– Cultural and linguistic support
Access to Care
• Easy to access– Same day sick visits– Same day/next day hospital discharge visits– 24/7 access to a doctor
• Affordable to access– No or reduced copay to visits if able in plan design– No or reduced copay for medications
• One-stop access– Onsite pharmacy services– Mail order pharmacy
Highest Quality Care
• Care models• Procedures• Hospital stays
Pharmacy Services
• Built a Pharmacy on-site• Hospital based institutional pharmacy• Daily communication with team• Mechanisms to ensure patient pick up• Monitor compliance
Reduced Costs Care
• Focus on supporting patient health which results in maintaining community living without ED and hospital stays
• Effective care of chronic conditions CAN be done in an ambulatory setting if vision is to support each patient to manage their health
Reduced Costs Care
• Know the cost of everything-learn unknown costs
• Network of care that is cost responsible• Reduce out of pocket cost for the patients• Reduce cost to the partner• Reduce overall PMPM- PMPY
Electronic Connected Care
• Electronic medical record– EMR follows patient through the continuum
• Patient registry– Optimizes patient and population management
• Accurate patient profile at each contact/portal• Reduces duplication of testing/procedures
Integrated Care
• Team Approach– Use of “morning huddle” to review care plans– Each member ‘s input is integral to care – Each member is invested in the vision of care
• Behavioral Health Services– Mental health and substance abuse services– Social services to access community resources– Focus on reducing depression, anxiety and stress
Patient Experience Care
• Desire to feel better• Want to feel special• Need to learn about their conditions• Support to effectively manage life circumstances• Adopted CG-CAHPS surveying
Special Care Center TimelineCatalyst for Innovation
Implemented 2007
Concept and Design 2006
2013
SCC ModelEMRPharmacyPatient Registry
Second SCC Site 2010
ACO 2012
Enterprise Implementation of Registry 2012
2007 AtlantiCare had 3 Primary Care Office- 2013 expanded to 30 Primary Care OfficeEMR has 300,000 patients
Opening pharmacy in each hospital
DATA COLLECTION
Reduction in Systolic BP
0
20
40
60
80
100
120
140
160
180
-42 mmHg -26 mmHg
SBP > 160 SBP > 140Start Start
Pre SCC
Post SCC
Reduction in LDL-Cholesterol
0
20
40
60
80
100
120
140
160
180
-50 mg/dL -38 mg/dL
LDL > 160 LDL > 130 Start Start
Pre SCC
Post SCC
Diabetes Outcomes
0
20
40
60
80
100
2008 2009 2010 2011 2012%Patients
Benchmark: 49.1
A1c<7% A1c>9% SBP<140 mmHg
SCC Heart Failure Outcomes Compared to Joint Commission Averages
88
90
92
94
96
98
100
% Pat
ien
ts
LVEF ACE/ARB SMOKING CESSATION
Other Health Outcomes vs Benchmarks
0
10
20
30
40
50
60
70
80
% Patients SBP<140 in HTN LDL<100 in CAD Quit Smokingin COPD/Asthma
Benchmark 71.3 42.6 15.0
SCC Jul 08 64.1 64.1 19.0
SCC Jul 09 69.1 69.1 19.4
SCC Jul 12 78.6 78.6 26.0
%Patients
Reduction in Smoking Rates
0
5
10
15
20
25
30
35
40
Diabetes CAD COPD All Patients
Pre SCC
Post SCC47%Quit Rate
63%Quit Rate
63%Quit Rate
48%Quit Rate
Greater reductions in SBP in minority groups
110
115
120
125
130
135
140
White Black Hispanic Asian
Pre SCC
Post SCC
mmHg
Greater reductions in LDL-C in minority groups
80
90
100
110
White Black Hispanic Asian
Pre SCC
Post SCC
mg/dL
Greater reductions in HbA1c in minority groups
6.4
6.6
6.8
7
7.2
7.4
7.6
7.8
8
8.2
White Black Hispanic Asian
Pre SCC
Post SCC
%
Higher Smoking Cessation rates-minority groups
0
10
20
30
40
50
60
White Black Hispanic
%
33% 39% 60%
Reduction in Utilization Measures
-30
-20
-10
0
10
20
30
40
50
Office ER Admissions Length AverageVisits Visits of Stay Cost/Day
%
+43%
-15%-8%-23%-22%
Cost Savings – Large Payer Group at the SCC
• Our large payer group sought controls from a Las Vegas population with similar age, chronic disease state and spending pattern
• By definition, the “sickest” patients are outliers who are difficult to match with controls
• Still, early analysis showed short term savings of $208 per member per month– Medication– Hospital LOS– ER Utilization
• Later analysis will likely show a greater long term saving as long term complications are prevented