Senior Total Health Assessment CHCF/CIN Webinar … Multiple Medicare Health Assessment Requirements New: Annual health assessment for Medicare members Existing: “Welcome to Medicare”

Senior Total Health AssessmentCHCF/CIN Webinar

Matt Stiefel & Charlotte CristKaiser Permanente

Jan 23, 2013

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From Cost-Quality-Service to Triple AimFrom To

Cost Cost

Quality Service Care(Quality+Service)

Population Health

TripleAim

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The Case for Population Health Measurement

Individual care, engagement

Population care management

Population health surveillance

Research, evaluation

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Predictive Validity of Single-Q Health Status

“Predicting Mortality and Healthcare Utilization with a Single Question,”DeSalvo et al., Health Services Research 40:4 (August 2005).

“In general, would you say your health is…?

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Adding Self-Reported Health Data Can Improve Traditional Predictive Models• The addition of self-reported health data from the Health Status

Questionnaire improves the predictive power of the DxCG model for admissions, costs, and mortality, with some loss of specificity

– The percentage of variance explained increased by 3-9 percentage points, to 10-25%

– Sensitivity increased by an average of 31% – Specificity decreased by an average of 13%– PPV decreased by an average of 16%

Perrin NA, Stiefel M, Mosen DM, Bauck A, Shuster E, Dirks EM. Self-reported health and functional status information improves prediction of inpatient admissions and costs. The American Journal of Managed Care. 2011 Dec 1;17(12):e472-8. http://www.ajmc.com/articles/Self-Reported-Health-and-Functional-Status-Information-Improves-Prediction-of-Inpatient-Admissions-and-Costs/

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Example: Using Single-Q Health Status from HCAHPS Survey

Source: Robert Mangel, Ph.D., and Wenbin Mo, Ph.D., KP National Service Quality (unpublished data)

Data for all 2007 inpatient survey respondents, with 2.5 year f/u

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Multiple Medicare Health Assessment Requirements

New: Annual health assessment for Medicare members

Existing:“Welcome to Medicare” visit (Initial preventive physical exam)Health assessment of new Medicare Advantage (MA) members Initial and annual health assessment of SNP* membersMedicare Stars quality bonus (HOS survey-based- MA)Potential phase 3 “Meaningful Use” requirement

Section 4103 of Affordable Care Act covers an annual wellness visit and personalized prevention plan, including a required health risk assessment (HRA).

*SNP = Special Needs Plan

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Annual Wellness Visit (AWV) Final Rule for Section 4103 of ACA

Benefit: Annual Wellness Visit with Health Risk Assessment (HRA*) and Personalized Prevention Plan (PPP)

Affordable Care Act, Section 4103 / CMS Final Rule Section / Medicare Physician Fee Schedule for 2012

Required Elements of HRA: Demographics, Biometrics, Overall Health Status, Psychosocial risks, ADLs/IADLs, Behavioral risksEffective date: AWV: 1/1/2011; AWV with required HRA: 1/1/2012

Eligibility: All Medicare members

Time Limits: Once every 12 months beginning 12 months after Part B effective date, or 12 months after the “Welcome to Medicare” Visit (IPPE)

HRA Duration: Can take no more than 20 minutes to complete

Who can perform the visit? Any health or licensed medical professional, e.g. MD, NP, PA, CNS, health educator, or RD, under MD supervision

*At KP national level, called “Medicare Total Health Assessment” or M-THA.

10 | © Kaiser Permanente 2010-2011. All Rights Reserved.

January 25, 2013

Overview of CMS Requirements:HRA must be administered prior to or as part of the Wellness Visit to collect self reported health information

Must take no more than 20 minutes to complete

Requirements include collection of specific HRA assessment criteria

Provision of a specific and personalized screening schedule and intervention recommendations/referrals (Personalized Prevention Plan – PPP)

Must take into account specific communication needs, literacy and language requirements

Psychosocial risks (depression, anxiety, anger, isolation, pain)


January 25, 2013

Kaiser Permanente M-THA instrument includes:Self-rated physical and emotional health status

Frailty assessment to include report on ADL’s and IADL’s

Behavioral risks (tobacco use, physical activity, nutrition, oral health, alcohol consumption, sexual practices, motor vehicle and home safety)

Consideration for specific communication needs, literacy, language requirements and time to complete

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• PATHWAAY is a proactive, interdisciplinary outreach program to screen and address geriatric issues and ensure regulatory compliance

• Targets all Medicare patients annually who have not had a visit in the past year

• Identifies positive responses from screening in areas of greatest risk both clinical and financial (e.g., falls, medications, depression, UI, physical activity, advanced directive, malnutrition, pain, anxiety, etc)

• Structured chart review and proactive telephone encounter occurs prior to PCP visit. with RN (Senior Assessment Coordinator) for members self-identifying with gaps for frail, incontinence, mental health, nutrition, pain or frailty

• Care is delivered prior to visit with PCP including labs, assessment, med review with pharmacist if needed, RN call, etc.

The Colorado PATHWAAY Program (Proactive Assessment of Total Health & Wellness to Add Active Years)


January 25, 2013

PATHWAAY for Seniors KP-Colorado (KPCO)

Utilization of self rated health measures for predictive analysis

Specific regional interventions in place to

address care gaps

Creation of PPP in advance of office visit

Scoring of patient HRA responses to identify Care

gaps

Patient Wellness Visit

Scheduling of this visit triggers workflows to collect

HRACollect in advance of

scheduled visit

Utilize technology to collect HRA

(on line/IVR*)

Other language translations

*IVR = interactive voice response


January 25, 2013

New Medicare Members/New Member ModuleKPCO Approach - Volumes

2012 Medicare New Members

2012 Medicare Members lost

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KPCO Medicare THA Regional Launch Summary7/1/12 – 9/24/12

Positive triggers for Senior Assessment Coordinator (SAC) referral (Nutrition, Falls, UI, Mood, Pain, or Frailty) N=7896

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Medicare - Total Health Assessment

Thought the M-THA questions were easy to understand 100% Thought the M-THA took a reasonable amount of time 96%Thought the IVR was easy to use 83%Found kp.org entry very easy 72%Felt issues would not have been addressed otherwise 62%

Member Feedback

Source: National Department of Organizational Research, 2012


January 25, 2013

Discussion

Charlotte Crist, RN, Project ManagerWendee Gozansky, MD, MPH

Measurement of quality outcomes

Approach for those seniors not currently receiving wellness visits

Pilot use of care categories in scheduling provider (mid-level vs. physician)

Other populations consider some of these innovations for their workflows

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Resources

KP Senior Total Health Assessmenthttp://kpcmi.org/stha/ Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012.http://www.ihi.org/knowledge/Pages/IHIWhitePapers/AGuidetoM

easuringTripleAim.aspx

| © Kaiser Permanente 2010-2011. All Rights Reserved.

Senior Total Health Assessment CHCF/CIN Webinar … Multiple Medicare Health Assessment Requirements New: Annual health assessment for Medicare members Existing: “Welcome to Medicare”

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