Genesis Health System PromiseCare Research Summit June 8, 2016 1 - PowerPoint PPT Presentation

Genesis Health System PromiseCare Research Summit – June 8, 2016 1

PromiseCare - Concepts  The PromiseCare process is known by many titles, and in summary is focused on: • Re-designing clinical care to achieve these goals • Reducing variation in care • Increasing reliability of outcomes • Increasing efficiencies in the use of resources 2

Reliability in HealthCare Almost all studies that investigate the reliability of the application of clinical science in healthcare conclude that there are significant opportunities for improvement. V olume 348(26) 26 June 2003 pp 2635-2645 The Quality of Health Care Delivered To Adults In the United States McGlynn, Elizabeth A.: Asch, Steven M.: Adams, John: Jeesey, Joan: Hicks, Jennifer: DeCristofaro, Alison: Kerr, Eve A. BACKGROUND We have little systematic information about the extent to which standard processes involved in healthcare — a key element of quality — are delivered in the United States. METHODS We telephoned a random sample of adults living in 12 metropolitan areas in the United States and…received written consent to copy their medical records…to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventative care… RESULTS Participants received 54.9 percent of recommended care. CONCLUSIONS The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits are warranted. 3

4

PromiseCare - Origins  The concept of decreasing variation in care is not new.  It has been successfully implemented by organizations such as Geisinger Health System and Intermountain Health Care.  They have documented success in achieving the desired results. 6

Geisinger Model – Proven Care  Developed a process one procedure / DRG at a time.  About 10 years in the making so far  Originally started with CABG  Led by a Cardiac Surgeon to start with  Currently about 17 projects in place  CABG Ave. LOS fell 0.5 days (6.2 vs. 5.7)  CABG 30-day readmission rate fell 44% 7

GHS - Performance Excellence as Strategy Physician Led - Professionally Managed 8

The Promise in PromiseCare Patient-Centered Timely Safe Right Patient Right Time Right Care Equitable Care Crossing the Quality Chasm 2001 – Institute of Medicine Every time Every patient Right Resources Right Setting Effective/Efficient 9

PromiseCare - Objectives  Differentiate Genesis based on quality outcomes  Reduce the overall cost to treat • Research current best evidence • Hardwire care delivery processes • Reduce unwanted variation to deliver high clinical reliability • Reduce operational inefficiencies • Provide effective and efficient clinical care  Develop the internal infrastructure (people, process and technology) that will ensure sustained improvements, maintain consistency and provide ongoing cost-effective care 10

PromiseCare - Operational Structure GHS Performance Excellence Leadership Committee PromiseCare GMC-Davenport MOC Steering Committee GMC – Illini MOC CAH MEC Chair: CMO Medical, Clinical & Administrative Leadership Condition Specific Leadership Committee Physician, Nurse & Administrative Champions Stroke Diabetes Sepsis HF Leadership Rehab Total Knee (Phase I & Leadership (Phase I & Leadership Procedure II)Teams and Team and II)Teams and Team and (Sleep Apnea ) Workgroups Workgroups Workgroups Workgroups PromiseCare Coordinator and Specialist PromiseCare Project Support Team: IT, BIC, Finance, Quality, Nursing Education, Pharmacy, and others 11

PromiseCare - Steering Committee  Essential governance to make the process consistent  Reports to the MOC and MEC on progress and state of the program  Needs multidisciplinary input 12

PromiseCare - Steering Committee  Differentiate Genesis based on quality outcomes • Receive and review ongoing requests for PromiseCare initiatives • Approve selection criteria • Select DRG / Diagnosis for Promise Care • Charter DRG & Clinical Redesign Teams • Monitor progress of PromiseCare projects • Monitor attainment of metrics for Promise Care initiatives (process and outcomes) • Oversee communication plan 13

PromiseCare - Selection Criteria for Care Redesign Criteria Rank Percentage Total (1 – 5 high) Weighting Availability of Evidence 25% Base Medicine Physician Leadership in 20% Area/Condition Quality Opportunity 20% Sufficient Volume for 15% Change Availability of Data 10% Financial Opportunity 10% 14

PromiseCare – What are We Doing?  Agreeing on what the right care is (Best Practice Elements)  Designing the processes to ensure the right care happens every time  Measuring compliance to the process measures  Measuring the outcomes  Expecting improved outcomes with less cost 15

PromiseCare - Structure & Relationships  A methodology to bring the optimal coordination of resources to a clinical situation in a consistent, quality oriented, cost effective manner  Requires the utmost collaboration between all components of patient care  Needs extensive resources • Medical Oversight • Nursing • Pharmacy and other Disciplines • Education • IT • BIC / Finance review • Quality 16

Stroke Rehab  Physician led - Dr. Chin  Professionally managed – Suzanne Schalber  Stroke Rehab process is fully implemented and the model for the rest of the System to follow  Will promise future Stroke Rehab patients they will deliver specific best practice elements 17

Condition: Stroke Rehab GMC - Daven Discharges in Discharges Discharges Discharges Discharges Discharges Discharges Discharges Discharges Discharges Discharges Discharges sample in sample in sample in sample in sample in sample in sample in sample in sample in sample in sample in sample GMC - Davenport n = 14 n = 17 n = 9 n = 18 n = 12 n = 15 n = 9 n = 12 n = n = n = n = Compliance to Process Measures Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 YTD Avg. PromiseCare Admit Stroke Rehab Power 100.0% 100.0% 81.8% 100.0% 100.0% 93.8% 88.9% 92.3% Plan Percentage % of Patients Assessed by Therapies within 24 Hours 1 100% 100% 100% 100% 100% 100% 100% 100% 100% of Receipt of Initial Rehab Order % of Patients Who Received a Dietary Consult within 2 100% 100% 100% 100% 100% 93% 100% 100% 99% 24 hours of Receipt of Initial Rehab Order % of Patients Who received Bowel and Bladder 3 100% 100% 100% 100% 100% 100% 100% 100% 100% Training % of Patients Who Completed Depression Screening 4 86% 100% 100% 100% 100% 100% 89% 100% 97% within 48 Hours of Receipt of Initial Rehab Order % of Patients Who Had Swallowing Assessment 5 100% 100% 100% 100% 100% 100% 100% 100% 100% Completed % of Patients With Communication Disorder Who 6 100% 100% 100% 100% 100% 100% 100% 100% 100% Received Training by SLP % of Patients With Cognitive Deficit Who Received 7 100% 100% 100% 100% 100% 100% 100% 100% 100% Training % of Patients Who Have Neurofeedback Assessment 8 100% 100% 100% 100% 100% 100% 100% 100% 100% Completed % of Patients Who Have Daily Monitoring for Skin 9 100% 100% 100% 100% 100% 100% 100% 100% 100% Integrity 10 % of Patients Who Receive 3 Hours of Therapy Daily 93% 100% 89% 100% 100% 100% 100% 100% 98% % of Patients Who Have Mobility Issues AND 11 100% 100% 100% 100% 100% 100% 100% 100% 100% Received PT Training Goal is % of Patients Who Have Self Care Issues AND 12 100% 100% 100% 100% 100% 100% 100% 100% 100% Received OT Training 98.5% % of Patients Who Were Discharged by Estimated 13 100% 100% 78% 100% 100% 93% 100% 85% 94% Discharge Date PromiseCare Stroke Rehab Bundle 98.1% 100.0% 97.2% 100.0% 100.0% 98.9% 99.1% 99.3% 99.2% PromiseCare All or Non Bundle 78.6% 100.0% 66.7% 100.0% 100.0% 86.7% 88.9% 92.3% 90.7% n = 12 n = 16 n = 11 n = 18 n = 11 n = 16 n = 9 n = n = n = n = n = Clinical Outcome Measures Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 YTD Avg. Baseline Target 1 % of Patients Discharged to Acute Care 6.3% 10.2% 0.0% 6.3% 27.3% 11.1% 0.0% 12.5% 11.1% 7.7% 2 Case Mix Index 1.31 1.54 1.5751 1.3291 1.1231 1.4732 1.1707 1.5338 1.2057 1.3456 3 FIM Change Admission to Discharge 21.97 22.07 28.58 21.06 16.91 22.56 25.18 23.69 22.00 23.46 4 % of Discharges to home 66% 67.96% 42% 56% 64% 61% 73% 63% 44% 77% 5 % of Discharges to a Skilled Nursing Facility 21.17% 58.3% 37.5% 9.1% 27.8% 27.3% 25% 33% 15% 6 ALOS 19.86 14.25 15.33 15.88 11.45 12.73 15.36 15.06 15.89 15.15 7 ALOS O/E Index N/A 0.85 1.03 0.86 0.74 1.10 0.85 1.01 0.96 8 Rehab Unit Patient Satisfaction Percentile 38 80 Financial Outcome Measures Baseline Target Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 YTD Avg. $ 10,592 $ 8,911 $ 9,996 $ 7,086 $ 8,562 $ 9,845 $ 8,880 1 Variable Cost per Case 3 Contribution Margin $ 78,917 $ 75,499 $ 25,119 $ 109,141 $ 94,101 $ 76,555 18

Goal is 98.5% 19

20

21

22