Re-engineering India Healthcare: Meeting the Triple-Aim

Stephen D. Sisson MD FACP Executive Director, Ambulatory Services Phillip Tumulty Professor of Medicine The Johns Hopkins University

Objectives

• Why does Indian Healthcare need “re-engineering?”

• What is the ‘triple aim’ of healthcare?

• How can primary care help achieve the triple-aim?

• How are HCL Healthcare and Hopkins collaborating to meet these

needs?

Re-engineering India’s healthcare: Critical Imperatives

• Most privatised health system in the world- 62% of inpatient care and 81% of outpatient care provided by private sector

• Shifting of disease burden to NCDs- Chronic diseases to drive health expenditures to high levels

• Healthcare expansion focused on tertiary and specialty care leaving a big gap in Primary Care delivery

• 95% of country’s healthcare delivery system is fragmented and operated out of small practices and small hospitals

THE TRIPLE AIM

Best practices from the US healthcare delivery innovations will help re-engineering healthcare in India

The Triple Aim

AIM 1: Patient Outcomes AIM 2: Patient Satisfaction AIM 3: Lower Costs

A narrower view…

Treat the:

– Right patient at the

– Right place at the

– Right time at the

– Right cost

The Triple Aim 1: Improving Patient Outcomes

Part 1: The role of primary care

How are we (i.e., US) doing?

Key recommendation:

“Clinical care should be based on continuous,

healing relationships”

Benefits of a continuity-of-care model:

• Hospitalization rates for primary care conditions are higher in

geographic areas where access to primary care is limited.

• States with a higher ratio of primary care providers to population

have lower per-beneficiary Medicare expenditures than states

with fewer primary care providers and more specialists.

Improving Primary Care

• The Patient-Centered Medical Home

– Care-delivery model whereby patient treatment is coordinated

through a primary care team led by a physician, but including case

management, social work, pharmacy, behavioral health and

others.

– Focus is on enhanced access to care, communication, continuity

of care, and quality/safety outcomes.

The Triple Aim 1: Improving Patient Outcomes

Part 2: The role of access to care

Why improve access?

• Patient safety

• Patient satisfaction

• Maximizes underutilized capacity and improves operational efficiency

• (Tracking metric: Median Lag Days)

The Access Puzzle

Patient with

Condition X

Provider treating

Condition X

Scheduling Process

Area of Opportunity #1

Area of Opportunity #2

Note: Same-day access and follow-up access conflict with each other

Components of Access

• Scheduling • Geography • Coordination of Care across sub

specialties

Triple Aim 2: Improving Patient Satisfaction

Key domains assessed

• Getting timely appointments, care, and information – Outside the office: Access – Inside the office: Wait times

• How well providers communicate with patients

– Outside the office: Responsiveness to calls; communicating test results

– Inside the office: Showing respect*; listening*; explaining things

*halo items

Patient satisfaction = patient safety

#1 reason for malpractice in ambulatory:

Failure to review/communicate about test results

Operationalizing patient satisfaction

• Two major surveys in US:

– CG-CAHPS: Clinician/Group Consumer Assessment of

Healthcare Providers and Systems.

• Surveys how often things are done

– Press-Ganey:

• Surveys how well things are done

Triple Aim 3: Lowering System Costs

In the old days…

Ambulatory patients • General wards • Specialty wards • Progressive care • Intensive care

• Clinic • Emergency

Department

Hospital patients

Now…

Hospitalized patients

Ambulatory patients • General wards • Specialty wards • Progressive care • Intensive care

• Retail clinic • Clinic • Infusion clinic • Emergency

Department • Observation unit

Chang JE et al. N Engl J Med 2015;373:382-388.

IOM Key recommendation:

“Clinical care should be based on continuous, healing relationships”

Best practices for a health care delivery model • Essential elements for meeting the triple aim:

– Continuity of care by primary care providers

– Access to care

• Key metrics in patient satisfaction include: – Access to care in and out of clinic

– Communication in and out of clinic

• Patient convenience is a major driver in new ambulatory models, but the impact on continuity of care is uncertain

Bringing the Triple Aim to healthcare delivery to India

Johns Hopkins—HCL Healthcare Partnership

• Johns Hopkins is collaborating with HCL with its ambition to transform healthcare delivery in India using high-quality patient-centered, primary care

• Thus far, there has been two years of in-depth

involvement focused on operations, quality, care pathways, and provider education

Johns Hopkins- HCL Healthcare Model

Services

Ultrasound

TMT

Lab

Pharmacy Physio

Dietetics

ECHO

X-RAY

Specialists

Gynae

Pulmo

Dental

Ortho

ENT

Derma

Paed Core

GP Internal

Medicine

• 5 centres in Delhi NCR • Acute care, Chronic Care, and

Preventive care delivered in a collaborative multispecialty care delivery environment • All clinics are affiliated with Johns

Hopkins Medicine

• 4 Centres accredited by NABH

Triple Aim in Johns Hopkins HCL Model

Improving Patient Outcomes

• Clinical Pathways development supported by Johns Hopkins • EMR and analytics for longitudinal care management • Care coordination in collaborative, multispecialty environment

Improving Patient Satisfaction

• Convenient access: web, call, and patient portal • Johns Hopkins validated KPIs for tracking Patient Experience • Care reviews by Johns Hopkins clinical experts

Lowering Costs

• Preventive care programs, including early stage management of chronic diseases

• Convenient access for primary and specialty care ensuring early-stage comprehensive care

• Clinical pathways enabling efficient, evidence-based care

1

2

3

Early Experience Is Promising • Family physicians, specialists, diagnostics and pharmacy all under

one roof to meet the access needs of the time challenged urban middle class

• 25,000+ patients serviced on a regular basis with 80% reporting highest level of satisfaction

• Corporate health programs covering 10,000+ customers through in-campus preventive and promotive health programs

• Innovations in the payor models can accelerate the adoption of the triple aims.