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www.prohealthmd.com How to Achieve Cost Savings and Patient Satisfaction Through Clinical Best Practices James Cox-Chapman, MD February 18, 2015 1
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Transcript of Www.prohealthmd.com How to Achieve Cost Savings and Patient Satisfaction Through Clinical Best...
www.prohealthmd.com
How to Achieve Cost Savings and Patient Satisfaction Through Clinical Best Practices
James Cox-Chapman, MDFebruary 18, 2015
1
Today’s Presenter
James Cox-ChapmanSenior Vice President and CMOProHealth Physicians
• Introduction to ProHealth Physicians
• The Path to Proactive Risk Management
• Strategy for Change
• Designing the Program
• The Experience
• Results
• Impact
Today’s Discussion
3
• Founded in 1997
• Largest physician-owned healthcare delivery system in Connecticut
• 95 practices
• Over 350 providers
• Cares for over 10% ofstate population
Introduction to ProHealth Physicians
4
• Alarming increases in claim frequency and severity
• Significant increases in PL premiums– In danger of being dropped by carrier– Threat to expansion plans / ability to attract
new groups
• Patient satisfaction not part of culture
• Clear need for decisive action
The Path to Proactive Risk Management
5
• Create a risk management committee• Identify issues
– Perform baseline assessments– Analyze claims
• Create an action plan– Develop a risk education program
• Ensure success– Gain physician buy-in
• Share claims experience and educate on necessity
– Develop an incentive program to ensure compliance• Premium rebates
– Failure was not an option
Strategy for Change
6
• Annual themes– Enable team to focus on risk priorities
• Multi-modality approach– Combination of live and online learning to reinforce
annual themes– Analysis of actual malpractice cases– Interactive sessions, not just
lectures and recordings
• Audits and measurement– Track compliance– Track reactions to program– Track behavior change
Designing the Program
7
• Reluctance to change
• Skeptical of need / value of program
• Initial sessions were confrontational
The Experience: A Painful Start
8
• By 2011, 99% of participants requested that the program be held every year
• Physicians requested that program be extended to the entire staff
• Achieved culture change (2 to 3 years)
• Strong impact on financial health
• Strong impact on patient satisfaction
• Ability to respond quickly to threats
The Experience: Ten Years Later
9
Results
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1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
-0.02
-3.46944695195361E-18
0.02
0.04
0.06
0.08
0.1
0.12
Claim Frequency per Physician
Risk management intervention
82%reduction
Results
11
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 $-
$10,000
$20,000
$30,000
$40,000
$50,000
Claim Severity per Physician
Risk management intervention
82%reduction
Results
12
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 $-
$4,000
$8,000
$12,000
$16,000
$20,000
Malpractice Premiums
69%reduction
Compliance of best practices in colorectal screening during well visits was identified as a problem area
Our 2008 risk education program specifically targeted failure to diagnose colorectal and breast cancer
Example: Ability to Respond to Threats
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2007
2008
Example: Ability to Respond to Threats
14
Best Practices ComplianceColorectal screening during health maintenance visits
Risk management intervention
2006 2008 2010 2011 2012 20130%
20%
40%
60%
80%
100%
45%
88%
99%
33%
53%
83%
Poor performance of best practices increased to 99% compliance2010
Example: Ability to Respond to Threats
15
2006 2008 2010 2011 2012 20130%
20%
40%
60%
80%
100%
45%
88%
99%
33%
53%
83%
Best Practices ComplianceColorectal screening during health maintenance visits
EHR Implementation
With EHR implementation, compliance plummeted2011
• With risk management audits and infrastructure in place, and with a strong, patient-centric culture:
– The problem was immediately exposed– We were able to immediately
react– The problem was proactively
solved before adverse eventsoccurred
Example: Ability to Respond to Threats
16
Example: Ability to Respond to Threats
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2006 2008 2010 2011 2012 20130%
20%
40%
60%
80%
100%
45%
88%
99%
33%
53%
83%
Best Practices ComplianceColorectal screening during health maintenance visits
EHR ImplementationRisk management intervention
• Improved patient communication
• Improved patient follow-up
• Improved perception of care received
• Greater focus on quality measures
• Reduced number andseverity of incidents
• Improved patient safetyleads to improvedpatient satisfaction
Impact
18
Questions?
19
Thank You!
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