Planning a Course to Population Health Management · Planning a Course to Population Health Management January, 2015. Introducing LifeBridge Health 5 Sinai Hospital Levindale Hebrew

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Agenda — Approximately 45 Minutes

• 30-35 minutes: Tressa Springmann, VP/CIO, LifeBridgeHealth

• 10-15 minutes: Q&A w/Tressa Springmann

Planning a Course to Population

Health Management

January, 2015

Introducing LifeBridge Health

5

Sinai Hospital

Levindale Hebrew

Geriatric Center

Northwest Hospital

LifeBridge

Health & Fitness

LifeBridge Health

Physician Enterprise

LifeBridge Health

Commercial Division

$1.4 Billion in

Gross Patient

Revenues

1,400 Physicians

1,285 Licensed

Beds

8,000 Employees

So much more than hospitals……

6

PRIMARY

CARE,

PREVENTION,

and

WELLNESS

AMBULATORY

CARE

ACUTE CARE,

TERTIARY

CARE

POST-ACUTE

CARE

Maintain and improve health

● Favored by the greatest number of patients and physicians

● Compassionate, high quality, cost-effective health services

● Provide undergraduate and graduate medical education

● Regardless of age, race, ethnicity, emphasizing community

concern for all

Mission Statement

• Changes to private insurance, e.g.,

Young adults on parents’ policies to age 26

Prohibit lifetime monetary caps

Minimum medical loss ratio (i.e. 80% of Premium must be on

claims)

• Closes the Medicare prescription “doughnut hole” (i.e. out of pocket

at 100% between about 3K and 6K of medication costs)

• Expands coverage + imposes individual mandate in 2014

Expands Medicaid to 138%* of FPL from Maryland’s 116%

Exchanges

• Promotes the transition from volume to value

Bundled payments, Value based purchasing, ACOs

Most relevant to us as a health system

ACA High Level Impacts

8

• Source: Marketing and Planning Leadership

Council interviews and analysis.

Transition from Volume to Value

Key AttributesBundled

PaymentsValue-BasedPurchasing

Accountable Care Organizations (ACOs)

Definition

• Single payment to cover hospital, physician and post-acute needs

• Providers gainshare on savings

Rewards or punishes hospitals based on performance

• Network of providers collectively accountable for the cost and quality of care for a population

• Reimbursed through shared savings or capitation

Purpose

Incent all providers to coordinate care

Create link between reimbursement and clinical quality, patient satisfaction

Reward providers for reducing total cost of care

Change From Today

Small Small Big

9

ACOs Have Three Main Levers To

Manage Costs

10

• Source: Health Care Advisory Board interviews and analysis.

Retain Care Within Your NetworkPopulation Health

Manager

Prevent Utilization through Medical Management

1

2

3

Strategies for Risk-Bearing Providers

Example:

High-risk patient care

management (e.g., medication

management, care transitions

management)

Example:

Retaining care for employees

within your hospital

Example:

Lowest cost nursing home

Direct Care to Low-Cost

Partner

• Maryland’s new waiver has many of the same goals as the ACA

• The basic constructs of the Modernized Waiver are: (STATE GOALS)

– Limit growth in Hospital Revenue (inpatient and outpatient) to

3.58% per Capita through a Global Budget

– $330 million in Medicare savings over 5 years

– Reduce MHACs by 30% over 5 years

– Reduce rate of readmissions to the National average

• Renewal after 5 years with favorable performance and expansion to

include physician and post acute services; if not renewed, revert to

the national system

• Maryland only state with Medicare Waiver

• Hospital rates set by Healthcare Cost Review Commission (HSCRC)

Maryland Modernized Medicare Waiver

11

The key aspects of the Global Revenue

Budget are as follows:– Fixed revenue base

– Age and population adjustments as determined by

HSCRC policy

– Adjustments for market share changes as

determined by HSCRC policy

– Adjustments for Potentially Avoidable Volume

(PAUs)

Global Budget Model

12

Maryland’s Waiver is Focusing Health

Systems on Strategy 1

13• Source: Health Care Advisory

Board interviews and analysis.

Retain Care Within Your NetworkPopulation Health

Manager

Prevent Utilization through Medical Management

1

2

3

Strategies for Risk-Bearing Providers

Example:

High-risk patient care

management (e.g., medication

management, care transitions

management)

Example:

Retaining care for employees

within your hospital

Example:

Lowest cost nursing home

Direct Care to Low-Cost

Partner

Improve Quality & Reduce Costs Delivering High Value Care

• Core Measures

• MHACs

• Prevention Quality Indicators (PQIs)

• Prevent Readmissions

Build Centers of Excellence

Advance Population Health While Addressing the Social

Determinants of Health

• Ensure right level of services based on acuity

• Improve access to preventive care, including primary and

chronic care management

• Enhance community programs and social services

connections in our community to support our

neighborhood’s health development

LifeBridge Strategy

Program Care Delivery Initiatives

Admission /

Discharge

Revamp our patient education & discharge program ensuring patients are covered until connecting with their

PCP; coordinate with chronic care centers and FQHCs; increase the number of patients that are discharged

with their medications

Ensure completion of Present on Admission testing including urinalysis on every patient to clearly identify UTIs,

etc and ensure accurate present on admission documentation

HospitalistsComplete hospitalist redesign and require best practice care across the inpatient care continuum

(Implementing accountable care unit model)

IntensivistsComplete intensivist redesign and require best practice care across the inpatient care continuum (house-wide

on-call coverage implemented)

Medication

Reconciliation

Engage pharmacy team throughout the continuum from ED to inpatient units to ensure medication

reconciliation and education as well as bedside and home delivery of medication (Bedside and home delivery

programs, med education program, new ED pharm tech)

Nurse Rounding Continue nurses rounding hourly on every patient and performing shift report at the patient’s bedside

Observation

Status

Use observation status to focus on appropriateness of admissions and prevention of 30-day readmissions (14-

bed REU)

Palliative CareComplete the recruitment of the palliative care team and ensure hospice coordination (palliative care

coordinator and palliative risk assessment)

Chronic Care

Clinics

Initiate Chronic Care Clinics at Sinai and Northwest for CHF, COPD/Asthma, Diabetes, HIV, and Sickle Cell

Disease using multi-disciplinary teams

Urgent CareFully engage with Express Care in referrals for lower cost of care delivery and efficient reception of patients

needing more care

Over 20 Initiatives Currently Underway

Program Care Coordination Initiatives

Hospital

Network

Aggressively leading the way on creating Advanced Learning Collaborative to explore partnerships around

population health initiatives across a network of hospitals.

Clinical

Integration

Submitted our application for MSSP ACO with final decision pending by end of CY2014.

LifeBridge Physician Network (LBPN) created to engage over 400 loyal physicians around delivering clinically

integrated care.

Home CareExpand home care resources to address a significant increase in visits and invest in unfunded care to minimize

avoidable readmissions

Sub Acute/

SNF

Ensure Sub Acute and continuum care partners have a care coordinator to assist in pulling patients through the

system and preventing bounce back (Provider of Choice network, Adult Day Care)

FQHC

Engage our FQHC partners to reroute unnecessary ED visits and provide increased access to primary care

Ensure Sinai’s FQHC partner, Park West, meets LBH requirements for patient care or replace with another FQHC

partner

Strengthen Chase Brexton relationship at Northwest Hospital to ensure care coordination

Care

Coordination

Target high utilizers of services with more effective care management and outpatient navigation

Ensure that a care navigation team follows up on discharged patients, focusing on frequent utilizers and seniors

Implement ED Navigation programs to address care 24/7

Population

AnalyticsUnderstand and segment high utilizers of healthcare services

Cont’d

CRISP – Maryland’s HIE

18

CRISP is a regional health information exchange (HIE)

serving Maryland and the District of Columbia. We are a

not-for-profit organization advised by a wide range of

stakeholders who are responsible for healthcare

throughout the region. CRISP has been formally

designated as Maryland’s statewide health information

exchange by the Maryland Health Care Commission.

Chesapeake Regional Information Systems for our Patients

Technology Supporting Our Global Budget

19

High Utilizers

Potentially Avoidable Utilization

Care CoordinationQuery PortalEvent Notification

Utilization by Census Tract Map

All Payer All Patients Medicare Medicare % High Users% of Total

Charge Category

Patients 81,058 78 0.1% 1,686 2.1%$50,000-$100,000 Visits (IP+OP) 180,189 701 0.4% 9,810 5.4%

Charges (IP+OP) $551.5 M $17.3 M 3.1% $114.9 M 20.8%

• Limited to Patients with > 2 IP encounters for the last 12 months

• Limited to Total Charges (IP + OP) and excludingAmbulatory Surgery encounters

394 0.5%$100,000 -$150,000 3,780 2.1%

$47.1 M 8.5%

181 0.2%

≥ $150,000 1,786 1.0%

$40.9 M 7.4%

Identifying High Utilizers

Cross-Facility Super-Utilizer

Analysis

22

Inter-Hospital Readmissions

23

Care Coordination

HIE Integration with EMR

Encounter Notification Service

26

ENS enables CRISP participants to

receive real-time notifications when one of

their patients or members is hospitalized.

The alerts are generated from the “ADT”

messages CRISP receives from all

Maryland hospitals.

There are currently over 3,000,000

patients subscribed to with in ENS resulting

in over 6,000 notifications per day

If an individual has opted out of the HIE,

an alert will not be triggered.

Also:

Document Routing through

ENS - recipients can choose to

receive structured documents

upon patient discharge.

Auto-subscription – hospitals

can choose to automatically

subscribe (CRISP will use the

ADT discharge message) for a

window of time.

Population Health Tools – Broad Strokes

End of CY 2014-Decision on IT vendor

0-6 months Build Platform and Acquire Data

6-12 months Health Information Exchange (HIE)

9-12 months Smart Registries Solution

12-15 months Care Management Solutions/ Population Health Analytics Capabilities

Timeline for Population Health Information Technology

Implementation

**Already assuming risk of our employed population and families (10,315) delivering more effective care delivery and incorporating on-line risk assessment**MSSP effective January 1, 2015

Population Health Tools –LBH near term

Connect

Hiding in the department won’t make these mandates go away

Collaborate

If you’re engaged you’re aware

Control

Lead

The Role of the CIO

29

Where we DON’T want to land!

31

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Q&A

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Thank You!

• Thanks to our featured speaker: Tressa Springmann!

• You will receive an email when our archive recording is ready. (Separate registration is required)

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