Redefining Patient Care from
Hospital to Home
December 11, 2012, 2:00 - 3:30 pm ET
Tracey Moorhead
President and Chief Executive Officer
Care Continuum Alliance
Ron Greeno, MD
Chief Medical Officer
Cogent HMG
Welcome to Philips
Healthcare’s
“Reimbursement
Simplified” Webinar
Series
David Baker
Chief Executive Officer
Banner Home Care
Laurel Sweeney (moderator)
Senior Director
Global Health Economics & Reimbursement
Philips Healthcare
1
The voice of wellness, prevention
and chronic care management
2
The Continuum of Care
3
Essential Elements of Population Health Management
Maintain and/or improve the physical and
psychosocial well being of individuals
through cost-effective and tailored health
solutions.
•Central leadership role of the physician
•Importance of patient engagement,
education, activation
•Capacity expansion of care
coordination through non-physician
team members
Address health needs at all
points along the continuum of
health and well being through:
•participation
•engagement
•targeted interventions
4
Conceptual PHM Framework
Source: Care Continuum Alliance, Outcomes
Guidelines Report, Vol. 5, 2010.
5
PHM Program Elements
Population
Identification
Health
Promotion
and Wellness
Health Assessment
Risk Stratification
Care
Coordination &
Advocacy
Health Risk
Mgmt
Care Mgmt
Program Outcomes
and Evaluation
Quality improvement reporting and feedback (loop)
6
How do you deliver PHM in any Care
Setting?
Assess
Stratify
Implement
Solutions
Measure &
Report
7
Healthcare Reform
Moving Toward an Accountable Health Care
System
Coverage
Payment Reform
for All
Align incentives
Pay for Value
Improve Quality
and Support
Innovation
Strengthen Primary Care
Tools to Rebuild and Restructure Health Care
8
Turning the Ship
Drivers:
• Health
care cost
crisis
• Health
reform
• Improved
HIT
• Greater
stakeholder
align-ment
Creating need for new skill sets,
policy, tools and competencies
Physicianmanaged
health rather
than health
plan
managed
care
• New models of care delivery
and coordination
• Payment aligned with goals
• New tools for clinical alignment
• Better PHM capabilities
• Experience in performance
management/ data reporting
• Experience in population risk
adjustment/ risk mitigation
• Increased awareness of
prevention and wellness value
• Educated, empowered patients
9
Accountable Care Organizations
• “Shared Savings Program”
• Largest pilot program in ACA
• Physician practices/Hospitals
• Promote accountability in care (quality vs. volume)
• Require coordination of all services and redesigned care
processes – including home care and community care
• Encourage infrastructure investment
• Requires reliance on telehealth, RPM
10
Redefining Care through Payment
• Provider organizations (IDS; ACO; Hospitals, etc)
receive lump sum payments for all care in a given
episode
• Finances telehealth indirectly – providers incented to
invest in technologies to reduce costs.
• Concern: no direct reimbursement for telehealth
devices/services
11
12
Important Physician Competencies
Care
Coordination
Clinical
Integration
Care
Management
13
Characteristics:
• Outcomesoriented
• Enabled by
technology
• Patient centered
• Use of data
and analytics
• Performance
transparency
• Ability to
partner
across
organizations
Bridging Care and Provider Settings
Physicians Practices
Hospitals
Health Coordinators
14
“Active Care Pathway”
Capture Persons
under Active
Provider care
1) Self ID
2) MD
Referral
3) Medical
Claims
4) Rx Claims
5) HRA
6) Predictive
modeling
Outpatient 1:1,
Face-to-Face or
Remote
Monitoring
Identify persons
without access
1) Patient SelfCare
2) MD
Engagement
3) Care
Coordination
(Specialists)
4) EvidenceBased Guidelines
5) Care
Transitions
1) Self ID
2) MD
Referral
3) Medical
Claims
4) Rx Claims
5) HRA
6) Predictive
modeling
15
Triple Aim
Outcomes
(Better care,
better health,
lower costs)
1) Inpatient
Utilization
Outcomes
2) Outpatient
Claims Expense
3) HEDIS and
NQF
4) Care
Experience
Measures
Evolving Role of Health Coordinator
Case Management
Care Management
• the collaborative process of
assessment, planning,
facilitation and advocacy for
options and services to
meet an individual’s health
needs through
communication and
available resources to
promote quality costeffective outcomes
• Individual, high touch, high
intensity
• Package of physician
supervised interventions
assisting patients & their
support systems in
managing diagnoses
&related psychosocial
problems.
• Seeks to improve patients’
functional status, enhancing
the coordination of care,
eliminating the duplication
of services, & addressing
expensive services
• Populations, high tech &
medium intensity
16
Redefining Patient Care from
Hospital to Home
The Role of Site Based Specialists In the
Healthcare System of the Future
Ron Greeno MD, MHM, FCCP
Chief Medical Officer
Cogent HMG
Chairman, Public Policy
Society of Hospital Medicine
17
Cogent HMG
Quick Facts:
Nation’s leading privately held
Hospital Medicine and Critical Care
company
Headquartered in Nashville, Tenn.
Hospital partners with
over 130 hospitals and
over 1,100 physicians
Solutions Include:
Full Outsource hospitalist and
critical care programs designed and
managed from the ground up.
Consulting Services to provide a
roadmap for high performing
hospitalist and critical care
programs.
18
“The Accountable Care Organization is a
patient care model, not a financial model.”
19
20
Macro Trends
•
•
•
•
•
Consolidation
New forms of intergration
Emphasis on Quality and Outcomes
Increased Transparency
Shifting risk
21
Macro Trends
Everyone in Healthcare is going to be in
the Same Business,
the Population Health Business
22
The Current Challenge
To prepare for the future environment of
increased integration and population
health while growing and prospering in
the current environment of FFS payment
and financial uncertainty.
23
What Does It All Mean For Us
• This environment means increased risk,
but also increased opportunity for
hospitals and providers
• Hospitals will need reliable physician
partners to manage this risk
• The winners will be the hospitals that are
able to create innovative and enduring
partnerships with physicians
24
Those relationships will take many forms
• Successful relationships will share
several features:
– Team based
– Supported by systems of care
– Data driven
– Enduring governance
– Design will be “organization centric”
not “practice centric”
– Shared goals, incentives, and risks
25
The Home Team In Acute Care Hospitals
• Intensive Care Medicine
• Emergency Medicine
• Hospital Medicine
26
Hospital Medical Staff of the Future
• Inpatient Physicians (ED docs, Hospitalists,
Critical Care physicians) “live” in the
Hospital and have primary accountability
for the majority of patients
• Supporting services provided by Path,
Radiology, Anesthesia
27
Medical Staff of the Future
• Specialists will be specialists and be as
efficient as possible
• Administration, Nursing, Pharmacy, Case
Managers will work with “inpatient
physicians” in a system designed to
improve quality, satisfaction, safety and
cost efficiency
28
29
Macro Trends
Everyone in Healthcare is going to be in
the Same Business,
the Population Health Business
30
Impact
Impact of these factors on:
•
•
•
•
Our Growth Strategies
Our Business Models
Our Provider Models
Our Deliverables
31
Expansion of Scope of Services
•
•
•
•
•
•
•
•
•
Acute Care Hospital
ICU
Specialty hospitals
Specialty hospitalists
Post DC Clinic
Pre op Clinic
LTACH
Acute Rehab
SNF
32
Scope of Services
•
•
•
•
NH
Hospital at home
Palliative care
Hospice
33
What Additional Capabilities Will We Need
•
•
•
•
•
•
•
•
•
Data aggregation
Data analysis
Data sharing
Predictive modeling
Mobility
Integrated decision support
Care coordination and long term planning
Communication optimization
Quality and compliance alerts
34
What is the Index?
The Greeno-Hawley Hospital Medicine Index is the
first objective tool designed to measure the
capabilities of a hospital’s Hospital Medicine
Program.
35
36
Benefits:
hmindex.net
The Index will highlight areas for improvement in your
Hospital Medicine program’s capabilities. A welldesigned, high-functioning Hospital Medicine Program
can have significant impact on improving:
• Hospital and or system-wide strategic patient outcome
initiatives
• Clinical quality and safety
• Cost efficiency
• Patient satisfaction
• Avoidable readmissions
hmindex.net
37
Banner
Health
Banner Health
Making aNetwork
difference in people’s
lives through excellent patient care.
38
Banner Health:
National Leader in Health Care
• Top 5 Health System - Clinical Quality
•
TOP 5 HEALTH SYSTEM – CLINICAL QUALITY
Thomson Reuters – 2012
• Top 10 Integrated Health Network
•
TOP 10 INTEGRATED HEALTH NETWORK
SDI – 2010, 2011, 2012
• Health Care’s Most Wired
•
HEALTH CARE’S MOST WIRED
Hospitals & Health Networks Magazine
• US News/World Report
•
US NEWS & WORLD REPORT
Best Hospitals (six in top 14 in Arizona)
Banner Good Samaritan Medical Center ranked #1 in AZ
• Top Leadership Team in Health Care
•
TOP LEADERSHIP TEAM IN HEALTH CARE
Awarded in 2011 by HealthLeaders Media
Selected as a Pioneer ACO
39
Banner Health
One of the nation’s largest nonprofit health care organizations.
• 23 hospitals, and an array of other services, including family
clinics, home care & hospice, home medical equipment, longterm care, surgery centers, etc.
• Located in seven states…major footprint in metro Phoenix
• High performing specialty hospitals
– Cardon Children’s Medical Center (Pediatrics)
– Banner Heart Hospital (Cardiology)
– Banner MD Anderson Cancer Center (Oncology)
• Robust research enterprise
–
–
–
–
Banner Alzheimer’s Institute
Banner Sun Health Research Institute
Banner MD Anderson Cancer Center
Clinical research in cardiology, Parkinson’s, Neurology, cancer
40
BHC Entry Into Telehealth
• Banner Home Care partnered with Banner Heart Hospital and Tri-City
Cardiology to provide home telehealth services to CHF patients in August,
2006.
– Part of successful approval process as a Colloquium
– Also part of IHI 5 million lives campaign
– Target was Medicare patients with primary diagnosis of CHF from Banner
Heart
– Initial goal: reduce 30 day readmission of primary/secondary CHF patients
by 50% by December 2008.
• Results of this initial phase (19 months).
– Patients served: 122
– Readmission results: Total readmissions with primary/secondary CHF –
5%
41
BHC Growth Strategies
•
•
•
•
Geographic Expansion
Specialty Services
Recruitment of Clinicians
Payer Mix
– Banner Capitated Market
42
BHC Payor Mix
50%
45%
40%
35%
Medicare
Medicaid
Insurance
Capitated
30%
25%
20%
15%
10%
5%
0%
2007
2008
2009
2010
2011
2012
43
Telehealth by Disease Category
100%
90%
80%
Other Chronic
Conditions (CAD, HTN,
COPD, etc)
CABG
70%
60%
50%
40%
CHF
30%
20%
10%
0%
2007 2008 2009 2010 2011 2012
44
BHC Telehealth – Patients Served
1200
1000
2007
2008
2009
2010
2011
2012 Annualized
800
600
400
200
0
Number of Patients
45
Clinical / Operational Model
Goals
• Decreased visit utilization
with increased patient
monitoring
• Decreased acute care
hospitalization
• Balanced costs and
outcomes
Achievements
• Visits/episode
All patients : 10
visits/episode
Capitated: 8.1 visits/episode
• Re-hospitalization rate
All patients : 9%
Capitated: 5%
• Exceed financial/clinical
targets
46
H@H Phase I
• Banner Health IRB-approved study- patient consent was required
• Location - BGMC
• Started September 2011, ends September 2012
– Recruitment ends Sept 14, 2012
– 30d HH care ends Oct 14, 2012
• Admitted patients with one of 4 primary diagnoses: HF, COPD, CAP,
Cellulitis
• Evaluate feasibility, safety, effectiveness, and satisfaction- of a
program that attempts to discharge these inpatients earlier, into a 30d
tele-monitored/ Home Health environment
• Metrics- adverse outcomes/ complications, LOS/ 30d re-admission
rate, patient/ physician satisfaction surveys, lessons learned
47
Readmission Rates (preliminary data analysis)
Diagnosis
(n = 139)
Readmit Day
(rate)
Comments
HF*
(n = 33)
(12%)
30
1
25
8
cardioversion
COPD
(n = 14)
(14%)
6
0
CAP*
(n = 39)
(2.5%)
30
Cellulitis
(n = 53)
(0%)
stroke driving home
* National readmission rates (2010) for CHF 25% and CAP 18%
48
Post Hospital Discharge Pt Satisfaction Survey
% Favorable Response (n=107)
49
Post 30d Program Discharge Patient
Satisfaction Survey
50
% Favorable Response (n=72)
Hospitalist Satisfaction Survey
51
% Favorable Response
Home Tele-monitoring to avoid HF admissions
• Pilot- Banner Home Care PI Project (sites= BTMC, BBWMC, BBMC)
–Tele-health components
•Weight, VS, signs/ symptoms, education, daily pt call
from TH Center
–In home, medication reconciliation
•Results- BHC TH has decreased HF re-admissions rates to below 5% (BHH)
• Spread ‘service’ to those who don’t ‘qualify’ for HH services
–Cost
•HH Nurse visit $125, 30 d TH monitoring $90, total
$215/ patient.
–Benefit-
•Hospital re-admission cost $7000 to $12000.
• Spread this program to patients w other hi re-admission chronic disease states
–Identify patients in ED
–Define H@H Phase II
52
H@H Phases
Urgent Care/
Doctor’s Office
Phase III
Emergency
DepartmentPhase II
Hospital
Study- Phase I
53
Obstacles
• Logistics: equipment delivery, inventory
control
• Technology: data transfer/extraction
• Culture: health promotion, patient-centered
goals
54
Into the Future
• Define future needs
• Business requirements for technology
• Partnering with device firms
55
Questions?
Please type your questions into the video player window.
The moderator will pose questions to the panelists.
We would like to hear your views on today’s webinar. Go to
http://www.surveymonkey.com/s/JVYFZB5
For more information on reimbursement, please visit the Philips Healthcare
Reimbursement Website at www.philips.com/reimbursement
56
Speaker Bios
Tracey Moorhead
President and Chief Executive Officer
Care Continuum Alliance
Tracey Moorhead is President and Chief Executive Officer of the Care Continuum Alliance. The Care Continuum Alliance
convenes all stakeholders providing services along the care continuum toward the goal of population health improvement.
Based in Washington, D.C., the Care Continuum Alliance represents corporate and individual members in promoting the role of
population health improvement to raise the quality of care, improve health outcomes and reduce preventable health care costs
for people with chronic conditions and those at risk for developing chronic conditions.
Ms. Moorhead is recognized as a leading health care advocate with considerable experience in public policy and coalition
management. She effectively directs policy formulation and strategic advocacy efforts, as well as represents the population
health management community before the media, allied organizations and constituents, and all levels of government.
Ms. Moorhead previously served as Executive Director of the Alliance to Improve Medicare (AIM), a bipartisan coalition
advocating comprehensive Medicare improvements. AIM supported enactment of the Medicare Prescription Drug,
Improvement and Modernization Act of 2003. As AIM's Executive Director, Ms. Moorhead coordinated and moderated
educational and policy briefings for congressional staff; directed AIM's policy research, development and communications
efforts; and developed grassroots programs in conjunction with AIM member organizations.
In addition to her role with AIM, Ms. Moorhead served as Vice President, Government Relations, for the Healthcare Leadership
Council (HLC).
57
Speaker Bios
Ron Greeno, MD, FCCP, MHM
Chief Medical Officer
Cogent HMG
Ron Greeno is a founder of Cogent HMG and serves as its Chief Medical Officer. He is also Senior Consultant for The Cogent
Group, Cogent HMG’s consulting division. Dr. Greeno is the creator of the Greeno-Hawley Hospital Medicine Index, the industry
standard for evaluation of Hospital Medicine programs.
Dr. Greeno is the creator of the hospitalist program management model used by Cogent and originally developed and managed
Cogent’s national network of hospitalist physicians that has grown to over 1100 physicians. He is considered a pioneer in
Hospital Medicine, which has become the fastest growing field in the history of American medicine. He is a founding member
of the Society of Hospital Medicine and has served on the Society’s Leadership Committee since its inception. Dr. Greeno
graduated from the University of Nebraska, College of Medicine in 1979. After completing a medical residency in Internal
Medicine at the University of Iowa Hospitals and Clinics, Dr. Greeno completed fellowships in Critical Care and Pulmonary
Medicine at the Memorial Sloan-Kettering Cancer Center and was a Research Fellow at the Laboratory of Immunology and
Cellular Physiology at Rockefeller University in New York.
Dr. Greeno formerly served as Medical Director of the Intensive Care Unit and Director of Respiratory Medicine at Good
Samaritan Hospital in Los Angeles, California. He has received board certification in Internal Medicine, Pulmonary Medicine and
Critical Care Medicine.
Dr. Greeno is a nationally recognized expert on hospitalist programs and their clinical and administrative management and
speaks and writes regularly on the subject. He has authored over thirty articles and book chapters on Hospital Medicine
programs for national publications. In addition, he has presented at the national meetings of, among others, the Institute for
Healthcare Improvement, Society of Hospital Medicine, and American College of Healthcare Executives. He is on the Editorial
Board for both Today’s Hospitalist and Hospitalist Leadership Advisor. He is a recipient of the SHM Award for Outstanding
Service in Hospital Medicine given to only one hospitalist physician a year. In addition SHM has awarded him a Master in
Hospital Medicine, one of only seven individuals to ever receive this distinction. Three times Modern Healthcare has named Dr.
Greeno to its list of “50 Most Powerful Physician Executives in Healthcare,” the first hospitalist ever to make this prestigious list.
58
Speaker Bios
David Baker
Chief Executive Officer
Banner Home Care
David Baker was named the CEO of Banner Home Care and Hospice in June of 2003.
Prior to coming to Banner Health, Baker served as the regional executive director at St. John Home Care and
Genesys Home Care in Detroit, Mich. He also held a position as the manager of consulting for Ernst & Young
in Chicago, Ill. Prior to that, he served as the corporate director of Home Care Services, OSF Saint Francis,
Inc., (a subsidiary corporation of a multi-state hospital system). Baker's experience also includes being a
founder of St. Mary's Medical Center Home Care Division in Tennessee.
He received his undergraduate degree from Lincoln Memorial University, and his masters of social work from
the University of Tennessee.
He is married to Kay and they have two daughters.
59