Ken Buback, MA, CPCC (USA) Brian Marsh, MBA, PCC (USA) Express Coaching: A Breakthrough Research Study on Improving the Health Status of Diabetic Patients 1
Agenda Overview of organization and managed care Building the business case Express Coaching process Program administration Results and outcomes Summary Questions 2
Overview of the Organization and Managed Care 3
About Sutter Health Northern California Not-for-profit 26 hospitals 3,500 physicians 100+ communities Regional leaders in: pediatric, obstetrical, heart and cancer care 4
About Sutter Connect Subsidiary of Sutter Health Healthcare administrative and support services Our key competencies Integrative: bridges across multiple clients 5
Sutter Connect Vital Statistics Accounts Receivable Charges $650,000,000 Managed Care Incoming Cap $1,165,000,000 Commercial Capitated Lives 451,000 Medicare Advantage (Global) 34,352 Annual Transactions FFS Claims Billed 3,039,303 Invoice Payment Transactions 4,702,133 MC Claims Processed 2,093,000 Service & Support Calls 533,000 6
Managed Care Defined Systematic approach to healthcare Link between payers and providers and patients Providers are prepaid for services Motivated to manage risk by preventing costly care Incentives for improving quality (Pay for Performance) 7
Disease Management Definition A system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant. -Disease Management Association of America 8
Purpose of Disease Management? Improve patients quality of life A win-win in managing cost Physician Performance Incentives Mandated by national quality standards 9
Interventions Multiple Illnesses Medical Management Challenge Poor control Level of Illness Fair Co ntrol Case Mgmt Intervention Specialty Referral Coachin g Reporting On ly Self - management/ behavior modification recommended for poor and fair control Excellent Cont rol Monitoring Only Pre-Diabetes Not identifie d 10
Sutter Connect Niche Access to patient data Robust data analysis Pharmacy Data Medical History Lab Data Population Segmentation 11
Coaching/Disease Management Program Components Coaching Participants Lab Testing Physician Reports Disease Management 12
Building the Business Case for Disease Management Coaching 13
Diabetes Statistics $116 billion direct medical costs Additional $58 billion indirect costs $11,744 /yr AVG cost (per person) 2.3 times greater costs than non-diabetes 38% of patients incur 70% of total cost 18% of healthcare costs are incurred by patients with diabetes 2007, American Diabetes Association 14
Diabetes Statistics 23.5 million Americans (7.8%) have diabetes 5.7 million undiagnosed 10.7% of Americans over 20 years 23.1% of Americans over 60 years 2007, Center for Disease Control 15
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A Compelling Business Case Disease Management grant Voluntary (medical group) participation Sutter Connect s unique position Offered interdisciplinary approach Unique executive competence 17
Goals Improve clinical condition of patients: Reduction in HgbA1C levels Reduction in LDL-C levels Slow rate of increase in patient acuity 18
Express Coaching Process 19
The Sutter Connect Plan Cutting edge telephonic coaching program Complement physician s work Target specific population Staffed with certified coaches Focus on (patient) self-management Measure the change in diabetes control (HgbA1c) 20
Sutter Connect Approach to Disease Management Coaching Patient-centered Non-judgmental Compassion without colluding Engage values Accountability Non-prescriptive Patient self-management 21
Benefits of 10-Minute Express Coaching Model? Simple and straightforward Optimizes productivity Cost-effective High-impact, low-cost Scalable 22
Driving Factors in Developing the Model Economic factors PMPM cost (per member per month) Client-relevant outcomes 23
Express Coaching Process Identify Level of illness Invite/Enroll Letter/phone call Discovery 30-minute session Phase I Coaching 8 weekly 10-min. sessions Phase II Coaching Monthly maintenance 24
Effective Coaches Skill Set Empathetic without Collusion Listening & Synthesize Specific Accountability Compassion Choice, Commitment, Wellness vs. Illness Non- Judgmental Expose Barriers Connect Values to Behavior 25
Coach Selection Criteria Coach training / certification Coaching experience Willingness to utilize Express Coaching model Inspiring and motivating Coaching vs. non-clinical expertise 26
Coach Training Coaches Training Institute Wellness Coach Training LAD EPICS Basic overview of Diabetes 101 Regular on-site coach training/ development 27
Coaching Model Unifying Force Foundation Simple L.A.D. Listen Appreciate Design 28
Coaching Model Higher expectations for our patients Unifying Force Foundation Simple Wellness L.A.D. Change Process Community Diagnostic Listen Appreciate Design 29
Coaching Model Higher expectations for our patients Teachable Moments Sustainability Self-Reliance Community EPICS Wellness Empathy, Planning, Individualized, Community, Sustain Change Process Community Diagnostic Unifying Force Foundation Simple L.A.D. Listen Appreciate Design 30
Exercise Knowledge & Information Supportive Relationships Weight Diabetes Wellness Nutrition Medication Lifestyle Stress 31
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Typical Coaching Call Brief check-in (e.g. last blood sugar reading/current state self-assessment) Follow-up on goals/accountability Discuss barriers, concerns, successes, etc. Set goals for/accountability coming week 33
Group Discussion What critical observations do you have? List some pros / cons of this model. What are the limitations of the model? What are other applications of the model? 34
Program Administration 35
Coaching/Disease Management Program Components Coaching Participants Lab Testing Physician Reports Disease Management 36
Organization Chart 37
Staff 4 Coaches Program Manager Administrative support Capacity 4 coaching sessions per hour 300 coaching sessions per week Structure 30-minute Discovery call Eight 10-minute Weekly sessions Ongoing Monthly sessions Monitor/Re-enroll 38
Participant Identification & Enrollment Physician Feedback and Report Phase I & II Program Administration Record Keeping Management Coaching Patient Letters (lab slips) 39
Timeline Wave 1 10/2005 Wave 2 1/2006 Wave 3 4/2006 Wave 4 7/2006 Wave 5 10/2006 Wave 6 1/2007 Wave 7 4/2007 Wave 8 7/2007 Wave 9 10/2007 Wave 10 1/2008 Wave 11 4/2008 40
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Results and Outcomes 42
Population Studied Coaching Group 250 patients received coaching Study Population Identified 4500 patients with diabetes Control Group 2500 patients received traditional medical treatment Cohort Group 1750 patients counterpart to Coaching Group 43
78% Patient Satisfaction with Disease Management Coaching 73% 86% 81% Diabetes Lipid 61% 51% Very Satisfied Would recommend Set/achieve health goals
Patient Satisfaction Trend 89% 76% 78% 82% 87% 68% 63% Diabetes Lipid 85% 79% 76% 76% 74% 71% 71% 71% 65% Q1-06 Q2-06 Q3-06 Q4-06 Q1-07 Q2-07 Q3-07 Q4-07 Q1-08 Q2-08
65% Monitor Blood Sugar More Regularly 55% 52% 48% 45% 45% 46% 37% 38% 40% Q1-06 Q2-06 Q3-06 Q4-06 Q1-07 Q2-07 Q3-07 Q4-07 Q1-08 Q2-08
8.00 Coaching Group: Improved A1c Scores! 7.90 7.90 7.80 Coaching Group (6% improvement in test results) 7.70 Average A1c Score 7.60 7.50 7.40 7.49 7.33 Control Group (no improvement) 7.45 7.42 7.30 7.20 7.27 7.10 Cohort Group (3% improvement) 7.00 Time Period 47
44.4% Better Diabetes Control in Coaching Group: 51.5% 44.6% 53.7% 55.2% 47.2% 41.4% 49.2% 42.6% 43.6% 43.6% 46.6% Poor Control (A1c>9) Good Control (A1c<7) 15.2% Affiliate 1 14.3% With coaching 13.1% Affiliate 2 12.8% With coaching Affiliate 14.4% 3 13.6% 13.9% No coaching Baseline Year 1 Year 2 9.0% 8.4% Affiliate 4 No coaching 12.3% 12.6% 11.8% Affiliate 1 With coaching Affiliate 2 With coaching Baseline Year 1 Year 2 Affiliate 3 No coaching Affiliate 4 No coaching 48
Coaching Group: Better P4P Rates 90.76% 82.59% 82.43% 72.48% 69.20% 2006 57.34% 49.82% 39.62% 31.84% 23.73% 94.55% 85.74% 90.18% 2007 72.48% 65.02% 57.34% 55.45% 46.30% 25.58% 18.73% A1c Testing LDL Testing LDL < 130 LDL < 100 Poor Control 49 Patients With Coaching All Patients
$250.00 Coaching Group: Decrease in Cost of Care! $236 $225.00 Coaching Group -11.5% decrease in medical costs $200.00 $209 $175.00 $167 Control Group - 7.6% increase in medical costs $176 $150.00 $164 Cohort Group - No change in cost of care $166 Does not include fees for hospital/emergency care 50
Cholesterol Trend for Patients Working with Coach 126.03 LDL Cholesterol 121.48 118.37 117.34 118.10 Baseline at 3 months at 6 months at 9 months at 12 months 51
Summary 52
Clinical Findings and Conclusions Coaching group showed: greater improvement in diabetes control (A1c testing) greater reduction in cost of care (PMPM decreased 11.5 %) Better performance in all P4P measurement areas Patient perceived benefits Physicians continue to fund/support Effective with other conditions 53
Coaching Findings and Conclusions Dramatic impact from brief sessions Coaching as a viable product line Simple and structured works best Fundamentals of coaching endure stakeholder priorities Balance productivity and nurturing Offers diversity in field of coaching 54
Benefits Coach Insights Challenges, tips and traps Coach as entrepreneur or employee Expect the unexpected Reaching the next level 55
Critical Success Factors Quantify, link and align priorities Top level support / buy-in Coach buy-in Eliminate existing bias Integrate and systematize Endowment funded Courage to try something different 56
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Presenter Contact Information: Ken Buback Chief Administrative Officer BubackK@sutterhealth.org The ICF values your feedback. Please take a moment to complete a session evaluation form and return it to the room host located at the back of the room. Brian Marsh Program Manager Disease Management MarshB@sutterhealth.org 58