Ken Buback, MA, CPCC (USA)

Transcription

1 Ken Buback, MA, CPCC (USA) Brian Marsh, MBA, PCC (USA) Express Coaching: A Breakthrough Research Study on Improving the Health Status of Diabetic Patients 1

2 Agenda Overview of organization and managed care Building the business case Express Coaching process Program administration Results and outcomes Summary Questions 2

3 Overview of the Organization and Managed Care 3

4 About Sutter Health Northern California Not-for-profit 26 hospitals 3,500 physicians 100+ communities Regional leaders in: pediatric, obstetrical, heart and cancer care 4

5 About Sutter Connect Subsidiary of Sutter Health Healthcare administrative and support services Our key competencies Integrative: bridges across multiple clients 5

6 Sutter Connect Vital Statistics Accounts Receivable Charges $650,000,000 Managed Care Incoming Cap $1,165,000,000 Commercial Capitated Lives 451,000 Medicare Advantage (Global) 34,352 Annual Transactions FFS Claims Billed 3,039,303 Invoice Payment Transactions 4,702,133 MC Claims Processed 2,093,000 Service & Support Calls 533,000 6

7 Managed Care Defined Systematic approach to healthcare Link between payers and providers and patients Providers are prepaid for services Motivated to manage risk by preventing costly care Incentives for improving quality (Pay for Performance) 7

8 Disease Management Definition A system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant. -Disease Management Association of America 8

9 Purpose of Disease Management? Improve patients quality of life A win-win in managing cost Physician Performance Incentives Mandated by national quality standards 9

10 Interventions Multiple Illnesses Medical Management Challenge Poor control Level of Illness Fair Co ntrol Case Mgmt Intervention Specialty Referral Coachin g Reporting On ly Self - management/ behavior modification recommended for poor and fair control Excellent Cont rol Monitoring Only Pre-Diabetes Not identifie d 10

11 Sutter Connect Niche Access to patient data Robust data analysis Pharmacy Data Medical History Lab Data Population Segmentation 11

12 Coaching/Disease Management Program Components Coaching Participants Lab Testing Physician Reports Disease Management 12

13 Building the Business Case for Disease Management Coaching 13

14 Diabetes Statistics $116 billion direct medical costs Additional $58 billion indirect costs $11,744 /yr AVG cost (per person) 2.3 times greater costs than non-diabetes 38% of patients incur 70% of total cost 18% of healthcare costs are incurred by patients with diabetes 2007, American Diabetes Association 14

15 Diabetes Statistics 23.5 million Americans (7.8%) have diabetes 5.7 million undiagnosed 10.7% of Americans over 20 years 23.1% of Americans over 60 years 2007, Center for Disease Control 15

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17 A Compelling Business Case Disease Management grant Voluntary (medical group) participation Sutter Connect s unique position Offered interdisciplinary approach Unique executive competence 17

18 Goals Improve clinical condition of patients: Reduction in HgbA1C levels Reduction in LDL-C levels Slow rate of increase in patient acuity 18

19 Express Coaching Process 19

20 The Sutter Connect Plan Cutting edge telephonic coaching program Complement physician s work Target specific population Staffed with certified coaches Focus on (patient) self-management Measure the change in diabetes control (HgbA1c) 20

21 Sutter Connect Approach to Disease Management Coaching Patient-centered Non-judgmental Compassion without colluding Engage values Accountability Non-prescriptive Patient self-management 21

22 Benefits of 10-Minute Express Coaching Model? Simple and straightforward Optimizes productivity Cost-effective High-impact, low-cost Scalable 22

23 Driving Factors in Developing the Model Economic factors PMPM cost (per member per month) Client-relevant outcomes 23

24 Express Coaching Process Identify Level of illness Invite/Enroll Letter/phone call Discovery 30-minute session Phase I Coaching 8 weekly 10-min. sessions Phase II Coaching Monthly maintenance 24

25 Effective Coaches Skill Set Empathetic without Collusion Listening & Synthesize Specific Accountability Compassion Choice, Commitment, Wellness vs. Illness Non- Judgmental Expose Barriers Connect Values to Behavior 25

26 Coach Selection Criteria Coach training / certification Coaching experience Willingness to utilize Express Coaching model Inspiring and motivating Coaching vs. non-clinical expertise 26

27 Coach Training Coaches Training Institute Wellness Coach Training LAD EPICS Basic overview of Diabetes 101 Regular on-site coach training/ development 27

28 Coaching Model Unifying Force Foundation Simple L.A.D. Listen Appreciate Design 28

29 Coaching Model Higher expectations for our patients Unifying Force Foundation Simple Wellness L.A.D. Change Process Community Diagnostic Listen Appreciate Design 29

30 Coaching Model Higher expectations for our patients Teachable Moments Sustainability Self-Reliance Community EPICS Wellness Empathy, Planning, Individualized, Community, Sustain Change Process Community Diagnostic Unifying Force Foundation Simple L.A.D. Listen Appreciate Design 30

31 Exercise Knowledge & Information Supportive Relationships Weight Diabetes Wellness Nutrition Medication Lifestyle Stress 31

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33 Typical Coaching Call Brief check-in (e.g. last blood sugar reading/current state self-assessment) Follow-up on goals/accountability Discuss barriers, concerns, successes, etc. Set goals for/accountability coming week 33

34 Group Discussion What critical observations do you have? List some pros / cons of this model. What are the limitations of the model? What are other applications of the model? 34

35 Program Administration 35

36 Coaching/Disease Management Program Components Coaching Participants Lab Testing Physician Reports Disease Management 36

37 Organization Chart 37

38 Staff 4 Coaches Program Manager Administrative support Capacity 4 coaching sessions per hour 300 coaching sessions per week Structure 30-minute Discovery call Eight 10-minute Weekly sessions Ongoing Monthly sessions Monitor/Re-enroll 38

39 Participant Identification & Enrollment Physician Feedback and Report Phase I & II Program Administration Record Keeping Management Coaching Patient Letters (lab slips) 39

40 Timeline Wave 1 10/2005 Wave 2 1/2006 Wave 3 4/2006 Wave 4 7/2006 Wave 5 10/2006 Wave 6 1/2007 Wave 7 4/2007 Wave 8 7/2007 Wave 9 10/2007 Wave 10 1/2008 Wave 11 4/

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42 Results and Outcomes 42

43 Population Studied Coaching Group 250 patients received coaching Study Population Identified 4500 patients with diabetes Control Group 2500 patients received traditional medical treatment Cohort Group 1750 patients counterpart to Coaching Group 43

44 78% Patient Satisfaction with Disease Management Coaching 73% 86% 81% Diabetes Lipid 61% 51% Very Satisfied Would recommend Set/achieve health goals

45 Patient Satisfaction Trend 89% 76% 78% 82% 87% 68% 63% Diabetes Lipid 85% 79% 76% 76% 74% 71% 71% 71% 65% Q1-06 Q2-06 Q3-06 Q4-06 Q1-07 Q2-07 Q3-07 Q4-07 Q1-08 Q2-08

46 65% Monitor Blood Sugar More Regularly 55% 52% 48% 45% 45% 46% 37% 38% 40% Q1-06 Q2-06 Q3-06 Q4-06 Q1-07 Q2-07 Q3-07 Q4-07 Q1-08 Q2-08

47 8.00 Coaching Group: Improved A1c Scores! Coaching Group (6% improvement in test results) 7.70 Average A1c Score Control Group (no improvement) Cohort Group (3% improvement) 7.00 Time Period 47

48 44.4% Better Diabetes Control in Coaching Group: 51.5% 44.6% 53.7% 55.2% 47.2% 41.4% 49.2% 42.6% 43.6% 43.6% 46.6% Poor Control (A1c>9) Good Control (A1c<7) 15.2% Affiliate % With coaching 13.1% Affiliate % With coaching Affiliate 14.4% % 13.9% No coaching Baseline Year 1 Year 2 9.0% 8.4% Affiliate 4 No coaching 12.3% 12.6% 11.8% Affiliate 1 With coaching Affiliate 2 With coaching Baseline Year 1 Year 2 Affiliate 3 No coaching Affiliate 4 No coaching 48

49 Coaching Group: Better P4P Rates 90.76% 82.59% 82.43% 72.48% 69.20% % 49.82% 39.62% 31.84% 23.73% 94.55% 85.74% 90.18% % 65.02% 57.34% 55.45% 46.30% 25.58% 18.73% A1c Testing LDL Testing LDL < 130 LDL < 100 Poor Control 49 Patients With Coaching All Patients

50 $ Coaching Group: Decrease in Cost of Care! $236 $ Coaching Group -11.5% decrease in medical costs $ $209 $ $167 Control Group - 7.6% increase in medical costs $176 $ $164 Cohort Group - No change in cost of care $166 Does not include fees for hospital/emergency care 50

51 Cholesterol Trend for Patients Working with Coach LDL Cholesterol Baseline at 3 months at 6 months at 9 months at 12 months 51

52 Summary 52

53 Clinical Findings and Conclusions Coaching group showed: greater improvement in diabetes control (A1c testing) greater reduction in cost of care (PMPM decreased 11.5 %) Better performance in all P4P measurement areas Patient perceived benefits Physicians continue to fund/support Effective with other conditions 53

54 Coaching Findings and Conclusions Dramatic impact from brief sessions Coaching as a viable product line Simple and structured works best Fundamentals of coaching endure stakeholder priorities Balance productivity and nurturing Offers diversity in field of coaching 54

55 Benefits Coach Insights Challenges, tips and traps Coach as entrepreneur or employee Expect the unexpected Reaching the next level 55

56 Critical Success Factors Quantify, link and align priorities Top level support / buy-in Coach buy-in Eliminate existing bias Integrate and systematize Endowment funded Courage to try something different 56

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58 Presenter Contact Information: Ken Buback Chief Administrative Officer The ICF values your feedback. Please take a moment to complete a session evaluation form and return it to the room host located at the back of the room. Brian Marsh Program Manager Disease Management MarshB@sutterhealth.org 58