HLC Wellness Briefing November 30, 2011 Mary Ella Payne Vice - PowerPoint PPT Presentation

HLC Wellness Briefing November 30, 2011 Mary Ella Payne Vice President – System Legislative Leadership Ascension Health

The Diabetes Epidemic IP Hospitalization Costs in Arizona According to the Arizona Diabetes Association, over (Billions $) the past decade diabetes has risen 40% and prevalence of obesity has risen 37% Arizona is ranked 8 th in the U.S for the incidence of diabetes where 40% of its residents are considered overweight and 23% obese In 2006, the direct medical cost of diabetes in Arizona % Arizona Population With Diabetes Related Diagnosis was $2.3 billion and the indirect cost associated with lost productivity was $1.1 billion totaling a $3.4 billion burden for the state and economy Arizona trends exceed that of U.S. trends 2

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Proactive S tep to Health Care Reform CMG Diabetes Disease Management Program Diabetes Scorecard Patient Grade Annual Cost per Patient A $1,621 B $3,405 C $9,720 D $21,003 4

S coring S ystem Relative Grade Score Grade Annual Cost Weights $ A 100 HbA1c 40% A 1,621.00 B 80 $ BP 20% B 3,405.00 C 60 $ LDL 20% C 9,702.00 Neuropathy D 40 $ & 10% D 21,003.00 Last visit Retinopathy 10% & Last Visit 5

Patient-Centered Health Care CMG Diabetes Intervention Grid PCP Visits (EHR Diabetes Diabetes Navigator (Promotora) Template) Behavioral Health Diabetes Nurse Educator Visits Web-based scorecard and care team intervention Telehome monitoring for high- management (Ascension risk patients Transformation Div) Dietitian Visits Patient score drives the Diabetes Day Clinics for annual interventions per Carondelet exams Intervention Grid 6

Distributing Cost of In-Practice Care Team Across PCP Network Health Coach Rental Program Allows Practices In-Office Care Team Access Diabetes Primary Care Team Lease Program 1 2 Provides care to patient Bills 99211-99213¹ panel Physician Practice Diabetes Care Team Payers 4 3 • RN (CDE 2 ) Pays hourly rate for leasing team Reimbursed, covering team • Regist ered diet it ian (CDE) leasing costs • Diabet es Navigat or • Communit y Healt h Out reach worker Each pract ice det ermines which individuals from care t eam t o host in t heir pract ice, and for what lengt h and frequency of t ime Case in Brief: Carondelet Health Network • Four-hospit al syst em based in Tucson, Arizona, part of Ascension Healt h • Growing diabet es populat ion prompt s comprehensive out pat ient diabet es st rat egy • S yst em leases diabet es t eam— healt h coach (communit y healt h worker), RN, and regist ered diet it ian who are Cert ified Diabet es Educat ors— t o pract ices, bot h employed and independent • Diabet es t eam bills payers at an hourly fair market value rat e 7 Source: Health Care Advisory Board interviews and analysis.

Leveraging Non-Clinical Community Health Workers to Enhance Patient Engagement Community Health Worker (Navigator) Enhances Patient Care, Coordination at Carondelet Navigator Helps Manage Navigator Helps Patient System Contact with Patient Access Care Resources Helps manages pat ient dat a, Act s as peer cont act , bridging disease regist ry socio-economic, language barriers S chedules and coordinat es pat ient cont act wit h Assist s pat ient int eract ion wit h diabet es care care t eam of RN and diet it ian, PCP, specialist s t eam Calls pat ient wit h appoint ment reminders, Helps pat ient navigat e care management follow-up resources made available by healt h syst em Car onde le t He alt h Ne t w or k • Four-hospit al syst em based in Tucson, Arizona • Est ablished Diabet es Care Cent er, offering a variet y of care management services • Diabet es t eams, composed of RN, cert ified diabet es educat or, and communit y healt h worker known as a navigat or, leased t o pract ices (owned and independent ) t o provide care management and connect pat ient s t o ot her Diabet es Care Cent er services • Navigat or coordinat es pat ient ’ s cont act wit h care t eam, specialist s, Diabet es Care Cent er services, helps bridge cult ural and language barriers 8 Source: Health Care Advisory Board interviews and analysis.

Diabetes Clinics with Health Plans Annual Eye and Foot Exams Medical Nutrition Therapy Vital Signs and Labs 9

Post-Program Confidence Levels Self- Self Self Self- -Management Behavior -Management Behavior Management Behavior Management Behavior Jan 09 Jan 09 Jan 09 Jan 09 Apr 09 Apr 09 Apr 09 Apr 09 July July July July Oct Oct Oct Oct – Mar – Mar – – Mar Mar – June – – – June June June 09 – 09 – 09 09 – – 09 – 09 09 – 09 – – 09 09 09 09 09 09 09 09 Sept Sept Sept Sept Dec Dec Dec Dec 09 09 09 09 09 09 09 09 1. Can check blood sugars 1. Can check blood sugars 1. Can check blood sugars 1. Can check blood sugars 4.8 4.8 4.8 4.8 5.0 5.0 4.8 4.8 correctly correctly correctly correctly 2. Make healthy food choices 2. Make healthy food choices 2. Make healthy food choices 2. Make healthy food choices 4.4 4.4 4.4 4.4 4.5 4.5 4.4 4.4 3. Know which foods are carbs 3. Know which foods are carbs carbs carbs 4.4 4.4 4.5 4.5 4.6 4.6 4.5 4.5 3. Know which foods are 3. Know which foods are 4. Know about meds and side 4. Know about meds and side 4.4 4.4 4.2 4.2 4.5 4.5 4.4 4.4 4. Know about meds and side 4. Know about meds and side effects effects effects effects 5. Know how to exercise 5. Know how to exercise 4.4 4.4 4.7 4.7 4.8 4.8 4.6 4.6 5. Know how to exercise 5. Know how to exercise regularly & safely regularly & safely regularly & safely regularly & safely 6. Can find diabetes info and 6. Can find diabetes info and 4.6 4.6 4.7 4.7 4.7 4.7 4.6 4.6 6. Can find diabetes info and 6. Can find diabetes info and support support support support 7. Know signs of low BG and 7. Know signs of low BG and 4.6 4.6 4.5 4.5 4.7 4.7 4.6 4.6 7. Know signs of low BG and 7. Know signs of low BG and what to do what to do what to do what to do 8. Can check feet for 8. Can check feet for 4.6 4.6 4.6 4.6 4.7 4.7 4.6 4.6 8. Can check feet for 8. Can check feet for problems/take care of feet problems/take care of feet problems/take care of feet problems/take care of feet 9. Can work with doctor to get 9. Can work with doctor to get NA NA 4.6 4.6 4.7 4.7 4.6 4.6 9. Can work with doctor to get 9. Can work with doctor to get complete, regular diabetes complete, regular diabetes complete, regular diabetes complete, regular diabetes exams exams exams exams 10

Knowledge Assessment Administered pre- and post-program Multiple choice items Item % Correct % Correct Answers Answers Oct 08 – Dec 08 Jan 09-March-09 A1c Goal 79% 100% 74% Fasting BG goal 100% 93% 2 hr PP goal 100% 86% BP goal 100% 97% Care goal 100% 87% AVE 100% 11