testing population health models of care

Testing Population Health

Models of Care

Claire Cordeaux: Executive Director, Healthcare

Brittany Hagedorn: U.S. Healthcare Lead

_________

SIMUL8 Corporation | SIMUL8.com | [email protected]

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Presenters

Brittany Hagedorn US Lead Healthcare, SIMUL8

Claire Cordeaux Executive Director, Healthcare SIMUL8,

background UK NHS, original developer of

Scenario Generator


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Agenda

• Strategic planning for health delivery

networks

• Understanding an attributed population

• The healthcare delivery network as flow

through the system

• Testing new models of care: impact on

finance and capacity utilization

• Creating the business case


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What is population health?

Noble, D Improving population health one person at a time? Accountable care organisations:

perceptions of population health—a qualitative interview study, BMJ Open 2014


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Planning Services for an

Population

• Who is in my attributed population?

• What are their service needs, based on

demographics and disease prevalence?

• How do we make sure we can meet the

demand without excessive cost?


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Whole System Analysis

Understand the

Population

Flow through care

model

Capacity Utilization & Cost of Care

• What is our current state?

• How do we implement best practices?

• What are the financial and clinical impacts of a new

care model?

• Where am I going to have high/low capacity

utilization?

Click to edit Master title style


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ATTRIBUTED POPULATIONS

Understand the

Population


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Characterizing a Population

1. Population Size

2. Demographics

3. Disease Prevalence


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Population Size (Senior Care)


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Age-banded disease prevalence


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Demographic Effects

(Maternity Care)

Population

1.17m

Conception rate by

female age-band

Annual births @ 13,000

% split for uninsured

etc.

annual growth

+ 3.6%


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• A state transition model considers the likelihood of a

particular patient moving between acuity levels.

• Severity and number of conditions determines which

services are required by that individual patient.

Disease Prevalence

(Chronic Conditions)



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FLOW THROUGH A SYSTEM

Examples

Understand the

Population

Flow through

care model


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How does the population interact

with health services?

• From the first point of contact

• Flow through services for a particular care

bundle or disease progressions

• Emergency and/or scheduled

• Patient behaviours are influenced by

– Lifestyle

– Distance to service

– Payor/insurance

– Health need


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Dementia Care


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Hepatitis C

Simulated Progression Actual Disease Progression


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Standard Maternity Pathway


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High Complications for Uninsured



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TESTING NEW MODELS OF CARE

Avoiding Costly Maternity Complications

Understand the

Population

Flow through care

model



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Reaching Uninsured Mothers

• Toronto has a population of uninsured

maternity patients

• They have poor access to proper prenatal

care, and thus experience high rates of

complications

• These patients are eventually served, at a

high cost when complications arise


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Maternity Bed Capacity

• 180 beds • Length of stay 2-15 days C-section, 1-5 days vaginal

48% utilization • Minimum delays


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Impact on capacity if no uninsured?

- Less 1 % utilization - Less $400k


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Impact if 5% fewer elective C

sections?

- Less 2 % utilization - Less $37k



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Costing reduction of unscheduled admissions by increased access

to primary care

Understand the

Population

Flow through care

model



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Toronto Food Bank To reduce ED visits Mt. Sinai hospital

partnered with the local food bank.

ED visit costs

$1.16m


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Hypothesis to Test

• Goal: increase access to health services for

food bank users and reduce ED visits from

this group ($1.1m+)

• What if a senior nurse service was provided

direct to Food Bank users?

• How many appointments?

• How long will users wait?

• If they wait too long, will they attend the

ED?

• What is the cost?


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Care Model Change

Scenario • 4,676 visits per year

• 1 nurse – operating 48 hours a week

Cost Implications • 1 hour (cost of $100) per new appointment,

• 15 minutes ($50) follow up appointment

• Emergency Room visit $500

If patients have to wait more than 24 hours to see a

nurse at the food bank, they will revert to visiting the

ER.


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Business Case

ED visits reduced Costs reduced overall (including nursing, mental health services and primary care) to $850k Saving $300k


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Add a second nurse

• Reduces overall costs to $830,850

• Fewer ED visits

• More nurse consultations



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Reducing Emergency Admissions by Seniors

Understand the

Population

Flow through care

model



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Urgent Primary Care

• As the population ages, there is greater

need for unscheduled care.

• Access to urgent primary care:

– Reduces emergency visits.

– Reduces inpatient admissions.

– Avoids readmission penalties.


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Hypothesis: 24/7 Primary Care

• By creating a 24/7 service, primary care can be

provided for seniors with acute care needs

• Assumptions:

– To avoid an ER visit, 3 primary care visits are needed,

over 3 days, 10-60 minutes per visit

– Staffed by experienced nurses and therapists


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Clinical Assumptions

• Clinical review indicated a potential avoidance of

4,855 emergency visits

• Rerouting to Primary Care Locality Hubs:

– 50% of ambulance calls

– 50% of care home

– 50% of out of hours

– 50% of primary care


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Simulated Pathway

Cost of admission £23m

Bed occupancy 318-412 ave 376


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Validation Simulation Historical Data Ratio

Elective admissions 1,813 1,810 1.00

Day case 7,196 7,233 0.99

Regular attenders 155 158 0.98

First outpatients 53,657 53,692 1.00

First telephone outpatients 3,322 3,321 1.00

Follow up outpatients 199,394 200,786 0.99

Follow up telephone

outpatients 6,639 6,637

1.00

ED attendance 16,181 16,456 0.98

Walk in attendance 5,644 5,569 1.01

Emergency admissions 10,467 10,353 1.01


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Year 1 Impacts

Total Service Volumes

£7m savings

Bed occupancy 355-318 ave 273


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Year 1 Staff Utilization

With 5 FTEs on call 24/7, the anticipated patient volumes

would result in 85% utilization. This is adequate staffing for

year 1.


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5 Year Volume Projections

Existing vs New models of care


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5 Year Staff Projections

At the end of year 2 resources start to struggle to keep up

with demand, and the service will become unmanageable

by year 3.

One additional FTE 24/7 (equivalent of 3 staff), hired in

year 3, will bring service levels back in line with access

targets.



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CONCLUSIONS

Understand the

Population

Flow through care

model



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Key Take-Aways

• Providers are taking on increased financial risk

for patients’ utilization of services

• Payors need to understand the financial impacts

across providers for attributed population

• Simulation enables you to

– Evaluate investments in a risk-free environment,

– Reduce financial risk,

– Improve clinical outcomes, and

– Manage healthcare costs per patient.


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• Strategic planning for healthcare delivery networks

• Answer system wide questions quickly to inform

strategic decisions

• Pre-built pathways of care

• Pre-populated data for immediate scenario testing

• Developed with NHS Institute UK

• 80% of UK NHS, Europe, Canada, Australia, Qatar

Simulation Software


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Benefits of Scenario Generator

• Validate strategic decisions

• Minimal historical data requirements

• Quick to learn and understand

• Complete an evaluation in under 4 days

• Engage stakeholders through visualization


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4 Day Challenge

• Provide us with your new model of care to

test and high level data

• We will provide you with the results

• 50% discount to first ACO applicant


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QUESTIONS

• Please forward any topics you would like

to see covered to [email protected]

• Continue the discussion on SIMUL8 in

Health – LinkedIn Group

• July Workshop – Simulating Bed Capacity

mailto:[email protected]



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QUESTIONS & DISCUSSION

Understand the

Population

Flow through care

model


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