VCU Health Initiative: Addressing High Utilizer/Multi-Visit Patient - - PowerPoint PPT Presentation
VCU Health Initiative: Addressing High Utilizer/Multi-Visit Patient Readmissions November 15, 2016 Objectives Provide an overview of the process utilized to identify a high utilizer/multi-visit patient population Discuss the
November 15, 2016
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Health Sciences Schools Colleges and Schools College of Humanities and Sciences Graduate School
Government and Public Affairs School of the Arts School of Business School of Education School of Engineering School of Mass Communications School of Social Work School of World Studies VCU Health System
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MCV Hospitals
VCU Community Memorial Hospital
Children’s Hospital of Richmond
MCV Physicians
medical students and residents
Virginia Premier Health Plan
Plan
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2% 2%
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VCUHS and Richmond City Health Dept. launch the “City Care” program for women and children
Meetings held with Community leaders to expand “City Care” to include uninsured adults
The VCC program is established in partnership with community PCP’s
Introduction
Population Health Management model
VCUHS purchases 30% interest in Chartered Health Plan (Virginia Premier)
VCUHS purchases remaining interest in Virginia Premier Health Plan
1995 1998 1999 2000 2011
Established the Complex Care Clinic
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1Based on last VCC contract during FY2015.
*Selected conditions use primary and secondary ICD codes from MCVH, MCVP, and VCC Community Claims data.
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38% reduction
One Yr Enrollment Multiple Year Enrollment Continuously Enrolled
45% reduction
One Yr Enrollment Multiple Year Enrollment Continuously Enrolled
Bradley, C, Gandhi, S, Neumark, D, Garland, S, Retchin, S, Lessons For Coverage Expansion: A Virginia Primary Care Program For the Uninsured Reduced Utilization And Cut Costs, Health Affairs 31, No. 2 (2012): 350-359
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VCC Population Average Cost/Year (2000 – 2007)
$- $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 Year 1 Year 1 Year 2 Year 3 Year 1 Year 2 Year 3
$6,833 $7,604 $5,768 $4,726 $8,899 $6,106 $4,569 Multiple Year Enrollment Continuously Enrolled One Yr Enrollment
49% reduction
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Indigent Care program
VCC Historical Enrollment
Unique Patients
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network
conditions
responsible for the majority of the utilization
VCC Program Update December 2013
Hospital Costs
ED Visits
Step 2: Assign the highest level based on hospital costs and ED visits Step 3: If prescribed more than 6 medications then bump up
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Medical Home for VCC Enrollees
Co Located : Practice/HS Multi-disciplinary Care Team
Level 1 Maintenance/Intake Level 3 Complex Level 2 Chronic
Risk Stratification Stable, intermittent care needs. Other basic issues (food, shelter, safety). May not engage with PCP. Moderate illness burden. Physical as well as mental health issues. Understands need for ongoing care and is willing to work with caregiver. At highest health risk High utilizers of expensive services and at risk for using more. Many have mental health as well as physical conditions.
24% of the population represents 77% of the total cost
Source: VCU Health System Enterprise Analytics and compiled by VCU Office of Health Innovation
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– Physician – Nurse Practitioner – Social Worker – Clinical Psychology Fellow – Pharmacist – Clinical Nurse – RN Case Manager – Medical Outreach Worker
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17% 18% 18% 23% 24% 32% 41% 50% 53% 82% Cerebrovascular disease Peripheral vascular disease Mild liver disease Renal disease Substance abuse CHF COPD Mental illness Diabetes Hypertension
% patients
Top 10 most frequent diagnoses*
Hypertension, Diabetes, Mental Illness, COPD, and CHF were the leading diagnoses in the Complex Care Clinic.
Source: VCUHS Enterprise Analytics compiled by VCU Office of Health Innovation, January 2016 24
78% of Complex Care Clinic patients had 3 or more chronic conditions.
*Includes primary and secondary diagnoses
(Year 1 Results)
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*Includes Hospital inpatient, outpatient and ED costs Source: VCUHS Enterprise Analytics compiled by VCU Office of Health Innovation, January 2016
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Pre and Post Analysis (N= 443)
Source: VCUHS Enterprise Analytics compiled by VCU Office of Health Innovation, January 2016
Source: VCUHS Enterprise Analytics compiled by VCU Office of Health Innovation, January 2016 27
4403 6105 6259 FY13 FY14 FY15 CCC primary care visits per 1000 enrollees
39% increase 3% increase
Source: CCC KPI report January 2016
Source: VCUHS Enterprise Analytics compiled by VCU Office of Health Innovation, January 2016 28
955 850 784 FY13 FY14 FY15 Inpatient discharges per 1000 enrollees
11% decrease 8% decrease
Source: CCC KPI report January 2016
Source: VCUHS Enterprise Analytics compiled by VCU Office of Health Innovation, January 2016 29
$1,240 $1,223 $1,056 FY13 FY14 FY15 Inpatient costs per member per month
Source: CCC KPI report January 2016
Source: VCUHS Enterprise Analytics compiled by VCU Office of Health Innovation, KPI Report, January 2016 30
25% 24% 27% FY13 FY14 FY15 30-day all cause readmision rate
*NOTE: VCC enrollee readmission rate (FY15) = 12% *
Supported by the Robert Wood Johnson Foundation
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1Kangovi S. et al. Patient-centered community health worker intervention to improve
posthospital outcomes-a randomized clinical trial. JAMA Intern Med. 2014;174(4):535-543.
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needs
doctor’s appointments
resources
cultural and linguistic barriers
ORW makes visit to bedside to engage patient in 12-week intervention program Does patient agree to participate? No Yes Clinical Staff reviews Daily IP report and makes assignment to ORW for 12-Week intervention Thank patient and document in Recap and CERNER Time: =/<24 hrs.
ORW registers patient for max 12 week intervention program
Complete participation agreement Confirm contact information Conduct baseline surveys Schedule post- discharge home visit ORW conducts initial home visit Time: within 2 business days Complex Care Team
Reinforcement of Medical Plan Assistance with Medical Appointments Connection to Non-Medical Community Resources Patient Specific Requests
ORW conducts weekly calls for 1 week ORW conducts weekly home visits for 6-12 Weeks until the patient is able to self-manage Patient is transitioned back to the Clinic ORW
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Virginia Food Bank and meeting space.
management education.
risk of homelessness.
who are need of behavioral health and/or substance abuse prevention and intensive case management services.
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during recent hospitalization regarding her frequent ED use (avg. 4-5 visits/month) and multiple hospitalizations
completing dialysis treatments
early due to anxiety - causing fluid retention which resulted in her returning to the ED due to shortness of breath most weeks
during the week prior to dialysis treatments, and in-person visits during the last hour of dialysis
no hospitalizations reported
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University of New Mexico Hospitals (NM) Rural Health Education Outreach Grady Health System (GA) Heart Failure Clinic Parkland Memorial Hospital (TX) Prenatal Care
Virginia Commonwealth University Health System (VA) Virginia Coordinated Care for the Uninsured
Nassau University Medical Center (NY) Emergency Operations Planning Cambridge Health Alliance (MA) Asthma Program Truman Medical Centers (MO) Chronic Conditions Hennepin County Medical Center (MN) Coordinated Care Clinic UW Medicine Harborview (WI) Mental Health Integration Project San Francisco General Hospital (CA) Healthy San Francisco
Source: AEH Gage Award Submission, 2013, Health Affairs, 2012, 31(2)
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populations in Virginia’s 2015 CMMI State Innovation Model (SIM) grant
the 2016 Vizient/UHC “playbook” for the design of programs to manage chronically ill populations
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Contact Information: Sheryl Garland, MHA Vice President, Health Policy and Community Relations VCU Health System Director, VCU Office of Health Innovation sheryl.garland@vcuhealth.org 804-828-1290