Why Patient Centered Care Matters on the Path to Value GENA COOK - - PowerPoint PPT Presentation
Why Patient Centered Care Matters on the Path to Value GENA COOK CEO, NAVIGATING CANCER October 13, 2017 Institute Insti tute for r Heal ealthcar thcare e Im Improvem vement ents Tr Triple Ai Aim He Health o of a a P Popu
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Care He Health o
a P Popu pulation Pe Per Capita Cost Be Better Heal alth Be Better Car are Be Better Val alue Utilization Management Pathway compliance Reducing headcount Increase throughput Care Management programs Patient Engagement programs Benchmarking & Analytics BI Tools
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Care He Health o
a P Popu pulation Pe Per Capita Cost Be Better Heal alth Be Better Car are Be Better Val alue
Pa Patient Tr Triage Nur Nurse Pr Provider St Staff
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Pa Patient
Pr Provider & Care Team
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Remember to send refill script for James D. TODAY!! Call John Smith back on 3/2 re: pain follow-up
Call Cynthia L. back on 3/2 re: pain and fatigue follow-up
Level of sophistication
Outlook Excel EMR BI Tool
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Analytic Tools & Vendors
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CO CONNECT CTING THE HE PATIENT
Layering in an understanding of the patient experience outside your care
UN UNIFYING THE HE CAR CARE TEAM AM
A single, comprehensive view enables true care coordination
CAP CAPTUR URING THE HE INTERACT ACTION
NEW
Document in detail separate interactions between different care team members
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The pa patient ent’s compa pani nion to empowering their own care beyond the clinic
Pa Patient Li Link
The in integrated tools ls essential to the delivery of personalized care for every patient
Ca Care Management Pa Patient En Engagement
The di digital channel that connects providers to their patients and caregivers The au automat ation engi engine ne that scales patient-centered care from individual patients to broad populations
Po Population He Health
Pa Patient ent Rel elations nshi hip Mana nagem ement ent Personalized care for every patient
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Patient touch points each month
Patient approval rating
Invited patients who join & use platform
Patient Portal Adoption, KLAS Research
All the information and paperwork is hard to process, but the portal has everything organized for you! Everything one needs is right here. Its fantastic... Easy to use and you have all your info in one place to access at any time. My two daughters are able to get to my records - if I forget something, one of them will remember - thanks to the access to my information. It is a great tool. The service is great and easy to navigate through to find info I want or need. For me it's perfect.
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DIAGNOSIS STARTING TREATMENT CHEMO TEACH 30, 60, 90 days
Patients arrive informed and prepared for session Automatic delivery
Push content to match patient therapy regiment Deliver self-care instructions at every patient check-point
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Patients who read the education st stayed on
V pe pemetrexed therapy an average of 286 286 da days vs. 236 236 da days versus those patients who did not read the education
(p<0.01)
(p<0.01)
Patients who read the education had an average one year survival rate of 66% 66% vs. 53% 53% versus those patients who did not read the education
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Source: 2016 Navigating Cancer Patient Survey, 2,152 respondents
22% 22% i in l n les ess t tha han 30 m n 30 minut nutes es 42% 42% c called ed b back b bet etween 1 een 1-2 ho 2 hour urs 17% 17% c called ed b back b bet etween 3 een 3-4 ho 4 hour urs 19% 19% c called ed b back g grea eater er t tha han 4 ho n 4 hour urs
at risk fo for h r hospita talizati tions
Phone Triage at the Center for Cancer and Blood Disorders
Patient experiencing symptom Patient calls centralized triage phone line Dedicated triage RN receives call RN launches symptom management pathway in Navigating Care RN advises patient:
Patient receives follow-up and self-care instructions in their Navigating Care account
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ing is issues ü Standardized tri triage ge pa pathways enable comprehensive symptom assessment and management ü Ability to sc schedule follow-up up re reminders tied to an incident
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Sy Symptom m mana nagem ement ent p pathw hways
Body Aches Chest Pain Constipation Cycle One Follow-up Diarrhea Emergency Services Fatigue Fever & Chills Follow Up Nausea & Vomiting Nosebleed Oral Problems Pain Respiratory Changes Sinus & Cold Symptoms Transitional Care Management
Re Reduce ced va variability Sm Smarter er de decision-mak making Con Consi sist stent do documentation Be Better pat atient car are
+ mor
ment
Co Costs Avoid ided* Emergency Dept. $192,985 Hospitalizations $1,588,562 Combined $1,781,547 Co Costs Avoid ided* Emergency Dept. $177,290 Hospitalizations $1,376,724 Combined $1,555,014 2 locations in Tacoma, WA area 10 medical oncologists OCM participant | 3 payer pilots 9 locations in Forth Worth, TX area 13 medical oncologists OCM participant | 3+ payer pilots
*Calculation of costs avoided based on annualized data from January – April 2017
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PATIENTS MANAGED COST OF CARE PROACTIVE CARE REACTIVE CARE COST OF CARE
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Health Tracker Program Patient Reported Outcomes Dashboard Triage Dashboard Symptom Mgmt. Pathways
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Reported symptoms are immediately prioritized
Patients can submit how they’re feeling at the click of a button
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Put the right infrastructure in place
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Ba Barriers s to patients s reporting sy symptoms: s:
Making it difficult for programs to proactively address needs
Unaware of symptoms or don’t know which
Assume care team will anticipate and reach
Don’t believe care team is available to help Afraid to bother their care team Not sure who to call Of active cancer patients do not report symptoms because they do not want to bother their doctor
Of symptoms identified by systematic assessment are voluntarily reported to the care team by cancer patients
Source: Advisory Board Oncology Roundtable interviews and analysis. 27
Pa Patients Pr Providers ü Reminds patients to take their oral therapy on schedule ü Prompts patients to report their current health status ü Keeps patients connected to their care team in between
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Asra Erdem (589646) 19 March 1950 8 February 2017 10:35 pm
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Patients were asked to:
using a tablet or computer
chemotherapy on a scale of 1-4 Improved quality of life (34% v. 18%) Reduced ER visits (34% v. 41%) Reduced hospitalizations (45% v. 49%) Longer time on therapy (8.2 months v. 6.3 months)
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Pamela Jones
Dx: Breast Cancer Payer: Medicare Medication: Afinitor
Physician Triage Nurse Case Manager Pharmacist Financial Counselor OCM month 3 3 days post-refill PHQ-9 results Follow-up appt. Triage incident follow-up Reminder: refill check-in Determine payer coverage Pre-appointment summary
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