Debra Hurwitz, MBA, BSN, RN CTC-RI Co-director October 20, 2016 Care Transformation Collaborative of Rhode Island Evidence of Practicing with Value: CTC-RI Perspective Debra Hurwitz, MBA, BSN, RN CTC-RI Co-director October 20, 2016

CTC-RI Practicing with Value: Making a Difference in Cost of Care: Reducing In-Patient Admissions

All-Cause Admissions: All CTC-RI Cohorts** Reduced IP Admission Rates vs. Comparison *Includes BCBS-RI, UHC, NHP data. Does not include Medicaid FFS or Medicare FFS data or RHO Dual Eligible NHP members. **Refer to Appendix for list of practices per cohort

All-cause Inpatient Admissions per 1000 Member Months…..CTC Target= 5% Group July '13 – June '14 July '14 – June '15 Difference % Difference Difference Relative to Comparison* (A) (B) (B-A) Comparison 6.9 7.4 0.5 7.0% - CTC Cohort 1 5.8 0.0 0.0% -7.0% CTC Cohort 2 6.6 6.7 0.1 1.0% -6.0% CTC Cohort 3 6.0 0.2 3.3% -3.7% Observation: the longer the practice cohort has been in CTC, the greater the relative reduction in IP admissions …….suggesting that transformation is hard work and takes time.

CTC-RI Practices Demonstrate In-Patient Savings > than program costs for FY2015 Difference in Admissions/1000 MM 1.15 Total CTC Member Months 1,538,538 Difference in number of Admissions (1.15 x 1,538,538 MM/1000) 1769 Average Cost per Admission * $ 12,000 CTC Savings $       21,231,824 Total Program costs 2015-16** $       15,754,793 Net Savings $ 5,477,031 *Cost per Admission = 60th percentile; vs mean=$14k; Median=$10k **Total Program Cost include CTC Admin, CHTs and Practice Payments paid by health plans

CTC-RI Practicing with Value: Making a Difference with Quality

Clinical Quality CTC Outperform Regional Benchmarks

CTC-RI Practicing with Value: Making a Difference with Customer Experience

2014 MAPCP CAHPS Patient Experience Data Provider Communication statistically significant and Better Than All Other States – Note: This measure is a performance incentive in the CTC contract

2014 MAPCP CAHPS Patient Experience Data- Access Approaching Statistical Significance and Better Than All Other States

CTC-RI Practicing with Value: Integrated Behavioral Health

Integrated Behavioral Health Pilot* (Phase1): 12 Practices Assessment of Behavioral Health Integration Intervention : monthly on site consultation provided by Dr. Burdette Evaluation: Practices used the Maine Site Assessment to re-measure behavioral health integration in primary care *Made possible through funding from Tufts health care

Maine Site Assessment -Evidence Based Tool Average for All Dimensions (18) Average Maine assessment score across all 18 dimensions Pre-intervention average: 2.73 Post-intervention average: 3.49 CHANGE = 0.76

Integrated Behavioral Health Phase 2* – 12 practices Intervention On Site embedded Behavioral Health Staff Monthly on site consultation Staff training : universal screening for depression; anxiety and substance use disorder Patient Care: BH providers provides counseling mild to moderate depression; anxiety and SUD Referral and care coordination for more complex cases to specialty BH NCM Coordination with complex patients *Made possible through Rhode Island Foundation and Tufts Health Car Funding

CTC-RI Practicing with Value: Community Health Teams

Community Health Teams: Program Development 2014 -Implemented Pilot with 2 teams 2015 -Evaluation of Pilot* 2016 - Phase 2 : Centralized Management and IT ( *Formative Evaluation conducted by Brown University Faculty)

What Did Patients Say? Whatever was needed: Behavioral Health Food, clothing, furniture, medication…… Assistance with medical system and getting benefits Behavioral Health Moral Support and anxiety reduction Encouragement to ask for help

Community Health Team Phase 2 Right Patient: Use of Standardized Triage Tool Right Time: Direct Alert Notification; Health plan communication Right Data: Common data base to track results

Rhode Island: Practicing with Value: Moving Forward: OHIC Sustainability Payment 2017 CTC Expansion Comprehensive Primary Care Plus Accountable Care Organizations Transforming Clinical Practice Initiative