Using Data to Drive Health Reform

Transcription

1 Using Data to Drive Health Reform Mary Kate Mohlman, PhD, MS Vermont Blueprint for Health Jennifer Fels, RN, MS Southeastern Vermont Medical Center Melissa Miles, MPH Bi-State - Vermont

2 Potential Uses of Data Assessment o What is the current situation? Trend Analysis o What is happening over time? Setting benchmarks o Establishing goals or incentives Inputs for predictive analysis o Future work

3 Bennington: Data Use In An HSA Jennifer Fels, RN, MS Director Bennington Blueprint United Health Alliance Director Utilization Management, Clinical Documentation Improvement Southwestern Vermont Medical Center

4 Rate of 30-day Readmissions Health Service Area Data Project BOOST SVMC 30-day All Payer, All Cause Readmission Rate Practice Based Transitions Processes NCQA Certifications Hardwire SASH Coordination Spoke Services ADRC Coordination with PCMH Co-Management Agreements Shared Care Plan ADRC 8 Organizational Goal 8% Stretch Goal 6% 6 4 July 8.2% 28 Readmissions 2 0

5 Practice Level Data 9 PCMHs Currently Monitor Breast Cancer Screening Baseline (earliest 2012) vs. Current Measure (2014/15) 100% 90% 80% 70% % of Women yrs with mammogram within the past 2 yrs Baseline Current 60% 50% 40% 30% 20% 10% 0% B C D E F G H I J 9 Practice Avg Bennington NCQA Certified Patient-Centered Medical Homes

6 Practice Level Data 90% 80% 70% 60% 50% 40% 30% 20% 10% 7 PCMHs Currently Monitor Colon Cancer Screenings Baseline (earliest 2013) vs. Current Measure (2014/15) % of Patients yrs with a colonoscopy within the past 10 years Baseline Current 0% A B D E H I J 7 Practice Avg Bennington NCQA Certified Patient-Centered Medical Homes

7 Number of Patient Visits Practice Level Data Southwestern Vermont Medical Center (SVMC) Express Care Visits for Blueprint Medical Home Practices SVMC Express Care March - June 2015 Number of Patient Visits by Time of Day Hour of Day

8 Number of visits 30 Practice A SVMC Express Care Visits by Time of Day March - June Hour of Day Number of Express Care Visits = 132 Number of patients with more than one visit to Express Care = 11 15% of Express care visits were on weekend days

9 Numbre of Patient Visits 6 Practice B Express Care Visits by Time of Day March - June Hour of Day Number of SVMC Express Care Visits = 26 Number of patients with more than one Express Care Visit = % of Express Care visits were on weekend days

10 Express Care Visits - Patient Level Details A Sunday, March 22, :49 AM 8920: OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE, WITHOUT MENTION OF COMPLICATION B Sunday, May 24, :26 AM 07999: UNSPECIFIED VIRAL INFECTION C Sunday, May 03, :59 AM 6929: CONTACT DERMATITIS AND OTHER ECZEMA, UNSPECIFIED CAUSE D Sunday, April 19, :11 AM 7856: ENLARGEMENT OF LYMPH NODES E Wednesday, April 08, :52 PM 37230: CONJUNCTIVITIS, UNSPECIFIED F Sunday, April 26, :53 PM 6929: CONTACT DERMATITIS AND OTHER ECZEMA, UNSPECIFIED CAUSE G Friday, May 22, :02 PM 37230: CONJUNCTIVITIS, UNSPECIFIED H Wednesday, May 27, :32 PM 462: ACUTE PHARYNGITIS I Sunday, March 29, :53 PM 71946: PAIN IN JOINT, LOWER LEG J Friday, May 01, :18 PM 68100: CELLULITIS AND ABSCESS OF FINGER, UNSPECIFIED K Wednesday, June 24, :33 PM 4659: ACUTE UPPER RESPIRATORY INFECTIONS OF UNSPECIFIED SITE L Sunday, March 08, :37 PM 3829: UNSPECIFIED OTITIS MEDIA M Monday, May 04, :45 PM 78791: DIARRHEA N Sunday, April 12, :49 PM 8830: OPEN WOUND OF FINGER(S), WITHOUT MENTION OF COMPLICATION O Wednesday, April 29, :14 PM 07999: UNSPECIFIED VIRAL INFECTION P Wednesday, March 04, :23 PM 0340: STREPTOCOCCAL SORE THROAT Q Sunday, May 24, :13 PM 71942: PAIN IN JOINT, UPPER ARM R Sunday, May 10, :15 PM 5589: OTHER AND UNSPECIFIED NONINFECTIOUS GASTROENTERITIS AND COLITIS S Monday, May 11, :24 PM 81383: CLOSED FRACTURE OF UNSPECIFIED PART OF RADIUS WITH ULNA T Wednesday, April 29, :51 PM 7856: ENLARGEMENT OF LYMPH NODES U Wednesday, April 01, :02 PM 71943: PAIN IN JOINT, FOREARM V Tuesday, May 26, :17 PM 5282: ORAL APHTHAE

11 Bennington Dashboard Bennington Blueprint Grant Award: United Health Alliance Key Partners: United Counseling Services (UCS) and SVHC, State Level Leadership: Craig Jones, MD, Beth Tanzman Local Leadership: UHA Board of Directors, RCPC Physician Champion: Jim Poole, MD Bennington Program Director: Jennifer Fels September 2015 Program Goals Improve the health of the population Improve the patient experience Reduce healthcare costs Patient Centered Medical Homes Battenkill Valley Health Center Bennington Family Practice Brookside Pediatrics & Adolescent Medicine Green Mountain Pediatrics Keith Michl, MD Mount Anthony Primary Care Eric Seyferth, MD Shaftsbury Medical Associates SVMC Deerfield Valley Campus SVMC Medical Associates SVMC Northshire Campus SVMC Pediatrics Avery Wood, MD Blueprint Grant Funding FY 2016 Grant Funding $217,300 QI Facilitator 1 FTE Director 1 FTE Self-Management Coordinator.5 FTE Self-Management Operations (training, books) CHT Budget Community Health Team (CHT) Funding FY 2015 Quarter 4 Claims Attributed patients Community Health Team (CHT) FTE Staffing 3.92 RN Case Manager.5 FTE Social Worker (vacancy).8 FTE Dietitian 1.24 Behavioral Health Total Actual FTEs 5.96 Quarterly payments BCBSVT 5,511 $ 45, Cigna 66 $ Medicaid 5,867 $ 48, Medicare 3,714 $ 27, MVP 337 $ 2, Total 15,495 $ 125, Medical Home Payment Model Starting July 1, 2015 Utilization and Quality Incentives are based on benchmarks and improvement payment based on change Utilization.25 Quality.25 Payment tied to HSA results FY 2016 Blueprint Improvement Activity Implement ACEs initiative across practices Implement Pre-Diabetes coaching program Increase marketing of Self-Management and Tobacco Cessation Offer HLW for Chronic Pain Express Care Utilization March June 2015 Bennington PCMH practices had 1,285 Express Care Visits from March June % (131) of PMH Express Care visits were patients with multiple visits (range 0 33) 14% (317) of PCMH Express Care visits were on the weekend (range 6-68) Self-Management Grant deliverable: 10 classes, 50 participants Healthier Living/Chronic Pain Workshops Stanford University Date of HLW # Completers 9/18/14 Bennington 12 10/18/14 - Brookside 9 3/12/15 -Left Bank (NB) 2 9/24/15 Equinox Village Sept - Oct Deerfield Sept Oct - Bennington 1 HLW class cancelled due to low enrollment Fresh Start Tobacco Cessation American Cancer Society Date of Offering # Completers 10/21/14 - VDH 4 12/2/14 - SVMC 3 1/6/15- SVMC 1 1/13/15 Brookside Apt 2 Base Payment NCQA 2014 Standards $3.00 PMPM to all eligible practices Payment tied to practice activity Participation in RCPC initiatives NCQA recognition SVMC 30 day Readmission Rate (all cause, all payer) Rate for July 8.2% (28 readmissions) 2/10/15 - Walloomsac 2 3/3/15 SVMC 1 4/7/15 - SVMC 4 6/2/15 - SVMC 2 7/21/15 - SVMC 5 9/15/15 Hawthorn RC CHT funding covers staffing for 34,512 patients CHT Funding has decreased by $3,909/month starting July 2015 Notes: Utilization and Quality incentives are to incentivize work with RCPC partners. CHT activity to be part of at least one RCPC quality initiative per year. 6/2/15 - SVMC 8/4/15 SVMC 9/8/15 - SVMC

12 Adult Prevention Screening Measures

13 Patient Volume July 2015 Bennington Blueprint Spoke Dashboard Bennington Blueprint Grant Award: United Health Alliance Key Partners: United Counseling Services (UCS) and SVHC, State Level Leadership: Craig Jones, MD, Beth Tanzman Local Leadership: UHA Board of Directors Physician Champion: Jim Poole, MD Bennington Program Director: Jennifer Fels Program Goals Spoke Services Spoke Program Volume Spoke Program Volume Improve the health of the population Improve the patient experience Reduce healthcare costs Bennington Spoke Practices Provides on-going care system for buprenorphine patients. RN Case Managers coordinate care, recovery support and refer to community services. Hawthorn Recovery Center Mount Anthony Primary Care Shaftsbury Medical Associates SVMC - Deerfield Valley Health Center SVMC Medical Associates (Fall 2015) Spoke Funding $163.75/PPPM for Medicaid Patients Requirements: 1 RN Case Manager and 1 Licensed Behavioral Health Specialist or Licensed Social Worker for every 100 Spoke patients Spoke services are not billable. FY 2015 Bennington Program Budget: Quarter 2015 Program Funding # Medicaid Beneficiaries Medicaid Funding Qrt $85,969 Qrt $110,531 Qrt $110,531 Qrt $122,812 Patients must have at least one service per month as defined by the CMS Medicaid Waiver: Comprehensive Care Management Care Coordination Health promotion Comprehensive Transitional Care Individual & Family Support Referrals to community and social services support Hub Services West Ridge Addiction Center (Rutland) Brattleboro Retreat (Brattleboro) Performance Improvement Initiatives Standardize patient contracts across practices Implement standard Spoke referral tool Implement standard communications to PCP tool Establish standard communications with Probation and Parole Provide expertise to standardization of SVMC discharge opiate ordering protocol Hawthorn Recovery Center Total Volume by Medicaid and other Payers 0 VT Medicaid Other Payers Total Current Staffing Hawthorn Recovery Center Mount Anthony Primary Care Shaftsbury Medical Associates SVMC Deerfield Total Actual FTEs RN Case Manager 1.2 FTE.4 FTE.4 FTE.4 FTE 2.4 Behavioral Health Therapist/Social Worker 1 FTE.4 FTE.4 FTE.4 FTE 2.2 Patient Transfers 2015 Apr May Jun Jul Aug Sep Oct Nov Dec # pf pts transferred from IOP # of pts transferred from Hub # of pts transferred to Hub 0 1 2

14 Spoke Program Measures Shaftsbury Medical Associates Mount Anthony Primary Care SVMC Deerfield Hawthorn Recovery Center Screening is not completed by Spoke Staff in this addiction specialty practice.

15 Thank-you Jennifer Fels, MS, RN

16 Community Health Accountable Care (CHAC): Data Use by ACO Melissa Miles, MPH Project Manager Bi-State Primary Care Association Montpelier, Vermont

17 CHAC s network: statewide & community-based CHAC s Network & Partners (9/1/2015): 11 Federally Qualified Health Centers 5 Hospitals 14 Designated Agencies 9 Certified Home Health Agencies

18 CHAC clinical committee timeline CHAC Board votes to contract with remote monitoring program 9/14 Committee decides to work on CHF, COPD, Falls Risk, and Diabetes readmissions 6/14 CHAC best practice recommendations adopted 2014 April June August October December 2015 April June August /15 3/15 Dashboards approved by Committee and Board 9/15 1st outcome data on remote monitoring program 9/15 4/14 7/14 Committee receives presentation on remote monitoring program 7/14 Sub committees form to work on CHF, COPD, Falls Risk recommendations 5/14 CHAC Board examines remote monitoring program 1st CHAC Clinical Committee examines Medicare and Blueprint Data 8/14-12/14 Committee reviews materials and writes recommendations 3/15 100,000 data points pulled for ACO chart abstraction 2/15 Remote monitoring program with nursing triage protocols starts Today 8/15 Initiatives based on ACO findings being evaluated 6/15 ACO data sharing begins at Committee and health center level 4/15 Committee chooses measures for templates

19 Per 1,000 Discharges Rate Per 1,000 Discharges 30 Day All-Cause Readmissions: 2013 Blueprint Practice Profiles FQHC 1 FQHC 2 FQHC 3 FQHC 4 FQHC 5 FQHC 6 FQHC 7 FQHC 8 FQHC 9 FQHC 10 FQHC Statewide Avg Day All-Cause Readmissions: CMS Medicare Data , Q1 2015, Q2 CHAC All MSSP ACOs

20 Per 1,000 Beneficiaries Per 1,000 Beneficiaries CMS Medicare Shared Savings Program initial data walkthrough Congestive Heart Failure , Q1 2015, Q2 CHAC All MSSP ACOs COPD or Asthma , Q1 2015, Q2 CHAC All MSSP ACOs

21 Remote monitoring intervention for rising risk Medicare patients CHAC starts contacting patient

22 900 Utilization improvement February thru June 2015 Remote Monitoring (RM) Impact on Admissions Per 1,000 (APK) TA Impact on Admissions/1, Decrease of 39% February March April May June RM APK TA APK Non RM Non APK TA APK Avg TA RM Avg Non Avg TA Non RM

23 Depression screening and follow up plan: Discovery and opportunity Depression Prevalence found in charts FQHC 1 FQHC 2 FQHC 3 FQHC 4 FQHC 5 FQHC 6 FQHC 7 FQHC 8 FQHC 9 Have Dx FQHC 1 FQHC 2 ACO Measure Rate FQHC 3 FQHC 4 FQHC 5 FQHC 6 FQHC 7 FQHC 8 FQHC 9 Measure Rate (CHAC 41.06%)

24 Depression screening and follow up plan: provider level Original # Dx Medical Denom Seen % Seen Seen, screened % Seen, screened Seen, not screened Compliant % Compliant Dx% % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % %

25 On the horizon Depression best practice recommendations Proactive preventive care Implementation of the 4 existing recommendations Deepening work on remote monitoring to look at transitions in care and enrollment of new patients

26 Thank-you Melissa Miles, MPH , ext. 219

27 Data Use Statewide Mary Kate Mohlman, PhD, MS Vermont Blueprint for Health

28 New Payment Structure

29 Measures Used Utilization based on Total Resource Use Index Quality based on four ACO measures o Adolescent Wellness Visit o Developmental Screening, under age 3 o Diabetes Poor Control, Hb A1c > 9% o PQI Chronic Condition Composite

30 Payment Model Preliminary Proposal Point System Points awarded for achieving benchmarks and minimum improvements for each measure Benchmark points Improvement points Total HSA score associated with one of three payment levels, up to $0.25

31 Community Health Teams Question: What is the value added of community health team? o How do they effect expenditures, utilization? Method: o Intervention group: individuals with contact with a CHT members o Controls: matched on demographics, CRGs, chronic conditions etc. o Time frame: pre-year, intervention year, post-year Results: Looked at expenditures and utilization (inpatient discharges, inpatient days, ED visits, 30-day readmissions

32 Comparison of Expenditures - CHT Mean Annual Expenditures per Person Pre-Year Entry Year Post-Year CHT Controls CHT Intervention

33 Comparison of Expenditures - CHT Mean Annual Expenditures per Person Pre-Year Entry Year Post-Year CHT Controls CHT Intervention

34 Community Health Team 36% 31% Control % Case % % CHT Patients 36% Control Patients 38% CHT Patients 29% Control Patients 5 0

35 Future Goals for Data Use Predictive analysis o Identifying indicators and likely outcomes o Projections for future trends o Questions: What are effects of an intervention? Where are resources most effectively allocated?

36 Thank you Mary Kate Mohlman, PhD, MS Vermont Blueprint for Health Phone: