The Memphis Model: Mapping and

Early Findings

Teresa Cutts, Ph.D. : Director of Research for Innovationteresa.cutts@mlh.org; (901) 516-0593

August 18, 2011

Memphis: Land of Disparity

Egregious disparity exists: Income, Heart Disease, Diabetes, Cancer,

Suicide/Homicide, Limb Amputation

Memphis: Assets are the Blues and Lots of Church/Faith/”Soul”

• Anchors Memphis Model• 7 Hospital system• $1.5 Billion budget

• Provides high percentage of all indigent care in Tennessee

• Owned by the UMC Arkansas, Memphis, and Mississippi Conferences

Metropolitan Inter-Faith Association (MIFA) formed in 1968: Safety Net

Church Health Center founded 1987: Safety Net

Christ Community Health Service Neighborhood Clinic Opens 1995:

Safety Net

Mapping: Memphis Style

Our Ultimate Aim :• Build a trusted care delivery system that

integrates traditional clinical care and community-based caregiving

• Align and leverage religious and community health assets to improve health outcomes and access for all by 2020

An Integrated Health System

Pharmacy

Employers

CHN Partner

Community Health Worker

Education Church Health Center

MIFA Social Net

Hospice

Christ CommunityHealth Services

PersonFamily

Government

Hospital Health SystemBlue

Care, United, Cigna

Sports ClubsCHN Partner

Memphis Health Ctr.

Nutrition

Environment

Mapping: Memphis StyleWhat do we mean by “mapping”: making

visible, aligning and leveraging assets(“using what you got”….Memphis Style)Mapping shaped primarily by the patient

journey (not hospital, healthcare or provider-centric)

1. GIS mapping (congregational partners in CHN, safety nets, schools, agencies, others)

CHN Congregations30 Level 4

176 Level 342 Level 286 Level 1

496 trained liaisons

11,385 members registered

501 members from 128 congregations have been through ‘Visitation Training’

212 persons have been in the ‘Care for the Dying’ training

78 persons were in the first Mental Health First Aid training

106 persons have been in ‘Aftercare’ training

08-18-11

2. Participatory community based mapping to align and leverage both tangible (e.g., faith based clinic) and intangible assets (e.g., trust) outside hospital walls

PIRHANA morphs to CHAMP: Community Engagement

• ARHAP PIRHANA tool used for 11 workshops (5 most under-served neighborhoods)

• Adapt to US: renamed Community Health Assets Mapping Partnership to highlight ongoing collaboration (www.memphischamp.org)

• Public “ownership” and transparent sharing of data and models to nurture relationships

• CHAMP model: Specialty mapping done in 2 areas: eldercare, mental health; one case study

Mapping: Memphis Style3. In-hospital aligning and leveraging of case

management, social work, quality, clinical informatics, marketing, policy and all divisions (e.g., CHF projects, meds) to build seamless care pathways and transitions in terms of continuity of caregiving in community (liaisons and navigators) with clinical in-house staff and Big Table partners (e.g., TennCare)

Mapping: Strengthening Webs of Trust• Leveraging CHN’s role as

a “trusted intermediary” integrating with other assets for 313 faith entities (Cochrane, 2011)

• Share Abundantly and Transparently

• Invitational, not prescriptive…

• Emergent, leadership holds open space for organic growth; well adapted to turbulence

Mapping Blended Intelligences through the Center of Excellence in Faith and Health

• Traditional hospital medical and spiritual care structures (>10,000 Associates)

• CHN Covenant with 400 congregations

• Honor and blend local and global intelligence: training, webs of learning, participatory analyses

Mapping Data Inside the Hospital-Working with Case Management, Social Work, Alliance Aftercare and Hospice to integrate their work with our CHN navigators to seamlessly build care pathways for members/patients

CHN process measures through our Electronic Medical Record (EMR)

-Preliminary CHN outcome and pre-post data tracked through EMR

Navigator Consult Screen

Congregational Health Network:Outcome Measures

• Impact measured in hospital from Electronic Medical Record (compare CHN vs. non-CHN patient on disease care piece of “health journey”)– Decreased length of stay?– Decreased recidivism (return within 30 days)?– Decreased total costs?– Decreased mortality rate?

Member Registration: 11,385

CHN Early Outcome Data

Initial Data from first 25 months of build-out and operation of CHN: Nov. 2007-Nov. 2009

Comparison of 473 CHN Members who came into MLH to controls who also were patients (matched on age, gender, ethnicity) in this timeframe

CHN Outcome Data: 25 MonthsCHN Matched Controls*

N=473 473Mean Age: 60 58Gender:Female 304 304Male 169 169Ethnicity:African American 419 358European American 54 115*Matched on age, ethnicity and gender, DRG

CHN vs. Non-CHN: Admission Flow Portals

0

50

100

150

200

250

EDAdmits

MDRefer

OtherHos.

LTC

CHNNon-CHN

CHN vs. CHN Payor MixCHN Non-CHN

Medicare A&B 62% 50%

Cigna FlexCare 9.1% 8.5%United HC 6% 7.3%

TennCare 6% 6.1%Uninsured 2.1% 9%

CHN: Top Diagnoses

Congestive Heart Failure: 23%Fibroids (intramural, uterine): 21%Uncontrolled Diabetes: 10%Coronary Artherosclerosis: 8%Schizoaffective Disorders NOS: 8%Transient Cerebral Ischemia NOS: 6.5%Other: UTI, Septicemia, Renal Failure

CHN vs. Non-CHN Length of Stay and Re-admissions

0

10

20

30

40

50L

OS

tota

l

Rea

dmits

CHNNon-CHN

CHN vs. Non-CHN: Mortality Rate

0.00%0.50%1.00%1.50%2.00%2.50%3.00%

Mor

talit

yR

ate

CHNNon-CHN

CHN vs. Non-CHN CHF and Septicemia Charges

$0

$10,000

$20,000

$30,000

$40,000

$50,000

CHF Septicemia

CHNNon-CHN

CHN vs. Non-CHN Stroke and DM Charges

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

Stroke DM

CHNNon-CHN

CHN vs. Non-CHN Renal Failure and Other Cardiac Charges

$0$20,000$40,000$60,000$80,000

$100,000$120,000$140,000$160,000

Ren

alFa

ilure

Oth

erC

ardi

ac

CHNNon-CHN

CHN vs. Non-CHN: Total Charges

$6,800,000.00$7,000,000.00$7,200,000.00$7,400,000.00$7,600,000.00$7,800,000.00$8,000,000.00$8,200,000.00

Sum ofCharges

CHNNon-CHN

CHN vs. Non-CHN: System Savings and Per Capita:

25 months, N=473

0100000200000300000400000500000600000700000

Tot

al S

yste

mSa

ving

s

Per

Cap

itaSa

ving

sCHNNon-CHNSystem Savings

Savings to Patients on Readmits*: CHN vs. Non-CHN

$0$50,000

$100,000$150,000$200,000$250,000$300,000

Rea

dmit

Cos

t to

Pt

Net

Sav

ings

CHNNet SavingsNon-CHN

*Based on Medicare Inpatient Deductible, net savings of $110,000

CHN vs. Non-CHN Discharge Flow Pathways

0

20

40

60

80

100

120

140

Hom

e

Hhe

alth

Reh

ab

SNF

Hos

pice

LT

C

CHNNon-CHN

CHN Pre-Post Data• Compared Pre-Post Utilization Patterns in

subset of 50 (N=473) CHN patients 27 months before CHN started and first 27 months of CHN (within subject design)

• Excluded Trauma, Joint replacements and expirations in either pre or post timeframe

• Excluded outliers 3 SD beyond mean for LOS

CHN Pre-Post Data: Sample Characteristics

• Mean Age=64.5; Median age=65• 58% Female; 42% Male• 86% African-American; 14% Euro Am.• Major DRG: Circulatory System

Disorder• Payor Mix:

68% Medicare; 12% Commercial;14% TennCare/Medicaid; 6% Self-pay/uninsured

Hospital Metrics Pre-CHN Post-CHNTotal admissions 159 101Admits/patient 3.2 2.0Total readmits 37 17Readmits/patient 0.74 0.34Total patient days 1,268 772Days/admit 8.0 7.6Days/patient 25.4 15.4Total charges $6,396,111 $3,740,973Average charge/admit $40,277 $37,409Average charge/patient $127,922 $74,819ER admissions 84.9% 80.2%

Statistical Tests: T-TestsHospital Experiences Pre-FBN and Post-FB (N=50)

Characteristic Pre-FBN Post-FBN PAdmits/patient 3.2 2.0 .0180*

Readmits/patient 0.74 0.34 .0632

Days/patient 25.4 15.4 .01111*

Average charge/pt $127,922 $74,819 .0034*Significant at the p<.05 level

CHN Pre-Post Data• Significant utilization differences existed

for patients served before and after the CHN existed– Fewer Admits, Hospital Days, Lower Average

Charge/Patient– Readmits/Patient Approached Significance – Charge data were not adjusted for inflation

over the full 54 month period– Cohort aged over the timeframe

CHN Pre-Post Data

In this sample of CHN members:• CHN implementation decreased overall

utilization of services, particularly decreased average number of admissions

• Not due to inpatient clinical management differences (no change in average charge/admission)

• Which leads us outside of the hospital….

What’s moving the data?

• The hypothesis:– Blended intelligence

• What the hospital knows about disease• What the clergy and liaisons know about life

– Aligned assets leveraging Trust• Faith-driven treatment system (reimbursed)• Faith-driven healing system (non-reimbursed)

– Center of Excellence is the blender• Constant data-driven innovation

CHN Outcome DataPreliminary data is promising, but

needs more systematic review, more rigorous scrutiny and deeper dive.

• Data sets archive at no cost• Need funds/resources to analyze data• Developing best practice models for

analyzing these data via interdisciplinary models/lens

CHN Outcome DataBut, imagine what can happen when

we more strategically:• Deeply analyze patterns of data to

drive program and education• Connect the webs of trust• Align and leverage all resources• Grow to scale (400 churches)• Flesh out patient care journeysBuild care-giving and other capacity!!!!

The Center of Excellence: Blending Faith & Health

• Mature Faith should always mean – “Compassionate”– Merciful– Just

• But also– Smart– Innovative– Disruptively expansive

The Center of Excellence: Blending Faith & Health

Relevant Science should: – Be evidence based – Result in improvement in

quality of life for all– Eliminate disparity

But also be:– Participatory and teachable by

blended intelligence– Innovative– or grounded in life;– Disruptively useful for

promoting justice…UNTIL

We Grow into the Vision: The Beloved Community