Steven J. Kravet, MD, MBA President, Johns Hopkins Community Physicians Associate Professor of Medicine Johns Hopkins University School of Medicine
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1 Innovations Panel Steven J. Kravet, MD, MBA President, Johns Hopkins Community Physicians Associate Professor of Medicine Johns Hopkins University School of Medicine 11/2/2011
2 Objectives / Outline Overview of JHM Meaningful use of data Insurance and managed care 3 initiatives TAP program Sickle cell program Urban Health Residency Program 11/2/2011
3 Dr. Edward Miller, Dean and CEO Johns Hopkins Medicine Two policy imperatives [have]emerged: exploring alternatives to the current reimbursement system and restructuring graduate medical education. Academic Medical Centers have a distinct role to play in both of these components of health care reform. However, to achieve these payment and education objectives academic medical centers will need to operate more as academic medical systems. 11/2/2011
4 Medical crisis: then vs. now Year Problems Solutions 1889 Young people p with acute disease Little scientific knowledge Doctors poorly trained 2010 Older people with chronic diseases Information overload knowledge in silos Systems dangerous, expensive Triangle 11/2/2011 Pyramid
5 Johns Hopkins Medicine Organizational Structure The Johns Hopkins Health System Corporation (JHHSC) The Johns Hopkins University (JHU) Johns Hopkins Medicine (JHM) The Johns Hopkins Hospital Johns Hopkins Bayview Medical Center, Inc. Howard County General Hospital Johns Hopkins Community Physicians Suburban Hospital, Inc Sibley Memorial Hospital All Children s Hospital School Of Medicine Johns Hopkins HealthCare LLC Johns Hopkins Home Care Group JH Ventures, LLC Johns Hopkins Medicine International, LLC = Legal entity = Unincorporated board or division
6 All Children s Hospital St. Petersburg Florida 11/2/2011
7 Integrated network Physician Enterprise Components 11/2/2011 () (a) Source JH MSO, includes Faculty and JHCP (b) JHBMC does not specify FT/PT, all BMC Faculty in FT category (c) Includes all 4 hospitals (d) Source Dr. Griffith, CPD (e) Source P. Brown, JHHC, for MD, may include physicians in above categories
8 Hopkins Goal: moving from a hospital centric approach. Johns Hopkins School of Medicine Johns Hopkins Bayview All Children s Hospital Johns Hopkins Community Physicians Johns Hopkins Home Care Group The Johns Hopkins Hospital Johns Hopkins HealthCare Howard County General Suburban Hospital Sibley Memorial Hospital Community / Home
9 Hopkins Goal: to a delivery system approach Johns Hopkins School of Medicine Johns Hopkins Community Physicians Johns Hopkins Home Care Group Johns Hopkins HealthCare Community / Home
10 Insurance landscape MHCC and HSCRC Health Choice State MCO Medicaid Commercials w BC program that dominates 10
11 MD Multi-payor Pilot vs CF PCMH Program MD Multi-payor CF Program Base Req ts NCQA PCMH Work with CF Care In office care coord. Coord. Team Base $ $4-$6 pmpm 12% fee increase $200 / Care Plan Incentive $ Shared Savings Shared Savings c/w c/w self self & region Incentive Meet quality Qual score modifies Req ts threshold incentive $ Add l Tools Specialty costs
12 Case management model Goal is to embed in practices Each practice had independent assessment (different needs) Initiated at EBMC State MMPP design should help 12
13 Initiative 1: The Access Partnership Provides access for locals to Hopkins specialty care regardless of resources / insurance Nominal fee to patient Referrals all screened and weeded If accepted, specialty clinic i must appoint expeditiously 13
14 Dashboards 14
15 Refine Workflow: Example Preventive Care Tool View last result decline order Historical entry Reminders for DUE Measures appear based on age & sex logic
16 Refine Workflow : Example Disease Management Tool Historical entry Reminders for DUE order View last result Template links Logic to display for active problem
17 Share the Data: Dashboard Sample Quality Metrics productivity workflow 11/2/2011
18 Communication: Real Time Data Disease Registry and Reporting Tool - Data views by provider or group - Export data into Excel and mailing lists 18
19 Ambulatory Outcomes FY Oct-10 Jan-11 Apr-11 11/2/2011
20 Please do not distribute without permission of primary author Gary 20
21 Please do not distribute without permission of primary author Gary Noronha 21
22 Please do not distribute without permission of primary author Gary Noronha 22
23 Incentives for staff Adult medicine teams (MD, MOA, CMA): Diabetics with HgbA1C in past year (% above 85%) x $15 + Diabetics with LDL in past year (% above 70%) x $15 + Pneumovax given to patients over 65 (% above 80%) x $10 + Mammogram in past 2 years in women (% above 70%) x $10 Pediatric teams (MD, MOA, CMA): M-CHAT rate (% above 75%) x $25 + Td within 5-10 years in patients t (% above 70%) x $25 Reception, Phlebotomy Patient Portal sign-up rate (% above 1%) x $175 RNs Asthma severity recorded in pediatric asthmatic patients (% above 40%) x $40 Lead PA Percent decrease in HgbA1C in patients attending DM group sessions x $550 Practice Administrator Average of all bonuses 23
24 Initiative 2: Sickle Center Outpatient care and inpatient consultation: Comprehensive and directed care Hydroxyurea Pain management Support group Since 2/08 Sickle Cell Infusion Center: open weekdays 8:00 am to 5:00 pm
25 JHH Adult Sickle Cell Discharges (Calendar Year) Discha arges Pre opening infusion After opening infusion
26 Impact of Sickle Center on Hospital Discharges in the City of Baltimore QTR1 FY 2008 vs 2009 QTR 2 FY 2008 vs Total: 92 fewer discharges in 6 mo Baltimore City 49 more discharges at Hopkins
27 Hospital Discharges for Adults with Sickle Cell Disease in Baltimore City, FY 2008 and Adult - Baltimore Metro Only At $8300 per admission the decrease would lead to cost savings of $1.3 million per year in Baltimore City.
28 Reduced population costs, feeds JHM mission Reduce Costs: 2M grant to establish State of Maryland adult/pediatric clinic Managed Care Plans -Less ED Visits Heme Faculty -Fewer Admits/patient ti t Research Publications Care Program Publications Make Profit even though fewer ED Visits Johns Hopkins Hospital -More Admissions -Infusion Fees Make Profit: Hematology Division i i Per member management fee Professional fees Grant Revenue Health System Patients Btt Better Patient Pti tcentered dcare
29 Initiative 3: Education innovations Urban Health Residency Urban Health Track 29
30 Urban Health Med Peds Residency Program 4 residents per year for all total of 16 residents physicians Residents will be board-eligible ibl in both Pediatrics i and Internal Medicine after 4 years Masters degree during PGY 5 and 6 while working as part-time attending physician Loan repayment of $25,000-50,000/year during the two-year masters program Johns Hopkins houses approximately 30 MP trained physicians 30
31 Urban Health Residency Track 4 residents per year for a total of 12 resident physicians (subset of Osler program) Residents will be board-eligible ibl in Internal Medicine i after 3 years Masters degree during PGY4 and PGY5 while working as part-time attending physician Loan repayment of $25,000-$50,000/year during the two-years masters program 31
32 11/2/2011 THANK YOU!
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