CARE PATHWAYS. Allyson Ashley

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1 CARE PATHWAYS Allyson Ashley

2 WHAT IS A CARE PATHWAY? An explicit statement of the goals and key elements of care based on evidence, best practice, and patient s expectations and their characteristics The facilitation of communication among the team members and with patients and their families. The coordination of the care process by coordinating the roles and sequencing the activities of the multidisciplinary care team, the patients and their relatives. The documentation, monitoring, and evaluation of variances and outcomes. The identification of appropriate resources. International Journal of Integrated Care Volume 12 September 18, 2012

3 PURPOSE OF CARE PATHWAYS The aim of a care pathway is to enhance the quality of care across the continuum by improving risk adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. International Journal of Integrated Care Volume 12 September 18, 2012

5 EXAMPLES OF CARE PATHWAYS RANGE IN SCOPE FROM: Medication Utilization An evidence based practice such as Parent Child Interaction Therapy Breast Cancer detection through mammograms RESULTS IN: A Treat to Target Goal The Triple Aim (better help for individuals, better health for populations, and lower per capita costs)

6 CARE PATHWAYS USEFUL IN: 1. Managing care 2. Managing quality 3. Managing costs 4. Managing outcomes International Journal of Integrated Care Volume 12 September 18, 2012

7 WHEN TO CONSIDER USING A CARE PATHWAY PREVALENT PATHOLOGY IN THE CARE SETTING PATHOLOGY WITH A SIGNIFICANT RISK FOR PATIENTS PATHOLOGY WITH A HIGH COST FOR THE HOSPITAL PREDICTABLE CLINICAL COURSE PATHOLOGY WELL DEFINED AND THAT PERMITS HOMOGENOUS CARE EXISTENCE OF RECOMMENDATIONS OF GOOD PRACTICES OR EXPERT OPINION UNEXPLAINED VARIABILITY OF CARE POSSIBILITY OF OBTAINING PROFESSIONAL AGREEMENT MULTIDISCIPLINARY IMPLEMENTATION MOTIVATION BY PROFESSIONALS TO WORK ON A SPECIFIC CONDITION

8 Show Me Outcomes Missouri CMHC Healthcare Homes Progress Update

9 WHY CREATE BEHAVIORAL HEALTH HOMES 1. People with serious mental illnesses were dying 25 years earlier than their counterparts in the general population 2. People with serious mental illness were dying of chronic medical issues 3. Medications prescribed for serious mental illness were contributing to this problem

10 CHRONIC MEDICAL ISSUES OF CONCERN Asthma/COPD Diabetes Congestive Heart Failure Cardiovascular Disease Hypertension High Cholesterol Tobacco Use Over Weight/Obesity Medication Adherence Use of Hospitals and ERs

11 KEY ELEMENTS OF CARE HEIGHT WEIGHT BMI WAIST CIRCUMFERENCE BP SYSTOLIC BP DIASTOLIC PLASMA GLUCOSE HgbA1c TOTAL CHOLESTEROL LDL HDL TRIGLYCERIDES ANTIPSYCHOTIC USE TOBACCO USE PREGNANCY ER USE HOSPITALIZATION LEVEL OF FUNCTIONING

12 METABOLIC SCREENING GOAL 80% OF HCH PARTICIPANTS

13 100% 90% 80% 80% 89% 88% 70% 60% 50% 40% 30% 46% 61% All CMHC Health Homes have attained a completion rate above 80%! N = 6,553 (3.5 yr. enrollment) N = 21,407 (Apr 2016) 20% 10% 12% 0% Metabolic Syndrome Screening Feb'12 Baseline Feb'13 12 Months June'13 18 Months June' Years June' Years Apr'16 current enrolled pop

70% 60% 50% 40% Score 31-40 Major impairment in several areas

in functioning Daily Living Activities (DLA-20) Assessment 30%

with DLA-20 in last 18 months 10% 0% 1-20 mgaf 21-30 mgaf

14 70% 60% 50% 40% Score Major impairment in several areas of functioning Score Some serious symptoms or impairment in functioning Daily Living Activities (DLA-20) Assessment 30% Total CMHC Health Home participants (CY 2014): 20% N = 13,550 with DLA-20 in last 18 months 10% 0% 1-20 mgaf mgaf mgaf mgaf mgaf mgaf mgaf mgaf 14

15 70% General Nat. Pop. 60% HCH Adults HCH Youth 62% 53% 50% 40% 36% 45% Chronic Health Conditions 30% 29% 29% 20% 10% 0% 7% 18% 9% 3% 4% 11% 7% 15% 9% 9% 8% 1% 0% 9% 6% Total CMHC Health Home participants ( ): HCH Adults N = 22,801 HCH Youth N = 3,944 General population stats from 2015 Centers for Disease Control and Prevention (CDC) and Substance Abuse and Mental Health Services Administration (SAMHSA)

16 50% General MO Adult Pop. 45% 40% 35% 30% HCH Adults DM3700 Adults 37% 37% Body Mass Index (BMI) & Obesity 25% 20% 25% 20% 19% Total CMHC Health Home participants (2014): 15% HCH Adults N = 20,590 10% 7% DM3700 Adults N = 2,407 5% 0% Underweight BMI <18.5 Normal BMI Overweight BMI Obese BMI Extremely Obese BMI 40 16

17 80% 70% 60% 50% 40% 57% 54% 47% 38% 73% 59% 46% 71% 61% 53% 42% 62% Adults continuously enrolled at each point in time and adults enrolled as of December 2015 N = 1,889 (3.5 yr. enrollment) 30% 20% 22% 27% 18% N = 4,667 (Apr 2016) 10% 0% Good Cholesterol (LDL<100 mg/dl) Normal Blood Pressure (BP<140/90 mmhg) Normal Blood Sugar (A1c<8.0%) Feb'12 Baseline Feb'13 12 Months June'13 18 Months June' Years Apr'16 current enrolled pop

18 80% 70% 70% 67% 60% 50% 49% 60% 57% 55% Adults continuously enrolled at each point in time and adults enrolled as of December % 37% 41% CVD N = 232 (3.5 yr. enrollment) 30% 20% 21% 24% CVD N = 550 (Apr 2016) HTN N = 2,401 (3.5 yr. enrollment) 10% HTN N = 6,349 (Apr 2016) 0% Good Cholesterol for Clients w/ CVD (LDL<100 mg/dl) Normal Blood Pressure for Clients w/ HTN (BP<140/90 mmhg) Feb'12 Baseline Feb'13 12 Months June'13 18 Months June' Years Apr'16 current enrolled pop 18

19 ANTI-DEPRESSANTS ANTI-PSYCHOTICS MOOD STABILIZERS ANTI-HYPERTENSIVES CARDIOVASCULAR MEDS COPD MEDS DIABETES MEDS 100% 90% 80% 70% 60% 84% 85% 86% 85% 84% 85% 83% Total CMHC Health Home participants (Apr 2016): N = 16,900 50% 40% 30% 20% 10% 0% Medication Adherence (>80% in 90 days) 19

40% 35% 30% 25% CMHC Health Homes January 1, 2012 37% 30% 28% % of clients

20 40% 35% 30% 25% CMHC Health Homes January 1, % 30% 28% % of clients with 1+ Hospitalizations 20% 23% 15% 14% 10% 5% 0% Baseline Year 1 Year 2 Year 3

ER Visits Hospital Days 300 250 CMHC Health Homes January 1, 2012 38% Hospital & ER Days per 1,000

21 ER Visits Hospital Days CMHC Health Homes January 1, % Hospital & ER Days per 1, % Hospital Days Per Baseline Year 1 Year 2 Year 3 ER Visits Per 1000

22 small changes make a BIG DIFFERENCE

23 Small Changes Big Difference 10% reduction in cholesterol 6 mm/hg reduction in blood pressure 1 point reduction in HgbA1c 10% in cardiovascular disease 16% in cardiovascular disease 42% in stroke 21% in diabetes related deaths 14% in heart attacks 37% in microvascular complications

24 % 106 Baseline Year 1 Year 2 Year 3 Improving uncontrolled cholesterol Baseline to Year 1: Reduced the mean LDL 131 to 115 = 12% decrease Baseline to Year 3: Reduced the mean LDL 131 to 106 = 19% decrease For individuals with LDL >100 at Baseline

25 mm/Hg Systolic Improving uncontrolled blood pressure mm/Hg Diastolic 83.3 Baseline to Year 1: Reduced the mean BP Systolic: 152 to 134= 18 mm/hg Diastolic: 98 to 86= 12 mm/hg Baseline to Year 3: Reduced the mean BP Systolic: 152 to 133= 19 mm/hg Diastolic: 97 to 83= 14 mm/hg 30 Baseline Year 1 Year 2 Year 3 For individuals with Systolic BP >140 and Diastolic BP >90 at Baseline

26 points 8.6 Improving uncontrolled A1c Baseline to Year 1: Reduced the mean HgbA1c 10.1 to 9.2 =.88 points Baseline to Year 3: Reduced the mean HgbA1c 10.1 to 8.6 = 1.48 points For individuals with HbA1c >9.0 at Baseline Baseline Year 1 Year 2 Year 3

Missouri s Health Homes have saved an estimated $36.

Healthcare Homes have saved Missouri $31 million ($98 PMPM Cost

27 Missouri s Health Homes have saved an estimated $36.3 million ($60 PMPM Cost Savings) Community Mental Health Center Healthcare Homes have saved Missouri $31 million ($98 PMPM Cost Savings) Disease Management 3700 cohort enrolled in CMHC Health Homes saved $22.8 million ($395 PMPM Cost Savings) DM3700 N =4,800 lives Cost Savings Year 1 (2012) Current per member per month (PMPM) rate for CMHC Health Homes is $85.23 (Jan. 2016)

28 MN PFP Next Steps Submit Your Organization s Updates: Transformation Plan Updates MN-CAAT Updates Due between 10/14 and 10/26 October coaching calls: Work with your coach to complete the updates! Register Today for Upcoming Meetings: October 24 - Leadership Workshop November 10 Practice Facilitation Meeting November 30 - December 1 - Case to Care Training Registration links to be ed Contact Dana Lange at danal@thenationalcouncil.org for assistance

Know Your Number Aggregate Report Single Analysis Compared to National Averages

Know Your Number Aggregate Report Single Analysis Compared to National s Client: Study Population: 2242 Population: 3,000 Date Range: 04/20/07-08/08/07 Version of Report: V6.2 Page 2 Study Population Demographics