Does patient engagement result in more appropriate utilization?

Does Improving Patient Engagement Result in

More Appropriate Utilization?

Webinar 1 in a 3-part series

Thursday, March 24, 2011

Vermedx Proprietary Information

Today’s speakers

• Christine Dunn, Moderator

• President and Founder, Savoir Media

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• Benjamin Littenberg, MD

• Chief Medical Officer, Vermedx, Inc.• Henry and Carleen Tufo Professor of

Medicine• University of Vermont


About VERMEDX

A healthcare informatics company created by primary care physicians to improve the

care and reduce the cost of care for patients with diabetes in the primary care practice

Platform developed by technologists and clinicians from University of Vermont

Platform and results validated by an NIH funded clinical trial of 7,400 patients over a 5

year period

Company Background

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To improve care and reduce costs through technology that enables physicians to

better engage their patients.

Our Mission

About VERMEDX

4


Agenda

1. State of the Industry for Patient Engagement

2. Provider Use Cases

3. Impact and Demonstrated Results

4. Questions & Answers

5


State of the Industry

Review what published research has established about how patient engagement improves the overall clinical experience and

what that means for providers.

Objective

6


Patient Management

Emphasize the patient• Continual “dialogue” between provider and

patient• Prepared encounters

Supporting self-care• Data transformed into actionable intelligence

Activated patients• Adherence between visits

Low cost, high quality

What does engagement mean?

Engage & Activate

Reinforce Behaviors



Patient centered orientation• Communication• Self-care• Shared decision

making

Comprehensive Team based

care

Care that is coordinated

Superb access to care

System based approach to quality and

safety

Engagement in the PCMH

Source: www.pcmh.ahrq.gov/.../FINAL%20Patient%20engagement%20decisionmaker%20brief.pdf

Five Pillars of the Patient Centered Medical Home



Minimize barriers to timely and effective action

Involve patients in practice improvement

Patient advisory councils

Regular assessments of patient engagement

Patient Engagement in the ACO

Source: Society for Participatory Medicine

ACOs shall define processes to promote patient engagement



Manage Health from a

Population Perspective

Enhance and Individualize

the Care Experience

Control Unnecessary

Costs

IHI Triple Aim

Source: Adapted from the Institute for Healthcare Improvement



Organizational

modelsCare models

Reimburse-

ment

mechanisms

Legislative

Takeaway Points

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Patient engagement is a core theme of any and every major initiative in health care today


Use Cases

Discuss how large physician-lead groups have implemented technology solutions that

better prepare both providers and patients for more effective clinical encounters

Objective

12


Use Case #1Overdue for Test

Lost opportunities to improve

disease control

Lost opportunity to

engage patient and

PCP in other health issues

Lost visit and laboratory revenue

Low achievement

of P4P or other

incentive goals

Impact

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1 Source: Elizabeth A. McGlynn, Ph.D et al. The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine 2003; 348:2635-2645

40-50% of patients are overdue for any single recommended test 1

Root causes

Complex testing

regimens Lack of reminder systems

Out-of-sight

patients


• Personalized• Culturally appropriate• Specific and actionable

Use Case #1Overdue for Test

Automated reminders to

practice

Standing orders

Automated patient letters from the

provider

Engages patient and practice

Motivates action

Proven to increase recommended

testing by 17% to 74%

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Laboratory Test Registry


Use Case #1 Provider & Patient Reminders

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Use Case #2Out of control test result

Poor patient outcomes

Increased complications

Low achievement

of P4P or other

incentive goals

Impact

16

50% of patients are out of control for any given parameter at any given time

Root causes

Poor patient awareness

Low patient motivation

Reluctance to increase treatment intensity

Out-of-sight patients


Use Case #2Out of control test result

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• Personalized• Culturally appropriate• Specific and actionable

Flow sheets to providers

Automated patient letters

from the provider

Engages patient and

practice

Motivates action

Laboratory Test Registry


Use Case #2 Flow Sheet and Patient Alert

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Use Case #3Population Management

Poor quality of care:

process and outcomes

Low achievement of P4P and other goals

Avoidable emergency and hospital

visits

Impact

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Providers are trained to manage the one patient in front of them at that time

Lost-to-follow-up is a big problem

Out-of-sight…

Chronic disease generates preventable acute illness


Use Case #3Population Management

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Summary of overall performance (“report card”)• Identify areas for improvement within the practice

Lists of specific diabetic patients (“population roster”)• Identify patients needing attention from provider, nurse,

case manager, diabetes educator, etc.

Roll-ups at various levels:• Individual provider• Clinic• System-wide

Available to case managers, etc.

Population Reports


Use Case #3 Population Report Card and Registry

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Use Cases

Routine visits Early Stage Onset Population Health Management

Takeaway Points

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Patient engagement can (and should) be part of fundamental practice patterns


Impact of Health System Changes

Anticipate the impacts - risks and rewards - of pay for performance and health care reform

on how providers and patients interact

Objective

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ACOs

PCMH

P4P

Capitation

ACOs, Medical Homes, Payment Systems, etc.

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• Prominent role as coordinator of care

• Proxy models for clinical improvement through financial mechanisms

• Reemerging as a vehicle for aligning (?) payment and clinical performance

• Greater responsibility for operational and financial risks



Quality (process and outcomes) rather than procedures and volumes (E&M)

Greater transparency of practice and provider performance

Greater financial dependence on outcomes measurement

ACOs, Medical Homes, Payment Systems, etc.

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Mortality

Function

Symptoms

Satisfaction

Cost

Major OutcomesMajor Emphases



1. Patient engagement leads to fewer hospital and ER visits

2. Patient engagement leads to reduced costs per event

3. Patient engagement leads to lower overall costs

Theses

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Impact of Health System ChangesEvidence from a controlled trial

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Source: Khan S, et al. The Effect of the Vermont Diabetes Information System on Inpatient and Emergency Department Use: Results from a Randomized Trial. Health Outcomes Research in Medicine 2010 1:61-66.

All < 65 65>-45%

-40%

-35%

-30%

-25%

-20%

-15%

-10%

-5%

0%

-15.0%-13.3%

-22.2%

-27.7%

-10.8%

-41.7%

AdmissionsER Visits

Patient engagement leads to fewer

hospital and ER visits


Impact of Health System ChangesEvidence from a controlled trial

Source: Khan S, et al. The Effect of the Vermont Diabetes Information System on Inpatient and Emergency Department Use: Results from a Randomized Trial. Health Outcomes Research in Medicine 2010 1:61-66.

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All < 65 65>-45%

-40%

-35%

-30%

-25%

-20%

-15%

-10%

-5%

0%

-10.5% -10.4%-13.3%

-26.7%

-14.7%

-39.0%

Total IP ChargesTotal ER Charges

Patient engagement leads to reduced

charges


100

200

300

400

500

Cla

ims

Pai

d pe

r M

onth

($)

-48 -36 -24 -12 0 12 24 36 48Months Since Start

Control

Active

Effect of Vermedx on Total Claims Paid

Impact of Health System ChangesEvidence from insurance claims

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Patient engagement leads to lower overall

costs

Source: Littenberg B, et al.The Vermedx® Diabetes Information System Reduces Health Care Utilization. Am J Managed Care 2009 15:166-170.



Emergency Room Use Inpatient Admits Total Cost Length of Stay?

Takeaway Points

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Costs and Utilization can be statistically linked to patient engagement


Summary Points

Patient engagement is at the root of almost every major change in healthcare today

Medical groups need to focus on the patient as part of the process, not as an input to or output from the process

When the system works, the curve can be bent

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Page 32

Q&A

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Thank you for joining us todayPlease join us for these upcoming webinars

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Title: Pay for Performance in Primary Care: A Roundtable Discussion

Date: Thursday, April 28, 2011Time: 12:00 PM - 1:00 PM EST

Title: Managing Chronic Conditions in Primacy Care Settings: A Review of Best Practices

Date: Thursday, May 26th 2011Time: 12:00 PM - 1:00 PM EST


For more information:

Jim RoseSenior Vice President, Business DevelopmentEmail: [email protected]: (703) 537-5050

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mailto:[email protected]

Does patient engagement result in more appropriate utilization?

Health & Medicine

patient engagement result

patient engagementsource

patient managementwhat

provider patient reminders15

industrypatient engagement

actionableuse case

test14laboratory test

quality of health care