Reducing total cost of care in final version v3

Sutter Compass Connect

Syed S. Ali MD, MBA, SCC

Medical Director

Sutter Compass ConnectReducing the Total Cost of Care(TCOC)

All men by nature desire knowledge.

~Aristotle

Paradigm Shift

Edward Deming, Shigeo Shingo and others perfected the the Toyota production System(TPS) by bringing Statistical Process Control and quality to Japan. Lean as we know it today was born.

We would like to introduce another concept, Patient Activation Measure(PAM).

What lean was to the TPS, PAM would be to population management. With Lean already engraved in our DNA reduction of Total Cost of Care (TCOC) with PHM will be possible.

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What determines your health status?

Failed Strategies

Neither financial Incentives nor information strategies have proven to have sufficient power to change and sustain consumer behavior.

Chronic care models/medical homes emphasize patient- oriented care yet have had difficulty showing success in return on investment.

Self management support programs have shown little improvement in clinical outcomes for those with chronic illnesses.

Trying to find a predictive model to identify patients/consumers before they become high utilizers has been unsuccessful except for AIM, Palliative and Hospice care

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Paradigm shift

Points we will discuss today. How do you measure behavior and effect a change. PAM-Science behind the modality Using systematic measurement to target consumer

activation strategies. The concept of “activation” as an organizing construct to

increase consumer involvement in health. Illustrative data that show how activation levels are

associated with engaging in specific health behaviors. The strategy of measuring activation and calibrating both

the type and the amount of support for consumers is discussed as a way to improve current approaches.

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Paradigm Shift

Tailoring activation to the individual, group, and community level.

Behaviors that are more challenging for consumers are unlikely to be adopted among those who are less activated.

Encouraging behaviors that are more realistic for the individual given the level of activation can improve the efficacy of current efforts.

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The Patient Activation Measure (PAM) – 1. Knowledge– 2. Skill– 3. Confidence

PAM

Background on PAM

PAM went through various development stages. Defining the construct; Development and psychometric testing, including

reliability and validity testing; Determining whether the construct is changeable; Determining whether tailoring activation to specific levels

improve outcomes Psychometric analysis was conducted using Rasch

stochastic measurement models and methods (Andrich,1978; Wright & Masters, 1982; Wright & Stone, 1979), as well as selected classical test theory (CTT) and item response theory (IRT) statistics.

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• 13-question• Based on responses to the survey, each person is

assigned–Activation Score –Level

PAM

Patient Activation Measure (PAM) Items

When all is said and done, I am the person who is responsible for taking care of my health problems.

Taking an active role in my own health care is the most important thing that affects my health.

I am confident I can help prevent or reduce the problems associated with my health condition.

I know what each of my prescribed medications do. I am confident I can tell whether I need to go to the doctor or whether I can take care of

a health problem myself. I am confident that I can tell a doctor my concerns, even when he or she does not ask. I am confident I can follow through on medical treatments I need to do at home. I understand my health problems and what causes them. I know what treatments are available for my health problems. I have been able to maintain (keep up with) lifestyle changes, like eating right or

exercising. I know how to prevent further problems with my health condition. I am confident I can figure out solutions when new problems arise with my health

condition I am confident I can maintain lifestyle changes, like eating right and exercising, even

during times of stress.

Source: Copyright© University of Oregon. All rights reserved.

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Level 1 : May not yet believe that the patient role is important

– PAM Score of 47.0 or lower

Level 2: Lacks confidence and knowledge to take action– PAM Score of 47.1 to 55.1

Level 3: Beginning to take action– PAM Score of 55.2 to 67.0

Level 4: Has difficulty maintaining behavior over time– PAM Score of 67.1 or above

Meaning of #s

Better as

score rises

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Increasing Activation at Group Level

Delivery system could stratify their enrolled patient population by both clinical indicators [example blood pressure or cholesterol levels]as well as their activation level.

This allows for early intervention with patients who have clinical risk factors and who lacks skills to self manage [that is level1 or level 2].

This allows limited resources to be used efficiently. When employed throughout the organization economy of

scale would show real reduction in TCOC.

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PAM baseline vs Recent - Graph

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VR-12 Baseline vs Most Recent

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Impact effort Matrix

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High Impact High Impact

low effort High effort

Low Impact Low impact

Low effort High Effort

Greatest ROI

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Hospital admit

ERPAM

SCC

OB/GYNPedsF.P

PAM

InternalMed.PAM

AncillaryServices

PAM UrgentCarePAM

SNFPAM

Cost Avoidance

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Jan Feb Mar Apr May $-

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

0

50

100

150

200

250

300

350

400

450

500

67 68 78

118

87

Sutter Compass Connect Cost Avoidance(2015)

# of urgent visits to SCCDirect Cost ($1861/day)Total Cost ($3,485/day)

Assumptions:• 17% of patients are admitted from ED• Avg Direct Cost of ED visit = $515/visit• Avg Total Cost of ED visit = $911/visit

• Avg Direct Cost per patient = $1,861/day• Avg Total Cost per patient = $3,485/day• Medicare ALOS = 5.72

YTD Direct Cost Avoidance: $941,030YTD Total Cost Avoidance: $1,743,719