Raising the Bar: Innovative Healthcare Program Fosters Collaboration, Education

RAISING THE BARInnovative Healthcare Program Fosters

Collaboration & Education

Big Data, Big Discoveries

Sponsored by:

HOST:Eric Kavanagh

GUEST:Dr. Anjum Khurshid

GUEST:Jim McNamara

It’s a Complex Situation

Regulations in the Affordable Care Act (ACA)

Uninsured Americans

Legal challenges to the ACA

Emerging Solutions

Health Information Exchanges (HIEs)

Collaboration among health care institutions

Social Media for analysis, outreach and education

Dr. Anjum KhurshidDirector, Health Systems Division

Louisiana Public Health Institute

Raising the Bar: Transforming Health Care in the

Crescent City

Anjum Khurshid, PhD, MD, MPAffDirector, Health Systems DivisionDirector, Crescent City Beacon CommunityLouisiana Public Health Institute

February 27, 2013

Outline

• Crescent City Beacon Community (CCBC) Goals– Clinical Quality Improvement – Transitions of Care through Greater New

Orleans Health Information Exchange (GNOHIE)

– Consumer Engagement and txt4health• CCBC-BioDistrict Collaboration and Future

Opportunities

Hawaii County Beacon Community

Hilo, HI

Southeast Michigan Beacon Community

Detroit, MI

Crescent City Beacon Community

New Orleans, LA

Delta BLUES Beacon Community

Stoneville, MS

Keystone Beacon Community Danville, PA

Utah Beacon Community

Salt Lake City, UT

Beacon Community of Inland Northwest

Spokane, WA

Great Tulsa Health Access Network Beacon

CommunityTulsa, OK

Southeastern Minnesota Beacon

CommunityRochester, MN

Rhode Island Beacon Community

Providence, RI

Greater Cincinnati Beacon

CommunityCincinnati, OH

Southern Piedmont Beacon Community

Concord, NCSan Diego Beacon Community

San Diego, CA

Western New York Beacon Community

Buffalo, NY

Colorado Beacon Community

Grand Junction, CO

Bangor Beacon CommunityBrewer, ME

Central Indiana Beacon

CommunityIndianapolis, IN

17 Beacon Communities

Crescent City Beacon Community Goals

Reduce the burden of chronic diseases, mainly diabetes and cardiovascular disease by :o Improving the quality of care for chronic disease

patients in patient-centered medical homes, enabled by HIT

o Reducing healthcare costs by decreasing preventable emergency department and inpatient visits through better coordination of care

o Engaging consumers in the healthcare process by using innovative technologies and strategies

3 Cs of CCBC

Clinical Transformation

Care Coordination

Consumer Engagement

Improve QualityBuild &

Strengthen HITInnovate

Patient-Centered Medical Home

(Primary Care System)

Inpatient

Emergency

Wellness

visits

Scr

eeni

ng

visi

ts Routine visits

for

medication m

onitorin

g

Pre

ve

nta

ble

A

dm

iss

ion

s

Pre

ve

nta

ble

E

D V

isits

Reduce readmissions

Patient Engagement/Disease Management

Identify frequent users

Patient Education/Risk Reduction

At-risk -- Low risk -- High risk -- Chronic -- Complex

Population

Specialty/Diagnostics

Appropriate referral

Appropriate admissions

Appropriate urgent care

Timely follow up

Dynamic Framework for a Coordinated System of Care

Dynamic Framework for a Coordinated System of Care

Patient-Centered Medical Home

(Primary Care System)

Inpatient

Emergency

Wellness

visits

Scr

eeni

ng

visi

ts Routine visit

s for

medicatio

n monito

ring

Pre

ven

tab

le

Ad

missio

ns

Pre

ven

tab

le

E

D V

isits

Reduce readmissions

Patient Engagement/Disease Management

Identify frequent users

Patient Education/Risk Reduction

At-risk -- Low risk -- High risk -- Chronic -- Complex

Population

Specialty/Diagnostics

Appropriate referral

Appropriate admissions

Appropriate urgent careTransitions of Care

Innovations/Consumer Engagement

Chronic Care Management

Timely follow up

Clinical Transformation

Improved quality of clinical care for chronic disease patients through improved workflow and health IT

population-based disease registries, risk stratification, care management/care team strategies, clinical decision support

Practice Coaching

Learning Collaborative

EMR Optimization

QI InnovationsClinical Seminar Series

Positive Trends on Adoption & Outcomes

11

7

4

9 9

7

14

12

9

14 14

10

January July

Number of Sites Using Care Management Processes - 2012

Quality Outcomes Q6 to Q7(October

2012)

Diabetes: A1C testing

Diabetes: A1C control (<8.0%)

Diabetes: Lipid testing

Diabetes: Lipid control (<100mg/dL)

Diabetes: Blood Pressure Control (<130/80)

Ischemic Vascular Disease: Blood Pressure Control (<140/90)

Ischemic Vascular Disease: Complete Lipid Profile

Coronary Artery Disease: Drug Therapy for Lowering LDL-C

* All data from QI Outcome Measure Reports

124,509

125,887

126,341

126,808

127,008

130,597

171,293

171,950

172,733

173,073

173,651

176,118

177,790

177,790

179,693

181,306

184,796

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

# of

Liv

es

Number of Unduplicated Lives in CDR Across the CommunityData as of 2/11/2013

Clinic A

Clinic B

Clinic C

Clinic D

Clinic E

Clinic F

Clinic G

Clinic H

Clinic I Clinic J

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

789

4311

1593

581

1384

720

148

2842 2826

575238

998

295 110304 243

45

619 645

67

Total ED/IP Encounters at ILH7/2/12 - 1/31/13

Sum of EDSum of IP

Care Coordination

ED/IP Notification

ElectronicSpecialty

Care Referral

Birth Outcomes

BehavioralHealth

IntegrationAnalytics

GNOHIE

Mirth Results (CDR)

Mirth Match (EMPI)

Mirth Mail (Secure

Mail)

Mirth Care (Care

Mgmt.)

Mirth Analytics (EDW)

GNOHIE Architecture

Currently connects 23 primary practices and 2 hospitals in GNO

• Encrypted data

• HIPAA compliant protocols

• Role-based access security

• Restricted administrative access

• Patient consent needed

• Extensive Auditing capabilities

Central Data

Repository

Data Security

Transitions of Care

o Emergency Department/Inpatient Notification: Alerts and clinical information are sent to primary care providers about patient visits to emergency departments and hospital admissions.

o Electronic Specialty Care Referral: Referral requests and supporting documentation of the referring primary care provider are sent electronically to the specialist. Specialist’s consult summaries are, in turn, provided electronically to the primary care provider.

Pre-ED/IP Notification

DebbieType 2 Diabetes


HOSPITAL HOMEDiabetic Ketoacidosis Discharged



HOSPITAL HOMEHypoglycemia Discharged



HOSPITAL HOMEFoot infection Discharged



HOSPITAL HOMEKidney Infection Discharged

9/15/12

9/25/12

10/2/12

10/20/12

PRIMARY CARE

PRACTICE

ED/IP Notification System



HOSPITAL HOMEDiabetic Ketoacidosis Discharged



HOSPITAL HOMEHypoglycemia Discharged



HOSPITAL HOMEFoot infection Discharged



HOSPITAL HOMEKidney Infection Discharged

9/15/12

9/25/12

10/2/12

10/20/12

PRIMARY CARE

PRACTICE

GREATER NEW ORLEANS HEALTH

INFORMATION EXCHANGE

10/2

2/20

12

10/2

7/20

12

11/1

/201

2

11/6

/201

2

11/1

1/20

12

11/1

6/20

12

11/2

1/20

12

11/2

6/20

12

12/1

/201

2

12/6

/201

2

12/1

1/20

12

12/1

6/20

12

12/2

1/20

12

12/2

6/20

12

12/3

1/20

12

1/5/

2013

1/10

/201

3

1/15

/201

3

1/20

/201

3

1/25

/201

3

1/30

/201

3

2/4/

2013

2/9/

2013

2/14

/201

3

2/19

/201

3

2/24

/201

3

3/1/

2013

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

124,509

125,887

126,341

126,808

127,008

130,597

171,293

171,950

172,733

173,073

173,651

176,118

177,790

177,790

179,693

181,306

184,796

Number of Unduplicated Patients in CDRas of 2/11/2013

# o

f L

ive

s

Total ED Encounters = 15,769

Total IP Encounters = 3,564

Clinic A Clinic B Clinic C Clinic D Clinic E Clinic F Clinic G Clinic H Clinic I Clinic J0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

789

4311

1593

581

1384

720

148

2842 2826

575

238

998

295110

304 24345

619 645

67

Total ED/IP Encounters at ILH7/2/12 - 1/31/13

Sum of ED Sum of IP

Since Dec. ’12 – 1 site

Since July ’12 – 3 sites

Since Sept. ’12 – 2 sites

Since Nov. ’12 – 1 site

Since Nov. ’12 – 3 sites

Since Sept. ’12 – 1 site

Since Nov. ’12 – 1 site

Since Sept. ’12 – 3 sites

Since July ’12 – 1 site

Since July ’12 – 1 site

23

Telemedicine Specialty Care

1 hospital – 11 telemedicine

specialties with designated

appointment slots

Cardiology

Dermatology

Endocrinology

Hepatitis C

NephrologyNeurology

Physical Medicine &

Rehab

Pulmonary

Psychiatry Rheumatology

General

Diabetes

Pain Management

Total Specialty Consults in Q4, 2012 = 1,394

Patient Consent

OPT-IN MODELException = break the glass

1 consent form – applies across all GNOHIE participants

PATIENT ENGAGEMENT

AND EDUCATION

PROVIDER ENGAGEMENT

PROVIDER WORKFLOW

Examples of Patient Materials

Community Engagement

Txt4health Campaign

Consumer Engagement

Model

Community Advisory Group

Targeted Community

Engagement

Provider Engagement

Other CCBC Interventions

Integration of Other Settings

to Actualize “Health Home”

Concept

Building Blocks: Text4Health Modules

User sends HEALTH

to 311 411

Development of Profile(Risk Categorization)

Enrollment

Goal Setting/Tracking(Weight & Exercise)

Education/Motivation(According to Risk)

Local Connections(Care & Activities)

System collects:

HEIGHT

WEIGHT (BMI)

AGE

GENDER

FAMILY HISTORY

DIABETES DIAGNOSIS

SMOKING STATUS

System categorizes:

HIGH RISK

MEDIUM RISK

LOW RISK

-------------------------------

UNDERWEIGHT

AT WEIGHT

OVERWEIGHT

OBESE

Enrolled participants in 12 months ~ 1,400

Solution Offering and Value Proposition

Care Management & Coordination System

•Engagement (Consumer,

Provider,)

• Health Information Exchange

• Chronic Care Management System

• Patient- Centered Medical Home

People Process

Data Analysis & Information Management

Technology (EMR/HIE)

Value PropositionSolution Offering

•HEDIS measures for diabetes and cardiovascular

•Reduce hospital readmissions•Reduce Emergency Room Visits•Reduce Avoidable Hospital Admissions•Reduce duplicate testing (e.g. imaging)•Medication management

Improve Quality

Improve Efficiency

Bend the Medical Cost Trend

• Reduction in per member per month cost

Bend the Medical Cost Trend

Use predictive modeling, propensity score matching,and other statistical techniques to investigate:

• High use of Emergency Department

• Avoidable hospital readmissions

• Duplicate procedures and tests

• Preventable hospital admissions

• High-cost patients

• Variation in care

• Root cause analysis

Advanced Analytics

Prescriptive How can we achieve the best outcomes?

Predictive modeling What will or could happen?

Descriptive What happened?

CCBC-BioDistrict Collaboration

• To promote research-community-industry collaboration

• To develop a real-time, real-world, intelligent, learning system that connects researchers and clinicians

• To provide a laboratory for innovation, social entrepreneurship, and translational medicine

• To measure and demonstrate impact on patient outcomes and population health

Opportunities for Future

• Use state-of-the-art health IT infrastructure to coordinate care and evaluate results

• Involve leading research institutions and medical centers to use data to inform clinical practice

• Develop Public-private partnerships to test new ideas, effective treatments, and innovative technologies

• Promote economic development and job creation through workforce training and new business ventures

Strength of the System

Leveraging Trust

Networks

EngagementOwnership &

Accountability

Stakeholder-defined use cases and provider-led design

Working Together

CCBC Receives 2013 “Healthcare Informatics Innovators Award”

“A massive effort to improve the health status of the entire New Orleans metropolitan area”

“What makes this collaboration worthy of Innovator Awards recognition is the combination of vision and scope on the one hand, and the successful leveraging of HIT to achieve those visionary goals, on the other”

-- Mark Hagland Editor-in-Chief, Healthcare Informatics

Contact:

Anjum Khurshid, PhD, MD, MPAffDirector Health Systems Division

Director Crescent City Beacon CommunityLouisiana Public Health Institute

1515 Poydras St, 1200 New Orleans, LA 70112Phone: 504-301-9800

Email: [email protected] www.lphi.org www.crescentcitybeacon.org

mailto:[email protected]

http://www.lphi.org/

http://www.crescentcitybeacon.org/

Jim McNamaraPresident & CEO

BioDistrict New Orleans

RECONNECTING NEW ORLEANS

A Sustainable Strategy for Job Growth,

Economic Development and Better Health Outcomes

BioDistrict

Iberville\Treme CNI

FrenchQuarter

CBD

Vision

BioDistrict New Orleans will become a thriving and highly livable business, education, science and healthcare destination, regarded throughout the City and the nation as the premier revitalized urban district of choice. The BioDistrict will be known for its walkable scale, new and historic neighborhoods, excellent schools and ecosystem support services, vibrant retail, accessible open space and transit, as well as a range of stable and well paying bioscience and healthcare industry jobs. The BioDistrict will become a national model for urban revitalization, job creation and economic and industry development.

10/12/12

Civic Leadership

Sustainably Built Environment

Jobs and training

Economic Development

An Amazing Collaboration working TOGETHER!

Research with Industry value

Bioscience Centers of Excellence Peptides HIV/AIDS Infectious Diseases Cancer Diabetes and Cardiovascular Biodefense Neuroprotection and

Rehabilitation Nano-particle Drug Delivery Health ITEmerging Centers Translational Medicine BioBanking

BioDistrict Areas of Concentration

• Economic Impacts— Over 20 years, the BioDistrict will

generate:

• 34,000 direct and indirect jobs created

• 3600 annual construction jobs

• $4 Billion in Capital Activity

• $24 Billion in Economic Activity

• $2.45 Billion in years 1-5

• $26.185 Billion in Personal Earnings

• $2 Billion in increased Personal

Earnings

• Economic Impacts— In 20 years, the BioDistrict will generate:

• $3.352 Bn in Sate and Local Tax

Generated, ($167 m per year)

• $1.91 Bn -- State tax - $95 Million

annually

• $1.44 Bn -- Local tax - $72 Million

annually

• 11.6 Million Square Feet of New,

Absorbed or Renovated Buildings

• 2,000+ Housing Units

Thank you!

Raising the Bar: Innovative Healthcare Program Fosters Collaboration, Education

Health & Medicine

Transcript of Raising the Bar: Innovative Healthcare Program Fosters Collaboration, Education