Demonstration Project Updates: Identifying and Predicting Patients - - PowerPoint PPT Presentation
Demonstration Project Updates: Identifying and Predicting Patients with Preventable High Utilization Rainu Kaushal, M.D., M.P.H. Professor and Chair, Healthcare Policy & Research @rainukaushal Rainu Kaushal, MD MPH Has nothing to
Professor and Chair, Healthcare Policy & Research @rainukaushal
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Theme Subtheme Quotation Unmet behavioral health needs Serious mental illness Health system leader: “Mental health is obviously huge, and the average primary care or specialist physician has very poor access for their patients to any kind of mental health services in any kind of timely way.” Socio-economic determinants of health Inadequate health literacy Patient: “Learn more about your condition. Get the proper medications, get the proper things that you need to be able to take care of yourself at home.” Unstable housing conditions Patient: “They put you in a bed. They take care of you, take your blood...your vitals laying on the bed with a nice warm pillow and blanket. They even offer you food.” Limited social support Health system leader: “[Workable solutions] probably have to do with...social support and reduction of isolation and helping them negotiate the complexities.”
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Theme Subtheme Quotation Socio-economic determinants of health Insurance challenges Patient: “I have Medicaid and some of the doctors don't take [it], and so you say to yourself, well, even if I get an appointment are they going to take me? So just go to the emergency room and let them handle it from there.” Financial burden Patient: “A lot of times [we’re] on a fixed income and you need to see a specialist...You may have a copay with your specialist. It could add up if you go
Challenges associated with accessing health delivery systems Transportation Physician: “I often hear patients voice that they can only come to the ED because that was when they got a ride...by ambulance [and] that’s the only way they can get a ride.” Administrative pressures Physician: “When your hospital is basically saying…here is 15 minutes for a repeat visit for another patient, I mean how are you gonna be able to actually provide the kind of care they need?”
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Stakeholder group Included roles Florida CDRN New York City CDRN End users (of the computable phenotypes) PCPs (including practice leads), hospitalist, NPs (primary care), care manager (RN), health coach (RN), case manager/social worker 6 9 Informatics CIOs, CMIOs, Chief Analytics Officer 3 4 Operations ACO Director, Chief Transformation Officer, Dir./Ass. Dir. of Population Health, Chief Q&S Officer, Chief/Associate Medical Directors, VP Care Integration, Dir. of Care Management, Dir. of Community Health, Chief Scientific Officer, Clinical Department Chairs 9 18 Total 18 31
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Emerging Category Emerging Theme Exemplar Quotes Operational resources The predictive model is irrelevant if there is no infrastructure (process, resources, and band-with) to support necessary actions “We have to face into the reality institutionally of; if we’re going to surface this information, are there going to be resources to actually do something about it?” (Informatics) “Unfortunately, because time is so limited that even if they see the score and even if it is useful… getting anyone to act on it in a meaningful way at least on the provider level might be hard.” (Operational) Arranging people and processes is more challenging than technical aspects of implementation “From a technology point of view, I think it’s almost – very little. I mean, it’s probably the easiest thing. It’s the ‘Who does what with it?’ That’s the big concern to me.” (Informatics)
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Emerging Category Emerging Theme Exemplar Quotes Credibility and perceptions It is important to differentiate from other predictive models “One has to be very careful to only bring forward new innovations into and organization that have clear value because there are so many companies out there pitching particularly IT-based tools at this point in time. There really is a huge cacophony.” (Operational) Need to overcome skepticism related to predictive models “There’s sort of a baseline level of skepticism … that you would have to overcome and somehow demonstrate…that this is somehow different, better, more valuable…” (Operational) Transparency and comprehensibility are key for trust and use “We’ve seen so many of them and one of the big questions that comes up is like how did you get to this number? What went into it? If there’s detail on what went into it, for sure it’d be a confidence booster.” (End user)
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Emerging Category Emerging Theme Exemplar Quotes Technical challenges Different sources of data have different cost-benefit tradeoffs “Well, there would be huge problems there because the [claims] data is…as much as three months [behind]. So I think that with that then the scores aren't contemporary anymore.” (Informatics) Local customizations of electronic health record systems “There are a couple ways. There are some where we actually put in it on the banner...there are other places we put…something in the doc flow sheet. And then there are some that are richer where we actually put it on somebody's dashboard.” (Informatics)
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Professor and Chair, Healthcare Policy & Research @rainukaushal