Moving from pa-ent to popula-on and community- based management

Transcription

1 Moving from pa-ent to popula-on and community- based management Ways and Means: Health Links 2015 Walter P Wodchis Health System Performance Research Network February 26, 2015

2 3 SuggesDons 1. ConDnue to focus on the top 5% 2. Specifically focus on populadons who commonly consdtute high cost users and for whom you can implement improvements in care. 3. Start shiking from individual care intervendons to community- oriented intervendons. 2

3 1. ConDnue focus on top 5% Why (part 1)? 45% of top 5% were in top 5% in prior year 15% came from th percentile 31% came from next 40 percent of population 6.5% came from lowest 50% 2009 Percen-le Group Top 5% 45.0% 15.0% 31.0% 6.5% % of Group by Source So yes, many people who are high cost users in a given year were lower-cost users in prior years. but most were already high cost users. 3

4 1. ConDnue focus on top 5% 2009 Percen-le Group % Movement of 2009 Percen-le Group to 2010 Percen-le Groups 12.8% 25.7% 26.8% 14.1% 44.2% 76.6% 62.9% 46.3% 26.3% 21.4% 15.5% 3.9% 6.1% 0.7% 1.0% 0% 20% 40% 60% 80% 100% to 1-49 to to to 95+ Why (part 2)? 2009 P'-le Group Top 5% 45.0% 15.0% 31.0% 6.5% % of Group by Source Only 0.7% of bottom 50% make it to the top 5% in the subsequent year Only 3.9% of those in 50 th to 89 th percentile transition to top 5% in subsequent year It is difficult to accurately identify the 3.9 and 0.7% who were low users 4

5 2. Types of high users Types Categorizing all high cost (top 5%) users 2011/12 Pregnancy Low Birth Weight Post- admission Causes Trauma/Accidents/Injuries/ Mental Illness and AddicDons Ambulatory Care SensiDve Acute Planned Surgical Acute Planned Medical Cancer Acute Unplanned Surgical Acute Unplanned Medical 1. Planned are most common but low cost. 2. Post-admission events are surprisingly common and expensive. 3. Trauma & Mental Illness/Addictions Percent Of Episodes are similar in magnitude. 4. Unplanned medical captures most older seniors with chronic diseases. 0% 10% 20% 30% 40% Percent Of Cost Such different populations require different forms of patient-centred interventions Address remediable gaps. 5

6 3. HL performance is Ded to community Findings: Baseline performance; early HLs; total populadon by SES Quin-le HEALTH LINK (**= early adopter) Avg Std Monthly Cost ($/person) Avg Std Monthly Cost ($/person) Better than average Std Rate Acute Std Rate Acute Hospitalization Hospitaliza-on (/100,000) (/100,000) Std Rate ED Visit: Std Rate ED Visit: Low Acuity (/ (/100,000) 100,000) Risk- adj. Es-mate Risk- adj. Estimate (%) CMG Readmission Rate Readmission Rate Worse than average Crude Es-mate (%) All Crude Estimate (%) All Individuals PC Follow- Up Ind. PC F/U W/IN 7D Acute Discharge Acute Discharge Std Propor-on Std Proportion Rostered to PC Physician (%) Physician (%) South Simcoe and Northern York Region** South West York Region Bolton High SES Dufferin** Arnprior Region and Ottawa West Upper Canada Burlington Niagara North West Guelph** Rural Wellington North York Central** Bramalea Brampton Haldimand Hamilton West East Mississauga** Barrie Community** Muskoka Community Mid- West Toronto** North Toronto East Cambridge Kitchener- Waterloo Niagara North East Orillia Community South Georgian Bay Community** Kingston** Rural Kingston** Salmon River Thousand Islands** Huron- Perth County** London- Middlesex County Mid East Toronto** Peterborough** Brantford, Brant & Six Nations Hamilton East Niagara South East Niagara South West Norfolk North Simcoe Collaborative City of Thunder Bay Quinte** Rideau Tay South Toronto Performance North Etobicoke- Malton- West Woodbridge** Prescott- Russell Regional South Renfrew Chatham City Centre Hamilton Central** Cochrane North Cochrane South/Timmins** Temiskaming** Rural Hastings** Don Valley/Greenwood** East Toronto** Low SES Health Link performance is highly related to community SES 6

7 Summary comments Health Links performance is linked by community more than providers. Improvements in care outcomes should be tailored to specific target populadons. The top 5% is an important focus as an idendfiable group of individuals with sustained high use and potendally remediable gaps in care. 7