Green Mountain Care Board Strategies to Reduce Cost and Improve - - PowerPoint PPT Presentation

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Green Mountain Care Board Strategies to Reduce Cost and Improve - - PowerPoint PPT Presentation

Oct 05, 2023 123 likes •254 views

The heart and science of medicine. UVMHealth.org Green Mountain Care Board Strategies to Reduce Cost and Improve Care Steve Leffler, MD Chief Population Health and Quality Officer UVM Health Network 1/16/2019 What is the Imperative Fee

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The heart and science of medicine.

UVMHealth.org

Green Mountain Care Board Strategies to Reduce Cost and Improve Care

Steve Leffler, MD Chief Population Health and Quality Officer UVM Health Network 1/16/2019

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What is the Imperative

  • Fee for Service pays for volume.
  • Incentivizes doing more cases.
  • All Payer Model- a value based system
  • Allows for investments to keep the population healthier
  • All Payer Model margin not generated by volume.
  • Margin comes from quality and efficiency.
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Network Quality Council

  • Clinical Leaders/Quality Leaders/Administrative

Leaders

  • Meet every other month
  • Use Clinical, Quality and Cost data.
  • Focused on Care Variation and Cost Data.
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How do we choose projects?

  • Utilization
  • Variation
  • Cost
  • Quality
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Emergency Medicine Chest Pain Protocol

  • What is it?
  • Why did we pick it?
  • Improve care/Decrease cost/Enhance patient experience
  • What was the opportunity?
  • What did we do?
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Emergency Medicine Chest Pain Protocol

  • In 2014, 32% of chest pain patients admitted after

Emergency Department evaluation.

  • Many of these patients cleared over a period of 24 - 36

hours and discharged.

  • Through better tests/standardization/collaboration with

Cardiology and Pathology in 2018, 15% of patients admitted.

  • Careful follow up has found no missed heart attacks.
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Timeline of Implementation

  • 2015-More sensitive blood test available
  • 2015 Work with Cardiology and Pathology to develop

protocol

  • Efficient Cardiology out patient follow up developed.
  • 2016 Test the system. Use the new blood test. Send

select patients home.

  • Assure close follow up.
  • 2017 Train providers.
  • 2018 Full Implementation.
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10 20 30 40 50 60 70 80 90 100 UVMMC 2014 UVMMC 2018

Overall Chest Pain Admission Rates UVMMC, 2014 vs 2018

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0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% 50.00%

UVMHN 2 2014 v vs 2018 Troponin N Nega gative Admission R Rates

UVMHN 2014 UVMHN 2018

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  • Continue robust follow up.
  • Treadmill testing in the Emergency Department.
  • Study Emergency Department Length of Stay.
  • Good date essential for this type of project.
  • Combined with Local Expertise
  • Application to further pathways

Next Steps

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Summary

  • Saved 270 bed nights
  • Kept people out of the hospital who didn’t need to be there.
  • Freed up beds for other patients.
  • Saved at least $750,000.
  • Allowed for much more outpatient testing.
  • Provided hospital level care in outpatient setting.
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The heart and science of medicine.

UVMHealth.org

Questions?