Comprehensive Primary Care: Our Success Story · 2017-07-20 · Comprehensive Primary Care: Our...

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Comprehensive Primary Care: Our Success Story March 2, 2016 Tamra Lavengood, RN, BSN, MSN CPC Coordinator and Clinical Performance Coordinator Centura Health Physician Group, Centura Health Will McConnell, PhD, MBA, MS VP Operations and Outreach Strategy Mercy Regional Medical Center, Centura Health

Transcript of Comprehensive Primary Care: Our Success Story · 2017-07-20 · Comprehensive Primary Care: Our...

Page 1: Comprehensive Primary Care: Our Success Story · 2017-07-20 · Comprehensive Primary Care: Our Success Story March 2, 2016 Tamra Lavengood, RN, BSN, MSN . CPC Coordinator and Clinical

Comprehensive Primary Care: Our Success Story

March 2, 2016

Tamra Lavengood, RN, BSN, MSN CPC Coordinator and Clinical Performance Coordinator

Centura Health Physician Group, Centura Health Will McConnell, PhD, MBA, MS VP Operations and Outreach Strategy

Mercy Regional Medical Center, Centura Health

Page 2: Comprehensive Primary Care: Our Success Story · 2017-07-20 · Comprehensive Primary Care: Our Success Story March 2, 2016 Tamra Lavengood, RN, BSN, MSN . CPC Coordinator and Clinical

Introductions

Tamra Lavengood, RN, BSN, MSN, CPNP, CCNS Clinical Performance Coordinator for Centura Health Physician Group in Colorado Coordinator for the Comprehensive Primary Care Initiative for Mercy Family Medicine in Durango, Colorado Will McConnell, PhD, MBA, MS VP Operations and Outreach Strategy for Mercy Regional Medical Center in Durango, ColoradoWill McConnell, PhD, MBA, MS • VP Operations and Outreach Strategy • Mercy Regional Medical Center

Page 3: Comprehensive Primary Care: Our Success Story · 2017-07-20 · Comprehensive Primary Care: Our Success Story March 2, 2016 Tamra Lavengood, RN, BSN, MSN . CPC Coordinator and Clinical

Conflict of Interest

Tamra Lavengood, RN, BSN, MSN Will McConnell, PhD, MBA, MS Have no real or apparent conflicts of interest to report

Page 4: Comprehensive Primary Care: Our Success Story · 2017-07-20 · Comprehensive Primary Care: Our Success Story March 2, 2016 Tamra Lavengood, RN, BSN, MSN . CPC Coordinator and Clinical

Learning Objectives Objectives: • Identify four qualitative and four quantitative elements used to determine an

individual's health risk • Construct an adaptation of a paper or electronic risk stratification tool using

the Mercy Adult Risk Stratification Tool (MARST) • Adapt a methodology for emergency department (ED) and hospital follow

up • Influence electronic health record (EHR) vendors to adapt a risk

stratification methodology that assesses the whole person • Influence the current healthcare environment to prepare for population

health management

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Agenda

• The Beginnings – What is the CPC Initiative? – Why did Mercy Family Medicine choose to participate? – Barriers

• Our Comprehensive Primary Care Initiative Story

– Task Force – 9 milestones, key elements

• Empanelment • Risk stratification

– Mercy Adult Risk Stratification Tool (MARST) development • Care Management vs. Care Coordination • ED and hospital follow-up

• Outcomes and lessons learned

Page 6: Comprehensive Primary Care: Our Success Story · 2017-07-20 · Comprehensive Primary Care: Our Success Story March 2, 2016 Tamra Lavengood, RN, BSN, MSN . CPC Coordinator and Clinical

Benefits Realized for the Value of Health IT STEPSTM VALUE CATEGORIES Treatment/Clinical: Care Management for high-risk patients identified by risk stratification looking at the whole person; ED and hospital follow-up care management; and care management to include behavioral health integration Savings: Realized by decreased Per Member Per Month (PMPM) expenses for Medicare population due to decreased ED utilization, hospital admissions for any cause and hospital admissions for Ambulatory Care Sensitive Conditions (ACSC)

http://www.himss.org/ValueSuite

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What is the Comprehensive Primary Care Initiative?

Four-year multi-payer initiative designed to strengthen primary care Population-based care management fees and shared savings opportunities to participating primary care practices to support the provision of a core set of five “Comprehensive” primary care functions.

– Risk stratified care management – Access and continuity – Planned care for chronic conditions and preventive care – Patient and caregiver engagement – Coordination of care across the medical neighborhood

https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/

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What is the Comprehensive Primary Care Initiative?

Demographics – 474 practice sites – 2,200 practitioners – 2.7 million active patients – 38 public and private payers – 335,000 Medicare beneficiaries

Purpose

– Improved care – Better health for populations – Lower costs – Inform future Medicare and Medicaid policy https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative

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What is the Comprehensive Primary Care Initiative?

Payment Model

– Participating primary care practices receive two forms of financial support on behalf of their fee-for-service (FFS) Medicare beneficiaries:

• A monthly non-visit based care management fee

• The opportunity to share in any net savings to the Medicare program

https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative

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Why did Mercy Family Medicine Choose to Participate? • Value-based purchasing was getting a lot of attention

– We needed to identify viable payment models and prepare for the future

• Cost neutral solution • Alignment with PCMH status • Great group of clinicians and staff • Huge potential within CPC • Timing was right

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Barriers to get the Comprehensive Primary Care Initiative started

• One more thing to do

– Do we have the bandwidth? • Moving into uncertain territory with CPC • A lot of additional reporting and process work would be needed • No real quantifiable risk stratification tools in the beginning • Practice was recently acquired

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Comprehensive Primary Care Initiative: Our Story

• Center for Medicare and Medicaid had a great idea! • Privileged to be a part of initiative • Started with a Task Force

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Comprehensive Primary Care: 9 Milestones

1. Budget 2. Care management for high-risk patients 3. Access and continuity 4. Patient experience 5. Quality improvement 6. Care coordination across the medical neighborhood 7. Shared decision making 8. Participation in learning collaboratives 9. Health Information Technology

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Comprehensive Primary Care Initiative: Our Story

CMS selected key elements that aligned with Patient Centered Medical Home elements Milestone 2: Empanelment; Risk Stratification; Care Management; Behavioral Health Integration

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Comprehensive Primary Care Initiative: Our Story

Empanelment • End of 2012 = 79% • End of 2015 = 99.9% • Four Cut Method (1)

• Care Teams

(1) Panel Size: How Many Patients Can One doctor Have?, Mark Murray, MD,MPA, Mike Davies, MD, Barbara Boushon, RN,Fam Pract Manag. 2007 Apr; 14(4):44-51

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Comprehensive Primary Care Initiative: Our Story

Risk Stratification • All 500 clinics asked to develop their own risk stratification

methodology • Mercy Family Medicine reviewed tools from:

– California Quality Collaborative – AAFP Risk Stratification Tool – Telluride Medical Center in Colorado (another CPC practice)

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Risk Stratification in CPC Practices

Comprehensive Primary Care practices risk stratify their patients by: • Clinical intuition: 71% • Practice developed clinical algorithm: 61% • Published clinical algorithm: 40% • Claims: 24% • EHR methodology: 19%

Practices were able to select more than one method

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Comprehensive Primary Care Initiative Our Story

Developed our own Mercy Adult Risk Stratification Tool (MARST) and the Mercy Pediatric Risk Stratification Tool (MPRST) Critical to have not only Objective elements but Subjective elements as well

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HIT Needed for Risk Stratification • Using the system we had • Our risk stratification elements flow exactly like our EHR

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Mercy Adult Risk Stratification Tool

Have risk stratified over 14,300 patients – 1.1% Highest risk – Level 6 – 20.4% High risk – Level 5 (6.5%) and Level 4 (13.9%) – 25.3% Medium risk – Level 3 – 26.5% Low risk – Level 2 – 26.7% Low risk – Level 1

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Risk Stratification and Care Management

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Risk Stratification Care Management

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Behavioral Health Integration

• Behavioral Health care is needed for the majority of level 6 patients

• In house Licensed Clinical Social Worker – Warm handoffs – Scheduled patients – Evaluation tools: PHQ9

• Tracking depression screening

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Care Coordination Care coordination across the Medical Neighborhood

– Emergency Department discharges – Hospital discharges

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Medicare Expenses Per Patient Per Month, All Attributed Patients

Page 29: Comprehensive Primary Care: Our Success Story · 2017-07-20 · Comprehensive Primary Care: Our Success Story March 2, 2016 Tamra Lavengood, RN, BSN, MSN . CPC Coordinator and Clinical

Medicare Expenses Per Patient Per Month, for Patients in the Highest Risk Quartile

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Hospital admissions, ED Visits, 30 day Re-Admissions for all attributed Medicare Patients

Page 31: Comprehensive Primary Care: Our Success Story · 2017-07-20 · Comprehensive Primary Care: Our Success Story March 2, 2016 Tamra Lavengood, RN, BSN, MSN . CPC Coordinator and Clinical

Hospital admissions, ED Visits, 30 day Re-Admissions for all Medicare patients in the highest risk quartile

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A Summary of How Benefits Were Realized for the Value of Health IT STEPSTM VALUE CATEGORIES

Treatment/Clinical: Care Management for high-risk patients via shared care plans, and improved communication with providers both inpatient and outpatient; Care Management, including behavioral health integration for high-risk patients and for chronic disease management led to reduced ED visits and hospitalizations for any cause and for Ambulatory Care Sensitive Conditions (ACSC); Care Management communication between the inpatient and outpatient settings for ED and hospital discharges enabling follow up at 97.5% within 1.8 day for ED visits and 96.7% within 8hrs for hospital discharges

http://www.himss.org/ValueSuite

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A Summary of How Benefits Were Realized for the Value of Health IT STEPSTM VALUE CATEGORIES Savings: Decreased Per Member Per Month (PMPM) expenses for Medicare population of $608, 10th lowest in Colorado region of 75 practices of which $677 is the median and high $1,168; decreased for Highest-Risk Quartile PMPM expense of $989, 10th lowest and median of $1,191 and high $2,247 for Colorado region Decreased ED utilization by 5% from 611 to 580 (not risk adjusted) per 1000 Medicare patients per year from last quarter equaling cost savings of $52K ($650/visit) Decreased hospital admissions for any cause of 1.1% per 1000 Medicare patients per year from last quarter cost savings of $135,200 ($26,000/stay) Decreased hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) by 8% per 1000 Medicare patients per year from last quarter cost savings of $135,200. Total cost savings annually $1,289,600

http://www.himss.org/ValueSuite

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Questions

Please reach out to us: Tamra Lavengood RN, BSN, MSN Will McConnell PhD, MBA, MS Clinical Performance Coordinator VP Operations and Strategic Outreach CPCI Coordinator Mercy Family Medicine Mercy Regional Medical Center Centura Health Physician Group Centura Health 970-764-3798 (direct) 970-764-3907 (direct) 970-759-2370 (cell) [email protected] [email protected]

1 Mercado Street Suite295

Durango CO 81301