Honored to Serve the Entire Delmarva Peninsula. Karen Poisker, MSN, MBA, NEA-BC Vice President Population Health

Transcription

1 Honored to Serve the Entire Delmarva Peninsula Karen Poisker, MSN, MBA, NEA-BC Vice President Population Health

2 Back to the Future And Why We re Here

3 The Past 1800 s Movement to insure workers 1930 s Insurance payment to medical providers 1965 Title XVIII of Social Security Act all Americans 65 and over (Lyndon B. Johnson (D)) 1960 s Rapidly increasing Medicare expense 1973 HMO Act (Richard M. Nixon (R)) 1983 DRG Reimbursement pre set rate regardless of LOS (Ronald Reagan (R)) 1986 EMTALA (Ronald Reagan (R)) 1997 Balanced Budget Act (Bill Clinton (D)) 2010 The Patient Protection and Affordable Care Act - ACA

4 Healthcare Trends and Implications Over the Next Five Years 1. The transformation of US hospitals to a new business model. 2. The expansion of the hospital role to include community wellbeing. 3. The focus on quality as long-term strategy to drive down healthcare costs. 4. The emergence of clinically integrated provider networks. 5. The development of state health insurance exchanges. 6. The volatility in the credit markets. 7. The aging of the baby boomers. 8. The increase in employment of physicians by hospitals. 9. Increasing scrutiny, compliance and oversight. 10. Political issues Source: SHSMD 2012 Futurescan; 2013 AHA Environment Scan

5 ACA Objective = Triple Aim 1. Improving the experience of care HCAHPS 2. Improving the health of populations Patient Centered Medical Homes, Population Health 3. Reducing per capita costs of health care Health care costs ~ 20% GDP

6 The Maryland Experiment! Innovation in the Delivery of Quality Care Historic Proposal Approved to Redefine Hospital Care in Maryland Current State Fee for Service People Care Volume-Based Future State Global Payment at Risk Population Health Management Value-Based Maryland Will Limit Hospital Charges Statewide By John Tozzi January 13, 2014 Maryland just became the biggest petri dish in America s experiment to contain health-care costs. The state will limit how much money hospitals take in: Over the next five years, it will try to keep hospital charges from growing faster than the average growth rate of Maryland s economy, saving Medicare $330 million.

7 Traditional: Fee-for-Service Hospital Doctors Patients

8 The Future: Global Payment / At Risk A Unified Approach to Care Management Employers Patients Medicare & Medicaid? Health Care Company? Embracing the Value of Partnerships Hospitals Doctors Surgery Centers Home Health Nursing Home Others

9 People Care to Population Care 9

10 Payor Lives % of Total Commercial 12,155 38% Medicaid 9,434 30% Medicare 6,775 21% Exchange 640 2% Uninsured 2,780 9% Total 31, % Payor Lives % of Total Commercial 47,909 47% Medicaid 28,153 27% Medicare 15,833 15% Exchange 2,162 2% Uninsured 8,903 9% Total 102, % Payor Lives % of Total Commercial 9,082 36% Medicaid 7,755 32% Medicare 3,965 16% Exchange 637 3% Uninsured 3,127 13% Total 24, % Demographics 2015 Estimated Payor Mix Payor Payor Lives % of Total Commercial 90,939 41% Medicaid 53,821 24% Medicare 54,134 25% Exchange 4,906 2% Uninsured 16,989 8% Total 220, % Payor Lives % of Total Commercial 26,330 51% Medicaid 9,889 19% Medicare 12,176 23% Exchange 840 2% Uninsured 2,844 5% Total 52, % Lives % of Total Commercial 13,713 40% Medicaid 4,928 15% Medicare 7,566 23% Exchange 1,327 4% Uninsured 5,871 18% Total 33, % Source: Truven Health Analytics, MapPoint

11 Demographics 2015 Total Population Density by Zip Code Findings: Berlin, Millsboro and Salisbury have a high density population and a favorable payor mix. Zip City 2015 Population Percentage of: Medicaid & Uninsured 45% 42% 30% Salisbury 70, Millsboro 26, Seaford 24, Berlin 22, Lewes 21, Milford 19, Georgetown 19, Cambridge 17, Laurel 15, Rehoboth 13, Delmar 12, Ocean City 12, Princess Anne 11, Milton 11, Bridgeville 9,210 50% 30% 26% 21% Population Density Source: Truven Health Analytics, MapPoint

12 Demographics Projected Population Growth by Zip Code Findings: The fastest growing areas in absolute growth over the next five years are East Salisbury and the Millsboro area. City 5 Year Growth Total Pop. Projected Population Growth Salisbury 2,476 Millsboro 2,094 Lewes 1,829 Rehoboth Be 1,277 Seaford 1,017 Milton 957 Georgetown 830 Ocean View 826 Milford 818 Ocean City 768 Easton 678 Delmar 621 Selbyville 580 Laurel 569 Bridgeville 519 Source: Truven Health Analytics, MapPoint

13 Demographics 2015 Medicare 65+ Population Density by Zip Code Findings: Salisbury, Lewes, Millsboro and Berlin have the highest concentration of seniors Medicare Projected Population Zip City Medicare Population 5 Year Growth Salisbury 10,051 1, Lewes 7,158 1, Millsboro 7,092 1, Berlin 6, Seaford 4, Rehoboth 4, Milford 3, Cambridge 3, Ocean City 3, Georgetown 2, Selbyville 2, Laurel 2, Ocean View 2, Milton 2, Delmar 1, Source: Truven Health Analytics, MapPoint

14 National Market Demand / Trends Findings: As the population continues to age and develop comorbidities, behavioral health is projected to increase. Legislation and expansion in federal and state initiatives will continue to grow behavioral health. In addition, the continued evolution and emphasis of lower-acuity care delivery models places a greater emphasis on outpatient behavioral health services. Outpatient Behavioral Health is Projected to Grow Legislation Mental Health Parity and Addiction Parity Act- law requires employer-sponsored health plans to provide coverage for behavioral health and addiction services consistent on the level with other health conditions Accountable Care Act: Expansion of Medicare and Medicaid Funding for Behavioral Health Increase in Block Grant Funding: (CCBHC) Certified Community Behavioral Health Clinic $1.1 Billon. Payors are encouraging outmigration of inpatient behavioral health services to lower-cost outpatient locations. Earlier detection by primary care means that more patients can be treated in lower-acuity outpatient sites. Demographics: as our population ages, the volume of individuals diagnosed with behavioral health disorders will increase. Outmigration of Services: innovations in the care delivery model and advances in screening and diagnosis are contributing to outmigration of services. Source: 2015 The Advisory Board Company

15 National Market Demand / Trends Findings: Nationally 20% of adults are diagnosed with a mental illness, of which only 45% of these adults are receiving care. There is a shortage of behavioral health providers of 6.6K. In addition, the cost of not treating behavioral health has increased our nation s health care costs by an estimated $48 billion. Nearly one in five- 20% of adults in the U.S is diagnosed with a mental illness, but fewer than half of patients referred to mental health services receive subsequent treatment. Behavioral health comorbidities significantly impact a patient s total cost of care, and have been attributed $48 billion in avoidable annual spending costs. Many communities in the nation struggle to maintain an adequate behavioral health workforce given provider shortages and inconsistent or low levels of reimbursement. Source: 2015 The Advisory Board Company

16 National Market Demand / Trends Findings: Gender and age are important factors to consider when examining patterns of behavioral health. Patterns of substance use vary by age, with these rates generally declining as people grow older. National Patterns of Behavioral Health Half of adult mental illness begins before the age of 14. Suicide is the third leading cause of death in youth. Alcohol and substance abuse is the high for the following age groups: 28.5% for people ages 18 to % for people ages 21 to % of youth ages 12 to 17 had a major depressive episode in the last year, and only 41% received treatment. About 18.7% of young adults ages 18 to 25 reported a mental illness in the past year. Approximately 25% of older adults (65+) have some type of behavioral health issue, typically depression not associated with the aging process. Source: The Substance Abuse and Mental Health Services Administration

17 State Market Demand / Trends Maryland s Behavioral Health Crisis Findings: Maryland is experiencing an increased demand for Behavioral Health and Addiction-related services, flooding hospital emergency departments. From 2013 to 2014, drug and alcohol-related intoxication deaths in Maryland jumped 21%. From 2010 to 2014, substance abuse and mental health visits to Maryland hospital emergency departments spiked by 34%. 21% Increase in Drug and Alcohol Related Deaths 34% Increase in Substance Abuse and Mental Health Visits to the Emergency Department Source: 2016 Maryland Hospital Association

18 State Market Demand / Trends Findings: Maryland is experiencing a Behavioral Health & Substance Abuse crisis. Maryland Substance Abuse-Related ED Visits Grew by 46%. Mental Health-Related ED Visits Grew by 29%. 100,000 80,000 60,000 40,000 20,000 0 Maryland ED Visits Substance Abuse 66,383 73,898 84,337 89,519 96, Hospital and physician capacity is strained, three state psychiatric facilities have closed in the last decade and less than twothirds of general hospitals in Maryland have psychiatric units. Source: 2016 Maryland Hospital Association 220, , , , , , ,000 Maryland ED Visits - Mental Health 161, , , , ,

19 State Market Demand / Trends Age-Adjusted ED Visits for Drug and Alcohol Related Incidences Source: Maryland Department of Health and Mental Hygiene Source: 2014 PRC Professional Research Consultants 19 Drug and Alcohol-Related Emergency Department Visits in Maryland

20 Regional (Wicomico, Worcester, Somerset) Market Demand / Trends Findings: Maryland s lower shore is experiencing a behavioral health and addiction crisis. Change Between Did you Know? A Significant % of Admissions Involve Behavioral Health 23% percent - Atlantic General 25% percent - McCready Health 25% percent - Peninsula Regional Medical Center 45% percent University of Maryland at Dorchester Wicomico: Overdose deaths have risen above homicide rates. Worcester: Death rate from opioids and heroin overdoses same as Baltimore County. Somerset: Increase in drug & alcohol-related, heroin-related and fentanylrelated deaths. Source: 2016 Maryland Hospital Association

21 Findings: Professional Research Consultants (PRC) 2014 self-reported mental health and substance use survey results (for Wicomico and Worcester County) are similar to and reflect national response rates. PRC indicates that the National Institute of Mental Health estimates that in any given year 13 million adults or approximately 1 in 17 have a seriously debilitating mental illness. Mental health is the leading cause of disability in the United States and Canada. Suicide is the 11 th leading cause of death in the United States, accounting for over 30,000 deaths annually. Regional (Wicomico, Worcester, Somerset) Market Demand / Trends 2014 PRC Community Health Needs Assessment (Wicomico & Worcester Counties) Self-Reported Mental Health: 12.9% of adults believe that their overall mental health is fair to poor (similar to national responses). 18.1% of adults have been diagnosed as having a depressive disorder (similar to national responses) 25.3% of adults have had two or more years in their lives when they felt depressed or sad on most days (chronic depression). Self-Reported Substance Use: 4.7% of adults are chronic drinkers (similar by county and nationally) 18.1% of adults are binge drinkers (similar to MD and nationally) 3.9% of adults acknowledge using an illicit drug in the past month (similar to the proportion found nationally) Source: 2014 PRC Professional Research Consultants

22 Estimated Prevalence Chronic Depression Findings: Within our primary service area it is estimated that approximately 27,700 individuals or 15% of the population has Chronic Depression. Of these areas, those that have high concentrations (greater than average) of chronically depressed populace include: Nanticoke Pocomoke Deal Island Delmar Snow Hill Index of Concentration Source: Truven Health Analytics

23 To be a world class Behavioral Heath care continuum through community partnerships and innovation.

24 Adventist & Peninsula Regional Behavioral Health Services PRMC Behavioral Health Treatment Programs PRMC 12 Bed Inpatient Behavioral Health Unit- provides the highest level of care for adults, who are in extreme crisis and potentially a threat to themselves or others. PRMC Partial Hospitalization Program (PHP)- Is a relatively new program (2 years) for adults and can be either a half or full day over a period of several weeks. PHP is designed for individuals who would typically require inpatient acute care but are not suicidal. This treatment alternative reduces readmissions and is clinically and financially viable. PRMC Outpatient Psychiatric Treatment- This treatment program is Adventist directed and staffed. The treatment consists of outpatient psychiatric counseling with a primary emphasis placed on medication management. PRMC Emergency Room- Is supported by a hospital-based psychiatric emergency response team, (PERT) and licensed clinical social workers. PRMC Electroconvulsive Therapy- This is an outpatient program of Peninsula Regional.

25 Adventist & Peninsula Regional Behavioral Health Services Forming Behavioral Health Network Alliances Adventist Behavioral Health and Peninsula Regional Medical Center entered into an agreement in 2014, to jointly recruit psychiatrists and develop a division of labor between the two institutions. The goal of the agreement is to increase access to both adult and child and adolescent services in Salisbury and Cambridge. Peninsula Regional has engaged Adventist to be the active manager of PRMC s Behavioral Health Service Line. The two institutions are currently developing and coordinating programmatic services and protocols, for adult and adolescent behavioral health services in Salisbury and Cambridge. These services include, inpatient and outpatient psychiatric treatment, partial hospitalization, as well as residential treatment.

26 2.1 Health, wellness, and chronic disease management 2.11 Establish Behavioral Health Services as part of a larger health, wellness, and chronic disease management system. Develop and establish Transitional Care Nurse role for high-risk, highutilization patients. Explore providing Behavioral Health assessment in PCP offices either by inperson service or tele-medicine. Explore Behavioral Health assessment for all PRMC/PRMG patients. Assist in expansion of depression screening in Emergency Department for patients with chronic somatic complaints (PHQ-9).

27 3.1 Continue expanding a consumer-oriented ambulatory network while delivering contemporary care Continue to develop ambulatory care options Explore development of Intensive Outpatient Program (IOP) as a step-down from PHP. Explore Transcranial Magnetic Stimulation (TMS). Recruit and onboard a minimum of 1 FT inpatient adult psychiatrist to alleviate on-call burden. Develop an aggressive, on-going recruitment strategy for psychiatrists. Evaluate the use of psychiatric nurse practitioners in Behavioral Health.

28 3.2 Develop Affiliations and Partnerships 3.21 Expand Behavioral Health services on the eastern Shore by partnering with existing providers. Expand addictions services on the Lower Eastern Shore Develop in partnership with Adventist HealthCare, a business plan for child and adolescent Inpatient services. Explore the addition of adolescent PHP services. Expand Outpatient Wellness Clinic services to include psychiatry for adults as well as individual, group, and family therapy for children, adolescents, and adults. Explore additional partnership opportunities with Adventist Behavioral Health and Wellness Services.

29 Providing Health Care Since 1897 Preparing for Future Generations 29