Transforming Healthcare In Arizona Priya Radhakrishnan, M.D. Chief - - PowerPoint PPT Presentation

Transforming Healthcare In Arizona

Priya Radhakrishnan, M.D.

Chief Academic Officer, Honor Health Medical Advisor, Practice Innovation Institute

& Jenn Sommers, Director, Practice Innovation Institute

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Transforming Clinical Practice Initiative (TCPI)

• TCPI is designed to help clinicians achieve large-scale health

transformation

• A four year initiative from Oct 2015 – Oct 2019
• Supports more than 140,000 clinician practices in sharing,

adapting & further developing their quality improvement strategies

• Enables new levels of coordination, continuity, and integration of

care, while transitioning volume-driven systems to value-based, patient-centered, health care services.

• TCPI participants include:

– 29 Practice Transformation Networks (PTNs) – 10 Support and Alignment Networks (SANs)

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Practice Transformation Networks (PTNs)

AIMs/Goals: Primary & Secondary Drivers

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TCPI Phases of Transformation

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Practice Innovation Institute

• One of 29 Practice Transformation Networks (PTNs) funded under the

national CMS Transforming Clinical Practice Initiative (TCPI)

• Four years of funding beginning Oct 2015 to transform the practices of

2,500 providers in Arizona

• A collaboration among Health Current, Mercy Care Plan and Mercy

Maricopa Integrated Care

• Supporting FQHCs, Integrated Health Homes, Clinically Integrated

Pediatric Network (PCCN), Crisis providers, Equality Health Network and Specialty practices

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In one word - UNIQUE

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Pii

Pediatric Clinically Integrated Network (119)

Outpatient Behavioral Health (10) FQHC’s (13)

Specialty Practices (10)

Unique: Crisis services, Corrections (6)

Integrated Health Homes (8) Statewide Health Information Exchange Mercy Care Plan/Mercy Maricopa Integrated Care Equality Health Network

Pii - Path to Health Care Transformation

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Patient & Family Centered Care Design

• Patient

Engagement

• Access to care
• Use of Data

Continuous, Data Driven Quality Improvement

• QI technical

assistance

• Identifying Data

Source and PDSA

• Linking with

Resources

• Success with

QPP/UDS/VBS Sustainable Business Operations

• Practice

management

• Service line

augmentation

• Staff vitality & joy

in work

How we plan to get there!

HIT Platform Services & Applications Data Sources Used by clinicians Used by

• ther staff

Used by patients & families Care Quotient

• Population Health &

Analytics

• Predictive Analytics
• Benchmarking
• Risk Stratification
• Claims

from health plans, via HIE

Care Unify

• Care Management
• Care Pathways
• Risk Stratification
• Patient Panels
• Alerts &

Notifications

• Claims

from health plans

Statewide Health Information Exchange (HIE)

• Clinical data

aggregation

• Clinical data

repository

• Direct secure e-mail
• Provider Portal

(query & response)

• Providers,

via direct connection

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Application to Behavioral Health

• Significant representation of BH in TCPI and Pii

– New Common Measures – The Behavioral Health Affinity Group

• Increasing awareness of the importance of behavioral health and

psychosocial determinants in health care

• Collaborating with other PTNs and SANs nationally

– Both APAs and the National Council – PTNs in NY, LA, CO, MI, IN, ME, CT, NC, and Vizient

• Pii Academy provides resources for transformation

– Access to TCPI resources – The Behavioral Health Affinity Group and the BH Resource Compilation – Subject Matter Experts – Workshops and Conferences

• GOAL: To work with our behavioral health and medical practices

to respond to industry changes and to support their need to be sustainable, thriving practices

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Application to Behavioral Health

Primary Change Driver: Person and Family Centered Care Design

• Integrating medical and behavioral health for persons with a

Serious Mental Illness

– Challenges in administering – Promoting team based care – Focusing on and engaging the member

• Collaborative Care Model
• Behavioral Health Members in emergency departments
• Innovation

– Multi-condition BH screening pilot with Community Bridges – Solutions supporting team base care

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TCPI PFE Program Components

Inclusion of the patient voice in practice

• perations

Enhanced Access Use of e- technology to engage patients & family Assessment to gauge patient readiness to be “activated” as a partner in their care Measurement

• f patient

health literacy Organized, evidence based care Shared decision-making among clinicians & patients

Application to Behavioral Health

Primary Change Driver: Continuous Data Driven Quality Improvement

• Connection to Health Information Exchange (Health Current)
• Addition of analytic and decision support tools

– Practice management – Practice dashboards – Utilization and cost data including pharmacy – Identifying the high needs, high cost members – ADT alerts – Integration of plan and provider data

• Innovation – CMT and Opioids

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Transformation process

Evaluate Implement Develop Design Analysis

Application to Behavioral Health

Primary Change Driver: Sustainable Business Operations

• Transitioning to value based reimbursement: learning to

count accurately, analyze, and document value

• Developing the right value based models
• Moving from compliance to outcomes
• More effective administration of integrated models
• Restoring joy in practice

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Transformational Pathways

ASSESS Diagnose with Data Teach

Graduating toward coordinated care

• High risk registry
• Warm hand offs
• Schedule appointments together ( co-located)
• Develop combined plan of care
• Identify member/peer/family engagement
• Post ER/Hospital visit plans
• EHR strategy

Operationalizing Integrated Care – Where to Start

Engaged leadership Data Driven Improvement Sustainable Business Operations Team Based Care Patient – Physician Partnership Population management Continuity of Care Access to Care Care Coordination Evolved Practice

Opioid Epidemic Solutions: HIE/PMP Integration

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• HIE integration with Arizona’s Prescription Monitoring Program required by

2016 Az Senate Bill 1283

– BEGINNING OCTOBER 1, 2017, THE CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM DATA INTO THE EXCHANGE…

• HIE/PMP integration “go-live” - August 1, 2017
• Impact on Opioid Epidemic

– Providers using HIE Portal will be able to access all controlled substance prescriptions from PMP database along with all medical history available through HIE – Aligns with integrated physical and behavioral health information exchange

• In emergency, providers able to break the glass and access patient’s Part 2 substance abuse data
• In other instances, can access Part 2 substance abuse data with patient consent

Successes to Date

• Alignment with FQHCs,

Collaborative Care Network along with Healthy Communities Collaborative Network on HRSA grant; successful meeting with the FQHCs to review technology, transformation, patient and family engagement

• Training programs coordinated

with ACP, APA, PCPCC and NP Supported Alignment Networks (SAN)

• Submitted 6 patient and family

engagement performance stories for national recognition

– Pulmonary Institute – A New Leaf – Recovery Innovations – Desert Senita FQHC – Community Bridges – Wesley Community & Health Center

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SMI population profile

Serious Mental Illness (SMI)

• 20% of population account for half of the cost
• 2/3 have substance abuse problems
• 2/3 have 1 chronic medical condition, half have 2,

and 1/3 have 3 or more

Non-SMI Adults

• Chronic physical conditions with co-morbid

mental health and substance abuse

• Drive high costs on medical side

High Needs/High Cost Members

• Complex physical and behavioral health needs
• Crisis episodes
• Emergency department (ED) and inpatient

admissions

• Substance use/abuse, polypharmacy
• Critical psychosocial supports needed
• Housing
• Employment
• Criminal justice involved
• Not engaged or empowered

Population SMI Adult Non- SMI Adult Top 20% SMI Total Members 25,000 450,000 4,500 Annual Cost $700m $400m $400m Average Cost Per Person $28k $889 $90k

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Partners in Recovery (PIR)

• Outpatient behavioral health practice serving persons with serious mental

illness (SMI)

• Started integrating physical and behavioral health care in April 2014
• Currently serves approximately 7,500 members
• Has 3 Assertive Community Teams (ACT) – 1 of which is a “M-ACT” or

Medical ACT Team

• Represents 1 of 6 similar practices serving 25,000 persons in Maricopa

County with SMI

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PIR Success!

M-ACT Team

46% reduction in psychiatric admissions 11% reduction in unnecessary emergency room services

OMEGA ACT Team

18% reduction in psychiatric admissions 11% reduction in acute hospitalizations 41% reduction in unnecessary emergency room services

VARSITY ACT Team

10% reduction in psychiatric admissions 39% reduction in acute hospitalizations .2 reduction in unnecessary emergency room services

WEST VALLEY ACT Team

24% reduction in psychiatric admissions

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Partners in Recovery – PFE Initiatives

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E-Tools  Implementation of patient portal (request appointments, send messages to clinicians, view medical documents)  Connected to statewide HIE Health Literacy  Require all staff to complete cultural competency trainings  Implemented Wellness Recovery Action Plan (WRAP) Programs for, both, participant and family (strong emphasis on self-management) Patient Activation  Uses PHQ-9 tool consistently across the various locations Support of Patient Voices in Governance & Operational Decision-Making  All of 7 locations have a member-led Patient Advisory Council  Member seat on Board of Directors Shared Decision-Making  Integrated Service Plan template includes section for member to identify personal, achievable goals (i.e. employment, housing, A1C numbers, etc)  All clinical team members (Nurse, case managers, vocational specialist, employment specialist) trained on Motivational Interviewing

Questions?

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