cathie markow, bsn, mba, senior director, clinical … 2014/anc/presentations/anc master... ·...

Cathie Markow, BSN, MBA, Senior Director, Clinical Quality – Castlight Health Ms. Markow leads Castlight’s quality strategy including efforts to find the best possible clinical quality information and to incorporate it into Castlight Health solutions, making it meaningful and actionable to consumers. While at Pacific Business Group on Health (PBGH), she managed the California regional collaborative, a multi-stakeholder organization focused on provider performance measurement and reporting, and was involved in a variety of health care quality reporting and improvement activities within the state and nationally. She holds a BS in nursing and BA in sociology from Hartwick College, and an MBA from Northeastern University.

Sophie Pinkard, Director of Strategic Analytics – Castlight Health Sophie Pinkard is Director of Strategic Analytics at Castlight Health. The Strategic Analytics team focuses on evaluating the impact of Castlight's platform on employers and users and providing meaningful, data-driven insights within the company and externally. Sophie previously worked at the Advisory Board partnering with hospitals on business intelligence tools to improve revenue cycle performance. She received both a BS in management science and engineering and an MBA from Stanford University.

CONFIDENTIALCONFIDENTIALCONFIDENTIALCONFIDENTIALCONFIDENTIALCONFIDENTIALCONFIDENTIALCONFIDENTIAL

Avoiding serious medical errors that compromise health and inflate costs

April 22, 2014

CONFIDENTIALCONFIDENTIAL

Today’s Speakers

Cathie Markow, BSN, MBASenior Director of Clinical QualityCastlight Health

Sophie Pinkard, MBADirector of Strategic AnalyticsCastlight Health

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Health Care Transparency

Transparency enables benefits success

Engaged Employees

Right Providers

RightCare

Transparency ties the employer’s benefits strategy together

| 3


Castlight supports an employer’s health goals

Quality

Engagement Innovation

Education

Integration Benefit Design

Price Personalization

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Serving benefits leaders across 26 industries

| 5


Meet Bob

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An example: Poor quality, one employer

14members with

serious pressure sores

12members with

catheter-associated blood

infections

13members with

catheter-associated

urinary tract infections

5members with foreign

object left in place after procedure

Data on never events as defined by CMS over a 2 year period.

1member who died or

was left with a serious disability from an

embolism

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Sources: Institute of Medicine (1999), “The Factors Fueling Rising Healthcare Costs 2006”, PricewaterhouseCoopers (2006), Medpec (2007), American Association of Endocrinologists (2006), Center for Disease Control and Prevention (2005), Solucient (2007), U.S. Outcomes Research Group of Pfizer Inc (2005), National Committee for Quality Assurance (2005), Analysis by PricewaterhouseCoopers’ Health

Defensive medicine

Preventable hospital

readmissions Poorly managed diabetes

Medical errors

Unnecessary ER visits

Hospital acquired infections

Treatment variations

Over prescribing antibiotics

$210 billion

$25 billion

$22 billion

$17 billion

$14 billion

$10 billion

$3 billion $1

billion

1/3 of health costs are the result of poor quality care

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Avoidable cost of poor quality care in the U.S.

$25billion

$17billion


What’s the true cost?

Longer hospital visits

Missed work

Complications

Re-admissions

Personal Financial

Pain

Emotional Toll

Loss of life

Caregiving

Loss of vitalityIncreased care

More provider visits

Productivity loss

Reduced ProfitabilityTime

Stress

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Grave impact of preventable events

Up to 440,000 deaths

attributed to some type of preventable harm or never event suffered in hospitals

3rd leading cause of death

behind heart disease(#1) and cancer (#2)

Source: Journal of Patient Safety (Vol. 9, Issue 3), September 2013 | 10

CONFIDENTIALCONFIDENTIAL | 11


Defining never events

28“Never Events”

identified by National Quality Forum

We analyzed 5:

Pressure ulcer

Vascular catheter-associated infection

Catheter-associated UTI

Foreign object retained after surgery

Air embolism

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300 million claims from 2011-2013

87 employers selected for analysis

275 U.S. metropolitan areas covered

Castlight’s data set

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We analyzed the following never events

Pressure ulcers

Catheter-associated UTI

Vascular catheter infection

Retained foreign objects

Air embolism

1

2

3

4

5

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These events are common, but not inevitable

Out of the 87 employers selected for analysis:

77had at least one

event occur

10had no events in

three years

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All events by metropolitan area

<1 event per 1000

1-2 events per 1000

2-3 events per 1000

>3 events per 1000

Dots represent average annual number of never events per 1000 Castlight eligible members, from 2011 - 2013. | 16


Top 15 metro areas with the most never events

2.28

2.30

2.31

2.59

2.59

2.60

2.69

3.12

3.16

3.17

3.19

3.35

4.42

5.45

5.67

Gainesville, FL

Gadsden, AL

State College, PA

Anniston, AL

Roanoke, VA

Athens, GA

Philadelphia, PA

Richmond, VA

Utica, NY

Jackson, TN

Charleston, WV

Flagstaff, AZ

Augusta, GA

Greenville, NC

Rochester, MN

Annual never events per 1K Castlight-eligible members

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Pressure ulcers by metro area

Dots represent average annual number of pressure ulcers per 1000 Castlight eligible members, from 2011 - 2013.

<1 event per 1000

1-2 events per 1000

2-3 events per 1000

>3 events per 1000

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Vascular catheter infections by metro area

<1 event per 1000

1-2 events per 1000

2-3 events per 1000

>3 events per 1000

Dots represent average annual number of vascular catheter-associated infections per 1000 Castlight eligible members, from 2011 - 2013.

<1 event per 1000

1-2 events per 1000

2-3 events per 1000

>3 events per 1000

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Catheter-associated UTIs by metro area

<1 event per 1000

1-2 events per 1000

2-3 events per 1000

>3 events per 1000

Dots represent average annual number of catheter-associated UTIs per 1000 Castlight eligible members, from 2011 - 2013.

<1 event per 1000

1-2 events per 1000

2-3 events per 1000

>3 events per 1000

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Retained foreign objects by metro area

<1 event per 1000

1-2 events per 1000

2-3 events per 1000

>3 events per 1000

Dots represent average annual number of retained foreign objects per 1000 Castlight eligible members, from 2011 - 2013.

<1 event per 1000

1-2 events per 1000

2-3 events per 1000

>3 events per 1000

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Top 15 metro areas with the fewest never events

These 15 metro areas have the highest number of of eligible members over the past three years with zero never events.

Within every metro area with never events, there were a number of hospitals with no events.| 22


Accountability for never events

Hospital? Surgeon?

Both – it’s a team effort.

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1) Know your population

2) Support efforts to measure and report performance

3) Programs and Incentives

What can employers do?

You can’t manage what you can’t measure.

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Use publicly reported metrics

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Benefits to Employers Rich information needed for developing value-based networks of

high-quality providers Better surgical outcomes and decreased absenteeism for

employees

How can employers get involved? Encourage health plans or Third Party Administrators (TPA) to

require registry data from hospitals Ask health plans or TPA to encourage hospital outcomes

transparency Advocate that health plans reward registry-participating

hospitals and surgeons Recognize registry-participating hospitals and surgeons

Support and use registries

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Identify variation, direct-to-high quality facilities

St. Patrick’s Hospital• Surgical Score: Below Average

Memorial Hospital• Surgical Score: Average

Pacific Medical Center• Surgical Score: Above Average

Regional Medical Center• Surgical Score: Average

Surgical score = Hospital’s composite average of CMS surgical safety measuresSelected surgeries include: Hip replacement, knee replacement, hysterectomy, C-section, low back surgery, CABG, radical prostatectomy

Key1-2 selected surgeries for Acme Corp members

3-10 selected surgeries for Acme Corp members

10+ selected surgeries for Acme Corp members

Atlantic Hospital• Surgical Score: Average

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Avoid unnecessary surgery with second opinions

Up to 30%of second opinions reveal that the

original diagnosis was wrong or need to be revised

Up to 90%of second opinions recommend changes to

original treatment plan

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A medical facility that is recognized as a leader in providing high quality, evidenced-based medicine Surgical procedure or medical condition Costs often considered Credentialing program available for some services

Incent use of Centers of Excellence (COE)

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Common COE procedures: Coronary Artery Bypass Graft

(CABG) Heart valve replacement Knee / hip replacement Spinal fusion / disc surgery Bariatric surgery Transplant surgery

1 National Business Group on Health, Large Employer’s 2014 Health Plan Design Survey, August 2013

of large employers offer a COE program for organ transplants1

72%

59%offer a COE program for conditions other than transplants1

Innovative employers see value in COEs

“This national program is about providing our associates with exceptional care and reducing their medical costs…”-SVP of Global Benefits, Castlight Customer

COE value proposition

Hospitals vary in quality

COEs optimize quality vs. cost

Higher quality leads to better outcomes

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Educate employees

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Select a high quality hospital and surgeon

Find provider(s) experienced in performing procedure

Review clinical outcomes data - Complication rates- Readmissions- Mortality

Review process metrics in the absence of outcomes data- Antibiotic management- Blood clot prevention- Timely urinary catheter removal

Employees can minimize risk of surgical events

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Be prepared Start healthy Schedule early in week Have a family member present

Avoid infections Ask about antibiotics Avoid razors Insist on hand washing Have tubes/catheters removed as soon as possible Good skin care

Prevent blood clots Prevention Get moving as soon as you can

Get the right drugs

Employees can minimize risk of surgical events

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Wrong site surgery Preoperative verification Marking the operative site “Time out” immediately before starting

the procedures Safe surgery checklist

Infection prevention Hand washing - can reduce the

nosocomial infection rate by as much as 40%*

Appropriate use of antibiotics Catheter care

What can hospitals do?

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770229/

It doesn’t have to cost a lot to save a life!| 34


Use of information technology Electronic order entry Electronic medical records

Care management Discharge planning/instructions Care coordination

What can hospitals do?

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Back to Bob

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Questions?

Q&A

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Rena Brewer, RN, MA – Southeast Telehealth Resource Center (SETRC) Rena Brewer, RN, MA serves as the Director of the Southeastern TeleHealth Resource Center (SETRC). www.setrc.us which is one of 14 federally funded (HRSA/OAT) regional & national resource centers with the mission of providing support/guidance to those wishing to implement telehealth services. SETRC’s region includes Alabama, Florida, Georgia, and South Carolina. Rena also serves as the Director of the National School of Applied Telehealth (NSAT) which is the online educational arm of SETRC. www.nationalschoolofappliedtelehealth.org. SETRC is a branch of Georgia’s highly successful, not-for-profit, state-wide telehealth network; Georgia Partnership for Telehealth (GPT). Rena, a Registered Nurse with a Masters in Organizational Leadership, has 9 year’s experience in building telehealth networks with GPT and 25+ years of experience in community health education and organization building.

http://www.nationalschoolofappliedtelehealth.org/

The New Wave of Health Care:

Telehealth

FHCC 2014

Annual National Conference

April 22-23, 2014

The New Wave of Health Care:

Telehealth

Plenary Session III

Moderator: Ken Peach, Executive Director - Health Council of East Central Florida

Panel Members:

Rena Brewer, RN, MA - SE TeleHealth Resource Center

John K. Holland, Senior VP for Research - AMC Health

Anna Baznik, President/CEO – IMPOWER

…...Healthcare was available anytime and anywhere

…..Clinicians / patients could obtain

consultations with medical centers of excellence anytime and anywhere

…..Home bound patients could be

monitored remotely anytime and anywhere

…..Medical education programs were

available anytime and anywhere

This is the potential of telehealth!!!

Can you imagine what health care would be like if….

Healthcare: Any Time….Any Place….

The healthcare system is coming under increasing pressure to:

•improve the quality of care while; •decreasing the cost to provide this improved care.

Telehealth has the potential to address some of the pressing issues

facing today’s stretched and stressed healthcare system.

Telehealth is simply….

The use of telecommunications technology to support and deliver healthcare from a distance.

On Site Telehealth Services

help organizations keep employees

where they are needed the most...

On the job!

Corporate Telehealth Benefits

• Access to on-site healthcare

• Convenience for employees

• Minimizes employee downtime

• Early diagnosis & treatment can minimize spread of disease

• Applicable to many common conditions

• Supplements current on-site health program

• Suitable within the corporate environment and adaptable to company culture

Cost Savings

• Onsite Provider Cost Savings

• Improved Health Outcomes

– Timely Acute Care Treatment for Common Illnesses

– Potential for Improved Disease Management

– Decreased Need for Crisis Care

• Decreased Employee Absenteeism

• Healthier Workforce

TELEHEALTH APPLICATIONS

Clinical Services – Patient / Provider Consultations; such as Primary Care, Specialty Care, ICU Monitoring, Emergency/ Stroke Services, Chronic Care Monitoring / Home Monitoring, Employee Health Care

• Live / Synchronous–Video, Interactive, Face to Face

Both the patient and the healthcare provider are available in real time and can communicate as though in the same room.

• Store & Forward / Asynchronous

Used when face to face interaction is not required ;

Radiology, Dermatology, Pathology, Home Monitoring, etc.

Educational Services – Patient and Clinical Staff Education.

Administrative Support – Video Conferencing for One-One Meetings or Multi-Point Meetings.

Barriers and Possible Reasons for the slow adoption of Telehealth:

• Human Factor – Low awareness by providers & receivers of telehealth and its benefits – Reluctance to change or embrace technology

• Lack of Wide-Scale Reimbursement – Reluctance of many insurers to pay for services – Medicare reimbursement restrictions – Medicaid reimbursement varies from state to state

• Regulations – Licensure of physicians / providers in multiple states – Credentialing of providers

• Technology – Hardware/Software Cost* (*Note: The industry is moving to higher

quality / lower cost solutions) – Disconnected Health Information because of the lack of standards & interoperability between systems / networks – Limited broadband access for patients in some regions

Final Thoughts… • Telehealth is one of the most promising evolutions in the

health care landscape.

• Remote healthcare services

and technology are quickly becoming commonplace in

the healthcare setting.

• Now is the right time for

telehealth to gain prominence

in helping the healthcare industry

resolve cost and care quality challenges.

The Florida Telehealth Workgroup

The Florida Telehealth Workgroup is a volunteer group of telehealth stakeholders interested in advancing telehealth services in Florida.

Workgroup Objectives:

• To provide insight and direction regarding the advancement of telehealth in Florida

• To encourage collaboration among existing telehealth networks and programs.

The Florida Telehealth Workgroup is Facilitated by the

Southeastern Telehealth Resource Center

Southeastern Telehealth Resource Center (SETRC). www.setrc.us

SETRC is one of 14 Regional/National Resource Centers funded by the Office for the Advancement of Telehealth through a grant program to provide support and guidance to telehealth programs. (# G22RH20212-04-00)

SETRC serves Alabama, Florida, Georgia, & South Carolina and is operated by the Georgia Partnership for TeleHealth, Inc.,

Georgia’s successful nonprofit statewide telehealth network.

[email protected]

http://www.setrc.us/

14 TRCs are located across the country…..

John K. Holland, Senior Vice President for Research – AMC Health John K. Holland, Sr. Vice President for Research Prior to joining AMC Health in 2010, Mr. Holland founded LifeLink Monitoring, a leading national telemonitoring company, in 1994. He developed the first home blood pressure telemonitoring service in the U.S., followed by a suite of telemonitoring services for clinical trials, homecare, managed care and disease management. He has spoken on telemonitoring at Partnerships in Clinical Trials, the American Heart Association, the American and International Societies of Hypertension, the Society of Behavioral Medicine, and the American Association of Health Plans, and has written several scientific articles. Mr. Holland was a member of the Working Group on Compliance of the National Heart, Lung and Blood Institute, and co-inventor, with Dr. Thomas Pickering, of a mercury-free hybrid sphygmomanometer.

Telemedicine Goes Mobile

John HollandSr. VP for Research & Business Development

Collect data at home, transmit electronically to clinician who prescribes treatment

Objective data: 101o F

Subjective data: sore throat and cough

Transmitted to clinician electronically

MD prescribes treatment and follow-up

“Take 2 aspirins and call in the morning.”

It’s Nothing New…

4/20/2014Telemedicine Goes Mobile 2

Today, It’s Automated

BP HR BG Weight Temperature ECG FEV1 PEF PT/INR Fluid status Lipids HbA1c Stethoscope

Bluetoothto Mobile


http://www.choicemmed.com/productshow.asp?articleid=116&classid=19&parent

http://www.choicemmed.com/productshow.asp?articleid=116&classid=19&parent

Video Visits Can replace many office & home visits

Supervise biometric monitoring

Affect, posture, gait, speech quality, etc.

Fine motor coordination

Psychological assessment


Monitor Physical Activity and Sleep Quality

GPS and accelerometers in smartphones track activity over time

2-3 days’ total activity may be a better indicator of recovery than an office assessment

Wrist bands monitor sleep quality

Measure the things that matter to patients


“Drugs Don’t Work in Patients Who Don’t Take Them”

Major cause of treatment failure Monitors remind patients to take medication If patients fail to take Rx on time, clinicians

&/or family are alerted

Oral Rx in single container or multi-compartment tray

Inhaled Rx in MDI or DPI


Reducing Readmissions

Geisinger patients with high readmission risk

Automated phone calls identify care gaps Unfilled prescriptions and poor adherence No follow-up appointment Symptoms Psychosocial support

Nurse case managers address problems Risk of 30-day readmission reduced 44%

n= 3,195, p= .0004 Medical Care, 2012; 50(1):50-57


Controlling Diabetes

330 NYC HHC Medicaid patients with high HbA1c

Blood glucose and blood pressure telemonitoring

Nurse case managers coordinated care Primary health care contact for many patients Advocated with clinic staff, counseled patients

Reduced HbA1c by 1.8 points! Lower risk of HF, PVD and microvascular complications Even patients who didn’t complete benefited

Journal of Managed Care Medicine October 2012


Blood Pressure Health Partners (MN) patients with elevated BP

Home BP telemonitoring managed by PharmDs Adherence counseling MD-approved protocol to escalate Rx as needed

Randomized trial compared telemonitoring and pharmacist care with MD office management

BP reduced 21.6/9.3 mmHg in 6 months

50% more patients achieved goal BP than usual office care by MDsJAMA July 3, 2013


Back to the Future…

TELEMEDICINE ON YOUR PHONE

DEMONSTRATION


Anna M. Baznik, President/CEO - IMPOWER Ms. Baznik has over 25 years of experience leading, managing and working within a wide range of social service and behavioral health programs for large, multi-program, non-profit and public sector entities delivering bottom-line results, efficient systems and strong community relations. IMPOWER provides mental health and child well being services in Orange, Osceola, Brevard, Seminole, Volusia and Polk counties. During her time with IMPOWER, she has ensured the financial stability of the agency during tumultuous economic times; enhanced visibility and involvement in the Central Florida community and the state; improved quality assurance programs; and greatly expanded our funding sources and relationships. IMPOWER is leading the way in Florida utilizing telehealth for psychiatric, mental health and child wellbeing/welfare services. Ms. Baznik has her BA in psychology, Sociology and Religious Studies from Eckerd College. She obtained a Masters in Organizational Management from the University of Phoenix.

TELEHEALTH

Anna M. BaznikPresident/CEO

Why Telehealth? Why Now? Behavioral Health Well-Suited Affordable Care Act 4 Million New in Florida to be Insured Shortage of Practitioners Rural / Geographic Challenges Insufficient Transportation

•Brings Care to Patient; Reconceptualization• Increases Access to Care • Reduces Travel Time and Costs • Improves Satisfaction in Health Care • Reduces Delays & No-Shows • Enables Continuity of Care • Reduces Stigma

Telehealth Benefits

Our Pilot

• Partnered with Value Options and American Well

• Designed Virtual Provider Connect (vPC)• Breakthrough• ePsychToday

Our Pilot Developed P&Ps & Best Practices Trained Docs in vPC Brevard Family Partners - Hub The Haven - Hub Went Live in May 2013 Over 100 Individual Sessions – All Children

Legislative Update• House and Senate Bills• Agency for Healthcare Administration

www.impowerfl.org

QUESTIONS ??

Stay Connected

www.impowerfl.org

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Ken Peach, FACHE , Executive Director - Health Council of East Central Florida Ken Peach is Executive Director of the Health Council of East Central Florida, the health planning agency for Orlando and the Space Coast. The Health Council provides planning, program development and evaluation support that enables community-based health organizations to enhance population health.

Before joining the Health Council in December, 2010, Ken owned a medical practice business development company and health insurance agency.

From 1985 to 2005, Ken was an administrator in hospitals, health systems, and senior living facilities. Ken began his career in New Jersey and Florida building, managing, and owning AM and FM radio stations.

Ken holds a B.A. in Communications degree from Seton Hall University and an M.B.A. with Health Services Administration degree from Florida Institute of Technology.

BIG PICTURE: HEALTH CARE EXPENSES WILL RISE…

Source: Centers for Medicare & Medicaid Services,“Estimated Financial Effects of the “Patient Protection and Affordable Care Act,”as Amended, April 22, 2010.

REFORM WON’T FIX THAT.

CHANGING WHERE CARE IS OFFERED WILL HELP REDUCE COSTS.

$GOAL

Telehealth Team Care

Self-Care mHealth

CHANGING LOCATION REQUIRES TECHNOLOGY AND NEW TEAM ROLES.

cathie markow, bsn, mba, senior director, clinical … 2014/anc/presentations/anc master... ·...

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