centura health: population management case study · 2019-02-08 · centura health: population...
TRANSCRIPT
1
Session 230, February 14, 2019
Big Red Consulting Team
Sloan Program in Health Administration, Cornell University
Centura Health: Population Management Case Study
2
Anand Chaudhari, BS, MHA (Candidate)
Madeline Haftel, BS, MHA (Candidate)
Jean Marte, BHSA, MHA (Candidate)
Presenters have no real or apparent conflicts of interest to report.
Conflict of Interest
3
As background, the HIMSS Student Case Competition provides opportunities for inter-disciplinary teams comprised of undergraduate, graduate, residents, and Fellows to demonstrate proficiency in understanding of the vast body of knowledge that comprises health information technology. By analyzing a HIMSS-supplied case study, these teams had the opportunity to “design the future” with an eye towards transformative care. In their analysis, teams are to apply recommendations that support current health information technology practices that involve transformative care while coupling recommendations with advocacy outreach at the Federal and State level.
The winning team of the HIMSS Student Case Competition is a group of students from Cornell University’s Sloan Program in Health Administration. The team has analyzed and proposed hypothetical analyses, improvements, and solutions to a 2015 health population case study by a healthcare provider (a previous Davies award winning organization).
The information and commentary provided in connection with today’s presentation solely and exclusively reflect the views and opinions of today’s presenters. There is no affiliation, association, connection endorsement, or sponsorship with the subject organization of the case study or any other organization or entity. The information provided today is solely academic in nature. Any similarities with the healthcare environment today or with any other organization are purely coincidental.
Disclosure Statement
4
Agenda
Centura Health Overview1
Case Review
Process Improvement
CMS & Health IT
Community & Hospital Interventions
Recommendations
Financial Impact
Risk Analysis
Conclusion
1 Subject of 2015 Davies Case Study
5
Centura Health
Process Improvement
CMS & Health IT
Hospital & Community
Recommendations
Financial Analysis
Risks & Mitigation
6
16 Hospitals Across
Colorado and Kansas
Created 1996Catholic Health Initiatives and
Adventist Health Collaboration
Facility and Geography VarietyRange from rural 30 bed hospital to
metropolitan 220 bed Level 1 Trauma
Background
7
Problem Statement
“Both Mercy Family Medicine and the ACO are experiencing
high rates of unplanned readmissions. What sustainable value-
based care models can we provide to further mitigate this
problem by targeting workflow processes, technology, and
community advocacy and education?”
8
Process
Improvement
Accountable Care
Organizations
Recommendations
CMS & Health
IT
Hospital &
Community
Outreach
9
Age: 67 years old
Education: GED
Race: African-American
Insured by: Medicare
City: Durango, CO
Retired
Medical History: Type I Diabetic, Hypertension
Rita Hope1
1 Rita Hope is a fictional patient used for demonstration purposes in this analysis and this data does not represent
actual patient data
10
Case Review – Mercy Family
Leverage IT Staff Participate in CPC
Design Risk Stratification Tool
Limited Ambulatory CareHigh Costs
Coordinate Care
Risk Stratification Tool – 95%99.98% Patient Empanelment
Care Coordination$56 PMPM Expenditure Decrease to $603
11
Case Review – ACO
Target COPD, HF, DiabetesInterventions for:
Population IDRisk Stratification
ID & Address Care GapsCare Transition
Demand for High Performing NetworksQuality Based Metrics
Reduce Overall Cost of Care
Dedicated TeamReal Time ACO Patient ID
CRM Tracking ToolHF, Diabetes, COPD Readmission Reduction
12
Process Improvement
Process Improvement
CMS & Health IT
Hospital & Community
Recommendations
Financial Analysis
Risks & Mitigation
13
Quality Reimbursement Programs
Readmission Reduction Program
Hospital Based Purchasing Program
MACRA & MIPS
3% Medicare Reduction
2% DRG Withhold + Bonus
Up to 27% Incentive
14
Lean Six Sigma (LSS)
• Structured Process Improvement Methodology
• Allows:
– Defect reduction / waste elimination
• Anything that causes patient dissatisfaction/harm
– Improve discharge procedures
– Strengthen communication between departments
15
CMS & Health IT
Process Improvement
CMS & Health IT
Hospital & Community
Recommendations
Financial Analysis
Risks & Mitigation
16
Comprehensive Primary Care Plus Initiative (CPC+)
• Advanced Primary Care Medical Home Model
• CPC Model discontinued May 23rd, 2018
• Two tracks:
– Track 1 – old CPC model being adapted to large population
– Track 2 – new CPC+ model with higher cost sharing incentives
17
EHR Module & Requirements
• Requires practices 40% or 65% Quality Based Payments
– Paired with 60% or 35% FFS, respectively
• CMS has generated list of EHRs
that support CPC+
• Additional requirements for CPC+
participation requires screening for
following factors:
• Social
• Psychological
• Behavioral
• Incorporate whole health of patient
to value metrics
18
Hospital & Community
Process Improvement
CMS & Health IT
Hospital & Community
Recommendations
Financial Analysis
Risks & Mitigation
19
Pre-Discharge Intervention
• 1 in 5 Medicare beneficiaries readmitted within 30 days of discharge
costing $26 billion per year
• Plan Addressing behavioral factors pre-discharge reduce readmission
rates:
– Medication Review
– Nutritional Coaching
– Family/Support System Education
– Social Service/Behavior Counseling
• IHI PDSA Cycles will measure and evaluate effectiveness of new
intervention
20
Community Advocacy
Focus on increasing quality
of post-discharge patient
engagement and continuing
education
Public education sessions
21
Recommendations
Process Improvement
CMS & Health IT
Hospital & Community
Recommendations
Financial Analysis
Risks & Mitigation
22
Recommendations
Process Improvement
ACO
Pre-discharge Interventions
Community Advocacy
CMS & Health IT
• Train Project Coordinator to become LSS
Specialist
• Full-Day Workflow Analysis Workshop
• Focus on Patient Satisfaction
• Develop Departmental PI Champions
• Analyze patients pre-discharge
• Convert to CPC+
• Purchase EPIC Instance (Sonnet)
• Hire 2 Behavioral Therapists
• Comprehensive Pre-Discharge
Appointments
• Community Outreach Programs
• Open office hours with BHT
• Focus some resources on Low-Risk Patients
• Design Incentive program using savings from process
improvement/interventions
• Program will include targeted classes, healthy habits
showcase, pain/disease management
23
Financial Analysis
Process Improvement
CMS & Health IT
Hospital & Community
Recommendations
Financial Analysis
Risks & Mitigation
24
Cost of Implementing Recommendations
Projected New Costs of $715,373
LSS Certification $16,000
Process Improvement Workshop $12,000
Care Coordinators Salary (2) $180,000
MA Data Entry Cost $5,000
Interface with QRDAIII $8,000
New E.H.R. Instance (EPIC) $388,908
First Year Maintenance costs $205,200
Behavioral Therapist Salary (2) $86,600
Staff Training EHR $6,665
Total $908,373
25
Risk Tier Attribution Criteria Track 1 Track 2
Average PBPM $15 $28
Tier 1 1st quartile HCC $6 $9
Tier 2 2nd quartile HCC $8 $11
Tier 3 3rd quartile HCC $16 $19
Tier 44th quartile HCC for Track 1;
75-89% HCC for Track 2$30 $33
Complex
(Track 2 only)
Top 10% HCC
OR
Dementia
N/A $100
CPC/ CPC+Utilization
(PBPM) Quality (PBPM) Total (PBPM)
Track 1 $1.25 $1.25 $2.50
Track 2 $2.00 $2.00 $4.00
Track 1 vs Track 2
26
Projected Revenue Comparison
Track 1 (old CPC) Track 2 (CPC +) Track 2 (CPC+)
Number of Patients 6,336 6,336 6,336
Projected Revenue $1,140,480 $ 3,105,936 $ 3,105,936
Per Patient Bonus Estimate $1.50 $3.25 $4.00
Total Projected Bonus $9,504 $20,592 $25,344
Total Projected Revenue with Bonus $ 1,149,984 $ 3,126,528 $3,131,280
Profit increase of $2,000,000
27
Process Improvement Projected Savings
• Unplanned 30-day Readmission
Reduction
• 97 Readmissions/year
• $3,000 additional cost per
readmission
• $291,000 risk per year
Cost of 97
Unplanned
Readmissions
$291,000/year
Savings due to 40%
Reduction$116,400/year
Savings due to 20%
Reduction$58,200/year
Savings due to 10%
Reduction$29,100/year
28
Risks & Mitigation
Process Improvement
CMS & Health IT
Hospital & Community
Recommendations
Financial Analysis
Risks & Mitigation
29
RISK• Weak Buy In
• Higher Cost Sharing
• EHR Module
Implementation
• Data Breach
• Workflow Disruption
• Patient Information
Overload
• Patient Non-Compliance
• Effective Use of Limited
Resources
MITIGATION• Provide Data
• Utilize IT to Track Initiative
Progress
• Design Training Schedule
• Bucket Data
• Restructure Discharge
Process
• Provide Information via
Multiple Sources
• Design Incentive Program
with Savings
• Use EHR to Tailor
Services
Risk & Mitigations
30
Rita Hope
Process
Improvement
Accountable Care
Organization
CMS &
Health IT
Hospital &
Community
Outreach
31
• Anand Chaudhari • Email: [email protected]
• LinkedIn: https://www.linkedin.com/in/anand-chaudhari/
• Madeline Haftel• Email: [email protected]
• LinkedIn: https://www.linkedin.com/in/madelinehaftel/
• Jean Marte• Email: [email protected]
• LinkedIn: https://www.linkedin.com/in/jeanmarte/
Questions