Transcript view presentation - DC Primary Care Association

Embracing Disruptive Innovation:
Camden Coalition of Healthcare Providers
Natassia Rozario, JD, MPH
Associate Counsel & Associate Director of Policy & Engagement
Camden Coalition of Healthcare Providers
Contents:
1)
2)
3)
4)
5)
Who we are
Why disrupt
Our story
How we embrace innovation
Beyond Camden: Spreading & supporting innovation
Who
we are
c h a p t e r
1
Our Basics
•
•
•
•
13 year old membership non-profit
20 member board
Incorporated non-profit
Approximately 80 full time staff
Our Mission
To improve the health of Camden
residents by enhancing the quality,
capacity, coordination, efficiency,
and accessibility of the health
care system.
Why
Disrupt?
c h a p t e r
2
IRELAND
AUSTRALIA
CZECH REPUBLIC
CANADA
NEW ZEALAND
JAPAN
LUXEMBOURG
POLAND
UNITED KINGDOM
SLOVENIA
SPAIN
GREECE
NORWAY
UNITED STATES
HUNGARY
PORTUGAL
NETHERLANDS
FINLAND
ITALY
BELGIUM
GERMANY
DENMARK
SWITZERLAND
AUSTRIA
SWEEDEN
FRANCE
Countries ranked by amount spent on health expenditures
2009 United States falls in the middle (out of top 26 countries)
Source: American Healthcare Paradox
Social Expenditures
Health
Expenditures
UNITED STATES
SWEEDEN
FRANCE
NETHERLANDS
GERMANY
SWITZERLAND
CANADA
AUSTRIA
DENMARK
PORTUGAL
BELGIUM
GREECE
FINLAND
NEW ZEALAND
IRELAND
ITALY
UNITED KINGDOM
SLOVENIA
SPAIN
NORWAY
AUSTRALIA
HUNGARY
JAPAN
LUXEMBOURG
POLAND
CZECH REPUBLIC
Countries ranked by amount spent on health expenditures
2009 United States spends the most (out of top 26 countries)
Source: American Healthcare Paradox
Social Expenditures
Health Expenditures
FRANCE
SWEEDEN
AUSTRIA
SWITZERLAND
DENMARK
ITALY
BELGIUM
FINLAND
GERMANY
HUNGARY
NORWAY
PORTUGAL
GREECE
SPAIN
POLAND
NETHERLANDS
SLOVENIA
LUXEMBOURG
UNITED KINGDOM
CZECH REPUBLIC
JAPAN
NEW ZEALAND
AUSTRALIA
IRELAND
CANADA
UNITED STATES
Countries ranked by amount spent on social expenditures
2009 United States spends the least (out of top 26 countries)
Source: American Healthcare Paradox
Social Expenditures
Health Expenditures
Total US Spend: $2.3
trillion (2012)
World ranking: Average
at best
Total US Spend: $2.3
trillion (2012)
World ranking: Average
at best
Total US Spend: $2.3
trillion (2012)
World ranking: Average
at best
What can be
learned from
Camden?
Who has been hurt the most by the system?
ESRD
Renal carcinoma
HEP B
Meet Joe.
Hypertension
Hyperlipidemia
Peripheral vascular dx
Glaucoma
Asthma
Sleep anemia
9 EDs=
$4,500
6 months
1 Inpt
$10k
2 Inpt
$10k
3 Inpt
$10k
4 Inpt
$10k
Total costs= $64,500
5 Inpt
$10k
6 Inpt
$10k
6 Inpts=
$60.000
Who has been hurt the most by the system?
ESRD
Renal carcinoma
HEP B
Meet Joe.
Hypertension
Hyperlipidemia
Peripheral vascular dx
Glaucoma
Asthma
Sleep anemia
9 EDs=
$4,500
6 months
1 Inpt
$10k
2 Inpt
$10k
3 Inpt
$10k
4 Inpt
$10k
Total costs= $64,500
5 Inpt
$10k
6 Inpt
$10k
6 Inpts=
$60.000
Who has been hurt the most by the system?
ESRD
Renal carcinoma
HEP B
Meet Joe.
Hypertension
Hyperlipidemia
Peripheral vascular dx
Glaucoma
Asthma
Sleep anemia
9 EDs=
$4,500
6 months
1 Inpt
$10k
2 Inpt
$10k
3 Inpt
$10k
4 Inpt
$10k
Total costs= $64,500
5 Inpt
$10k
6 Inpt
$10k
6 Inpts=
$60.000
Who has been hurt the most by the system?
ESRD
Renal carcinoma
HEP B
Meet Joe.
Hypertension
Hyperlipidemia
Peripheral vascular dx
Glaucoma
Asthma
Sleep anemia
9 EDs=
$4,500
6 months
1 Inpt
$10k
2 Inpt
$10k
3 Inpt
$10k
4 Inpt
$10k
Total costs= $64,500
5 Inpt
$10k
6 Inpt
$10k
6 Inpts=
$60.000
Who has been hurt the most by the system?
ESRD
Renal carcinoma
HEP B
Meet Joe.
1 ER
$500
2ER
$500
1 Inpt
$10k
3ER
$500
2 Inpt
$10k
4ER
$500
5ER
$500
3 Inpt
$10k
Hypertension
Hyperlipidemia
Peripheral vascular dx
6 months
Glaucoma
Asthma
Sleep anemia
9 EDs=
$4,500
6ER
$500
7ER
$500
4 Inpt
$10k
Total costs= $64,500
8ER
$500
5 Inpt
$10k
9ER
$500
6 Inpt
$10k
6 Inpts=
$60.000
Who has been hurt the most by the system?
ESRD
Renal carcinoma
HEP B
Meet Joe.
1 ER
$500
2ER
$500
1 Inpt
$10k
3ER
$500
2 Inpt
$10k
4ER
$500
5ER
$500
3 Inpt
$10k
Hypertension
Hyperlipidemia
Peripheral vascular dx
6 months
Glaucoma
Asthma
Sleep anemia
9 EDs=
$4,500
6ER
$500
7ER
$500
4 Inpt
$10k
Total costs= $64,500
8ER
$500
5 Inpt
$10k
9ER
$500
6 Inpt
$10k
6 Inpts=
$60.000
Who has been hurt the most by the system?
ESRD
Renal carcinoma
HEP B
Meet Joe.
1 ER
$500
2ER
$500
1 Inpt
$10k
3ER
$500
2 Inpt
$10k
4ER
$500
5ER
$500
3 Inpt
$10k
Hypertension
Hyperlipidemia
Peripheral vascular dx
6 months
Glaucoma
Asthma
Sleep anemia
9 EDs=
$4,500
6ER
$500
7ER
$500
4 Inpt
$10k
Total costs= $64,500
8ER
$500
5 Inpt
$10k
9ER
$500
6 Inpt
$10k
6 Inpts=
$60.000
Who has been hurt the most by the system?
ESRD
Renal carcinoma
HEP B
Meet Joe.
1 ER
$500
2ER
$500
1 Inpt
$10k
3ER
$500
2 Inpt
$10k
4ER
$500
5ER
$500
3 Inpt
$10k
Hypertension
Hyperlipidemia
Peripheral vascular dx
6 months
Glaucoma
Asthma
Sleep anemia
9 EDs=
$4,500
6ER
$500
7ER
$500
4 Inpt
$10k
Total costs= $64,500
8ER
$500
5 Inpt
$10k
9ER
$500
6 Inpt
$10k
6 Inpts=
$60.000
Who has been hurt the most by the system?
ESRD
Renal carcinoma
HEP B
Meet Joe.
1 ER
$500
2ER
$500
1 Inpt
$10k
3ER
$500
2 Inpt
$10k
4ER
$500
5ER
$500
3 Inpt
$10k
Hypertension
Hyperlipidemia
Peripheral vascular dx
6 months
Glaucoma
Asthma
Sleep anemia
9 EDs=
$4,500
6ER
$500
7ER
$500
4 Inpt
$10k
Total costs= $64,500
8ER
$500
5 Inpt
$10k
9ER
$500
6 Inpt
$10k
6 Inpts=
$60.000
Who has been hurt the most by the system?
ESRD
Renal carcinoma
HEP B
Meet Joe.
1 ER
$500
2ER
$500
1 Inpt
$10k
3ER
$500
2 Inpt
$10k
4ER
$500
5ER
$500
3 Inpt
$10k
Hypertension
Hyperlipidemia
Peripheral vascular dx
6 months
Glaucoma
Asthma
Sleep anemia
9 EDs=
$4,500
6ER
$500
7ER
$500
4 Inpt
$10k
Total costs= $64,500
8ER
$500
5 Inpt
$10k
9ER
$500
6 Inpt
$10k
6 Inpts=
$60.000
Cost Breakdown in Camden
Total revenue to hospitals for Camden residents
$108 million per year
•
•
•
•
Most expensive patient $3.5 million
30% hospital receipts = 1% patients
80% hospital receipts = 13% patients
90% hospital receipts = 20% patients
Embracing
Innovation
our story
c h a p t e r
3
The
Beginning
Embracing
Innovation
how we do it
c h a p t e r
4
How we embrace
change: Our Theory
of Change
How we embrace
change:
Collaboration
Governance
•
•
•
•
•
•
•
•
Board of Directors
Executive Committee
Quality Committee
Finance Committee
HIE Committee
CEO Roundtable
Care Coordination Meetings
Community Advisory Council
Our Board
PCPs
Hospitals
Home
Health
Consumer &
Community
Organizations
•
•
•
•
Fairview Village
Dr. Roman Acosta
Reliance
St. Luke’s Catholic
Medical Services
Behavioral
Health
Social Service
Current
Model
1) We focus on the sickest, most frequently
hospitalized patients.
1) We focus on the sickest, most frequently
hospitalized patients.
2) City’s hospitals and practices share
information to create a data-rich
environment.
1) We focus on the sickest, most frequently
hospitalized patients.
• We focus on the sickest, most frequently hospitalized
2) City’s hospitals
and practices share
patients.
information• City’s
tohospitals
create
a
data-rich
and practices share information to create a
data-rich environment.
environment.
• We use that data to understand the right problems at the
right time in the right settings all across the city.
3) We use that data to understand the right
problems at the right time in the right
settings all across the city.
Well-coordinated,
Patient-centered
care
TRIAGE
BEDSIDE ENGAGEMENT
INITIAL CARE PLANNING
HOME VISIT
ACCOMPANIMENT
562
Our care management
team has worked with
562 patients
6,911
home visits
1,925
bedside engagements
29,364
staff hours spent with and
on behalf of patients
93%
30%
of our enrolled
clients are taking
5+ medications
have self-reported
depression and/or
anxiety
90%
26%
have 4 or more
chronic
conditions
are homeless
during enrollment
337
graduated patients
Practice and
Community
Engagement
Practice Engagement
Citywide Care Management Meetings
Practice Engagement
Community Partners
Over
35,000
capitated patients monthly
3,985
individual patients triaged
since beginning of ACO
3,768
provider visits scheduled
7,038
Follow up phone calls
Goal:
All patients
hospitalized in
Camden will be
reconnected with
primary care
within 7 days of
discharge.
CITYWIDE
INVESTMENTS
Percentage of patients reconnecting with primary care
within 7 days of discharge
26%
NOV 2014
42%
AUG 2015
Spreading & Supporting
Innovation
Beyond Camden…
c h a p t e r
5
Building the field &
the movement
1)
2)
3)
Medicaid ACO Demonstration Project
Statewide Coalition
National Center
1) Medicaid
ACO
Demonstration
Project
The Medicaid ACO is special
Because it’s a community based model of
healthcare delivery that . . .
Encourages a group of docs and
hospitals in a community
Tosdas
work
together
with shared data
& public input
T
Deliver
Better care
@
Lower costs
Under the model,
if we can improve quality and reduce costs, then…
It’s possible that the community . . .
Can share in
the cost
savings
sdas
&
Re-allocate
funds
T
to initiatives that
matter to the
community.
What do we mean by better care?
We’re focusing on
Maternal
&
was
Child
Health
Access to
Primary
Care
Patient
Satisfaction
What do we mean by lower costs?
-Projected Cost
Shared Savings
-Actual Cost
Cost
Was$
Time
Projected
Actual
$
2) Statewide
CoaiItion
POLICY AGENDA
• Housing First
• Transportation
• Community-based (not telephonic) care
coordination
• Integrated behavioral health
• Integrated data systems
• Medicaid ACO
3) National
Center
The future