Transcript Doing the Impossible—Leveraging Technology to Reduce Costs

Technology and the Uninsured:
Increasing Access and Coordinating Care
Doing the Impossible—Leveraging Technology to Reduce
Costs and Improve the Quality of Care for the Uninsured
COUNTY OF ORANGE
HEALTH CARE AGENCY
Hank Fanberg
Dan Castillo, MHA, FACMPE, CHE
Manager of Research & Development
Program Administrator
2007 National Congress on the Un and Under-Insured
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Today’s Objectives
• To share with you how two different types of
healthcare organizations are utilizing
technology in their efforts to serve the
underserved.
– What a Provider System is currently doing
– What a Public Health (Payor) System is currently
doing
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Today’s Objectives (cont.)
• We will demonstrate the different technology
applications that have been implemented and how
they support our respective initiatives.
• We will share with you the outcomes of our efforts
and how leveraging technology has not only made
our respective systems more efficient but how it
has enhanced the patient’s quality of life.
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Today’s Objectives (cont.)
• The Provider Perspective
– Hank Fanberg – CHRISTUS Health
• The Public Health (Payor) Perspective
– Dan Castillo – Orange County Health Care Agency
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Our Healing Ministry
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
PRESENTATION GUIDE
•
•
•
•
CHRISTUS Health background
Market Statistics re: un and under insureds
Programmatic Approach to Care
Technology Tools to Accomplish
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Our Vision
What We Are Striving To do.
• Strengthen current ministries and expand into new
locations and services
• Implement innovative approaches to caring for
the whole person
• Increase access to health care for the poor and
underserved through advocacy and other
initiatives
• Make significant contributions to creating
healthy communities
• Create a work environment filled with hope, dignity and
mutual respect
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Our Legacy
• In 1866, Texas was faced with
illness, disease and poverty of
staggering proportions.
• Galveston Bishop Claude M.
Dubuis turned to his native France
and issued a plea to Religious
Sisters for assistance
• Three Sisters answered the Bishop’s
call, Mother Blandine, Sister Ange,
and Sister Joseph
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Our Legacy
• The Sisters arrived in Galveston in
October 1866 and founded the
Congregation of the Sisters of
Charity of the Incarnate Word.
• In 1887 the Sisters opened the
state’s first Catholic hospital in
Galveston, Charity Hospital.
• Mother Madeline, Sister Agnes and
Sister Pierre traveled from
Galveston to San Antonio in 1869
• Within months, the Sisters
established Santa Rosa Infirmary in
San Antonio.
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Facts and Figures - Today
• 40 hospitals and other health care ministries in
more than 70 communities
• Dozens of other health services in Texas,
Louisiana, Arkansas, Utah, Oklahoma and Mexico
• Approximately 27,000 employees
• More than 8,000 staffed beds
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Cont’d
Uninsured in Texas and Louisiana –
Demographics
• Texas leads nation in uninsured; Louisiana is third
(2005)
• Majority are:
- Working families with low and moderate incomes
- Young adults age 19-34
- Disproportionately Hispanic and African-American
- Legal, US residents
• Health care coverage is not available from employer or
is unaffordable
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Sources: Health Policy Institute; The Access Project
Percent of Population
Uninsured and Underinsured in
Texas and Louisiana, 2005
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
LA
TX
Medicaid/CHIP
Uninsured
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
CHRISTUS Direction
From
To
Focus on high cost,
ER-based charity care
to treat illnesses that
Could have been
prevented.
Comprehensive strategies
to address the symptoms
and underlying causes of
health problems.
Proprietary approaches
to planning and
implementation.
Community collaboratives
that mobilize and build upon
existing community assets.
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Three Pronged Approach
Manage Care
Provide Access to Care
•
•
Identify/establish
medical homes
Identify/develop other
building blocks
•
•
•
Uninsured
Population
Manage Acute Care
•
•
•
Develop clinical pathways/
supply chain management
Implement strategic pricing
Implement communication
plan
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Identify high risk
patients
Manage Lifestyle
Navigate the System
Current Building Blocks
Enrollment
Medical Home
Wellness &
Prevention
Disease
Management
Pharmaceuticals
Access
Care
Management
Diagnostic
Service
Referrals
System
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Durable
Medical
Goods
Comprehensive Integrated Care
Enrollment
Wellness &
Prevention
Disease
Management
Mental Health
Care
Management
Admission
Medical Home
Prepare for
treatment &
discharge
Dental Health
Community
Collaboration
Diagnostic
Service
Expanded
Insurance
Coverage
Pharmaceuticals
Access
Referrals
System
Durable
Medical
Goods
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Medical or
surgical
treatment
Discharge to
home and/or
aftercare
Success Requires Tech and Touch
• Technology:
– variety of tools that fit the need
• Touch:
– Community Health Workers
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Community Health Workers
• People who are residents of underserved
communities who are uniquely knowledgeable
about their neighbors’ needs
• Care Managers by many different names
– Health Promoter
– Family Health Care Advisor
– Natural Caregiver
– Promotora
– Resource Mother
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
CHRISTUS Spohn Kleberg –
Preliminary Results (12-06)
A study of 77 chronically ill clients during the first 6 months of
intervention by CHWs
Utilization Impact
•
•
•
52 of 77 had no ED visits or admissions
49 ED visits by 25 patients
28 admissions by 20 patients
Financial Impact (6 months)
•
•
•
$123,329 in net savings for ED & Acute Care
Costs of $35,152
Return on investment (ROI) $3.80 per $1 invested in the
Kleberg CHW program
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Patient Specific Results
• 22 year old Caucasian female
– Diabetic
– ED as primary care site
– Admitted to ICU ~ 6 weeks for acidkerotosis
• Community Health Worker + Home Monitoring
– No admissions 11 months
– 3 ED visits
– $215,000 cost avoidance
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Home Monitoring Device
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
What Technology building Blocks
Are Needed?
• Clinical Systems
• Communications Systems
• Financial Systems
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Map the technology to the Need
NEED
Enrollment
SOLUTION
Financial
Medical Home
Wellness
Diagnostics &
Disease Mgmt
Referrals
Medications
Data Analytics
Clinical/ Comm
Clinical
Clinical
Eligibility &
Enrollment
EMR/PHR
PHR, on line
Home Monitoring
Communications
Clinical
Data base
Portals
ePrescribing
Oracle SQL
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
What Technology building Blocks
Are Needed?
• Clinical Systems
– Shared electronic medial record
– Community Wide Master Patient Index
– Vital sign monitoring device in the home
• Communications Systems
– Secure network for accessing and sharing
– Web based access and applications
• Financial Systems
– Eligibility verification
• Strong Authentication
– Positive patient identification and verification
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
CDA document-based network
• All transform to CDA
• View the complete record
• No loss in computable semantics
EMR
HL7|^v2
data
PMpaper
HL7|^v2
text
text
HL7|^v2
chart
LIS
text
DICOM
RIS/dictation
paper
NCPDP
eRx/paper
•
•
•
•
•
•
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
EHR
V-EHR
PHR
Patient Portal
Physician Portal
Health Record Bank
HIE Infrastructure
HIE Infrastructure
CLINIC / HEALTH CENTER
EMPI – Patient Lookup Portal
Custom Patient Lookup / Update Portal
EMPI Face Sheet
Patient Care Home Assignment
EMPI Patient Lookup
Patient Compliance Review
Clinics / Health Centers
Cloverleaf® Secure Object Client
Cloverleaf® Integration Services
Protocol
Services
Message
Services
Monitoring
Services
Physicians
TCP/IP (S)
SOAP
SMTP
POP3
LU 3
LU6.2
APPC
File
Fileset
FTP(S)
HTTP(S)
MQ (MQSeries)
JMS
MS MQ
UPoC
PDL Async
(RS232)
HL7 V2.x
HL7 V3.
X12 HIPAA
NCPDP
CeRx
XML
UN/EDIFACT
Fixed Length
Variable Length
Hierarchical
Record Length
Transformation
Services
Parsing
Translation
Routing
HOSPITAL
Network Monitor
Global Monitor
Engine Stats
Auditing
Engine Logging
Messages Logging
System Alerts
Message Alerts
IHB
Services
Web Services
Security (WSS 1.0)
ESB Adaptor*
ServiceMix Adaptor*
Hydra SDO Adaptor*
Security
Services
Identity Services
SDK
Services
Initiate
Engine
Web Services
Java API
C++ API
Identity Rules
Comparison
Algorithm
Security &
Access Control
IHE
Services
Secure Messenger
SSL
Basic Security
Security Server
(Advanced)
Audit Tracking /
Reports
User Auth. (x509)
Entity Auth. (x509)
Access Control List
(ACL)
PIX/PDQ v2 & v3
ATNA
XDS DOC SRC/
CONSUMER
PWP
BPPC
XDS-SD
Database
Services
Implementation
Serivces
Recovery Dbase
Error Dbase
Patient Lookup
Patient Update
Patient
Registration
Initiate™ Enterprise
Viewer
Initiate™ Auditor
Patient
Directory
Member Data
Linkage Data
Audit Data
* Current 2007 Development plan
Health Interoperability Solutions
Hospitals
Cloverleaf® Secure Object Client
Leverage existing Quovadx Infrastructure
MD Office
Connectivity
eRX Translation
Services
Medication History
Services
Financial
Interoperability
Clinical Terminology
Service
Secure object Client
Cloverleaf® Gateway
EMR/eRx/CPOE
HL7 - NCPDP SCRIPT
Medication Safety
Directive
RxHub MEDS
Revenue Management
Direct & Hub
transaction support
3M Data Dictionary
Standardized
terminology
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
OUTCOMES TO DATE AND
FUTURE NEEDS
• Divert inappropriate care from ED
– By using home monitoring devices and Community Health Workers for
support
• Provide a medical home with electronic linkages to entire care
team
– Virtual PHR using grid technology
• Establish a community wide referral network
– Web site, in early development
• Collect de-identified data for analytics
– Not yet robust enough
• Identified the major components to implement and integrate –
much more work to be done
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Still Building Infrastructure
• Evaluating social networking model (i.e. Face Book)
for sharing and notifications
• Standardizing terminology across multiple systems
• Integrating eligibility and financial systems with
clinic systems
• Continue to develop the virtual EMR
• Continue to improve communication and
collaboration tools
• Continue to automate as much as possible
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Summary
• The Need drives the technology
– Not the other way around
• Technology by itself is insufficient
– But it is necessary
• Underlying Foundation is the Medical Home
– Requires sharing of information
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Doing the Impossible—Leveraging Technology to Reduce
Costs and Improve the Quality of Care for the Uninsured
2007 National Congress on the Un and Under-Insured
Dan Castillo, Medical Services Initiative Administrator
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
About Orange County MSI
• Orange County’s state mandated indigent
program
• Serves as the County’s safety net program for
the underserved
• Operates without the benefit of a County
controlled healthcare delivery system
– Public-private partnership
– No County-Employed Physicians
– No County-Run Hospital system
• Annual enrollment of 25,000 patients
• $87 million annual budget
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
By the Numbers
• 22 hospitals reporting admit and discharge data
– Over 10,000 ER admits electronically
reported
– Over 3,000 hospital stay notifications
• 14 Community Clinics connected
• Over 200 ER Physicians connected
• Over 200 Primary Care Physicians connected
• Over 500 Pharmacies connected
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
By the Numbers (cont.)
• Over 5,000 eligibility checks per month by
provider network
• Over 10,000 ER Queries in 12 Months
• Over 2,000 ER Physician notes submitted
• Over 700 e-Referrals to Community Clinics
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
e-fficiencies Result in Cost Savings
• Reduction of inappropriate ER utilization by 11%
over the last quarter
• Hospital cost savings per re-admitted patient is
$2,000
• Duplicate prescription cost savings per patient
per year is $600 (avoidable)
• Diagnostic and ancillary cost savings is $130 per
patient per year
• Improved quality of care:
– PRICELE$$
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
The Bottom Line…Improving Care
• Medical Home linkage (over 12,000 patients
assigned)
• Reduction in prescription errors
• Increased continuity of care
• Increased access to timely care
• Improved outcomes
• Increased patient satisfaction
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
The Dark Ages
• Manual enrollment process with “paper” record
keeping
• More likely to wait over 45 days for eligibility
determination
• Limited medical home linkage
• Less likely to have a regular source of care
• Lack of clinical information at the point of care
• More likely to report they have not received
needed care
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Health IT Renaissance
• Standardized paperless enrollment
• 30% reduction in eligibility staff
• Patient eligibility wait times decreased to less than
30 days
• Balancing Stakeholder ROI with quality patient care
– Enhanced Physician and Clinic reimbursement
through P4P
• Increased ability to monitor and manage program
costs
– Addressed through Case Management
enrollment, patient outreach, and consultation
with Medical Homes.
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
“Need” Drove Technology
The four pillars to our technology initiative:
1. Electronic Eligibility Determination & Enrollment
2. Hospital Census Notification and Tracking
3. ER Connect
4. Clinic Connect
With these technologies, MSI is the most
technologically progressive Safety Net Program
in the State.
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Electronic Eligibility & Determination
A streamlined and automated web-based
enrollment and eligibility determination
System.
• An immediate and automated way to screen
and enroll applicants online
• Workflow approach promoting efficiencies in
management oversight and processor
accountability
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Hospital Census Notification & Tracking
• Collects daily census data electronically from
hospital scheduled batch runs
• Uploads data automatically and provides the
user with a current daily census report in a
web-based environment
• Tracks and displays “Level of Care” and “Length
of Stay” information
• Case Management linkage
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
ER Connect
• Provides usable patient data at the “point of
care”
• Facilitates communication between ER
physicians
• Tracks patient’s utilization activity
• Reduces consumption of the community’s
scarce healthcare resources
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
ER Connect – Patient History Tab
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
ER Connect – Prescriptions Tab
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Clinic Connect
•
It’s an innovative, technology-based, data
communication platform, facilitating the use
of available patient information.
•
It allows Clinic Providers to access patient
information with the goal of enhancing the
health services both “at the point of care”
and for ongoing care management purposes.
•
It’s a patient flow management tool for those
patients referred into the clinic.
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Clinic Connect – Patient Referral Worklist
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Clinic Connect – Patient Summary
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Clinic Connect – Patient Encounter Documented
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
MSI Technology Schema
Referrals
e-Referral
Fiscal
Intermediary
Case Management
Eligibility
Data Accessed
by ERs
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Emergency Room
Critical Success Factors
• End-user was included from the beginning
– Community clinics and ED physicians created it!
• Early adoption by the hospital association
• Proven return on investment
– Reduction in redundant procedures and prescriptions
– Reduction in delays and costs associated with
enrollment
– Efficiency savings to us and our partnering hospitals
from avoided tests
– Increased patient safety
– Better continuity of care
– Improved provider reimbursement
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Current and Future Opportunities
• Additional funding from Federal Govt. (CI)
• OCPRHIO – this is viewed as a potential
backbone for the RHIO in Orange County
• Platform to expand Chronic Care Management
• Easily modified to support e-Referral system
providing access to over 5,000 specialists in OC
• Expansion to other public health sectors such as
County Medicaid that manages ~350,000 lives.
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Closing Remarks
The MSI Program is now a proven leader in
utilizing innovative technologies within
the County health sector
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
The Common End Goal
To Address the issues of serving the Underserved.
– How? – Technology supports Payor and Provider initiated
programs.
– Why? – Increased accountability, enhanced efficiencies,
and most of all improved the quality of patient care.
– Where? – Technology knows no boundaries. It allows our
services to extend our reach across many underserved
populations.
– When? – Now. Both organizations have presented today
what is currently on the ground and operating in their
respective regions.
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
CHRISTUS Objectives - Revisited
• What has CHRISTUS Health, a Provider system, done
with technology?
– The medical home as the foundation
– Share clinical information among providers
electronically – virtual EMR (grid)
– Include touch with the tech
– Continue to install and integrate the necessary
clinical, financial and communication systems
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
OC MSI Objectives – Revisited
• What has Orange County MSI, a Public Health Payor
system, done with technology?
–
–
–
–
Implemented an electronic enrollment system
Deployed an ER-based, patient history, query system
Integrated an electronic referral system
Enhanced the linkage of unattached patients with a
Medical Home
– Improved quality of care
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Whether through a Provider System such as
CHRISTUS Health or a Payor system such as
Orange County MSI, technology has clearly
improved the delivery of health care services,
supported targeted patient programs, increased
the ability to track and manage our transient
population, and has more efficiently utilized
our scarce health care resources.
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured
Questions & Answers
Hank Fanberg
Manager of Research & Development
CHRISTUS Health
Office – (504) 838-1550
E-Mail – [email protected]
Dan Castillo, MHA, FACMPE, CHE
Administrator
County of Orange – Medical Services Initiative
Office – (714) 834-6249
E-Mail – [email protected]
Doing the Impossible—Leveraging Technology to Reduce Costs and Improve the Quality of Care for the Uninsured