Reform Nadia Siddiqui MPH Director of Health Equity Programs Texas Health Institute THI Team Dennis Andrulis PhD MPH Lauren Jahnke MPAff Anna Stelter MPH MSSW and Matthew Turner PhD MPH ID: 714067
Download Presentation The PPT/PDF document "Delivery System Transformation in the Er..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Delivery System Transformation in the Era of Reform
Nadia Siddiqui, MPHDirector of Health Equity ProgramsTexas Health InstituteTHI Team: Dennis Andrulis, PhD, MPH, Lauren Jahnke, MPAff, Anna Stelter, MPH, MSSW, and Matthew Turner, PhD, MPHProject support provided by: Blue Shield of California Foundation and W.K. Kellogg Foundation
Lessons and Promising Practices from Safety Net Systems
4
th
Annual Texas Primary Care and Health Home Summit
JW Marriott Houston Galleria | Houston, Texas
June 10, 2015Slide2
Health Reform Holds Both Risks and Rewards for Safety-Net ProvidersSlide3
Safety-Net Systems at a Crossroads
Newly Insured, Paying PatientsKeeping up with CompetitionCaring for Uninsured & Low-IncomeDelivery and Payment Reform
Declining Financial Support, Payment Reductions,
and PenaltiesSlide4
Study ObjectivesIdentify
how safety-net systems varying financially are adapting and responding to health care reformExperiencesChallengesLessons LearnedStrategies and ModelsOffer insights and perspectives to California’s safety-net systems at varying degrees of readinessSlide5
Study DesignQualitative study:Literature review
Web-based program reviewInterviews with executives from 13 leading safety-net systemsStudy focus:AEH public hospitals and select other safety-net systems in Medicaid expansion states with at least 50% Medicaid and self-pay mixSlide6
Study Safety-Net Systems
Table 1. Study Safety-Net ProvidersHospital NameState
Provider Type
AEH Member Public
Hospitals
Boston Medical Center
MA
Public Hospital
Cambridge Health Alliance
MA
Public Hospital
Cook County Health & Hospitals Corp
IL
Public Hospital
Hennepin County Medical Center
MN
Public Hospital
Maricopa Integrated Health System
AZ
Public Hospital
MetroHealth
System
OH
Public Hospital
Mount Sinai Hospital of Chicago
IL
Public Hospital
NYCHHC - Elmhurst Hospital
NY
Public Hospital
UK HealthCare Hospital System
KY
Public Hospital
UW Harborview Medical Center
WA
Public Hospital
Other Safety-Net
Providers
Clinica
Family Health Services
CO
FQHC
Maui Memorial Hospital
HI
Public Hospital
Yuma District Hospital
CO
Critical Access Slide7
Safety-net provider
interviewedSlide8
What are promising ways in which safety-net systems are adapting to the new health care environment?Slide9
1. Redesigning Primary CareSlide10
PCMHs: From the Field“PCMH doesn’t mean the same thing in all
markets”Disease or population specific health homesCommunity wide medical home neighborhoodsHennepin Coordinated Care Center (CCC)3% of patients represented 50% of costsGoal to avoid preventable readmissions among complex patientsFocus on medical follow up after hospitalization, focusing on behavioral and social needs of patientsReduced ER visits by 37% and inpatient stays by 25% following one year of implementation Slide11
Team Care: From the Field
Clinica’s Flip Visit: The RN “Co-Visit” ModelNurse provides bulk of care to minor acute, routine, and non-chronic disease patientsPhysician oversees and modifies diagnosis and care plan converting nurse’s visit into a billable provider visitOutcomes from 2014 pilot:17% increase in daily visit capacityDouble-booked visits were eliminatedOne provider could bill for 15 vs. 12 patients during morning visits Improved physician and nurse communicationImproved physician and nurse satisfactionPatient satisfaction averaged 9.5/10 for FLIP visitsKA Funk and M Davis. Enhancing the Role of the Nurse in Primary Care: The RN ”Co-Vist” Model. J Gen Intern Med. 2015 Dec; 30(12): 1871–1873. Slide12
Integrated Behavioral Health: From the Field
CHA Mental Health Home PilotIntegrating primary care in outpatient mental health settingPurpose to provide medical care where behavioral health patients are most comfortableWeekly groups targeting nutrition, smoking cessation, activity, and social isolationSan Mateo Medical Center’s Innovative Care ClinicProviding mental health screening and treatment at their primary care clinics780 diabetic patients, 23% screened positive for depressionBehavioral health clinician on the team to provide seamless referral and careSlide13
Addressing Social Determinants: From the Field
Boston Medical Center’s Poverty Simulation for Pediatric ResidentsDesigned to spread awareness about the socioeconomic and non-health struggles many patients faceSimulating real situations of families living below povertyGrowing importance of role of community health workers to address patient social determinant needsSlide14
2. “Turning the dial” from volume to value
Moving away from fee-for-service to more risk or value-based payment and deliveryAccountable Care Organizations (ACOs): holding health care providers financially accountable for outcomes of a defined patient populationUW Medicine Accountable Care Network has taken the payer completely out of the arrangement and instead the provider has partnered with an employer (Boeing)Social ACO established by Hennepin Health is partnering with social service organizations to target care for vulnerable populations, including those with mental illness, unstable housing, chemical dependence, and 2+ chronic conditionsSlide15
Two-Canoe Situation
Shift to value-based delivery is happening gradually, requiring most providers to operate on both fee-for-service and value-based reimbursementSlide16
3. Responding to Competition
Increasing need to retain “their” patients while also attracting new patientsMultiple strategies in place:Investing in outreach & enrollmentProviding qualified health plans on the marketplace Re-branding to be “providers of choice” Addressing social determinants of healthResponding to competition through “collaboration”Slide17
Responding to Competition through Collaboration: Quotes from the Field
We are learning to collaborate out of necessity. It would be crazy in this landscape to think differently. We are creating collaborations to generate referrals. The language of care delivery is changing because capacity is being tested. We are caring for the same populations. It just makes sense to collaborate. Slide18
4. Managing transformation through leadership
Championing, flexible, and adaptable leadershipAssuming short-term risk for long-term savingsInvestment in medical homes, ACOsConsolidation and downsizingManagement restructuring“Hierarchical” to “flat” structure to facilitate efficient decision-making (e.g., Cook County)Slide19
5. Undertaking cost-cutting strategies
Reducing waste and unnecessary costsStreamlining administrative processesAdopting transparent pricing for common inpatient and outpatient servicesSome hospitals are finding a reduction in uncompensated care when uninsured patients can realistically evaluate cost and their ability to pay (e.g., Maricopa)Slide20
We asked Safety-Net Executives:Slide21
Uncertain role and relevance: “Where do we fit in the puzzle?” and “what will define us?”
Challenges shifting delivery and payment structures: especially for financially struggling institutions without capital or resources to take on added “risk”Safety-Net System ChallengesSlide22
Financial viability:
looming federal DSH reductions, new penalties, state/local budget cuts Personnel transitions: resistance to change within unionized workforce, as well as from physicians and other providers Safety-Net System ChallengesSlide23
What’s ahead for safety-net systems?Slide24
1. Assuring patients and communities are
at the heart of transformation“Whole person” careIntegrating social determinants in care redesignIdentifying clinical-community collaborative opportunitiesIncentivizing management of complex patientsWe’re focusing on behavior and lifestyle, which is 80% of the problem—this is a big deal and this is transformational. Slide25
Championing leadershipRevisiting vision and objectives to assure relevance in evolving health care environment
Forging new partnerships2. Managing transformation through leadership and strategic supportSlide26
Branding and marketing to broader community Building on safety-net strengthsUnique experience serving diverse patients
Existing ties with communityContinuing to advance outreach and enrollment 3. Positioning to become a competitive “Provider of Choice”Slide27
Education and training on evolving delivery and payment system, with evolving rolesImportance of “whole person” and “social determinants”
Role for navigators, care coordinators, and other non-clinical staff4. Transitioning and supporting health care workforceSlide28
In Summary…Safety net systems are entering a period of transformation with their “eyes wide open”
On the one hand they face many challenges and financial pressures, while on the other, they stand to benefit from new opportunities Success for many hinges on the ability to balance their mission while participating in new, tested ways to deliver and pay for careWhile there is no one-size-fits-all approach, experience suggests that PCMHs are at the start and heart of transformationSlide29
Contact Information
Nadia J. Siddiqui, MPHDirector of Health Equity ProgramsTexas Health Institutensiddiqui@texashealthinstitute.org http://www.texashealthinstitute.org/health-care-reform.html