Promoting the Spread of Health Care Innovations Web Seminar April 9, 2013 Follow this event on Twitter Hashtag: #AHRQIX

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Innovations Exchange Web Event Series Archived Event Materials Available within two weeks under Events & Podcasts at Next Events Thursday, April 25, pm ET Payment Models that Support Medical Home and Accountable Care Organization Principles: Maryland’s Experience Thursday, May 9, pm ET A Close Look at Care Coordination: West Virginia’s Experience 5

Today’s Event Moderator Ronie Nieva, PhD Vice President, Westat and Editor-in-Chief of the AHRQ Health Care Innovations Exchange 6

Essentia Health Linda Wick, RN, CNP 7 Manager, Heart Failure Program

Respondent Janell Moerer, MBA Group Vice President, Strategy and Business Development, Centura Health

Essentia Health Heart Failure Program First visit 5-7 days after discharge Cardiology oversight – once per year Patients managed in clinic: 4-7 office visits the first year Registered nurses do case management: use protocols, manage home telescale data, follow up on lab/test data, and triage phone calls

Program Components Coaching Coaching Education Education Support Support Consistency of care provider Consistency of care provider Immediate feedback on health choices Immediate feedback on health choices Prescheduled follow-up appointments Prescheduled follow-up appointments Relationship building with patient/family Relationship building with patient/family Multidisciplinary team approach to care Multidisciplinary team approach to care Engaged/passionate staff Engaged/passionate staff

Triple Triple Aim Outcomes Outcomes – – Use of guideline directed medications/devices – – Total yearly admissions/30 day readmissions Patient Satisfaction Patient Satisfaction Reduced Cost of Care Reduced Cost of Care – – Total yearly admissions/30 day readmissions – – Reduce duplication of testing – – Using the right provider at the right time for the right diagnosis

SHOW ME THE MONEY!

Readmission Rates Note: 6 month rates for heart failure patients N= FY

Essentia Health St. Mary’s Hospital Readmissions

“Times They are a Changing” Essentia Health is an Accountable Care Organization CMS Bundled Payments for Care Improvement Initiative Primary care is using health care home model: stable Heart Failure Program patients discharged to primary care physician

Challenges: Administrative Buy-In Ongoing challenge of administrative buy-in Dialog changed once organization became an Accountable Care Organization: risk/benefit Demonstrate how model fits Triple Aim Markets within the organization have different priorities NCQA accreditation process fits model

Challenges: Provider Buy-In Progress with physician and provider buy in: show data on outcomes Culture changing from physician- centered to patient-centered Culture changing from individual provider-based to team-based care Other chronic disease programs changing to Heart Failure Model within Essentia

Challenges: Workforce Sustaining workforce with potential nursing shortage Clear staffing roles Inclusion/exclusion criteria for patients Using Telehealth technology

Scale Up and Spread Added Telehealth video visits to remote sites Added Telehealth video visits to remote sites Added program staff to neighborhood clinics Added program staff to neighborhood clinics Developed interface with primary care case managers: shared care plan Developed interface with primary care case managers: shared care plan Integrated home scale data into electronic medical records with options for coverage from other sites Integrated home scale data into electronic medical records with options for coverage from other sites

Closing Thoughts If everything seems under control, you’re not going fast enough – – –Mario Andretti

Respondent Janell Moerer, MBA Group Vice President, Strategy and Business Development, Centura Health

Comments and Considerations Continuity of leadership and passion for the service has assisted growth and adoption Continuity of leadership and passion for the service has assisted growth and adoption Data beginning to reflect intended impact to new value equation Data beginning to reflect intended impact to new value equation

Impact of Changing Environment Transformation and disruption of the norm has accelerated adoption and scale Transformation and disruption of the norm has accelerated adoption and scale Fee-for-service payment to bundle/Accountable Care Organization Fee-for-service payment to bundle/Accountable Care Organization Change in value equation: outcomes/cost Change in value equation: outcomes/cost

Shift to Team-Based Care Emphasis on team-based care: patient- centered medical homes/health homes Emphasis on team-based care: patient- centered medical homes/health homes Heart Failure Program and team are more “part of” the delivery vs. “separate from” due to emphasis on team-based care. Heart Failure Program and team are more “part of” the delivery vs. “separate from” due to emphasis on team-based care.

Overarching Questions Where does this program need to reside in the short term, mid-term, and long- term? Where does this program need to reside in the short term, mid-term, and long- term? Who should “own” it? Accountability? Who should “own” it? Accountability? How are the physician champions engaged in development and adoption with peers? How are the physician champions engaged in development and adoption with peers? How will guardrails for compliance within the delivery system be addressed? How will guardrails for compliance within the delivery system be addressed?

Key Considerations How will the challenges and opportunities change due to the transformation of payment and care delivery? Administrative buy-in Administrative buy-in Physician adoption Physician adoption Delivery system needs and composition Delivery system needs and composition Data gathering to data aggregation and segmentation Data gathering to data aggregation and segmentation New competitors New competitors

Key Considerations How and what will the Heart Failure Program need for innovation and to accelerate adoption with sustainable value? Community partnerships i.e. parish nursing, community emergency medical services Community partnerships i.e. parish nursing, community emergency medical services Telehealth to clothing with monitoring devices; iHeart Failure Telehealth to clothing with monitoring devices; iHeart Failure Technology partnerships Technology partnerships Retail competitors and opportunities Retail competitors and opportunities Patient/consumer experience and literacy Patient/consumer experience and literacy

Transformation to Value SHOW ME THE MONEY!

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