Senior Total Health Assessment CHCF/CIN Webinar … Multiple Medicare Health Assessment Requirements...
18
Senior Total Health Assessment CHCF/CIN Webinar Matt Stiefel & Charlotte Crist Kaiser Permanente Jan 23, 2013
Transcript of Senior Total Health Assessment CHCF/CIN Webinar … Multiple Medicare Health Assessment Requirements...
Senior Total Health AssessmentCHCF/CIN Webinar
Matt Stiefel & Charlotte CristKaiser Permanente
Jan 23, 2013
2
From Cost-Quality-Service to Triple AimFrom To
Cost Cost
Quality Service Care(Quality+Service)
Population Health
TripleAim
3
4
The Case for Population Health Measurement
Individual care, engagement
Population care management
Population health surveillance
Research, evaluation
5 5
Predictive Validity of Single-Q Health Status
“Predicting Mortality and Healthcare Utilization with a Single Question,”DeSalvo et al., Health Services Research 40:4 (August 2005).
“In general, would you say your health is…?
6 6
Adding Self-Reported Health Data Can Improve Traditional Predictive Models• The addition of self-reported health data from the Health Status
Questionnaire improves the predictive power of the DxCG model for admissions, costs, and mortality, with some loss of specificity
– The percentage of variance explained increased by 3-9 percentage points, to 10-25%
– Sensitivity increased by an average of 31% – Specificity decreased by an average of 13%– PPV decreased by an average of 16%
Perrin NA, Stiefel M, Mosen DM, Bauck A, Shuster E, Dirks EM. Self-reported health and functional status information improves prediction of inpatient admissions and costs. The American Journal of Managed Care. 2011 Dec 1;17(12):e472-8. http://www.ajmc.com/articles/Self-Reported-Health-and-Functional-Status-Information-Improves-Prediction-of-Inpatient-Admissions-and-Costs/
7
Example: Using Single-Q Health Status from HCAHPS Survey
Source: Robert Mangel, Ph.D., and Wenbin Mo, Ph.D., KP National Service Quality (unpublished data)
Data for all 2007 inpatient survey respondents, with 2.5 year f/u
8
Multiple Medicare Health Assessment Requirements
New: Annual health assessment for Medicare members
Existing:“Welcome to Medicare” visit (Initial preventive physical exam)Health assessment of new Medicare Advantage (MA) members Initial and annual health assessment of SNP* membersMedicare Stars quality bonus (HOS survey-based- MA)Potential phase 3 “Meaningful Use” requirement
Section 4103 of Affordable Care Act covers an annual wellness visit and personalized prevention plan, including a required health risk assessment (HRA).
*SNP = Special Needs Plan
9
Annual Wellness Visit (AWV) Final Rule for Section 4103 of ACA
Benefit: Annual Wellness Visit with Health Risk Assessment (HRA*) and Personalized Prevention Plan (PPP)
Affordable Care Act, Section 4103 / CMS Final Rule Section / Medicare Physician Fee Schedule for 2012
Required Elements of HRA: Demographics, Biometrics, Overall Health Status, Psychosocial risks, ADLs/IADLs, Behavioral risksEffective date: AWV: 1/1/2011; AWV with required HRA: 1/1/2012
Eligibility: All Medicare members
Time Limits: Once every 12 months beginning 12 months after Part B effective date, or 12 months after the “Welcome to Medicare” Visit (IPPE)
HRA Duration: Can take no more than 20 minutes to complete
Who can perform the visit? Any health or licensed medical professional, e.g. MD, NP, PA, CNS, health educator, or RD, under MD supervision
*At KP national level, called “Medicare Total Health Assessment” or M-THA.
10 | © Kaiser Permanente 2010-2011. All Rights Reserved.
January 25, 2013
Overview of CMS Requirements:HRA must be administered prior to or as part of the Wellness Visit to collect self reported health information
Must take no more than 20 minutes to complete
Requirements include collection of specific HRA assessment criteria
Provision of a specific and personalized screening schedule and intervention recommendations/referrals (Personalized Prevention Plan – PPP)
Must take into account specific communication needs, literacy and language requirements
Psychosocial risks (depression, anxiety, anger, isolation, pain)
11 | © Kaiser Permanente 2010-2011. All Rights Reserved.
January 25, 2013
Kaiser Permanente M-THA instrument includes:Self-rated physical and emotional health status
Frailty assessment to include report on ADL’s and IADL’s
Behavioral risks (tobacco use, physical activity, nutrition, oral health, alcohol consumption, sexual practices, motor vehicle and home safety)
Consideration for specific communication needs, literacy, language requirements and time to complete
12
• PATHWAAY is a proactive, interdisciplinary outreach program to screen and address geriatric issues and ensure regulatory compliance
• Targets all Medicare patients annually who have not had a visit in the past year
• Identifies positive responses from screening in areas of greatest risk both clinical and financial (e.g., falls, medications, depression, UI, physical activity, advanced directive, malnutrition, pain, anxiety, etc)
• Structured chart review and proactive telephone encounter occurs prior to PCP visit. with RN (Senior Assessment Coordinator) for members self-identifying with gaps for frail, incontinence, mental health, nutrition, pain or frailty
• Care is delivered prior to visit with PCP including labs, assessment, med review with pharmacist if needed, RN call, etc.
The Colorado PATHWAAY Program (Proactive Assessment of Total Health & Wellness to Add Active Years)
13 | © Kaiser Permanente 2010-2011. All Rights Reserved.
January 25, 2013
PATHWAAY for Seniors KP-Colorado (KPCO)
Utilization of self rated health measures for predictive analysis
Specific regional interventions in place to
address care gaps
Creation of PPP in advance of office visit
Scoring of patient HRA responses to identify Care
gaps
Patient Wellness Visit
Scheduling of this visit triggers workflows to collect
HRACollect in advance of
scheduled visit
Utilize technology to collect HRA
(on line/IVR*)
Other language translations
*IVR = interactive voice response
14 | © Kaiser Permanente 2010-2011. All Rights Reserved.
January 25, 2013
New Medicare Members/New Member ModuleKPCO Approach - Volumes
2012 Medicare New Members
2012 Medicare Members lost
15
KPCO Medicare THA Regional Launch Summary7/1/12 – 9/24/12
Positive triggers for Senior Assessment Coordinator (SAC) referral (Nutrition, Falls, UI, Mood, Pain, or Frailty) N=7896
16
Medicare - Total Health Assessment
Thought the M-THA questions were easy to understand 100% Thought the M-THA took a reasonable amount of time 96%Thought the IVR was easy to use 83%Found kp.org entry very easy 72%Felt issues would not have been addressed otherwise 62%
Member Feedback
Source: National Department of Organizational Research, 2012
17 | © Kaiser Permanente 2010-2011. All Rights Reserved.
January 25, 2013
Discussion
Charlotte Crist, RN, Project ManagerWendee Gozansky, MD, MPH
Measurement of quality outcomes
Approach for those seniors not currently receiving wellness visits
Pilot use of care categories in scheduling provider (mid-level vs. physician)
Other populations consider some of these innovations for their workflows
18
Resources
KP Senior Total Health Assessmenthttp://kpcmi.org/stha/ Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012.http://www.ihi.org/knowledge/Pages/IHIWhitePapers/AGuidetoM
easuringTripleAim.aspx
| © Kaiser Permanente 2010-2011. All Rights Reserved.
