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

2. Using the Webcast Console and Submitting Questions 2 Click the Q&A widget to get the Q&A box to appear To submit a question, type question here and hit submit.

3. Accessing Presentations Download slides from console Download slides from console – Click on the “Download Slides” widget for a PDF version 3

4. What is the Health Care Innovations Exchange? Publicly accessible, searchable database of health policy and service delivery innovations Publicly accessible, searchable database of health policy and service delivery innovations Searchable QualityTools Searchable QualityTools Successes and attempts Successes and attempts Innovators’ stories and lessons learned Innovators’ stories and lessons learned Expert commentaries Expert commentaries Learning and networking opportunities Learning and networking opportunities New content posted to the Web site every two weeks New content posted to the Web site every two weeks Sign up at under “Stay Connected” Sign up at http://www.innovations.ahrq.gov under “Stay Connected”http://www.innovations.ahrq.gov 4

5. Innovations Exchange Web Event Series Archived Event Materials Available within two weeks under Events & Podcasts at http://www.innovations.ahrq.gov http://www.innovations.ahrq.gov Next Events Thursday, April 25, 2013 1-2 pm ET Payment Models that Support Medical Home and Accountable Care Organization Principles: Maryland’s Experience Thursday, May 9, 2013 1-2 pm ET A Close Look at Care Coordination: West Virginia’s Experience 5

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

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

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

9. 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

10. 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

11. 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

12. SHOW ME THE MONEY!

13. Readmission Rates Note: 6 month rates for heart failure patients N=294-229 FY2005-2010

14. Essentia Health St. Mary’s Hospital Readmissions

15. “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

16. 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

17. 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

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

19. 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

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

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

22. 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

23. 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

24. 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.

25. 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?

26. 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

27. 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

28. Transformation to Value SHOW ME THE MONEY!

29. Questions? Click me to get Q&A box to appear

30. The Innovations Exchange  Visit our Web site: http://www.innovations.ahrq.gov/http://www.innovations.ahrq.gov/ and http://www.innovations.ahrq.gov/ Scale Up and Spread Videos Scale Up and Spread Videos  Follow us on Twitter: #AHRQIX  Send us email: info@innovations.ahrq.gov 30