Institute of Quality Leadership AMGA

Transcription

1 Institute of Quality Leadership AMGA Ajay Sahajpal, MD Director Abdominal Transplant and Hepatobiliary Program Bradley Kruger, VP Operations ASLMC Laura Spurr, Director Clinical Transformation and Operations

2 Agenda Organization Snapshot Industry landscape Why Hepatitis C? Program Goals Operational Design Patient Outcomes Project Logistics and Lessons Summary

3 Organization Snapshot Aurora Health Care is one of the largest not-for-profit, integrated health care systems in the United States. Wisconsin and northern Illinois. ~1.2 million patients 15 hospitals ~175 clinics 80 pharmacies 60 laboratories Home care services 1600 physicians 800 advanced practice providers

4 Industry Landscape There is an ongoing transformation of the healthcare industry in anticipation of new economic models for financing healthcare. Key points organizations need to consider during this change: The need to do better with less by becoming agile around cost structures. The need for managing population health on a large scale by deploying more progressive business techniques such as outsourcing, shared services etc. The need to develop differentiated services with an increasing focus and transparency around quality measures, pricing, and managing populations at risk.

5 Hepatitis C Value-add for Patients and Healthcare Systems

6 Why Hepatitis C - National Attention

7 Summary of Hepatitis C 4-5 million people in the US have Hepatitis C virus infection 335,000 at risk patients at Aurora Health Care 8,000 undiagnosed patients within Aurora Health Care 37,000 undiagnosed people in WI 70% will progress to chronic Hepatitis C 20% will advance to cirrhosis

8 Goals of the Hepatitis C Program Develop a system-wide Hepatitis C screening program to standardize the care delivery process and improve clinical outcomes for this patient population. Better manage Hepatitis C patient population by enhancing integration of services throughout Aurora Health Care. Manage decompensated cirrhosis patients awaiting transplant using population health outreach-based care in the clinical contact center

9 Care Delivery and Treatment Diagnosis and Care Reduce the risk of transmission to others Early clinical evaluation and ongoing monitoring. Take measures to protect their liver from further harm Treatment New pharmacologic treatment can cure the disease 99% cure rate Simple 12 week regime Outcomes: Lower rates of liver cancer Lower rates of cirrhosis Lower rates of liver transplants Lower rates of all cause mortality Improves quality of life

10 Hepatitis C Operational Design to Succeed High Quality Outcomes

11 Importance of Operational Design Ensuring patients are connected with the right provider, at the right location, at the right time. Integrated health care requires seamless transition points Targets for Improvement: Service variation Under utilization of services

12 Integration of Services Primary Care Hepatology Clinical Contact Center GI Pharmacy Transplant

13 Operational Goals Target every patient Develop a mechanism to alert the provider if a patient met the criteria Develop easy and seamless Electronic Health Record tools to drive care to the right provider at the right time Develop decision points for the providers based on patient needs for further evaluation/treatment Target education efforts to keep patients informed and engaged in their care

14 Primary Care Workflow

15 GI and Hepatology Workflow

16 Benefits for the patient and organization Patient: Streamlined care path for patients Enhanced services Improved quality outcomes Reduced variation in services across specialties Organization: Improved Quality Increased Volume Patient Growth Financial

17 Primary Care Patient Education MA provides patient education by going over the Hepatitis C brochure.

18 Primary Care Alert displays for patients born between 1/1/ /31/1965, who have not had a hepatitis C screening. Follow Up Order smartset linked to BPA

19 Hepatitis C Flagging Patients This flag will identify the patient in the system as a Hepatitis C Program Patient

20 Population Management-Outreach Provider determines during evaluation if additional outreach will be needed for the patient. A referral to Contact Center Nurse order is placed.

21 Population Management-Outreach Standard templates developed for ease and a consistency of care

22 Population Management-Outreach Standard templates developed for ease and a consistency of care

23 Hepatitis C Performance patients previously undiagnosed Hepatitis C (Performance) Positive Confirmatory Test Patients Under Treatment Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15

24 Hepatitis C financial outcomes Hepatitis C- Financial Performance (YTD Performance and Expected Return) $7,000,000 HEP C Expected Return Total Cont. Margin (Yearly) HEP C Performance-to-Date (August 2015) $6,000,000 $6,000,000 $6,000,000 $5,000,000 $5,578,866 $4,000,000 $3,719,244 $3,000,000 $2,000,000 $1,000,000 $

25 Summary Lessons Learned Project Planning

26 Implementation/Support Sponsor: Director Transplant Program Team: Primary Care physician and chairs Hepatology providers GI provider and chair Pharmacy Hospital administration Medical Group administration Call Center leaders Project Management Report Writer/Analytics Transplant Coordinators Information Technology

27 Timeline Planning 4 months Initial Pilot (24 outpatient clinics): LIVE on Dec (all electronic tools) Target education and provider engagement for 140 providers and their clinical staff 3 month outcome tracking and monitoring System Wide (+100 outpatient clinics): in process Target education and provider engagement

28 Lessons Learned Reporting Continued education of new tools Ongoing provider communication Instilling accountability at the local level

29 Summary Expanded screening helps effectively manage our population New screening algorithm increases volume and streamlines care to Aurora Health Care services More efficacious treatments, shorter duration, less side effects mean better options for patients. Outcomes: More people screened and diagnosed More people linked to care and treatment More people cured of HCV Increased focus on HCV quality of care helps prepare us for the future

30 Questions