Mid idSouth PTN: VHAN Regional Summer Summit Ju July ly 18 th th - - PowerPoint PPT Presentation
Mid idSouth PTN: VHAN Regional Summer Summit Ju July ly 18 th th , 2019 Thank you for joining us as we showcase the outstanding, transformative work accomplished through TCPI, and as we journal the transformation of MidSouth PTN practices
Ju July ly 18th
th, 2019
Thank you for joining us as we showcase the
TCPI, and as we journal the transformation of MidSouth PTN practices through TCPI and chronicling our impact
Dir irector, Quality - Population Health, , Vanderbilt Health Aff ffiliated Network
11 11:45 45am – 12 12:00 00pm Bre Break 12 12:00 00 – 12 12:45pm Lu Lunch
Sl Slideshow of
Prac actic ices Pr Pres esentatio ion of
Certif ificates
12 12:45 45 – 1:00 1:00pm Conc nclusion: Refl Reflecti tion on n TCPi i Journey
Pam Pamela la Bruce, , RN, , MS MSN, , DNP, , CPP PPS
1:00 1:00 – 1:45 1:45pm The he Fu Futu ture of Hea Healt lthcar are: Impac pact t of TCPi Pi, Valu Value-bas ased Care are and and Adv Advan anced Paym Payment Model dels
CMS Keynote Guest Speaker
Rob
ert Fl Flem emming, , Ph PhD
1:45 1:45 – 2:00 2:00pm Clos losing Rem Remarks ks and and Concl clusion
Cynthia Po Powe well, ll, MD MD
10 10:00 00 – 10 10:10 Wel Welcome & & Over vervi view of Age Agenda Refl Reflecti tion on n TCPi i Journey
Pam Pamela la Bruce, , RN, , MS MSN, , DNP, , CPP PPS
10 10:10 10 – 10 10:30a 0am TCPi Pi Acc Accomplis ishments ts
Russ ussell ll Rot
, MD, MD, MP MPP
10 10:30 30 – 11 11:00a 0am The he Fu Futu ture of Val Value-based Care are
Regional Keynote Guest Speaker
C.J. . St Stim imson, , MD, , JD
11 11:00 00 – 11 11:45a 5am Sh Showcas ase of Practi Practices – Pract Practic ice St Stories
Tho homas Sp Spai ain, , MD, MD, MP MPH The Grove ve Pr Prim imary y Car are Clin inic ic (vid video) Coo
ille OB OB/Gyn yn Associates Wo Womens Group p of
Fran anklin lin (vid ideo) Mai Main St Street Fam Family ily Med edic icine Upp pper Cu Cumberla land Fam Family ily Pr Prac actic ice (vid ideo) Dr. . Fr Fran ances Ber erry-Brown Coo
ille Coll
ive (vid ideo) Ter errace Pe Pedia iatric ic Group Gallatin Women’s Clinic
Vic ice President, Population Health Research Dir irector, Center fo for Health Services Research
Transforming Clinical Practice Initiative is a 4 year, CMMI effort with 7 bold AIMs. MidSouth PTN is one of 28 PTNs across the country that, in total, contain 29,000 practices.
Support more than 140,000 clinicians in their practice transformation work
1
Improve health outcomes for millions of Medicare, Medicaid and CHIP beneficiaries and other patients
2
Reduce unnecessary hospitalizations for 5 million patients
3
Generate $1 to $4 billion in savings to the federal government and commercial payers
4
Sustain efficient care delivery by reducing unnecessary testing and procedures
5
Transition 75% of practices completing the program, to participate in Alternative Payment Models
6
Build the evidence base on practice transformation so that effective solutions can be scaled
7
Practices transform toward VBC after enrolling in TCPI by moving through 5 Phases of Transformation
PHASE I
Detailed Transformatio n Planning
Shared Vision of Transformed Practice
to achieve vision, including targeted metrics
PHASE II
Reporting and Using Data To Generate Improvements
quality improvement (QI)
population management & care coordination
PHASE III
Progressing Towards Success in Value-Based System
activities into day-to-day
coordination, population management, & team-based care strategies
PHASE IV
Sustaining Progress Over Time
targets
Deliver evidence- based, patient- focused, coordinated care
PHASE V
Preparing to Thrive in Value- Based System
data within practice to
success in APMs
readiness for alternative payment models
The MidSouth PTN supports 4,000 plus primary and specialty care clinicians in 112 practices across Tennessee, Mississippi, Kentucky, and Arkansas. These practices are successfully transitioning from fee for service environments to thriving, high quality value-based environments that focus on whole patient care. 4 Regions
Vanderbilt Health Affiliated Network (TN & KY) Baptist (TN & AR) Safety Net (TN) MS Affiliated Health Network (MS)
The MidSouth PTN supports 4,000 plus primary and specialty care clinicians in 112 practices across Tennessee, Mississippi, Kentucky, and Arkansas
To overcome the challenge of transformation, TCPI provides multi- faceted support
Support provided to practices
Metrics Assistance
Data collection from EMR Help to understand metric definitions and reporting criteria
Quality Improvement Assistance
Transformation Plan tailored to identify/accomplish practice goals Coach guidance throughout process
Stakeholder/Community Engagement
SE Board feedback Local resource lists
Financial Assistance to help practices transform over time
Incentive payments to invest into QI efforts
QI interventions moved the needle on reducing unnecessary E.D. visits, Increasing patient engagement through Shared Decision Making, and increasing practice QI skills with IHI improvement model training.
QI interventions moved the needle on reducing unnecessary E.D. visits, Increasing patient engagement through Shared Decision Making, and increasing practice QI skills with IHI improvement model training.
MidSouth Shared Decision Making Toolkit
TCPI Transformation was measured in two ways First, to identify where practice has room to improve, a baseline assessment was conducted with CMS’ Practice Assessment Tool (PAT) Based on the scores received, a practice is automatically categorized into one of CMS’ 5 Phases of Transformation
Second, In addition to establishing a practices baseline with regard to Phase Milestones, practices also selected -- with the support of their coach -- two quality metrics and two utilization metrics on which to improve
Focus on Recruitment, Enrollment, and Assessment Aim 1
Enrollment
Enrolled 3645 clinicians of 4 year target of 4050. Enrolled 97 Practices across TN, AR and MS
Aim 7
Transform Practice Beyond Phase 3
97% of practices completed baseline PATs and 13% had completed their first 6-month follow up PAT; no practices beyond Phase III
Aim 6
Transition Practices To APMs
Graduated 3 practices into APMs
QI
Metrics Reporting
12% of practices reported data via EHR
90 % 3 % 12 % 0 %
Focus on Recruitment, Enrollment, and Assessment Aim 1
Enrollment
VHAN contributed 75% of those clinicians Aim 6
Transition Practices To APMs
VHAN contributed 1 of those practice
Focus on Metrics and Reporting Aim 1
Enrollment
Surpassed enrollment goal with 4119 clinicians representing 110 diverse specialty and primary care practices
Aim 7
Transform Practice Beyond Phase 3
95% of our practices transitioned beyond phase I with 45% in Phases III and IV with 12 practices beyond phase III
Aim 6
Transition Practices To APMs
Graduated 14 practices into APMs Representing 3110 clinicians
QI
Metrics Reporting
68% of practices reported data via EHR
100 % 12 % 68 % 10 %
Focus on Metrics and Reporting Aim 1
Enrollment
VHAN contributed 69% of those clinicians
Aim 7
Transform Practice Beyond Phase 3
VHAN Contributed 3 of the five practices beyond phase 3
Aim 6
Transition Practices To APMs
VHAN contributed 5 of those practices
Focus on Intervention and Transformation Aim 1
Enrollment
Expanded our PTN to include 4426 clinicians across 113 practices, representing 109% of our year 4 goal
Aim 7
Transform Practice Beyond Phase 3
95% of our practices transitioned beyond phase I with 45% in phases III and IV and 53 practices beyond phase III
Aim 6
Transition Practices To APMs
Achieved 36% of our Aim 6 goal by enrolling 30 practices into APM and AAPMs
QI
Metrics Reporting
Increased the percent of practices reporting to 81%
109 % 36 % 81 % 47 %
Focus on Intervention and Transformation Aim 1
Enrollment
VHAN contributed 64% of those clinicians Aim 7
Transform Practice Beyond Phase 3
VHAN Contributed 18
Aim 6
Transition Practices To APMs
VHAN Contributed 15 of those practices
20 40 60 80 100 Aim 1 Aim 2 Aim 3 Aim 4 Aim 5 Aim 6 Aim 7
Generate savings to the federal government and commercial payers. MidSouth PTN generated more than $174 million in cost savings, representing 121% of our target.
Aim 4
Generate Savings Sustain efficient healthcare delivery by reducing unnecessary tests and procedures. MidSouth PTN far exceeded our target, reducing over 17,000 unnecessary tests and procedures, representing 1379% of our target.
Aim 5
Reduce unnecessary Tests Transition 75% of practices into APMs. MidSouth PTN has already accomplished 38% of that target, transitioning 31 practices into APMs.
Aim 6
Transition Practices To APMs Build the evidence base of practice transformation so that effective solutions can be scaled. MidSouth PTN has transformed 64% of our practices beyond phase 3.
Aim 7
Transform Practice Beyond Phase 3 Reduce unnecessary hospitalizations for
meeting 87% of our target.
Aim 3
Reduce Unnecessary Hospitalizations Support clinicians in their practice
transformation work. MidSouth PTN successfully enrolled 109% of our target of 4050 clinicians.
Aim 1
Enrollment Improve health outcomes of Medicare, Medicaid and other patients. MidSouth PTN achieved 267%
Aim 2
Improve Health Outcomes
MidSouth’s Current Year 4 Performance on TCPi Aims
20 40 60 80 100 Aim 1 Aim 2 Aim 3 Aim 4 Aim 5 Aim 6 Aim 7
Transition 75% of practices into APMs. VHAN has Successfully transitioned 15 practices to APMs
Aim 6
Transition Practices To APMs Build the evidence base of practice transformation so that effective solutions can be scaled. VHAN has transformed 30 practices beyond phase 3!
Aim 7
Transform Practice Beyond Phase 3 Support clinicians in their practice transformation
current clinicians.
Aim 1
Enrollment
VHAN’s Current Year 4 Performance on TCPi Aims
Supporting and Sustaining Our Practices’ Work
Value Based Care University
providers, and executives for implementing value-based care (VBC)
MidSouth has dedicated our final year to creating an active legacy of
partnership with CMS through TCPI.
Supporting and Sustaining Our Practices’ Work
Telling the Story of Our Success
MidSouth Media/PR Team Mission: An active legacy defining the future of healthcare. Vision: Create a living, replicable body of knowledge for practices to leverage as they take their transformation journeys from fee- for-service to value-based care.
Assistant Professor, Urologic Surgery (VUMC) Medical Director, Office of Episodes of Care, Population Health Senior Advisor to Chief Health System Officer (Vanderbilt Health) Senior Advisor to the Front Office for the Center for Medicare and Medicaid Innovation (CMMI)
C.J. Stimson, MD, JD
The views expressed in this presentation are my own, and do not necessarily reflect the positions of the Center for Medicare & Medicaid Services, the Vanderbilt Health Affiliated Network, or Vanderbilt University Medical Center.
Value is here to stay. Purchasers and patients will drive the value transformation.
Fake News: Value is Dead
Why?
Why else?
“[I] insist CMMI… cease all current and future planned mandatory initiatives within CMMI”
September 2016 “if [a model] needs to be mandatory
voluntary to get adequate data, then so be it.”
January 2018
The real story?
Value is here to stay.
Purchaser-Driven Value
Purchasers will continue to push providers to drive down spend while maintaining or improving quality.
What does all of this mean?
Purchasers will drive the value transformation.
Empowering and engaging patients to drive value and disrupt market share.
Empowering and engaging patients to driv rive valu lue and disrupt market share.
Empowering and en engaging patients to drive value and dis isrupt mark rket share.
Empowering patients to driv rive value lue.
61
Engaging patients to dis isru rupt mark rket sha hare.
What does all of this mean?
Patients will drive the value transformation.
Value is here to stay. Purchasers and patients will drive the value transformation.
Whole Pers erson Care
Prim imary Ca Care Practice 12 Pro rovid iders Date te Jo Join ined TC TCPI: I: 05/01/2017 Specific TCPI AIMS Impacted Through This Work: 2: Improved health outcomes 3: Reduce unnecessary hospitalizations 4: Generate savings
https://vimeo.com/338903929/b586e731e4
OBGYN Specialty Practic ice 9 Pro rovi viders Date te Jo Join ined TC TCPI: I: 03/28/2016 Specific TCPI AIMS Impacted Through This Work: 2: Improved health outcomes 3: Reduce unnecessary hospitalizations 4: Generate savings
Hydration Campaign to Reduce Visits to L&D for Pregnant Patients
HYDRATION CAMPAIGN
patients going to L&D, who did not deliver, were seen for conditions or complications related to dehydration.
lobby and exam rooms
around hydration for incoming patient phone calls
Th The Rig ight Care re at t th the Rig ight Tim Time
Specia ialt lty Ca Care re Pra ractic ice 10 Pro rovid iders Date te Jo Join ined TC TCPI: I: 04/06/2016 Specific TCPI AIMS Impacted Through This Work: 2: Improved health outcomes 3: Reduce unnecessary hospitalizations 4: Generate savings
https://vimeo.com/339635905/da7ee38eb7
Opioid Rx Reduction
Pri rimary Ca Care re Pra ractice 4 Provi viders Date te Jo Join ined TC TCPI: I: 03/17/2016 Specific TCPI AIMS Impacted Through This Work: 2: Improved health outcomes 5: Reduce unnecessary testing and procedures 7: Build the evidence base to scale solutions
Opioid Rx Reduction Initiative
No opioid prescriptions for new patients No opioids prescribed on weekends No swapping out prescriptions between providers Opioid patients required to come in for a visit once a month Chronic pain patients required to sign pain management agreement or referred to pain management clinic Rx <120 Morphine Milligram Equivalent (MME) per patient, preferably < 90
Opioid Rx Reduction Initiative
From November 2018 - February 2019, the practice saw a 65% decrease in the
individual providers also saw a decrease.
Ded edicated Vis isits fo for r Dia iabetic Pati tients
Pri rimary Ca Care re Pra ractice 6 Pro rovi viders Date te Jo Join ined TC TCPI: I: 02/08/2016 Specific TCPI AIMS Impacted Through This Work: 2: Improved health outcomes 3: Reduce unnecessary hospitalizations 4: Generate savings 5: Reduce unnecessary testing and procedures
https://vimeo.com/338901890/3c1c436ce5
Pri rimary Ca Care re Pra ractice 1 Pro rovi vider Jo Join ined TCP CPI: I: 04/0 /04/2016 Specific TCPI AIMS Impacted Through This Work: 1: Support physician practice transformation 3: Improve health outcomes 4: Generate savings
Paja jama-time PDSA: Decreasing Aft fter-hours Paperwork and In Inefficiencies
Paja jama-time PDSA: Dec ecreasing Aft fter-hours Paperwork and In Inef effi ficiencies
▪ Optimized reporting ▪ Messaging and team member assignments ▪ Referrals ▪ Check-out process ▪ Standardized templates (office notes, order sets, patient instructions)
▪ Review schedule for the day ▪ Clarify task assignments ▪ Close gaps ▪ High-priority messages
TC TCPi Success Sto tory & Bes est Pra ractice Coll llabora rative Even ent Hig ighlights
Specific TCPI AIMS Impacted Through This Work: 1: Support clinicians in their practice transformation work 2: Improved health outcomes 4: Generate savings 5: Reduce unnecessary testing and procedures
https://vimeo.com/339613801/48a2ce9522
Pediatr tric Practic ice 4 Pro rovi viders Date te Jo Join ined TC TCPI: I: 02/18/2016 Specific TCPI AIMS Impacted Through This Work: 2: Improved Health Outcome 3: Reduce Unnecessary Hospitalizations 4: Generate Savings 5: Reduce Unnecessary Testing and Procedures
Im Impacting Avoidable ER Utilization
Im Impacting Avoidable ER Utiliz tilization
Data analy lysis of
revealed a baseline of
.81% of
ients were ere repo reporting to
he ER ER
▪ Incl ncluded TennCar are as as well ll as as Commercial al paye payer patie patients
llected lis ist of
ED locations whe here patie ients were ere see seen
Determin ined if/how not notifi fications were ere bein eing sent sent by y hos hospit itals to
ractice offic
llected data and plan deve eveloped for
rotocol
itial Foll Follow-up Pro rotocol was deve evelo loped and implemented
▪ ED ED patie patient t list list (dai daily ly), ), Nur Nurse follo low-up phon phone ca calls lls and and appo appoin intments s made ade as as appr appropriate te, MD noti notified for inpu input
Second iteratio ion of
Follo low-up Pro rotocol was deve eveloped and imple lemented
▪ Incl ncluded patie patient t edu ducati ation, im impr proved doc documentat tation re regar arding atte attempts ts to to co cont ntac act t patie patient, t, tigh tighter diagn diagnosis foll llow-up param parameters, sign sign-off f by by MD if if no no foll llow-up ne needed
Im Impacting Avoidable ER Utiliz tilization
Data trend rended dow
rom 14.8 .81% in Q4 2016 to
.3% in Q1 2019.
e did see see an upt uptic ick in Q4 and Q1 ea each year year, we e attribute this his to
cold ld/fl flu se season
14.0% Target 14.1%
Specia ialt lty Ca Care re Pra ractic ice 5 Pro rovi viders Date te Jo Join ined TC TCPI: I: 04/18/2017 Specific TCPI AIMS Impacted Through This Work: 1: Support Transformation 3: Reduce unnecessary hospitalizations 4: Generate savings
Gallatin Women’s Center’s Transformation Jo Journey
Tra Transfo formation Jo Journey
QI Committee August 2018 Budget November 2018 Daily Huddles April 2019 Community Health Worker May 2019
Director of the Transforming Clinical Practice Initiative at The Centers for Medicare and Medicaid Services
Medical Director, Population Health
Our Goals
The Vanderbilt Health Affiliated Network
We are a collaborative alliance of providers committed to transforming
complex care, we are working together to make healthcare more proactive, accessible, and affordable. By creating innovative solutions and partnerships with clinicians, employers, and insurance carriers, we are improving the quality and value of healthcare across the Southeast.
Redesigning Care and Strengthening Communities
Our network includes hospitals, physician practices, clinics, and post-acute care facilities across Tennessee and surrounding states. Our mission is to improve care across the Southeast by equipping providers to succeed in population health and sharing evidence-based best practices.
Net etwork Highlig lights:
350,000
Millions in sharedsavings
delivered to health plan sponsors and network clinicians for 4 years running
MORE THAN
providers participating in
patients across Tennessee and surrounding states
Quality care for more than
Transforming Care Delivery
We have built a high-quality network of providers who are transforming the practice of medicine by focusing on care quality and value.
Improving Health & Productivity
Network providers use data-driven approaches to engage patients and offer access to the care they need, when and where they need it.
Driving Innovation
We work with insurance companies, brokers, and employers to create value-based solutions for managing workforce health and employee benefits.
Managing the Total Cost of Care
By transforming care delivery, improving health and productivity, and driving innovation, we’re effectively managing the total cost of care. As a result, our model delivers high value while reducing healthcare costs.
The Largest Network in the Region
The Vanderbilt Health Affiliated Network is driving a new level of clinical innovation and teamwork to bring high-quality, accessible healthcare and services to communities in Tennessee and surrounding states. The network includes more than 6,700 clinicians, 68 hospitals, 13 health systems, and hundreds of physician practices and clinics working together to provide the best care, at the right time, and at the right cost.
Hospitals
Contact us at vhan.com or call 1-877-969-3194.
PrimaryCare Providers QuickCare Clinics Post-Acute CareFacilities WEST: Baptist Memorial Health Care • West TennesseeHealthcare MIDDLE TENNESSEE: Cookeville Regional Medical Center • Jennie Stuart Health • LifePoint Tennessee Hospitals • Maury Regional MedicalCenter NorthCrest Health • Saint Thomas Midtown • Saint Thomas Rutherford • Sumner Regional Medical Center • Vanderbilt University Medical Center •Williamson Medical Center EAST: Erlanger Health System • Mountain States Health Alliance • University of Tennessee MedicalCenter
24 472 13 39
16 338 21 30 23 890 88 44
Our Goals
Creating Healthcare Valu lue
Ens Ensure the he ri right ca care Improve appropriateness Decrease unnecessary variation Ens Ensure the he hig highest quali lity ca care Improve outcomes and experience Red Reduce the he tota
cost of
care Pos
itio ion VH VHAN as as the he prefe referred fin inancially ly su sustain inable le inte ntegrated he health sy system
Our Approach
Care re Deliv elivery Models ls
Team-based care High value care coordination Transitions of care
Inte Integrated Care Te Team
A multidisciplinary approach to care
Cont ntin inuous Qua ualit lity and nd Pro rocess ss Im Improvement
Partner to redesign and improve care delivery Data collection, analysis, and reporting Standard care processes that can be measured
Communit ity Eng Engagement
Align community health strategies Integration of community resources
Patient/ Family
RN, Care Coordinator LPNs/ MAs Provider Data Analyst Pharmacy Social Work Community Health Worker
Clinical Integration Status
Why pursue?
Appropriateness
Maximize quality
Optimize utilization
Establish performance standards High performing care teams and systems Impact utilization and overall cost
affiliates and patients
Opportunity to create a common standard of care, an execution engine to support these standards, while measuring and demonstrating improvement of quality in each region of the network
Leveraging Successes from TCPi
Building the medical neighborhood
procedures
Continuous data-driven quality improvement
Patient and Family-Centered Engagement
Reducing avoidable ER utilization