HOME I S T HE HUB An I nitia tive to Ac c e le ra te Pro g - PowerPoint PPT Presentation

HOME I S T HE HUB An I nitia tive to Ac c e le ra te Pro g re ss to Re duc e Re a dmissio ns in Virg inia We b ina r # 3 – I mpro ving Ca re fo r Hig h Utilize rs Oc to b e r 20, 2016

HOUSE K E E PI NG • Slide s we re se nt this mo rning • We b ina r is b e ing re c o rde d • Ple a se use the “te le pho ne ” o ptio n • Audio pin pro mpt • All pa rtic ipa nts a re mute d • Ra ise yo ur ha nd • Ask a q ue stio n • Wa rm up

WE L COME AND OVE RVI E W Abraham Segres VHHA Vic e Pre side nt, Qua lity & Pa tie nt Sa fe ty a se g re s@ vhha .c o m (804) 965-1214

VI RGI NI A HOSPI T AL & HE AL T HCARE ASSOCI AT I ON An a sso c ia tio n o f 30 me mb e r he a lth syste ms re pre se nting 107 c o mmunity, psyc hia tric , re ha b ilita tio n a nd spe c ia lty ho spita ls thro ug ho ut Virg inia . Visio n T hro ug h the po we r o f c o lla b o ra tio n, the a sso c ia tio n will b e the re c o g nize d driving fo rc e b e hind ma king Virg inia the he a lthie st sta te in the na tio n b y 2020. Missio n Wo rking with o ur me mb e rs a nd o the r sta ke ho lde rs, the a sso c ia tio n will tra nsfo rm Virg inia ’ s he a lth c a re syste m to a c hie ve to p-tie r pe rfo rma nc e in sa fe ty, q ua lity, va lue , se rvic e a nd po pula tio n he a lth. T he a sso c ia tio n’ s le a de rship is fo c use d o n: princ iple d, inno va tive a nd e ffe c tive a dvo c a c y; pro mo ting initia tive s tha t impro ve he a lth c a re sa fe ty, q ua lity, va lue a nd se rvic e ; a nd a lig ning fo rc e s a mo ng he a lth c a re a nd b usine ss e ntitie s to a dva nc e he a lth a nd e c o no mic o ppo rtunity fo r a ll Virg inia ns.

VHHA 2015-2020 I MPROVE ME NT PRI ORI T I E S 1. Ho spita l re a dmissio ns 1a . Hospital- wide … (ne w foc us on high utilize r s) 1b . Po st-a c ute tra nsfe rs 1c . T o ta l hip/ T o ta l kne e Re pla c e me nt 30-da y re a dmissio ns 2. Clo stridium diffic ile – He althc are -ac q uire d I nfe c tio ns 3. Pa tie nt E xpe rie nc e – HCAHPS 4. Se rio us Sa fe ty E ve nts

State wide L e ar ning & Ac tion • Sta te wide c o lla b o ra tive June 2016 to No ve mb e r 2018 • oc us o n PAC, HU, T HR/ T K R in pa ra lle l F • E ng a g e with pa rtne rs in PAC • E ng a g e with VHQC fo r c r oss- c ontinuum wo rk • E ng a g e with AAAs fo r c ommunity base d c a re / CT I • Pro vide , use , inte rpre t data fro m VHHA & VHQC

Planne d Ac tivitie s for L e ar ning & Ac tion June 16 th* Hig h L e ve ra g e Stra te g ie s Aug ust 17 th* Da ta / Me a sure me nt Se pte mb e r 8 th* Re duc ing PAC Re a dmissio ns Oc to b e r 20 th* I mpro ving Ca re fo r Hig h Utilize rs 15 th Nove mbe r In- Pe r son L e ar ning E ve nt 9- 3:30 De c e mb e r 15 th Suc c e sse s in 2016 a nd Pla ns fo r 2017 *All we b inars will b e o ffe re d at 10am

I MPROVI NG CARE F OR HI GH UT I L I ZE RS Amy Boutwell, MD, MPP Collaborative Healthcare Strategies Pre side nt a my@ c o lla b o ra tive he a lthc a re stra te g ie s.c o m (617) 710-5785

AGE NDA • Hig h Utilize rs: ke y sta tistic s • I de ntifying ro o t c a use s: the “drive rs o f utiliza tio n” • L e sso ns le a rne d fro m e ffo rts to impro ve c a re fo r pa tie nts with hig h utiliza tio n • Spe c ific a c tio n ste ps

OBJE CT I VE S 1. Unde rsta nd ho w to de fine a nd ide ntify “hig h utilize rs;” 2. Unde rsta nd the impo rta nc e o f ide ntifying the “drive r o f utiliza tio n;” 3. I de ntify 3 pra c tic a l ne xt ste ps yo u c a n ta ke to re duc e re a dmissio ns fo r hig h utilize rs

HI GH UT I L I ZE RS: K E Y ST AT S

DE F I NI T I ONS I t is impo rta nt to b e spe c ific : • Hig h utilize r = ma ny a dmissio ns Hig h Utilize r Hig h Co st • Hig h c o st = to ta l c o st o f c a re • Co mple x = c o mple xity ma y o r ma y no t b e HU o r hig h c o st Co mple x

PROPOSE D T E RMI NOL OGY • Altho ug h “hig h utilize r” is de sc riptive sho rt-ha nd, it is so me wha t inde lic a te • Pro po se to use : “multi-visit patie nts,” o r “MVPs” • I t spe c ific a lly fo c use s impro ve me nt te a ms o n the c o re issue we a re fo c use d o n a ddre ssing – multiple ho spita liza tio ns, tha t ma y b e a sympto m o f unide ntifie d o r unme t ne e ds

K E Y ST AT S 4+ 7% – 25% – 60% 38% CHIA Ho spita l-wid e All Pa ye r Re a d missio ns in Ma ssa c huse tts June 2016 AHRQ HCUP Sta tistic a l Brie f # 184 No ve mb e r 2014 AHRQ HCUP Sta tistic a l Brie f # 190 Ma y 2015

K E Y ST AT S • 4+ ho spita liza tio ns/ ye a r • 7% o f ho spita lize d pe rso ns • Use d 25% o f a ll ho spita liza tio ns • Ac c o unte d fo r ~60% o f a ll re a dmissio ns • Re a dmissio n ra te 38% v. 8% So urc e : Ma ssa c huse tts Ce nte r fo r He a lth Info rma tio n a nd Ana lysis http :/ / www.c hia ma ss.g o v/ a sse ts/ d o c s/ r/ pub s/ 15/ CHIA-Re a d missio ns-Re po rt-June -2015.pd f

T OP DI AGNOSE S • Ac ute me dic a l: se psis, UT I , pne umo nia , c e llulitis • Chronic me dic a l: CHF ,COPD, dia b e te s, sic kle c e ll • Be ha viora l he a lth: mo o d diso rde rs, sc hizo phre nia , E T OH  Co mb inatio n o f me dic al, b e havio ral he alth and so c ial ne e ds

ME DI CARE MVPs I N VI RGI NI A • 4+ ho spita liza tio ns/ ye a r • ~49,000 disc ha rg e s • ~22,000 re a dmissio ns • ~ 45% re a dmissio n ra te • Se psis, COPD, HF , ARF , PNA, UT I , AMI

I MPROVI NG CARE F OR MUL T I -VI SI T PAT I E NT S Strate g ie s fro m ho spital-b ase d te ams

I DE NT I F Y T HE “DRI VE R OF UT I L I ZAT I ON” • Ask “why” • I de ntify the drive r(s) o f utiliza tio n • L iste n fo r all the fa c to rs tha t le a d to a c ute c a re utiliza tio n • Asse ss fo r c linic a l – b e ha vio ra l – so c ia l ne e ds • Do n’ t o ve r-me dic a lize re c urre nt utiliza tio n

61 man with 8 hospitalizations for shor tne ss of br e ath. “Oh ho ne y, I ’ m in he re e ve ry c o uple o f we e ks and it always take s ab o ut 5 days to tune me up” 32 man with a life time of unc ontr olle d diabe te s. “I ne e d ho using , no t a she lte r. I ne e d so me o ne to he lp make sure I take my me dic ine s. I n a she lte r the y do n't do that and the y kic k yo u o ut e ve ry mo rning . I ne e d a stab le re side nc e and no o ne is ab le to he lp with that."

RE ADMI SSI ON RE VI E W T OOL Purpose: • To understand patient perspective • To understand root causes • To understand there are multiple factors • To identify opportunities for improvement • To develop a better plan for the patient • To develop better services to offer Recommendation: • Interview all MVPs • Best practice: review all readmissions Ho spita l Guid e to Re d uc ing Me d ic a id Re a d missio ns

ST RAT E GI E S F OR MANAGI NG T HE CARE OF MVPs 1. Re a l-time ide ntific a tio n 2. I de ntify the “drive rs” o f utiliza tio n • No t the c c o r prima ry dx, no t e ve n the c hro nic dz, b ut ra the r the so c ia l, b e ha vio ra l, c linic a l fa c to rs tha t drive s re pe a te d use • Ofte n b e st ide ntifie d using a no n-c linic a l le ns 3. Addre ss the drive r(s) o f utiliza tio n • Hig h fre q ue nc y c o nta c t in the c o mmunity • Pro b le m-so lving o c c urs o ve r time until drive r is a ddre sse d • F re q ue ntly so c ia l wo rke rs a nd na vig a to rs a re e ffe c tive 4. Use “c a re pla ns” to c o nve y utiliza tio n histo ry, drive r(s) o f utiliza tio n, se rvic e s in pla c e , a nd ke y a dvic e to E D sta ff to g uide c a re a t ne xt pre se nta tio n

I DE NT I F Y AND E NGAGE I N RE AL -T I ME • Pa tie nt is he re , no w • Prio ritize e ng a g e me nt • Unde rsta nd pa tie nt’ s prio ritie s, ne e ds, c o nc e rns • E sta b lish a trusting , he lpful re la tio nship b a se d o n the pa tie nt’ s ne e ds a nd prio ritie s a nd no t le a ding with a me dic a lize d a g e nda

“DO SOME T HI NG DI F F E RE NT ” • Arra ng e fo r “Ma na g e me nt sta rts with the ho spita l • Co o rdina te b a se d te a m – no t just a sse ssing a nd • F o llo w up re fe rring , b ut initiating a nd fo r so me a mo unt o f time , pr oviding the a c tive follow • Na vig a te t with the g o a l o f de finitive ly up and suppor • Advo c a te linking the pa tie nt to the se rvic e s a nd • Che c k in suppo rts re q uire d to re duc e utiliza tio n.” • Re a ssure

COL L ABORAT E • I de ntify a nd e ng a g e pro vide rs, a g e nc ie s, pa ye rs • Co o rdina te “T he multidisc iplina ry te a m is • Co lla b o ra te ne e de d to do this….we ne e d • Alig n to re ly o n o the r e xpe rtise ” • L e ve ra g e e a c h o the rs’ e ffo rts  Ca se c o nfe re nc e  Cre a te , use c a re pla ns