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Improving Care for Multi Visit Patients: An Introduction to the MVP MethodPartner Learning Webinar
August 16, 2019
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Improving Care for Multi Visit Patients
An Introduction to the MVP Method
Sue Bergmann, MBA, BSNSenior Director, Safety and Quality
sueb@wsha.org
Washington State Hospital Association
Objectives
Describe the Multi Visit Patient Method and it’s role in reducing readmissions
Outline the steps for implementing the MVP Method
Review Harborview Medical Center’s experience in a Multi Visit Patient Acceleration Network
Explain Harborview’s learnings and barriers identified in their implementation
Whole Person Transitional Care (AHRQ ASPIRE)
A patient-centered approach to addressing the medical, social and behavioral needs of patients.
Medical BehavioralSocial
Designing and Delivering Whole-Person Transitional Care. Content last reviewed June 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/medicaidreadmitguide/index.html
Amy Boutwell, MD, MPPPresident, Collaborative Healthcare Strategies
Developer, the ASPIRE Guide and MVP Method
Washington Hospitals Coached on MVP
Confluence Health
Harrison Medical Center
PeaceHealth Southwest
Providence Regional Medical
Center Everett
Skagit Valley Hospital
Harborview Medical Center
Multi Visit Patient (MVP)A patient with four or more inpatient admissions within twelve months.
High Utilization Complex Medical Conditions
MVP’s in Washington State
Source: CHARS Washington State Comprehensive Hospital Abstract Reporting System (CHARS)- Timeframe: July 2016 – July 2018
CADHypertension
DiabetesCHF
COPD
DepressionAnxietyBipolar
Post Traumatic Stress Disorder
Substance Use Disorder
HomelessnessSocial Isolation
PovertyEducation Violence
Medical Behavioral Social
MVP Contributing Factors
MVP’s have unmet needs driving their utilization.
Utilization is a symptom of that unmet need.
Driver of utilization: The person-centered root cause of utilization
Driver of Utilization
Not the admitting diagnosis
Not the chief complaint
Not the problem list
Why is one patient an MVP and the other isn’t?
Mr. Smith42 year old male
DMCADHTNAfibARF
Mr. Johnson42 year old male
DMCADHTNAfibARF
MVP Not an MVP4+ admits/year 1 admit/year
Mr. Smith42 year old male
DMCADHTNAfibARF
MVP 4+ admits/year
Whole Person Transitional Care for MVP’s
Identify Assess Develop a Plan Link Plan for Return
Identify• Reliably identify MVP’s currently
in the hospital
• Start with a daily MVP report
• Work to build a real-time notification or alert in your EMR
Assess• Assess your MVP’s at the
bedside, while in the hospital
• Not a chart review, let the patient lead the conversation (motivational interviewing)
• Identify the driver of utilization
Develop a Plan• Develop a plan to address the
unmet need driving utilization
• Co-developed with the patient and/or caregivers
• The plan is feasible and gives clear guidance
Link • Link to outpatient and/or
community resources that will address the MVP’s unmet needs
• Warm hand-off, in-person meeting while the MVP is in the hospital
• Not a paper referral
Plan for the return • Prepare the ED for when MVP
returns
• ED Care Plans: • Summary for the ED
provider to inform care in the ED
• Link the patient back to community resources
It may take several attempts to successfully engage an MVP.
Identify patients that “refuse” services as an opportunity to try something different!
Harborview Medical CenterMVP Pilot Project Experience
HMC MVP Team Members
Mona Chambers, RNProject Operations SpecialistInpatient Care Management
Kari Nasby, SWSocial Work Supervisor
Ambulatory CareEllen Robinson, PTClinical Analyst
Quality Improvement
HMC Baseline Analysis
MVP defined as >= 4 IP Visits in 12 months240 patients ~ 1300 IP encounters
• 60% White, 22% Black, 10% Asian, 4% American Indian/Alaska Native• 47% patients with Mental Health condition • 41% patients with Housing Insecurity• 53% patients with Substance Use Disorder• 25% have all three conditions• 70% Male, average age 56 years old• 15% Non English Speaking• 51% Medicare, 43% Medicaid, 6% Commercial• 90% Home Discharges
MVP IdentificationReal Time Web Based Report
A day in the life…• ##/2019 - 25 MVPs • 16 patients > 4 (4-21 visits) • 9 patients current encounter = 4th visit • 7 Non English speaking • 4 Housing Insecurity• 15 Medicaid, 8 Medicare, 2 Commercial
Typical Daily List - 3-5 New patients5-15 minutes per patientTracking cases to expedite linkages
Harborview MVP InterviewsMedical One Liner:• Try to keep to one sentence and include the main reason for this admission.
Utilization history and pattern:• Include ED visits, Admits over the last 3 months, etc.
The Driver of Utilization:• Try to elicit from patient the underlying reason for return to the hospital. “Why do
you think you are needing to come back to the hospital so much?” “What can we do differently for you?” What can you do differently to be able to avoid coming back to the hospital?”
• Summarize in a short paragraph of what is driving this readmission with a holistic lens, looking at the specific medical, social and psychosocial status and needs of the patient which is causing them to seek medical help frequently.
Weekly Team Huddles
• Multidisciplinary Team allows us to look at the issues from all angles
• Brainstorming linkages for individual cases provided knowledge transfer across care settings
• Reviewed the services we “thought” the patient was getting and what they “were” getting
“There is no such thing as a referral for a MVP” – Dr. Amy Boutwell
Driver of Utilization Response SystemDrivers (Root Cause) Response System (Linkage) Primary Care Engagement Enhanced ACC, outreach to patient at bedside, make warm and helpful
connection, work on flexible scheduling, encourage patient to make connection (or re-connection) with community provider;
Chronic Symptom Management(HF, COPD, Renal, DM)
Describe chronic unstable baseline; identify maneuvers that provide rescue/relief; Develop strategies to deploy maneuvers as part of a known plan of care in-home, in urgent care, or in ED. Reconnect patient with specialty care providers already in place;
Inadequate Housing Assess patient level of need, determine if community resources are already in place or have begun application process, link to housing liaison PRN
Navigator/Coach/Cultural Mediator/Case Manager
Link to PCP with notification of additional wrap around services that might be required; Develop system for electronic notification and warm handoff Neighborhood Clinics connections
SUD Treatment Link patients with inpatient SBIRT services for transition to community care
Communication Challenges• Care Team roles/contacts don’t cross systems• Notification of MVP ED arrival is not visible • EDIE care plans not always complete and not integrated into all ED
providers work flow• Inpatient/ambulatory care plans not integrated• Warm handoffs optimal - - but challenging
Data Tracking
“More FTE’s is not the answer”
“Cross Continuum Care Management requires a reduction in gaps/duplication across system resources”
HMC Ongoing Work • Care Management Steering Committee• Review job roles and responsibilities across Care
Management teams• Inpatient and Outpatient IT integration • Considering how to facilitate “team huddles” across
care settings – including community partners
MVP Project Team
• Paula Minton-Foltz – Executive Sponsor• Dr. Nancy Sugg – Physician Champion• Mona Chambers – Care Co-ordinator RN (Inpatient)• Kari Nasby – Social Work (Ambulatory)• Curt Muhammad – COPD Care Manager (Inpatient)• Lea Ann Miyagawa (Cultural Mediators)• Kim Rezentes – Nursing (Ambulatory)• Ellen Robinson – Quality Improvement Support
MVP Training OpportunityWSHA and HealthierHere are offering
FREE MVP training for King County Hospitals
Late 2019: In person MVP Boot Camp for hospitals to work on their MVP Implementation Plans
WSHA will provide monthly coaching calls to support MVP Implementation
Early 2020: In person MVP Boot Camp for hospitals and community partners to work on MVP linkage
For more information on MVP Training, contact Sue Bergmann: sueb@wsha.org
Questions?
To implement MVP and/or
Whole Person Transitional Care at your facility:
Contact Sue Bergmannsueb@wsha.org