Transcript KCRA2015.McDill.Stephens.pres_

Healthy Lifestyle Centers
Jo Carol Stephens, MSN, RN, C
Director, Healthy Lifestyle Centers
Tammy Tyillian McDill, MS, CES, RCEP, FAACVPR
Supervisor, Healthy Lifestyle Centers
Beyond Cardiac and Pulmonary Rehab:
Transitioning to Wellness
Better Than A Pill
Better Than a Pill
Cardiac rehab produces a 20-30%
reduction in all-cause mortality, better than
aspirin and comparable to the efficacy of
antiplatelets and beta blockers.
ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and
Non–ST-Elevation Myocardial Infarction
December 9, 2008
Referral to Cardiac Rehab
Every major evidence-based guideline from the
American Heart Association and American College of
Cardiology about the management and prevention of
coronary heart disease provides a Class 1 a level
recommendation for referral to cardiac rehab.
Circulation. 2010; 122: 1342-1350
Entrance to Your Cardiac/Pulmonary Rehab Door?
Less than 20% Attendance
Happy Place
Modifying Lifestyle to Lower CVD Risk
The reduction in major risk factors would
ultimately lead to reduced incidence of CVD,
lower need for evidence-based therapies and
move even more the therapeutic success to
risk factor reduction.
Alfred A Bove, MD, PhD
Past President ACC
Editor-in-Chief, CardioSource
World News
January 2015
CardioSource (continued)
With the time and complexity of knowledge
needed to actively practice behavior
modifications, the whole endeavor MIGHT be
better done with a team of providers, not
necessarily a physician, who can spend the
time needed and who have collective expertise
to analyze individual CVD risk.
CardioSource (continued)
For those patients referred for management
of hyperlipidemia or hypertension, who have
no evident CVD or for patients who have
been treated and need a detailed secondary
preventative program, the “Lifestyle Team”
should be consulted to provide a full package
of therapies and advice on how to minimize
future risk for CV disease.
Not everyone knows what you really do!
What do we differently?
Selling Cardiac Rehab
Turn your service into a product
• Healthy Lifestyle Centers
Create packages
• Phase II
• Lifestyle Medicine (full/half month)
Create new offerings
• Integrative Medicine
Show your value
• Outcomes
Steps in making it happen…
Know your organization’s strategic plan
KentuckyOne Health Strategic Plan
“In a population health model of care, a
provider – such as KentuckyOne Health –
assumes accountability for the cost of health
services and the quality of health outcomes for
defined populations of people. These may be
people in a specific geographic area, who
share a specific diagnosis, or need to manage
a chronic condition.”
Inside KentuckyOne, 2012
KentuckyOne Health Strategic Plan
Wellness, preventive care and access to care will
become more important. Moving ahead, KentuckyOne
will do much more than treat illness.
Matt Gibson, Chief Strategy and Business Development Officer
Steps in making it happen…
Know your organization’s strategic plan
DATA, DATA, DATA
•
Outcomes
•
Volume – Potential Volume
•
N x $100 x 24 visits = $$$$$$$$$
Delivering Measurable Outcomes
2012 Data Pre- and Post- Phase II Cardiac Rehab
Blood Pressure
6%
6%
6%
6%
6%
5%
5%
5%
5%
5%
5%
4%
B/P systolic
70%
B/P dystolic
65%
60%
50%
40%
30%
MET and
Depression
17%
20%
10%
0%
MET
Depression
Delivering Measurable Outcomes
2012 Data Pre- and Post- Phase II Cardiac Rehab
Lipids
14%
13%
12%
10%
8%
7%
6%
4%
2%
3%
2%
0%
0%
Total
HDL
LDL
Trig
Lipid Quiz
16%
16%
14%
12%
10%
8%
Outcome
Improvement
(Ferrens & Powers
Quality of Life)
7%
6%
4%
2%
2%
2%
0%
0%
Quality of
Life
Health
Social
Psych
Family
822 Patients Discharged from JH
With Cardiac Intervention 2012
55%
20%
25%
Steps in making it happen…
Know your organization’s strategic plan
DATA, DATA, DATA
Outcomes
Volume – Potential Volume
N x $100 x 24 =
Cardiologist / Primary Care MD
What can your team do?
Walk with a Doc
Stay engaged with physicians
Walk With A Doc
Physician Education
“Most alarming, however, is that despite the wealth of
data on the benefits of cardiac rehabilitation, the
overall referral rate to cardiac rehabilitation (56%)
was far lower than for any of the other performance
measures studied (which ranged from 84% to 98%),
suggesting that physician awareness about the
benefits of cardiac rehabilitation is lower than for
other interventions.”
Journal of the American College of Cardiology
August 2009
MD Feedback
Steps in making it happen…
Know your organization’s strategic plan
DATA, DATA, DATA
Outcomes
Volume – Potential Volume
N x $100 x 24 =
Cardiologist / Primary Care MD
What can your team do?
Walk With A Doc
Talk to any one who will listen to you
Tell Your Story
Importance of Executive Champion
Be Determined!
Reinvention for the New Era of Health Care
An Investment In Wellness & Prevention
With an investment of $3 million from the
Jewish Hospital & St. Mary’s Foundation, we are
improving and expanding the Cardiac Rehab
infrastructure to create a geographically accessible,
full-service Wellness Program that provides
comprehensive prevention services and disease
management care for all health conditions.
Medical Center Jewish Northeast
Medical Center Jewish Northeast
Sts. Mary & Elizabeth Hospital
Sts. Mary & Elizabeth Hospital
Downtown Medical Center
Downtown Medical Center
Downtown Medical Center
Healthy Lifestyle Center Team
• Registered Nurses
• Chaplain
• Exercise Physiologists
√ Certified in their specialty
• Respiratory Therapists
√ Program certified by
American Association of
• Registered Dietitian
Cardiovascular and
• Licensed Clinical Social Worker Pulmonary Rehab
Healthy Lifestyle Center Services
Cardiac &
Pulmonary Rehab
(Insurance)
Lifestyle Medicine
(Private Pay)
Integrative
Medicine
(Private Pay)
Navigation to
KentuckyOne
Services
Lifestyle Medicine Program
• Private Pay ($75) per month
• Medically supervised
• Contains all Phase II
components except telemetry
• 1-5 days per week
• For people needing
encouragement and support
to meet their wellness goals
• Includes all classes, nutrition
counseling, Tai Chi and yoga
Lifestyle Medicine Program
• Diabetes / Pre Diabetes
• Fibromyalgia
• Overweight
• Depression
• Hypertension/Pre
Hypertension
• Sedentary Lifestyle
• Cancer
• Pulmonary
• Orthopedic
• Neuromuscular
• Stroke
• Osteoarthritis
• Risk Factor Modification
One-on-One Assessment – 1.5 hours
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Review of medical history/surgical procedure
Medications
Physical assessment
Depression assessment (PHQ 9)
Quality of Life (Ferrens and Powers)
Diabetes assessment
Peripheral vascular assessment (ABI)
Recent labs (glucose/cholesterol)
6-minute walk text
Northwestern Dietary Lipid Intake
Identify patient goals using motivational interviewing
Coping Skills Classes
•Journaling
• Rumination
•Relationship boundaries
• Feelings not facts
•Gratitude
• Acceptance
•Finding peace and joy
• Positive thinking
•Laughter
• My mission
•Price of being right
• Guilt
Other Educational Classes
• HTN & salt
• Fat and cholesterol
• Carbohydrates
• Breathing techniques
• Medication & angina
• Dining out
• Exercise
• Smoking cessation
• Metabolic syndrome
• Portion control
Clinical Outcomes
Clinical Outcomes
Participation Volume
500
468
450
400
350
No. of Participants
312
300
250
250
218
200
198
150
117
100
78
59
50
44
41
16
52
21
5
0
FY14
FY15 -Q1 DT
FY15 -Q1
MCNE
Phase II Participants
FY15- Q1
SMEH
FY15-Q1 Total
Lifestyle Medicine Participants
FY15
Annualized
Target FY 2015
Demographics
Gender
Race
80
60
40
71
80
84 88
Participants
Participants
100
23
20
7
4
1
1
0
60
41
40
20
0
White
Black
Unknown
Cardiac Rehab
Asian
Female
Lifestyle Medicine
Cardiac Rehab
Financial Class
5
10
15
20
BLUE CROSS MANAGED…
25
24
MANAGED CARE
18
MEDICAID MANAGED CARE
14
MEDICARE MANAGED CARE
12
OTHER COMMERCIAL
10
OTHER GOVERNMENT
1
MEDICAID TRADITIONAL
1
Lifestyle Medicine
Age
50
30
Participants
0
Male
42
36
40
33
29
30
19
18
20
13
10
1
2
4
3
8
0
20-29
30-39
40-49
Cardiac Rehab
50-59
60-69
70-79
Lifestyle Medicine
80-90
Integrative Medicine
Evidence-Based Integrative Medicine
NIH: National Center for Complementary & Alternative
Medicine (CAM)
Yoga
• Chronic low back pain
• Fatigue
Acupuncture
• Fibromyalgia
• Chronic Pain
Deborah Ballard, MD
Evidence-Based Integrative Medicine
Tai Chi
• Osteoarthritis
• Parkinson
Meditation
• Lower Blood Pressure
• Smoking Cessation
Massage
• Chronic Pain
• Osteoarthritis
Challenges
• Staffing
• Flexibility
• Construction
• Selling the product to internal
and external customers
• Merging insurance-based
program with retail
.)
Thank you!