transforming healthcare in arizona

Transforming Healthcare In Arizona

Priya Radhakrishnan, M.D.Chief Academic Officer, Honor Health

Medical Advisor, Practice Innovation Institute&

Jenn Sommers, Director, Practice Innovation Institute

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Transforming Clinical Practice Initiative (TCPI)

• TCPI is designed to help clinicians achieve large-scale health transformation

• A four year initiative from Oct 2015 – Oct 2019• Supports more than 140,000 clinician practices in sharing,

adapting & further developing their quality improvement strategies

• Enables new levels of coordination, continuity, and integration of care, while transitioning volume-driven systems to value-based, patient-centered, health care services.

• TCPI participants include:– 29 Practice Transformation Networks (PTNs)– 10 Support and Alignment Networks (SANs)

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Practice Transformation Networks (PTNs)

Presenter

Presentation Notes

To achieve these goals, TCPI funds two types of collaborative networks—Practice Transformation Networks and Support and Alignment Networks. The Practice Transformation Networks are peer-based learning networks designed to coach, mentor, and assist clinicians in developing core competencies specific to practice transformation. This approach allows clinician practices to become actively engaged in the transformation and ensures collaboration among a broad community of practices that creates, promotes, and sustains learning and improvement across the health care system. The Support and Alignment Networks will provide a system for workforce development utilizing national and regional professional associations and public-private partnerships that are currently working in practice transformation efforts. Utilizing existing and emerging tools (e.g., continuing medical education, maintenance of certification, core competency development) these networks will help ensure sustainability of these efforts. These will especially support the recruitment of clinician practices serving small, rural, and medically underserved communities.

AIMs/Goals: Primary & Secondary Drivers

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TCPI Phases of Transformation

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Practice Innovation Institute

• One of 29 Practice Transformation Networks (PTNs) funded under the national CMS Transforming Clinical Practice Initiative (TCPI)

• Four years of funding beginning Oct 2015 to transform the practices of 2,500 providers in Arizona

• A collaboration among Health Current, Mercy Care Plan and Mercy Maricopa Integrated Care

• Supporting FQHCs, Integrated Health Homes, Clinically Integrated Pediatric Network (PCCN), Crisis providers, Equality Health Network and Specialty practices

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In one word - UNIQUE

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PiiPediatric Clinically

IntegratedNetwork

(119)

Outpatient Behavioral Health (10)

FQHC’s (13)

Specialty Practices

(10)

Unique:Crisis services,

Corrections(6)

Integrated Health Homes

(8)

Statewide Health

Information Exchange

Mercy Care Plan/Mercy Maricopa

Integrated Care

Equality Health Network

Presenter

Presentation Notes

Highlight the variation of practices: Over 2500 clinicians; 48 Enterprises/Organizations representing 461 locations/practices

Pii - Path to Health Care Transformation

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Patient & Family Centered Care

Design

• Patient Engagement

• Access to care• Use of Data

Continuous, Data Driven Quality Improvement

• QI technical assistance

• Identifying Data Source and PDSA

• Linking with Resources

• Success with QPP/UDS/VBS

Sustainable Business Operations

• Practice management

• Service line augmentation

• Staff vitality & joy in work

How we plan to get there!

HIT Platform Services & Applications

Data Sources Used by clinicians

Used by other staff

Used by patients & families

Care Quotient • Population Health & Analytics

• Predictive Analytics• Benchmarking• Risk Stratification

• Claims from health plans, via HIE

Care Unify • Care Management• Care Pathways• Risk Stratification• Patient Panels• Alerts &

Notifications

• Claims from health plans

StatewideHealth Information Exchange (HIE)

• Clinical data aggregation

• Clinical data repository

• Direct secure e-mail• Provider Portal

(query & response)

• Providers, via directconnection

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Presenter

Presentation Notes

Care Quotient in implementation phase and targeted to be rolled out in the next quarter. Care Unify currently in use at 2 Integrated Health Homes (IHH); scheduled for deployment in additional IHH locations throughout the year. Statewide HIE (HC) currently use of ADTs and Portal in use at 16 organizations; prioritized for implementation across others throughout the remainder of the year

Application to Behavioral Health

• Significant representation of BH in TCPI and Pii– New Common Measures– The Behavioral Health Affinity Group

• Increasing awareness of the importance of behavioral health and psychosocial determinants in health care

• Collaborating with other PTNs and SANs nationally– Both APAs and the National Council– PTNs in NY, LA, CO, MI, IN, ME, CT, NC, and Vizient

• Pii Academy provides resources for transformation– Access to TCPI resources– The Behavioral Health Affinity Group and the BH Resource Compilation– Subject Matter Experts– Workshops and Conferences

• GOAL: To work with our behavioral health and medical practices to respond to industry changes and to support their need to be sustainable, thriving practices

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Primary Change Driver: Person and Family Centered Care Design• Integrating medical and behavioral health for persons with a

Serious Mental Illness– Challenges in administering– Promoting team based care– Focusing on and engaging the member

• Collaborative Care Model• Behavioral Health Members in emergency departments • Innovation

– Multi-condition BH screening pilot with Community Bridges– Solutions supporting team base care

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TCPI PFE Program Components

Inclusion of the patient voice in

practice operations

Enhanced Access

Use of e-technology to

engage patients & family

Assessment to gauge patient

readiness to be “activated” as a partner in their

care

Measurement of patient

health literacy

Organized, evidence based

care

Shared decision-making

among clinicians &

patients


Primary Change Driver: Continuous Data Driven Quality Improvement• Connection to Health Information Exchange (Health Current)• Addition of analytic and decision support tools

– Practice management– Practice dashboards– Utilization and cost data including pharmacy– Identifying the high needs, high cost members– ADT alerts– Integration of plan and provider data

• Innovation – CMT and Opioids

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Transformation process

EvaluateImplementDevelopDesignAnalysis


Primary Change Driver: Sustainable Business Operations• Transitioning to value based reimbursement: learning to

count accurately, analyze, and document value• Developing the right value based models• Moving from compliance to outcomes• More effective administration of integrated models• Restoring joy in practice

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Transformational Pathways

ASSESS Diagnose with Data Teach

Graduating toward coordinated care

• High risk registry• Warm hand offs• Schedule appointments together ( co-located) • Develop combined plan of care• Identify member/peer/family engagement• Post ER/Hospital visit plans • EHR strategy

Operationalizing Integrated Care – Where to Start

Engaged leadership

Data Driven Improvement

Sustainable Business

Operations

Team Based Care

Patient –Physician

Partnership

Population management

Continuity of Care

Access to Care

Care Coordination

Evolved Practice

Adapted from Center for Excellence in Primary Care & Transforming Clinical Practice initiative

Presenter

Presentation Notes

As the PDSA cycle is worked through, the first few cycles are concerned with testing new ideas, amending them if necessary, further testing leading to further cycles implementing the changes and ensuring their sustainability. It is imperative to involve all the relevant stakeholders in planning and implementing change as this ensures the appropriate sign up and ensures that the new system is sustainable.

Opioid Epidemic Solutions: HIE/PMP Integration

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• HIE integration with Arizona’s Prescription Monitoring Program required by 2016 Az Senate Bill 1283

– BEGINNING OCTOBER 1, 2017, THE CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM DATA INTO THE EXCHANGE…

• HIE/PMP integration “go-live” - August 1, 2017

• Impact on Opioid Epidemic– Providers using HIE Portal will be able to access all controlled substance

prescriptions from PMP database along with all medical history available through HIE

– Aligns with integrated physical and behavioral health information exchange• In emergency, providers able to break the glass and access patient’s Part 2 substance abuse data• In other instances, can access Part 2 substance abuse data with patient consent

Successes to Date

• Alignment with FQHCs, Collaborative Care Network along with Healthy Communities Collaborative Network on HRSA grant; successful meeting with the FQHCs to review technology, transformation, patient and family engagement

• Training programs coordinated with ACP, APA, PCPCC and NP Supported Alignment Networks (SAN)

• Submitted 6 patient and family engagement performance stories for national recognition– Pulmonary Institute– A New Leaf– Recovery Innovations– Desert Senita FQHC– Community Bridges– Wesley Community & Health

Center

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SMI population profile

Serious Mental Illness (SMI)• 20% of population account for half of the cost• 2/3 have substance abuse problems• 2/3 have 1 chronic medical condition, half have 2,

and 1/3 have 3 or more

Non-SMI Adults• Chronic physical conditions with co-morbid

mental health and substance abuse• Drive high costs on medical side

High Needs/High Cost Members• Complex physical and behavioral health needs

• Crisis episodes• Emergency department (ED) and inpatient

admissions• Substance use/abuse, polypharmacy

• Critical psychosocial supports needed• Housing • Employment • Criminal justice involved• Not engaged or empowered

Population

SMI Adult

Non-SMI

Adult

Top 20% SMI

Total Members

25,000

450,000

4,500

Annual Cost

$700m

$400m

$400m

Average Cost Per Person

$28k

$889

$90k

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Presenter

Presentation Notes

Population within IHH setting High level demographics (20K SMI, Maricopa County) 25% of the folks = 400M spend (annual) Address top 10% over 10 ED visits per year (2 have over 40 visits per year) Address fidelity scores compared to high cost, high need member impact; physical health cost implications

Partners in Recovery (PIR)

• Outpatient behavioral health practice serving persons with serious mental illness (SMI)

• Started integrating physical and behavioral health care in April 2014

• Currently serves approximately 7,500 members

• Has 3 Assertive Community Teams (ACT) – 1 of which is a “M-ACT” or Medical ACT Team

• Represents 1 of 6 similar practices serving 25,000 persons in Maricopa County with SMI

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PIR Success!

M-ACT Team

46% reduction in psychiatric admissions

11% reduction in unnecessary

emergency room services

OMEGA ACT Team


11% reduction in acute

hospitalizations

41% reduction in unnecessary


VARSITY ACT Team


39% reduction in acute

hospitalizations

.2 reduction in unnecessary


WEST VALLEY ACT Team


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Partners in Recovery –PFE Initiatives

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E-Tools Implementation of patient portal

(request appointments, send messages to clinicians, view medical documents)

Connected to statewide HIEHealth Literacy

Require all staff to complete cultural competency trainings

Implemented Wellness Recovery Action Plan (WRAP) Programs for, both, participant and family (strong emphasis on self-management)

Patient Activation Uses PHQ-9 tool consistently across

the various locations

Support of Patient Voices in Governance & Operational Decision-Making

All of 7 locations have a member-led Patient Advisory Council

Member seat on Board of DirectorsShared Decision-Making

Integrated Service Plan template includes section for member to identify personal, achievable goals (i.e. employment, housing, A1C numbers, etc)

All clinical team members (Nurse, case managers, vocational specialist, employment specialist) trained on Motivational Interviewing

Presenter

Presentation Notes

Over the past year, PIR has focused on improving patient outcomes and reducing costs. During this time PIR has implemented several patient & family focused programs. The reason why this information is key is that PIR has built it’s infrastructure (IT, Staffing, Training & Education); however they were lacking the “data”. With the ability to obtain real time admissions, discharges, and transfers, notifications and the strong infrastructure, PIR will be successful in this transformation initiative. Patient activation – standardize processes for screening

Questions?

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transforming healthcare in arizona

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