Transcript Document

Personalized Care Clinic
Tim Johnson, MD and Dave Henriksen, MHA
October 2014
Objectives
As a result of the presentation, participants will:
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Understand the new model of care being implemented at
Intermountain Healthcare to manage our most complex patients
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Be able to describe our intensive ambulatory model of care for complex
patients
Intermountain Healthcare
An Integrated Health System
Intermountain Healthcare
1975
SelectHealth
1983
Medical Group
1994
Intermountain’s Mission and Vision
Mission
Helping people live the healthiest lives
possible
Vision
To be a model health system by providing
extraordinary care and superior service at
an affordable cost
Intermountain Medical Group
• 1,106 physicians
• 344 primary care
• 506 secondary care
• 95 hospitalists
• 28 radiologists
• 133 urgent care
• 275 advanced practice clinicians
• 5,527 employees
Intermountain Medical Group Clinics and Services
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165 primary or specialty care clinics
27 InstaCare clinics
8 KidsCare locations
9 WorkMed locations
8 on-site employer clinics
5 community and school based clinics
Hospital-based clinical services
(NBICU, general, cardiac and neuro
hospitalists, intensivists)
Dual Model for the Medical Home
Distributed Model
Intensive Model
Personalized Care Clinic: Our patients
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Patients in the top 5-10% of costs
for 2 of the last 3 years
Patients ranked based on an
algorithm
Have multiple complex chronic
health, social and psychological
conditions
Intermountain has full risk for
the total cost of care
Intensive Model: Personalized Care Clinic
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An outpatient clinic that provides
intensive medical, behavioral, and
social management for
Intermountain’s high-risk patients
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Opened February 3rd, 2014 on the
Intermountain Medical Center
campus
Personalized Care Clinic: The Team
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2 Internal Medicine Physicians
Palliative Care Physician (0.2)
1 PA
RN Care Manager
Psychiatry APRN (0.5)
2 LCSW
Pharmacist
CDE (0.1)
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4 Medical Assistants
PSR
Clinic Manager
Process of care
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Functions like a primary care office with more resources to coordinate
care, treat mental health conditions, address financial challenges, and
manage complex medical issues
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Ensure patients receive care in an appropriate setting; focusing on acute
care utilization
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Coordinate and collaborate with all of the patient’s specialists
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Committed to eliminating all avoidable health care emergencies
Interaction with Primary Care Clinics
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Temporary transition of primary
care
Coordinate patient’s treatment plan
with the primary care teams
Warm hand-offs for all transitions
Length of time in the intensive
practice will vary for each patient
Establishing the Patient Population
• Phase 1: Invite top-utilizing patients in the Medical Group
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Send patient lists to Medical Group PCP’s
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Care managers talk with potential patients
• Phase 2: Invite other top-utilizing patients
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SelectHealth reaches out to affiliated practices
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SelectHealth care managers reach out to patients with no PCP
• Phase 3: Open to referrals from providers
• Referral guidelines developed and shared
Who are the patients?
Top 5 Diagnoses
Personalized Care Clinic
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Other Malaise/Fatigue
Depressive Disorder
DM Uncomp Type II Uncontrolled
Anxiety NOS
Backache NOS
Typical Primary Care
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2.
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5.
Routine Medical Exam
Benign Hypertension
DM Uncomp Type II controlled
Hyper-cholesterol
Depression
Current State of the Personalized Care Clinic
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1,239 visits in 7 months
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Includes care manager, physician, LCSW, PA, and psych
APRN visits
Roughly 75 unique patients
Enrolling more patients with the addition of our
second internist
Patients are much sicker than we anticipated
Personalized Care Clinic: Challenges
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Patients changing insurance
The speed of bringing a patient
into the clinic and transitioning
them back after stabilization
High number of chronic pain
patients
Bringing in the right patient that
the team can help
All initial employees, except the
manager, were new to Help2 and
Centricity
Personalized Care Clinic: Successes
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Preliminary feedback from an initial survey of 50 patients
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50% of patients feel they have better health
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80% of patients have more confidence that their healthcare is moving in the
right direction
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70% of patients feel they are more engaged in their healthcare
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Creating reciprocity from the patient (increased confidence in themselves
causing them to do more for their own care and health)
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Getting patients on right meds/dosage and figuring out medical issues
Receiving good feedback from secondary providers about the
patients in the clinic
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Example: “she is seeing a provider at the personalized care clinic and this seems
to be doing wonders for the patient” - Cardiologist
Personalized Care Clinic: Metrics
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Improve quality of care
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Improve quality of life
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DM Bundle, cancer screening, MHI
surveys, patient stories
Decrease cost and utilization
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inpatient stays, ED visits, overall cost of care
Patient Story 1
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43 year old female
Hx of severe depression, anxiety, post-traumatic stress disorder,
severe sleep apnea, chronic back pain, chronic ankle pain, GERD,
migraines, hypothyroidism, shoulder injury, vitamin B12 deficiency,
Vitamin D deficiency, insomnia, hyperlipidemia, and pre-diabetes
Patient had a work related injury to her back and ankle and had been
on long-term disability through her employer, Intermountain
Healthcare
Uninsured – had applied for Social Security disability, but was denied,
and COBRA was expired
Patient Story 1
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January 2014 Prescreen Data
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#1,456 out of #2150+ (top 10% utilizers)
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36 month cost: $51,966
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12 month cost: $9,257.26
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No ED visits or hospitalizations
• First appointment at the PCC was March 3, 2014
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Patient was severely depressed and had thoughts of hurting herself and young
child. The child was in the custody of friends at this time
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She would not make eye contact and spoke in a soft tone which was extremely
difficult to hear
Patient Story 1
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Seen by internist, care manager, LCSW, psych APRN, and pharmacist
Signed up for SelectHealth Community Care (Medicaid)
Referred to PT, orthopedics, sleep medicine, and the Neurosciences
Clinic for chronic pain
Unable to afford her medications
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The total cost of her medications for a one month supply was $36
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Care manager met with the patient to discuss resources
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Pharmacist met with the patient to discuss pharmacy resources
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Clinic manager approved medications being charged to the clinic until she
was able to put into place the resources the care manager had offered
Patient Story 1
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No longer in need of the medication co-pay assistance
Her interactions with the clinic are positive, makes eye contact,
laughs, and talkative
The patient’s child is back living at home and they have a great
relationship
This patient feels like a new person because of the whole team
pulling together
As of June 4, 2014 her 12 month cost is $4,791
Patient Story 2
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Restricted Access Medicaid Patient
January 2014 Data:
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Ranked #225 out of #2150+ (top 10% utilizers)
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75 ED visits in 2013
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3 Intermountain Hospitalizations
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$90,764 – 36 month cost – in the Intermountain System
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$45,839 – 12 month cost – in the Intermountain System
Patient Story 2
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11 office visits with internist and LCSW
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Weekly standing appointments with the Personalized Care Clinic along with
another specialty provider in the same office building
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Identification of several health issues that can help explain some of her health
complaints
Regular psychiatric treatment through psych APRN
Consult from Palliative/Pain/PM&R Physician
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Modification of pain meds to better meet her pain needs
Clinical Pharmacist monitoring medications, DOPL, and usage
Patient Story 2
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Care manager requesting authorization from the State of Utah for a
medication not covered by her Medicaid plan
Coordinating with SelectHealth care manager due to her restricted
status
Coordinating care with specialty providers
Helping with transportation
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Arrangement of transportation via cab vouchers
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Currently teaching her how to use the public transportation and para-transit
system
Patient Story 2
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Since being seen in the clinic on March 5, 2014
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3 Intermountain Healthcare Facility ED visits
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2 Non-Intermountain Healthcare Facility ED visits
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0 Hospitalizations
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Patient is calling the Personalized Care Clinic prior to going to the ED
Subjective comments from members of the team
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She is calling the clinic with questions and concerns
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She follows up on her appointments
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She looks better in her appearance
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She is a new woman . . . what a difference!
Your comments and questions…