Improving Care for High-Need, High Cost Patients Demonstration Project & Learning Initiative

Transcription

1 Improving Care for High-Need, High Cost Patients Demonstration Project & Learning Initiative Institute for Accountable Care November 27, 2018

2 Mission Build the evidence base on the impact of accountable care delivery strategies to support care transformation and inform public policy Vision About the Institute Become a nationally respected resource for developing, synthesizing and disseminating practical actionable research and analysis supporting valuebased care. ACO Linkages IMPACT Broad Data Warehouse 2

3 Addressing the Needs of HNHC Populations 3

4 HNHC Initiatives in ACOs: NAACOS Survey Toplines 85 percent of ACOs have programs targeting HNHC patients Multiple methods for identifying patients High spending and utilization (high cost) Predictive analytics (high-risk) Clinician referral (high need) Multiple programs deployed in many ways Nurse care management, care transition programs most common Designated HNHC clinic, community health worker, extensivist less common Primary impact measure is change in service use/cost Respondents believe programs have positive impact but don t know which programs are most effective 4

5 Exhibit 1 Adults with High Needs Have Higher Health Care Spending and Out-of-Pocket Costs Average annual out-of-pocket spending Average annual health care expenditures $21,021 $7,526 $4,845 $702 $1,157 $1,669 Total adult population million Three or more chronic diseases, no functional limitations 79.0 million Three or more chronic diseases, with functional limitations (high need) 11.8 million Note: Noninstitutionalized civilian population age 18 and older. Data: Medical Expenditure Panel Survey (MEPS). Analysis by C. A. Salzberg, Johns Hopkins University. Source: S. L. Hayes, C. A. Salzberg, D. McCarthy, D. C. Radley, M. K. Abrams, T. Shah, and G. F. Anderson, High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? The Commonwealth Fund, August 2016.

6 Exhibit 2 Health Care Spending Was Higher at Every Level for Adults with High Needs Than for Adults with Multiple Chronic Diseases Only Median Top 25% Top 10% Top 5% Top 1% $133,083 $55,962 $61,500 $51,380 $73,087 $20,895 $11,738 $4,362 $1,154 $3,688 $8,194 $17,218 $27,573 $10,710 $26,376 Total adult population Three or more chronic diseases, no functional limitations Three or more chronic diseases, with functional limitations (high need) Note: Noninstitutionalized civilian population age 18 and older. Data: Medical Expenditure Panel Survey (MEPS). Analysis by C. A. Salzberg, Johns Hopkins University. Source: S. L. Hayes, C. A. Salzberg, D. McCarthy, D. C. Radley, M. K. Abrams, T. Shah, and G. F. Anderson, High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? The Commonwealth Fund, August 2016.

7 Exhibit 3 Adults with High Needs Have Unique Demographic Characteristics Total adult population Three or more chronic diseases, no functional limitations Three or more chronic diseases, with functional limitations (high need) 55% 52% 58% 63% 67% 77% 72% 52% 83% 83% 31% 28% 30% 27% 28% 41% 26% 38% 17% 16% 14% Age 65+ Female White race No high school degree Income below 200% FPL Public insurance Fair or poor health status Notes: Noninstitutionalized civilian population age 18 and older. Public insurance includes Medicare, Medicaid, or combination of both programs (dual eligible). Data: Medical Expenditure Panel Survey (MEPS). Analysis by C. A. Salzberg, Johns Hopkins University. Source: S. L. Hayes, C. A. Salzberg, D. McCarthy, D. C. Radley, M. K. Abrams, T. Shah, and G. F. Anderson, High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? The Commonwealth Fund, August 2016.

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10 Improving Care for HNHC Patients in ACOs: A Demonstration Project 10

11 Timeline: Implementing HNHC Initiatives in ACOs Form ACO Advisory Group Select preferred interventions Develop detailed specs and implementation support plan Create evaluation strategy Recruit ACOs 11 Home Visit Program Extensivist Model

12 Project objectives 1. Support ACO implementation of programs to improve care for highneed, high-cost individuals by providing technical assistance, training, systematic learning opportunities and evaluation of what works and what doesn t. 2. Generate protocols, tools and education that will help other ACOs deploy programs effectively 12

13 Two Initiatives on Separate Timelines 11/2018 5/ /2019 5/ /2020 5/2021 Home Visit Program Proposal Review Planning Implementation Evaluation Extensivist Model Proposal Review Learning Collaborative Proposal Implementation 13

14 Home Visit Program Objectives of home visits Develop trusting relationship with HNHC individuals Identify and address social determinants of health Build effective linkage with primary care team Provide home based medical services (selected models only) Personnel Community health worker; paramedic; registered nurse; nurse practitioner Desired outcomes Close care gaps Address social needs Reduce avoidable hospitalizations/ed visits/post-acute care 14

15 Extensivist Model Multi-disciplinary care teams providing intensive outpatient management and home-based services for frail high risk patients with complex medical conditions. Objective: stabilize and manage high risk patients to reduce avoidable institutional care, improve quality of life and support independence Multiple potential models Extensivist clinic Virtual/mobile extensivist model Clinic within a primary care clinic Post-discharge clinic Ambulatory clinic providing hospital-level care 15

16 Technical assistance Help identifying HNHC patients (algorithms, screening tools) Analytic support: profile of ACO s high-risk patients and spending profiles using NAACOS Medicare data warehouse Program startup support (job description, training modules, patient assessment forms, checklists/protocols for home visit staff. Training/boot camps (for operational staff or care teams) Forms/formats for data collection Program evaluation support Did your project reduce spending/improve outcomes Building internal capacity for program evaluation 16

17 Learning collaboratives Separate collaboratives for home visit and extensivist initiatives Likely two in-person meetings and monthly virtual meetings over 9 12 months (likely support for travel) Guidance from expert faculty from ACOs with experience deploying successful programs Structure for sharing best practices and collaborating with peers on process improvement and troubleshooting 17

18 How Do I Get Involved? 18

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20 Thank You Institute Staff Rob Mechanic, Executive Director Jennifer Perloff, Director of Research Teresa Litton, Senior Advisor Advisory Group Member Amy Russell, MD, Chief of Community Medicine, Mission Health 20