Transcript Care Coordination Program

CARE COORDINATION PROGRAM
JULY 7TH, 2010
Who We Are
eQHealth Solutions is a not-for-profit clinical
services management company, focusing on
operational innovations in care delivery to drive
significant cost savings for payers while promoting
quality of care for beneficiaries
“…We change the behavior of the healthcare system”
We bring multi-state and multi-client
experience
Formerly Louisiana Health
Care Review (LHCR)
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Not-for-profit 501c(3) organization
2000 physician member and
physician sponsored organization
200 employees
Medicare and Medicaid Clients
“Established track record in building trusted long-term relationships with our clients”
“Committed to re-investing in the healthcare system for improving the quality of health care”
Proprietary to eQHealth Solutions
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eQHealth Capacity
Staff
 7 Full Time Medical Directors
 150 Physician Consultants
 105 Registered Nurses
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30+ yrs of Healthcare Mgmt Experience
25 member IT Team
6 member Analytical Team
5 Communications Team
Infrastructure
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In-house Software Development Team
Data Analytics
Call-center operations
Distributed staffing model
Communications
Project Management
→ Over 23 yrs serving Medicare and Medicaid
clients
→ Nationally recognized for industry leading
approaches to our solutions
→ Recognized for its ability to focus on
community development and physician
behavior change
→ Invested in learning and promoting best
practices and evidence based medicine
→ 20+ successful program implementations
across our clients
Proprietary to eQHealth Solutions
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Our Services
Healthcare Consulting
– Health Information Technology (HIT)
– Clinical Quality
– Analytics
Integrated Care Coordination
Services
– Care Transitions
– Chronic Condition
Community Development
Utilization Review/Mgmt Services
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Inpatient
Outpatient Therapy
Home health
DME
Behavioral Health
HCBS Waiver Consultation & Support
Services
– Patient and physician education
– Community outreach and education
– Outcomes disparities
Fraud and Abuse
• Medicare
• Medicaid
Proprietary to eQHealth Solutions
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QIO Opportunity in Care
Coordination Market
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Q: Can the healthcare system achieve
sustainability in today’s climate?
A: eQ thinks so.
QIOs have an opportunity to play a role in advancing
sustainability
We must, however, think outside of traditional solutions
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We must transition from episodic to streaming care
We must bring go beyond awareness of situation to behavior change
Traditional Solutions
Disease Management
Case Management
• Remote telephonic intervention
• Works independently only with
patient
• Minimal interaction with PCP
• Focus on disease condition only
• Staffing ratio: 1:250
• In-depth patient management
• Telephonic and in-person
interventions
• Episodic patient mgmt
• Moderate interaction with PCP
• Staffing ratio: 1:70
Patient
Physician
Office
Payor
For most part these key components of
healthcare delivery are not included in
traditional
solutions
Provider
Hospital
Proprietary to eQHealth Solutions
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QIO Core Capabilities
We understand how to work
with individual beneficiary
Patient
Local
community
Physician
Office
We build relationships with
physician and providers to drive
behavior change
Provider
Hospital
Proprietary to eQHealth Solutions
• We know how to work with
individual communities
• Interventions required to
engage the community and
drive behavior change
Payor
QIOs can leverage their core
capabilities to build a
platform that brings together
multiple stakeholders to act
in concert as a system 10
Potential Clients for QIOs
• Insurance Organizations
– Local Blue Cross Organization vs. nationwide insurance
companies
• Managed Care Organizations
• Third Party Administrator (TPA) Organizations
• Self-insured employers
Proprietary to eQHealth Solutions
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eQHealth Care Coordination
Program
Proprietary to eQHealth Solutions
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The Problem
• People like their doctors
• But no working model exists systematically connecting
stakeholders
• Treatment of chronic condition is merely episodic
• Other companies look to expensive technology to
maximize profits and protect market share
• These are band-aids and do not get at the root of the
problem
Our Philosophy
– People are the answer
– Technology is simply a support mechanism
– We must “extend” the voice of the physician in a
continuum of care
– We must “prompt” the patient to have the right
conversations
– Only this will achieve lasting behavior change
Our Solution
We understand where the care conversation breaks
down
– We modeled our program based one best practices of North
Carolina Community Care Networks, Vermont Blueprint of Health
and our own Care Transitions
We empower physicians through immediate access to
resources and information
Our model continually projects the physician’s
presence into the patient’s care
This leads to faster recovery, lower cost and less
recurrence
eQCare Coordination Model
Community Driven
• Engaging the clinical
thought leaders in the
community
• Engaging the business and
industry
• Connecting stakeholders
Embedded Care
Coordinator
• Care coordinators are part
of the community
• "High touch" interventions
• Whole person management
• Staffing ratio: 1:150
Technology Infrastructure
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Integrated web application – easy to use and adopt
Provider portal to drive the care outside of physician office
Evidence based guidelines
Cost and quality metrics
Proprietary to eQHealth Solutions
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Care Coordination Programs
Asthma
Childhood
Obesity
• Pediatric
• Adult
Maternity
Congestive Heart
Failure (CHF)
• Preconception
• Inter-conception
• Post partum
Chronic
Obstructive
Pulmonary Disease
Diabetes
Minor
programs
• Care Transition
• Smoking
Cessation
Minor
programs
Proprietary to eQHealth Solutions
• Medication
Adherence
• Depression
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Care Coordination Software
• Ability to drive patient care
• Easy access to guidelines
and educational resources
• Practice score card
Provider
Portal
Evidencebased
Guidelines
Module
• Nation Clearing House
• Milliman Care Guidelines
Population Risk Stratification
Comprehensive HRA (s)
Patient History (Claims, Utilization)
Issues driver Plan of Care
Patient
Care Mgmt
Module
Integrated
Web-based Application
• Workflow Engine
• Provider Channeling
• Alerts & Messaging
Care
Coordinator
Productivity
Module
Health &
Wellness
Module
• Condition specific education
• Medication
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Reports
Module
Proprietary to eQHealth Solutions
• Financial
• Quality
• Productivity
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Software Demo
Proprietary to eQHealth Solutions
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Q&A
Proprietary to eQHealth Solutions
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APPENDIX
Proprietary to eQHealth Solutions
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Care Coordination
Three models seem to have gained national
recognition in their approaches to Care Coordination
– North Carolina: – Community Care Networks
– Vermont: Blueprint of Health
– eQHealth: Care Transitions Model
Proprietary to eQHealth Solutions
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North Carolina
Community Care Networks
Grassroots approach centered around managing Medicaid enrollees
– 14 different networks; modeled to meet individual community needs
– Organized and operated local physicians, hospitals, health departments and
department of social services
Goals
Results
• To improve medical care for individuals
enrolled in Medicaid while controlling costs
• To develop Community Networks to manage
care provided to Medicaid recipients
Asthma
• 40% ↓ Hospital admission rate
• 16% ↓ ER Visits
• 93% received appropriate
maintenance medications
• To develop systems that coordinate care for
those with chronic illness
Diabetes
• 15% ↑ quality measures
• To encourage Primary Care / Medical Home
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790
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231
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Cost savings
in millions
FY 03
Proprietary to eQHealth Solutions
FY04
FY06
FY07
Total
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North Carolina
Community Care Networks
(Cont’d)
Three major elements form the basis for making these network
work
Financials
Stakeholder Collaboration
Infrastructure
• PCPs receive $2.50 pmpm to
provide a medical home and
participate in Care
Coordination
• Everybody involved in Care is
dedicated to improving the
care
• Systems
– $5.00 pmpm for Aged, Blind
and Disabled
• Networks receive $3.00
pm/pm from the State for
most enrollees
– $8.00 pm/pm for the Aged,
Blind and Disabled enrollees
– Physicians
– Hospitals
– Local Medical Entities
– Social Services
• Physician leadership
• Evidenced-based guidelines
are adopted by consensus
rather than dictated by the
state
Proprietary to eQHealth Solutions
– Case Management Information
System (CMIS)
– Claims data linking
– Data sharing (Electronic or
Paper based)
• Operations
– Case managers (stand alone
and integrated within facilities)
– Medical Director
– Pharmacist
– Network Director
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Vermont
Blueprint of Health
All payer model centered around primary care practices
– Public-private approach; Medicaid, Cigna, BCBS
– Centered around practices in communities as opposed to target population
– Increasing PPPM payment to PCP’s based on NCQA measures as opposed to
standard PMPM for PCP’s
Major components of the model are similar to North Carolina
model
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Financial reform
Multi-disciplinary Community Care Teams
Community Activation and Prevention
Health Information Technology
Multidimensional Evaluation
Third party evaluation of the results are yet to be conducted
Proprietary to eQHealth Solutions
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eQHealth
Care Transitions Model
Jeopardy Question: Which industry has ~20% product
recall rate in the first 30 days of product delivery
Correct Answer: What is Healthcare Industry?
Goals
Results
• CMS goal to reduce 30 day hospital
readmission rate by 2% in the Baton
Rouge community
• 74% ↓ re-admission rate
in the target population
• Targeted 4 conditions
– AMI
– CHF
– COPD
– Pneumonia
• Expanded from 1 to 4 hospitals
• Leading the nation in our results
• Improve patient care management
across care settings
• Improve patient satisfaction
-74%
19%
5%
Pre
Post
30 day readmission rate
Proprietary to eQHealth Solutions
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eQHealth
Care Transitions Model
(cont’d)
eQHealth proprietary model focused on behavior change among the key
stakeholders
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Patient
Physician
Provider
“Changing the focus of the conversation
among the stakeholders”
Fundamental principle behind the model is “aligning the relationship with
patient at the right time”
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During the stay in the hospital
Continuing the relationship across care setting
Key components of the program are:
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Redesigning the hospital centered discharge planning to be patient centered education
planning
Transition coaching and follow-up
Our program recently featured in “NY Times”
Proprietary to eQHealth Solutions
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