Senior Total Health Assessment CHCF/CIN Webinar Matt Stiefel & Charlotte Crist Kaiser Permanente Jan 23, 2013

Transcription

1 Senior Total Health Assessment CHCF/CIN Webinar Matt Stiefel & Charlotte Crist Kaiser Permanente Jan 23, 2013

2 From Cost-Quality-Service to Triple Aim From Cost To Cost Triple Aim Quality Service Care (Quality+ Service) 2 Population Health

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4 The Case for Population Health Measurement Individual care, engagement Population care management Research, evaluation Population health surveillance 4

5 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). 5 5 In general, would you say your health is?

6 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 Dec 1;17(12):e Prediction-of-Inpatient-Admissions-and-Costs/ 6 6

7 Example: Using Single-Q Health Status from HCAHPS Survey Data for all 2007 inpatient survey respondents, with 2.5 year f/u Source: Robert Mangel, Ph.D., and Wenbin Mo, Ph.D., KP National Service Quality (unpublished data) 7

8 Multiple Medicare Health Assessment Requirements New: Annual health assessment for Medicare members Section 4103 of Affordable Care Act covers an annual wellness visit and personalized prevention plan, including a required health risk assessment (HRA). Existing: Welcome to Medicare visit (Initial preventive physical exam) Health assessment of new Medicare Advantage (MA) members Initial and annual health assessment of SNP* members Medicare Stars quality bonus (HOS survey-based- MA) Potential phase 3 Meaningful Use requirement *SNP = Special Needs Plan 8

9 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 risks Effective 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. 9

10 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 10 January 25, 2013 Kaiser Permanente All Rights Reserved.

11 Kaiser Permanente M-THA instrument includes: Self-rated physical and emotional health status Frailty assessment to include report on ADL s and IADL s Psychosocial risks (depression, anxiety, anger, isolation, pain) 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 11 January 25, 2013 Kaiser Permanente All Rights Reserved.

12 The Colorado PATHWAAY Program (Proactive Assessment of Total Health & Wellness to Add Active Years) 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. 12

13 PATHWAAY for Seniors KP-Colorado (KPCO) Utilization of self rated health measures for predictive analysis Scheduling of this visit triggers workflows to collect HRA Collect in advance of scheduled visit Specific regional interventions in place to address care gaps Patient Wellness Visit Utilize technology to collect HRA (on line/ivr*) Creation of PPP in advance of office visit Scoring of patient HRA responses to identify Care gaps Other language translations *IVR = interactive voice response 13 January 25, 2013 Kaiser Permanente All Rights Reserved.

14 New Medicare Members/New Member Module KPCO Approach - Volumes 2012 Medicare New Members 2012 Medicare Members lost 14 January 25, 2013 Kaiser Permanente All Rights Reserved.

15 KPCO Medicare THA Regional Launch Summary 7/1/12 9/24/12 Positive triggers for Senior Assessment Coordinator (SAC) referral (Nutrition, Falls, UI, Mood, Pain, or Frailty) N=

16 Member Feedback 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% Source: National Department of Organizational Research,

17 Discussion 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 Charlotte Crist, RN, Project Manager Wendee Gozansky, MD, MPH 17 January 25, 2013 Kaiser Permanente All Rights Reserved.

18 Resources KP Senior Total Health Assessment 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; easuringtripleaim.aspx 18 Kaiser Permanente All Rights Reserved.