Presentation Template

Report
Population Health Management
David A. Burton, MD
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Population Health Management
Emphasis on the Continuum of Care
Outpatient
Inpatient
Skilled
Nursing
Facility
Home
Home
Health
Care
Hospice
Cemetery
Clinic
Care
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Population Health Management
Paradigm Shift
Inpatient
Outpatient
Inpatient
Skilled
Nursing
Facility
Home
Home
Health
Care
Hospice
Cemetery
Clinic
Care
Acute
Care-Centric
Management
Population-Centric Management
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Poll question
Outpatient
Inpatient
Outpatient
Inpatient
Home Health
Hospice
Outpatient
Inpatient
Home Health
Hospice
1
2
Clinic Care
3
Outpatient
Inpatient
Home Health
Hospice
Clinic Care
SNF
4
5
Other combination
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Population Health Management
Anatomy of Healthcare Delivery
Symptoms
Screening & Preventive
Health Maintenance and
Preventive Guidelines
Management of Preventive,
Ambulatory, Acute Medical,
Invasive & PAC Modules
Population-Focused
Knowledge Assets
Diagnostic Algorithms,
Triage Criteria, Referral &
Intervention Indications
Diagnostic Work-up
Diagnostic algorithms
Home
(Patient Portal)
Module-Focused
Knowledge
Assets
Triage to Treatment Venue
Triage Criteria
Admission Order Sets
Ambulatory
Non-recurrent
Ambulatory
Recurrent
Acute Medical
IP Med-Surg
Admission Order Sets
Invasive
Medical
Acute Medical
IP ICU
Treatment and Monitoring Algorithms
Standardized
Follow-up
Indications for Referral
Indications for Intervention
Substance Selection
Substance Selection
Supplementary Order Sets
Invasive*
Subspecialist
* To Invasive
Care Processes
Post-acute
care order sets
IP (SNF, IRF)
Home health
Hospice
Invasive
Surgical
Substance
Preparation
Chronic
Disease
Subspecialist
Pre-Procedure Order Sets
Clinical Supply Chain Management
Procedure
Bedside care
Postprocedure
Order Sets
Treatment and
Monitoring
Algorithms
Bedside care practice guidelines, risk
assessment and patient injury prevention
protocols, bedside care procedures,
transfer and discharge protocols
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Post-procedure Care
Discharge
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Population Health Management
Clinical Integration hierarchy - Care Processes
Home
Clinic Care
Outpatient
Inpatient
Hyperlipidemia
Acute
Myocardial
Infarction
(AMI)
Coronary
Atherosclerosis
Percutaneous
Intervention
(PCI)
Coronary
Artery Bypass
Graft (CABG)
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SNF
Home Health
Hospice
Cardiac
Rehab
Care Processes
6
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Population Health Management
Clinical Integration hierarchy - Care Process Families
Home
Clinic Care
Outpatient
Inpatient
Hyperlipidemia
Acute
Myocardial
Infarction
(AMI)
Coronary
Atherosclerosis
Percutaneous
Intervention
(PCI)
Coronary
Artery Bypass
Graft (CABG)
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SNF
Home Health
Hospice
Cardiac
Rehab
Ischemic Heart Disease
Care Process Family
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Population Health Management
Clinical Integration hierarchy - Clinical Programs
Home
Clinic Care
Outpatient
Inpatient
SNF
Home Health
Hospice
Cardiovascular Clinical Program
Ischemic Heart Disease
Care Process Family
Heart Failure
Care Process Family
Heart Rhythm Disorders
Care Process Family
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Vascular Disorders
Care Process Family
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Clinical Integration hierarchy
Clinical Programs – ordering of care
Primary
Care
CV
W&C
GI
Respiratory
Neuro
Sciences
Musculoskeletal
Surgery
General
Med
Oncology
Peds
Spec
Mental
Health
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
e.g.,
Diabetes
e.g.,
Heart
Failure
e.g.,
Pregnancy
e.g.,
Lower GI
Disorders
e.g.,
Obstructive
Lung
Disorders
e.g.,
Spine
Disorders
e.g.,
Joint
Replacement
e.g.,
Urologic
Disorders
e.g.,
Infectious
Disease
e.g.,
Breast
Cancer
e.g.,
Peds
CV Surg
e.g.,
Depression
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Clinical Integration hierarchy
Clinical Support Services – delivery of care ordered
Clinical Support Services (Delivery of Care)
12 Clinical Programs (“Ordering of Care”)
Primary
Care
CV
W&C
GI
Respiratory
Neuro
Sciences
Musculoskeletal
Surgery
General
Med
Oncology
Peds
Spec
Mental
Health
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
Care
Process
Families
e.g.,
Diabetes
e.g.,
Heart
Failure
e.g.,
Pregnancy
e.g.,
Lower GI
Disorders
e.g.,
Obstructive
Lung
Disorders
e.g.,
Spine
Disorders
e.g.,
Joint
Replacement
e.g.,
Urologic
Disorders
e.g.,
Infectious
Disease
e.g.,
Breast
Cancer
e.g.,
Peds
CV Surg
e.g.,
Depression
Diagnostic Clinical Support Service (work flow models)
(e.g., Pathology and Laboratory Medicine, Diagnostic Radiology)
Therapeutic Clinical Support Service (work flow models)
(e.g., Pharmacy, Transfusion Medicine, Respiratory Therapy, Physical, Occupational, Speech Therapy)
Ambulatory Clinic Clinical Support Service (work flow models)
(e.g., Primary Care Clinics, Chronic Disease Specialty Clinics, Sub-specialty Clinics))
Acute Medical Clinical Support Service (work flow models)
(e.g., Emergency Care, ICU/CCU/NICU/PICU, General Med-Surg)
Invasive Clinical Support Service (work flow models)
(Interventional Medical [e.g., cath lab, interventional radiology, GI lab, L&D, rad onc] and Surgical [e.g., amb, IP])
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Clinical
Program
Care Process
Families
Care
Processes
CARDIOVASCULAR
Heart
Rhythm
Disorders
Vascular
Disorders
Ischemic
Heart
Disease
Heart
Failure
ACS
AMI
PCI
CABG
ICD9 Diagnosis
Code Groupings
ICD9 Procedure
Code Groupings
CPT-4
Code Groupings
ICD9 Volumes I-II
17,674
Diagnosis Codes
ICD-9 Volume III
3,903
Procedure Codes
2013 CPT®
Code Set
9706 Codes
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Population Health Management
Medicare 2011 fee-for-service payments by venue
Clinic Care
Outpatient
Inpatient
SNF
Home Health
Hospice
$ 31.7 Billion
12.3%
77.6 Billion
30.1%
90.6 Billion
35.1%
$ 29.7 Billion
11.5%
$ 18.4 Billion
7.1%
$ 10.1 Billion
3.9%
Inpatient
SNF
Home Health
Clinic Care
Outpatient
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Hospice
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Poll question
How does your organization prioritize improvement
projects
•
Respond to desires of highest volume physicians
with loudest voices
•
Respond to regulatory and accreditation
imperatives
•
Based on pre-defined strategic criteria (including
objective and subjective factors)
•
Other
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Our Philosophy: Be Systematic
Change Process
and Behavior
Apply Evidence
and Standardize
Services
Installation Services,
Critical Improvement Services
Analytic Applications
Key Process Analysis,
Dashboards, Advanced Analytics
Late-Binding™
Integrate Data
and Measure
Data Warehouse Platform
Data Warehouse, Architecture, Metadata Management,
Security, and Auditing
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Catalyst Adaptive Data Warehouse
Catalyst’s Adaptive Data Model
Metadata: EDW Atlas Security and Auditing
Common, Linkable
Vocabulary
Financial Sources
(e.g., EPSi,
Peoplesoft, Lawson)
Financial
Source Marts
Departmental
Sources
(e.g., Apollo)
Departmental
Source Marts
Readmissions
Administrative
Sources
(e.g., API Time
Tracking)
Administrative
Source Marts
Diabetes
Patient
Source Marts
Patient Satisfaction
Sources
(e.g., NRC Picker,
Press Ganey)
Sepsis
EMR
Source Marts
HR
Source Mart
EMR Source
Human Resources
(e.g., PeopleSoft)
(e.g., Epic, Cerner)
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More Transformation
Less Transformation
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Catalyst approach
Application families
2
Content-driven
applications
1
Metadata-driven
platform
Foundational
Applications
Late-Binding™ Data
Warehouse Platform
3
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Discovery
Applications
Advanced
Applications
Late-Binding™ Data Bus
Data Acquisition
Engine and Storage
Metadata Engine
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Clinical Integration Leadership Team
(CILT)
Administration
Vice-Chair
CMO
Chair
CNO
Vice-Chair
Chief Information Officer
Chief Knowledge Officer
Cluster #1
Cluster #2
Cluster #3
Cluster # …
Cluster #N
Cluster
CMO
Cluster
CMO
Cluster
CMO
Cluster
CMO
Cluster
CMO
Cluster
CNO
Cluster
CNO
Cluster
CNO
Cluster
CNO
Cluster
CNO
Cluster
Administrator
Cluster
Administrator
Cluster
Administrator
Cluster
Administrator
Cluster
Administrator
Cluster = Hub Hospital/Region, Medical Group, Health Plan, Section/Division
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CV Clinical Program Guidance Team
CV Physician
Chair*
Nurse Director
Vice-Chair
Cluster #1
Cluster #2
Cluster #3
Cluster #4
CV
MD Lead
CV
MD Lead
CV
MD Lead
CV
MD Lead
CV
Nurse Lead
CV
Nurse Lead
CV
Nurse Lead
CV
Nurse Lead
CV
Administrator
CV
Administrator
CV
Administrator
CV
Administrator
Heart Failure
MD Chair
Rhythm Disorders
MD Chair
Vascular Disorders
MD Chair
Ischemic*
MD Chair
* One of the Clinical Implementation Team chairs also serves as the Guidance Team chair (Ischemic MD Chair in this example)
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Clinical Implementation Team (CIT)
Heart Failure Care Process Family
Heart Failure
MD Chair
Cardiologist
CV RN
Director
Vice-Chair
Facility #1
Facility #2
Facility #3
Facility #4
Heart Failure
MD Lead
Heart Failure
MD Chair
Heart Failure
MD Chair
Heart Failure
MD Chair
CV
Nurse Lead
CV
Nurse Lead
CV
Nurse Lead
CV
Nurse Lead
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CIT Work Group
Subject
Matter
Expert
Clinical Operations
Director
Data
Capture
Workflow
Analysis
Data
Provisioning
CIT Chair (MD)
Scientific SME
Provider/Patient
Education Team
Data
Analysis
Front Line Clinical Ops
Workflow SME
Data Architect
Knowledge
Manager
Administrative
Application
Steward
Clinical
Application
Steward
* CMIO, CQO, Chief Patient Safety Officer, or Chief Analytics Officer provided individual has requisite qualifications and skills
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Workgroup Roles
Subject
Matter
Expert
DATA CAPTURE
Knowledge
Managers
Data
Capture
Workflow
Analysis
Data
Provisioning
• Acquire key data elements
• Assure data quality
• Integrate data capture into operational
workflow
Application Administrators
(e.g., EMR Administrators,
Financial System Administrators)
Data
Analysis
DATA ANALYSIS
DATA PROVISIONING
• Interpret data
• Discover new information in the data
(data mining)
• Evaluate data quality
Knowledge
Managers
• Move data from transactional systems into
the EDW
• Build visualization for use by clinicians
Data
Architects
(Analysis)
Data Architects
(infrastructure)
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Data Architects
(Visualization)
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Poll question
Which clinical organizational teams do you have
•
Executive team responsible for prioritization and
governance of clinical improvement initiatives
•
Domain governance teams (e.g., CV Clinical
Service Line teams)
•
Clinical implementation teams (e.g., Heart Failure
improvement team)
•
Infrastructure personnel/work groups to support
clinical improvement teams
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Implementation flow diagram
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Standard “organizational” work
Monthly
Tasks and
Checkpoints
7 Steps
(Work Streams)
1
Gather Knowledge Assets
2
Define Cohort
3
Select AIM Statement
4
Select, Build,
Refine Metrics
5
Develop
Implementation Plan
for Process Improvement
6
Implementation
7
Measure Progress
Implementation
Design
Launch
Approval
Results
Review
• Supplement
BMJ content
• Refine Cohort
• Refine Metrics
• Develop Draft
Visualizations
• Develop
Recommended
AIM statement #1
• Cluster Reps
Obtain Front
Line Input
• Finalize Cohort
• Develop
Additional
metrics based
on feedback
• Develop
Additional
Visualizations
to support
• PDSA cycle
• Cluster Reps
Obtain Front
Line Input
• Improvement
Plan
• Implementation
Plan
• Develop cluster
rep assignments,
and deliverables
• Collect cluster
rep feedback
• Prepare Initial
Results from AIM
statement #1
• Summarized
report for
historical review
• Refine,
recommend AIM
statement #2
Build and Refine
Build and Refine
Build and Refine
Kickoff
AIM Statement
• Mission
• Cohort
Discover
• Data Analysis
and Review
• BMJ Best
Practices
• Building
Multiple
Potential AIM
statements
Select Initial Metric
27
Pregnancy
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Surgical Services
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Discharge from hospital to
post-hospital service
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Pressure injury prevention
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Standard organizational work
Slide Decks
MD Contract Templates
Team Charters
Meeting Agendas
Handbooks
Job Descriptions
Project Status Reports
Job Family Grids
Deployment Process Outlines
Compensation Grids
GRADE
MIN
MID
MAX
D.8
11.69
14.63
17.55
D.9
12.99
16.21
19.47
D.10
14.39
17.97
21.56
D.11
15.91
19.91
23.89
D.12
17.65
22.07
26.46
D.13
19.56
24.45
29.36
D.14
21.67
27.10
32.52
D.15
24.02
30.03
36.03
D.16
26.63
33.28
39.94
D.17
29.50
36.88
44.24
D.18
32.67
40.86
49.04
D.19
36.23
45.28
D.20
40.15
50.18
54.34
60.24
DATA ARCHITECT-ASSOC
DATA ARCHITECT-STAFF
DATA ARCHITECT-SR
DATA ARCHITECT-CNSLT
D.14
D.17
D.19
D.20
OUTCOMES ANALYST-ASSOC
OUTCOMES ANALYST-STAFF
OUTCOMES ANALYST-SR
OUTCOMES ANALYST-CNSLT
N.13
N.15
N.17
N.19
DATA MANAGER-ASSOC
DATA MANAGER-STAFF
DATA MANAGER-SR
DATA MANAGER-CNSLT
D.13
D.15
D.17
D.19
Compensation Rate by Specialty
Administrative Rates by Group
Large Clinic Median Compensation Data
$/hour Diff from
Min
Mid
Max
Group 5
2000 Data
2001 Data
2002 Data
2003 Data
2004 Data
2005 Data
2006 Data at 45/wk median
0.80
1.00
1.20
Neurosurg
345,250
389,644
395,305
400,942
450,006
465,000
499,992
214
27
CV Surg
380,207
415,351
438,901
441,133
440,000
474,772
455,455
195
8
Radiology (interventional)
306,000
356,001
375,000
410,250
410,250
424,992
440,004
188
2
Cardiology - Cath
276,001
304,750
325,494
375,003
380,234
412,101
432,618
185
-2
Radiology (non-interventional)
258,000
309,255
330,603
350,000
372,000
410,000
420,000
179
-7
Ortho
306,403
349,697
351,221
366,732
389,997
402,003
412,004
176
-10
Median - Group 5
306,202
352,849
363,111
387,973
400,124
418,547
436,311
186
$
149 $
186 $
224
Mean - Group 5
311,977
354,116
369,421
390,677
407,081
431,478
443,346
189
Step = $29,500
Group 4
MFM (Perinatology)
298,158
no data
385,917
312,238
395,809
375,005
382,414
163
16
Cardiology - General
261,000
279,470
304,994
320,000
312,010
350,000
359,004
153
6
Vascular
281,143
289,918
310,401
320,210
336,820
321,131
355,000
152
5
Urology
264,175
285,500
310,964
319,000
322,000
343,769
346,633
148
1
Anesthesiology
251,083
282,501
307,500
314,495
330,008
338,256
344,960
147
0
Plastics
273,261
294,039
297,250
300,000
340,880
343,497
342,901
147
0
Gastroenterology
240,000
246,500
271,503
300,000
304,994
314,495
340,010
145
-2
General Surgery
250,251
273,956
294,925
287,915
309,021
320,689
336,694
144
-3
ENT
250,000
268,403
279,985
293,000
308,363
320,958
320,890
137
-10
Ophth
235,033
245,615
259,585
278,023
212,746
286,434
309,281
132
-15
Median - Group 4
256,042
279,470
301,122
306,119
317,005
329,694
343,931
147
$
118 $
147 $
176
Mean - Group 4
260,410
273,989
302,302
304,488
317,265
331,423
343,779
147
Step = $21,000
Group 3
Clinical Pathology
217,500
233,677
232,984
251,227
225,000
263,750
287,927
123
10
Hematology & Med. Oncology
189,000
205,000
223,470
231,794
251,241
261,501
280,001
120
6
Dermatology
185,339
204,283
217,294
228,270
241,498
255,568
279,000
119
6
OB-Gyn - Branch
217,426
229,238
233,295
245,568
249,256
256,997
269,147
115
2
OB-Gyn
229,699
243,434
254,563
252,400
260,776
263,816
262,000
112
-2
Critical Care Medicine
207,250
218,000
223,500
228,740
228,740
234,503
249,996
107
-7
Emergency Care
189,286
202,690
211,000
221,927
232,749
238,523
248,227
106
-7
Neonatology
206,003
203,971
218,703
213,139
236,378
249,409
247,829
106
-8
Median - Group 3
206,627
211,500
223,485
230,267
238,938
256,283
265,574
113
$
91 $
113 $
136
Mean - Group 3
205,188
217,536
226,851
234,133
240,705
253,008
265,516
113
Step = $13,000
Group 2
Pulmonary Disease
188,250
201,714
200,000
205,764
218,000
223,273
234,885
100
12
Nephrology
187,000
191,661
196,752
204,617
214,751
217,757
225,504
96
8
Allergy/Asthma
175,363
191,385
194,500
198,376
201,241
210,970
221,833
95
7
Physiatry
176,617
180,953
187,252
183,337
201,993
207,004
219,992
94
6
Neurology
182,600
188,431
191,496
195,000
201,241
210,500
211,664
90
2
Endocrinology
165,000
182,658
180,354
188,992
185,000
185,250
200,529
86
-2
Infectious Disease
161,447
164,894
179,473
186,896
178,627
189,615
197,996
85
-3
Urgent Care
142,906
157,368
161,785
165,559
168,143
187,000
197,820
85
-4
Occ Med
172,414
178,224
186,250
181,459
186,402
194,247
194,213
83
-5
Rheumatology
158,506
175,117
176,805
179,700
181,016
185,000
190,000
81
-7
Median - Group 2
173,889
181,806
186,751
187,944
193,822
200,626
206,097
88
$
70 $
88 $
106
Mean - Group 2
171,010
181,240
185,467
188,970
193,641
201,062
209,444
90
Step = $5,000
Group 1
Psychiatry
150,232
159,448
162,000
161,202
171,300
172,350
184,827
79
5
General IM
142,084
150,046
153,786
153,939
165,375
172,565
178,005
76
2
Family Medicine
139,725
147,025
155,050
154,018
166,105
172,157
175,080
75
0
Peds
136,906
142,056
146,310
145,351
158,250
164,631
173,338
74
0
Internal Medicine - Branch
137,859
143,513
152,933
157,718
153,561
162,732
168,344
72
-3
Peds-Adol - Branch
135,800
138,000
144,643
144,436
150,112
154,000
163,917
70
-4
Median - Group 1
138,792
145,269
153,360
153,979
161,813
168,394
174,209
74
$
60 $
74 $
89
Average - Group 1
140,434
146,681
152,454
152,777
160,784
166,406
173,919
74
32
Poll question
How prepared do you feel to implement population
health management and shared accountability (e.g.,
ACO) strategies?
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Thank you
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