Transcript Kyle Allen - Health Affairs

The Institute for Post-Acute
and Senior Care
Kyle Allen, D.O.
Medical Director, Post Acute & Senior Services, Summa Health
System
Chief, Division of Geriatric Medicine
Professor, Internal and Family Medicine
Northeastern Ohio Universities College of Medicine and Pharmacy
Email: [email protected]
A Comprehensive
Approach
Summa Health
System
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Serves a five
county region in
Northeast Ohio
Seven owned,
affiliated and joint
venture hospitals
Regional network
of ambulatory
centers
240+ employed
multi-specialty
group
A 150,000+
member health
plan
A System-level
foundation
10,000+
employees
Total Net Revenue
of $1.6 Billion
Total Discharges
of 61,000
New ACE Model Applications
Stroke Unit
Applied to
Achieving ACE-like Benefits

Reduced Average Length of stay

Improved ADL function

Decreased discharge to LTC

Increased Patient, Nurse, Physician
Satisfaction
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Changes in process of care:
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The Interdisciplinary ACE Team focused on
geriatrics and chronic care management
Less bed rest
Early discharge planning
Fewer high risk medications
Depression recognized and treated
ACE-like Stroke Unit Results
Risk-Adjusted In-Hospital Mortality Rate for Medicare Stroke Patients
20
18
2001
16
14
1995
1996
1998
1997
2000
1999
12
1996
10
1997
1998
Pre-SU
8
Post -SU
2000
1999
6
2001
4
2
0
1995
1996
1997
1998
Summa
1999
2000
2001
Predicted
Other Quality Improvements
 Increased discharge to home
 Decreased discharge to acute
rehab
 Decreased readmission rate
 Decreased mortality
 Decreased Average Length of Stay
ACE Unit Principles
Lowering Cost of Care
Contribution Margin
DRG
45%
44%
40%
35.4%
35%
National average Summa's average
margin on
margin on
Medicare cases
Medicare cases
127: Heart failure and shock
($1,350)
$866
89: Simple pneumonia and
pleurisy age >17 with CC
($1,517)
$620
($868)
$579
($1,330)
$410
($1,162)
$668
143: Chest pain
30%
25%
ACE Unit
Rest of Hospital
ALOS
88: Chronic obstructive
pulmonary disease (COPD)
182: Esophagitis,
Gastroenteritis and
Miscellaneous Digestive
Disorders Age >17 with CC
4.8
4.75
4.7
 While Summa’s ACE Unit outperforms the rest of
the hospital, the pattern of care has spread to the
rest of the facility and led to significant cost
savings in DRGs with high Medicare populations
4.6
4.5
4.4
4.3
4.2
4.29
4.1
4
ACE Unit
Rest of Hospital
Where Care for Older Adults is
Headed: AD-LIFE and PEACE
 Post-discharge care
management of low
income frail elderly
 Nurse care manager
activation of client
 Collaboration between
a hospital-based
interdisciplinary team,
Area Agency on Aging,
and PCP
 Integration of acute and
long-term care
 AD-LIFE trial is supported by the Agency for Healthcare Research and Quality Grant #
R01 HS014539
 PEACE is funded by the National Palliative Care Research Center
 Both are supported by Summa Foundation