Innovation in Pediatric Healthcare Delivery Utah Regional Healthcare Innovation Day April 27, 2016
Comprehensive Care for Children with Complex Medical Conditions N Murphy MD E Clark MD Department of Pediatrics University of Utah School of Medicine
Child Health Expenditures 0.11% 0.99% 11.0% 9.9% 100% 12.8% 90% 63.2% of 20.6% Proportions of Children & Expenditures 25.2% 80% costs 70% 60% top 118 with chronic dx 29.8% next top 1,059 with chronic dx next top 10,595 with chronic dx 50% .with >=1 chronic dx .with no chronic dx 40% 63.8% 12.8% 30% 20% 24.0% 10% 0% Children Expenditures
Models of Sub-Specialty Care Primary Care Provider Primary Care Provider Master Clinician Care Team Subspecialist Sub-specialist
Master Clinician Team • Case Managers • Pediatrician/Med Ped/PMR/PNP • Social Worker • Dietician • Psychology • Clinical Pharmacist • Rehab/Education Specialists
Modular Clinics and Master Clinician Site Hospitalists Schools Mobile Gastro Team Mobile Master Clinician Rehab Neurology Team Mobile Team Programs Diabetes Team Modular Clinic Team Community Services Home Care
100 110 10 20 30 40 50 60 70 80 90 0 2009.01 2009.03 2009.05 2009.07 2009.09 2009.11 2010.01 2010.03 2010.05 # of CCP Enrolled Patients per Month 2010.07 2010.09 (January 2009 - July 2014) 2010.11 2011.01 2011.03 2011.05 Year Month 2011.07 2011.09 2011.11 2012.01 2012.03 2012.05 2012.07 2012.09 2012.11 2013.01 2013.03 2013.05 2013.07 2013.09 2013.11 2014.01 2014.03 2014.05 2014.07
Distribution of Patients by Trach Vent and Deceased Status % of Total (N=568) 100% 90% 76% 80% 70% 60% 50% 40% 30% 20% 14% 7% 10% 3% 0% Non Trach Vent Trach Vent Non Trach Vent, Trach Vent, Deceased Deceased 8% of Non-Trach Vent Patients (N=473) were deceased • • 16% of Trach Vent Patients (N=95) were deceased
Average # of ED Visits per Month 7 6 Average # of ED Visits per Month (CCP) 5 4 Average ED Visits per Month (CCP) Reference Line (ED Visits per Month) 3 Linear (Average ED Visits per Month (CCP)) 2 1 0 0 1 2 3 4 5 6 7 Average # of ED Visits per Month (Pre CCP)
Average LOS Hours per Month 1,600 1,400 Average LOS Hours per Month (CCP) 1,200 1,000 800 Average LOS per Month (CCP) Reference Line (LOS Hrs per Month) Linear (Average LOS per Month (CCP)) 600 400 200 0 0 200 400 600 800 1,000 1,200 1,400 1,600 Average LOS Hrs per Month (Pre CCP)
Average Cost per Month $600,000 $500,000 Average Cost per Month (CCP) $400,000 $300,000 Average Cost per Month (CCP) Reference Line (Cost per Month) Linear (Average Cost per Month (CCP)) $200,000 $100,000 $- $- $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 Average Cost per Month (Pre CCP)
Estimated Cost Impact for Patients >=1 years at CCP enrollment Expected Median # of Expected # of Total Cost Change Months in Cost Impact Patients Impact in Cost CCP per Patient per Month Non-Trach Vent -$5,620 20 -$112,400 433 -$48,669,200 Non-Trach Vent, $9,818 12 $117,816 40 $4,712,640 Deceased Trach Vent -$21,319 41 -$874,079 80 -$69,926,320 Trach Vent, -$5,881 32 -$118,192 15 -$2,822,880 Deceased Total Cost Impact -$116,705,760 Total Cost Impact -$16,672,251 per Year* *Total Cost Impact/(7 years)
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