Slide 1

Report
Transforming Whatcom
Health Care
A Case Study
July 28, 2011
Larry A. Thompson
Executive Director
Whatcom Alliance for Healthcare Access
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WAHA PROGRAMS AND INTIATIVES
Health Insurance &
Care Connection
Health Policy
Education
•
Access Counseling Services (insurance
and direct to care)
•
Statewide Health Insurance Benefits
Advisors (SHIBA) HelpLine
•
Whatcom Project Access
•
Nonpartisan analysis for decision
makers …Communities Connect
•
Convene community leaders, system
stakeholders and elected officials
2
WHATCOM ALLIANCE FOR HEALTHCARE
ACCESS (WAHA)
• Whatcom health leadership since 2002
• Access Mission:
Serves about 4% (9,000 people) of the population
annually
• Stewardship Mission (Policy)
Transforming Whatcom Health Care Project
• Long community history of collaboration
3
WHAT IS THE CASE
FOR CHANGE?
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5
6
Association between Medicare spending and quality ranking -U.S. States
Baicker and Chandra, Health Affairs, web exclusives
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Source: International Federation of Health Plans 2010 report (www.ifhp.com)
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A COMMUNITY PROCESS
Providers
(30)
Consumers
(6)
Transforming
Whatcom
Health Care
Local
Government
(4)
Business
(6)
Insurance
(4)
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SOME OF THE PARTICIPATING
ORGANIZATIONS
• PeaceHealth St. Joseph Medical
Center
• PeaceHealth Medical Group
• Northwest Regional Council
• Family Care Network
• Regence Blue Shield
• Group Health Cooperative
• Interfaith Community Health Center
• Sea Mar Community Health Center
• Mount Baker Planned Parenthood
• St. Luke’s Foundation
• Mt. Baker Imaging
• Brigid Collins Family Support Center
• Northwest Justice Project
• Bellingham-Whatcom Chamber of
Commerce and Industry
• Whatcom Counseling and
Psychiatric Clinic
• Whatcom County Medical Society
• Whatcom County
• City of Bellingham
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PROJECT TASK FORCES
Project Steering
Committee
Delivery
System
Task Force
Information
Systems
Task Force
Financial
Issues
Task Force
Consumer
Task Force
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Improving
Population
Health
Improving Each
Patients’ Experience
Of Care
Reducing
Per Capita
Costs
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GUIDING PRINCIPLES FOR A
FUTURE HEALTH SYSTEM
• Governance should be community based
• Health is a lot more than medical care
• Future system must be transparent and
accountable
• IT should help us do better
• Keep administration simple and non-redundant
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GUIDING PRINCIPLES FOR A
FUTURE HEALTH SYSTEM
• Financial incentives should reward quality and
efficiency
• Providers must be better organized
• All need to be served
• Integrated, coordinated care is critical
• Care delivery will be patient centered
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FUTURE WHATCOM HEALTH SYSTEM
COMMUNITY HEALTH
ENVIRONMENT
MEDICAL
NEIGHBORHOOD
(ACO)
MEDICAL HOME
(PCMH)
PATIENT
Patient: All services are centered on the
patients’ needs
Medical Home (PCMH): The primary care
provider team that maintains an ongoing
relationship with the patient and assures
access to needed care
Medical Neighborhood (ACO): A group of
providers working as a team with the goal
of improving quality and improving value
for patients
Community Health Environment: The
determinants of health such as behavior
patterns, social circumstances,
environmental exposures, and genetics
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ORGANIZATIONAL MODEL OF THE WHATCOM
COUNTY HEALTH CARE SYSTEM: TWO LEVELS
Whatcom Community
Health Association
(WCHA)
• Plans the health system and
aggregates dollars from various
sources to support care delivery
Accountable Care
Organization –
Whatcom County
• Organizes providers to
integrate care around best
practice care models.
• Accountable to the WCHA for
cost and quality
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Potential organizational composition of ACO-W and
its relationship to other parts of the health system
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Building Blocks
•
Certified Patient Centered Medical Homes
•
6 Point Community Care Management System
•
IT Infrastructure:
– EMRs
– HIE
– Patient Portals
– Care Coordination System
– Analytics
•
New Health Plan Contracts
– Global Budgets
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DELIVERY SYSTEM REFORM
• Patient-Centered Medical Homes
• Improved Care Coordination
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ALL PATIENTS SHOULD HAVE A
MEDICAL HOME
•The medical home is a team of providers who have a
whole person orientation
•All medical homes meet the NCQA criteria
•Patients have access to care when they want/need it
•Medical homes provide for self-care and link to
community resources
•Medical homes demonstrate continuous quality
improvement
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Mental Health/Behavioral Health
Integration
•
4 quadrants approach
• PMPM and case management fees
• Payment in mixed providers sites
• Private Sector Therapists
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A CARE COORDINATION SYSTEM
• One inclusive system, not 20 silos
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CARE COORDINATION SYSTEM
1.
Uses clinical data to assess needs
2.
Is built upon Patient-Centered Medical Homes
3.
Includes a case management system for the
very ill
4.
Aids transitions between settings
5.
Supports patients and families as they engage in
improving their own healthcare
6.
Includes an IT-based care tracking solution
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Population Management and Care Coordination
Level 3
Complex comorbidity
 Access multiple providers
and settings
 Case management utilized
 Identified through
predictive models
 PCMH in the loop but not
principal care coordinator
Level 1
Many patients need
logistical assistance
from a referral
coordinator
 Some patients need
access to disease
management programs
 Some patients will
choose self-care
activities
 Some patients will
need referral to
community resources
5% of the
population
Level 3
15% of the
Population
Level 2
80% of the
Population
Level 1
Level 2
Identified by predictive
modeling
 Generally 1 or more chronic
conditions
 Often transitioning care
settings: hospital to home,
nursing home to hospital, etc.
 May benefit from patient
activation
 May benefit from disease
management protocol
 Managed mainly in PCMH
but may access community
care coordinator
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Adapted from Kaiser Permanente
IT VISION
TODAY
• Groups of doctors and hospitals keep
their own records.
FUTURE SYSTEM
• The same clinical information is
available to all doctors and providers
across the country.
• Data is kept by individual
organizations and is unavailable for
making care improvements
• Aggregate clinical and financial data
is available and is used to
continuously improve care and
increase efficiency.
• Some patients have access to their
clinical information and use it to make
health improving decisions.
• All patients understand they can
access their clinical information and
understand the community resources
that can empower them to manage
their own health care.
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HEALTH INFORMATION TODAY
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HEALTH INFORMATION
TOMORROW
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KEY EXISITING IT GAPS
• About 35% of practices lack complying
EMRs.
• Local system lacks interoperability.
• Patient portal capability spotty.
• System-level analytic capability non-existent.
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HEALTH CARE FINANCIAL REFORM
• We can’t go on this way!
• Payment methods drive the delivery of
care
• Change will be gradual, but we must
make a start
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TODAY’S DOCTOR
• I get paid according to the number of services
I provide.
TOMORROW’S DOCTOR
• I get paid according to the health outcomes I
produce and the efficiency of my practice.
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MEDICARE SPENDING FOR BENEFICIARIES
WITH FIVE OR MORE CHRONIC CONDITIONS
Robert Wood Johnson Foundation, The Synthesis Project
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GENERAL TIMELINE FOR CREATING AN
ACCOUNTABLE CARE COMMUNITY
12/2010
Phase I Initiate
Feasibility
Assessments
7/2012
Initial Small
Pilot('s)
launches
7/2011
Stakeholder
“Go/No Go”
decision
7/2012-6/2014
Continue
building
infrastructure
7/2011 – 6/2012
Build initial PCMH,
Care Coordination, &
IT capabilities
7/2014
Demo Project
(10,000+
enrollees)
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Building Blocks
1. Patient Centered Medical Home Collaborative
2. Care Coordination System Build
3. Data Warehousing Software
4. MS/SU care delivery and financial integration
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Candidate Populations for Early
(mid 2012) Limited Pilot Projects
• Dual Eligibles (Medicare/Medicaid)
• PeaceHealth Self Insured’s
• Individual Insurance Coverage
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SUMMARY
Among the area’s health care leadership, the
following beliefs are prevalent:
•
The current health care system is not sustainable.
•
This community has learned a great deal in the past 25 years
and is now poised to move forward more aggressively.
•
The highest probability of creating a sustainable system is to
build it from the ground up here locally.
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