Better care for Individuals Better health for Populations Lower Cost.

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Presentation transcript:

Better care for Individuals Better health for Populations Lower Cost

3

Source: Costs/Background-Brief.aspx

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6

7 HCP Inpatient Strategy

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Comprehensive Care Programs provide: Medication management Advance care planning Disease education Access to additional community resources 24-hour on-call telephone access to a high risk program provider Interdisciplinary care plan Coordination of treatment plans across multiple providers or locations Teams document in EMR to facilitate care coordination Keep the patient’s PCP abreast of the patient’s care plan

HealthCare Partners (HCP) Care Model ACM/Disease Management CHF / COPD / DM / CKD Comprehensive Care Clinic ESRD/Dialysis Palliative Medicine Consults House CallsUrgent Care Hospitalist/SNF Programs Patient Family Primary Physician/Specialists

13 F/U Appointments Red Flags How to get HELP! Medication reconciliation

PreInPost Patients Admits Per Thousand (34.%) 913 Days Per Thousand (30.8%)

PreInPost Patients Admits Per Thousand (32.2%) 701 Days Per Thousand (37.8%) 4090 ER/ (9.9%)

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PreIn Patients523 Admits Per Thousand (28.5%) Days Per Thousand (37%) ER/ (26%) 17

HCP High Risk Program Impact

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21 QUESTIONS