Transcript NORTH MEMORIAL HEALTH CARE Community Paramedicine

NORTH MEMORIAL HEALTH CARE PRIMARY
CARE COMMUNITY PARAMEDICINE
Peter Carlson CMPA
Health workforce innovations
Sept 12-13, 2016
NORTH MEMORIAL HEALTH CARE
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18 clinics (specific to NMHC)
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5 additional clinic systems in ACO
Level 1 trauma services
Multi-state ambulance system
Air care division
BLS services
ALS services
 Critical Care ground
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2 hospitals
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Maple Grove hospital (Maple Grove) 100 bed
North Memorial hospital (Robbinsdale) Metro area 350 bed
The People: Paramedics
• Expands Role not Scope of Practice
• Scope of practice:
• Set by state
• Defined by relationship with Medical Director
• Medications, wound care, education, advanced care
planning, suturing…
• What they are not:
• Home care replacement
• Any service replacement
• Long term solution for most customers
Co-piloting care
I become faint and nauseous during even very minor medical
procedures, such as making an appointment by phone.
- Dave Barry
NMHC CP LAUNCH
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Specific application to NMHC primary care patients
(payor blinded)
Launched October 2012, 1.0 FTE/6 medics
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Integrated into Primary Care network NMHC
Focused Team based care delivery model
EHR access within first 2 months of program (EPIC)
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Current state 4.0 FTE 11 medics=ave 95 visits weekly
EPIC ambulatory hyperspace build
Geographical hubs created for efficiency
Scheduled via EPIC
DAILY SCHEDULE VIEW
CP APPLICATION BY SITE
Percentage of FTE
2014 REFERRAL SOURCE
✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆
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clinic
other
482
17
97%
3%
THE WHO-NMHC’S IHP POPULATION
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IHP/NMHC CP potential
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<2016 = apr 4,500 lives
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2016 = over 20,000 lives
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One of six systems to enter ground floor (yr 1=2013)
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Top three conditions NMHC IHP population
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Depression=32.2 %
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Hypertension= 23.4%
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Persistent asthma= 20.1%
OUR APPROACH TO CARE DELIVERY BY GROUPING
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Care transitions
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Improved experience
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Readmission focus
Increased primary care access
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Chronic disease management
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Increased primary care access
 In home disease monitoring
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Community engagement
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Attribution
Capture
Leakage
Increased primary care access
CARE TRANSITIONS GAP
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Patients not qualifying for in home services (not homebound)
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Patients refusing TCU/LTC
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Patients not accessing primary care in timely fashion
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Approached using Coleman model
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Aligned with North Memorial/Broadway Family Medicine
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Goal of follow up within 48 hours of discharge
Graduate patient within 30 days
Alternative access created (911)
Or no primary care established
Poor primary care relationship established (out of system)
Bariatric surgery example
MEET THE
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Faith Zwirchitz: Director of Nursing
and Professional Practice
Colleen Nadeau: VP Clinical
Operations MGH and Executive
Sponsor
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Andria Ruehl: PCF ICC
Kris Henderson: Director of Acute
Care
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Jo Knight: PCF ICC
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Mary Ellen Cook: Case Manager RN
Sheryl Vugteveen: Manager of
Med/Surg
Mike Choi: Manager of Clinical
Effectiveness
Deborah Warhol: Senior Case
Manager
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Julie Borchert: Social Worker
Emilie Hedlund: Manager
Outpatient Care Coordination
Peter Carlson: Community
Paramedic Manager
Cherry Kiser: Community Paramedic
Scheduler
John Riley: Community Paramedic
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Andrea Dorado: Clinical Social
Worker
Julie Heitzman: Case Manager RN
Sandy Bremer: Assistant Clinical
Manager, ICU
Deb Scheid: Patient Flow
Coordinator
Megan Matack: Pharmacy Manager
Sarah R Johnson: Director of
Clinical Support Services
Robby Moss: Pharmacist
Maura Hamilton: Administrative
Fellow
CHARTING VISUAL FOR CARE TRANSITIONS
Symptoms/Diagnosis
Do you have any new symptoms or problems that have occurred since Our last visit? {YES +++
/NO DEFAULT NO:13103}
Review symptoms if any or delete this
Has anyone called you to notify you of any test results? {YES:16607}
Medications
Have you been able to obtain and take all of the medications from your After Visit Summary
medication list? {YES +++ /NO DEFAULT NO:13103}
Review medications for discrepancies/ Develop a plan to resolve discrepancies
Use of Med box / pill minder / other (How?)
Refills needed? Or barriers to filling medications
Do you have any questions about your medications? {YES +++ /NO DEFAULT NO:13103}
Follow Up Appointments
Do you have a follow up appointment with a physician? {YES +++ /NO DEFAULT NO:13103}
Were all your questions answered? {YES +++ /NO DEFAULT NO:13103}
If PCP visit still upcoming, has Pt written down questions for PCP follow up
IMPACT ON COMPLIANCE
All patients Total Number of patients that Attended PCP Appointment
80
70
67
Total patients
60
54
50
40
Control
Intervention
30
20
13
10
6
0
No Attendance
P-Value = .05
Attended
IMPACT ON COMPLIANCE
NMHC patients Total Number of patients that Attended PCP
Appointment
30
27
25
Total patients
20
15
Control
Intervention
10
7
5
3
1
0
No Attendance
P-value = .019
Attended
IMPACT ON COMPLIANCE
701.1
644
459.8
CHRONIC DISEASE MANAGEMENT
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Infused in all approaches
Heavy emphasis on education
Specialty track for staff
Team integration
• Huddles
• Care conferences
Asthma project (partners)
• MDH
• Primary care
• CDC
• City of MPLS
PEDIATRIC ASTHMA RISK VIEW
assessment
DOCUMENTATION EXAMPLE: PED’S ASTHMA
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Let's Talk Triggers
Known Triggers include: {ASTHMA PRECIPITATING
FACTORS:408}
Obvious allergens in the home: {Asthma allergens:19070}
10 steps for making your home asthma-friendly (with handout)
 Does anyone smoke in the home? Yes, no
Do you have dust-mite covers for mattresses? Yes, no
Have you heard the air-quality report during the weather report? Yes,
no
Has someone dusted this month? Yes, no
Are there pets in the house? {YES:11706}
Have you seen cockroaches in the house? Yes, no
Do you need to use pesticide sprays in the house? Yes, no
Have you noticed mold anywhere? Yes, no
Are you able to ventilate the bathrooms and kitchen? Yes, no
Do you have @HIS@ Asthma Action Plan posted in the home? Yes, no
COMMUNITY ENGAGEMENT: TURNING POINT
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Chem dep center; all male
Staffed 8-12 Mon-Thur
Future telehealth hub/RPM station
Rule 25 for all clients
• MA billable
• Controlled duration of 90 days=care plan
creation
FQHC historical access point
• limited to pre treatment physical
• High ED utilization
VAIL PLACE CLUBHOUSE
Safe & productive environment for members
living with SPMI
 CP on site twice a month performing health
screenings/primary care discussions
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Members can receive primary anywhere in the metro
Vail staff on site at NMHC; 2E
 Education sessions on site; CPR/AED & first aid
 High engagement from CP staff
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2016 REFERRAL SOURCE
✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆✆
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other
375
221
63%
37%
CLINIC/SITE 2016
PAYOR BREAKDOWN 2015
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medicaid
medicare
other
122
259
111
PAYOR BREAKDOWN 2016
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medicaid
medicare
other
65
368
158
STRUGGLES/OPPORTUNITIES

Quantifying impact and associated savings (FFS - VBP)

Data access



Dedicated M&R is a challenge
Actionable data mining
Building documentation (extractible data)

EHR interoperability

Program growth; specific roles

Lab processes

Capitol purchasing

Vehicles, POC, tech growth, etc..
IS IT WORKING? -UTILIZATION
MN Community Paramedicine and Partners
PATIENT STORY #1; AVOIDING AMPUTATION
Before
• Non-healing diabetic wounds
• Told amputation necessary
After
• Amputation off the
schedule>10 months
• No hospitalization/TCU since
• Spending out of pocket for TCU>100
days three consecutive years
• Finding transport three times a week for
CP services started
• Wound care offered in home at
fraction of cost
• Wounds drastically improved
wound care
PATIENT STORY #2;“COMMUNITY ACCESS POINT”
Before
• Seizure disorder resulting in
After
• CPs helped develop plan to
unnecessary 911 calls, trips to
respond to seizures that involved
the emergency department
linking back in to CP on call
(over 100 times per year)
(lanyard patient wears includes
• Lack of coordination between
health systems
• Lack of social/caregiver
direct line to program)
• CPs attended appointments across
multiple sites of care in order to
support to help in managing
enhance communication and
condition
develop shared care plan
• Patient is back at work
QUESTIONS
Peter Carlson, CMPA
Community Paramedic Manager
[email protected]
O: 763-581-5177
C: 763-226-8931
Peter Tanghe, MD
Community Paramedic Medical Director
[email protected]
O: 763-226-6517
C: 612-298-7420