Systemic Challenges That Drive Up Costs

Transcription

1 Systemic Challenges That Drive Up Costs

2 Introductions Facilitator: Aledade Senior Advisor Kelly Conroy also leads the company s Florida Division. Kelly was previously the founding Executive Director of Palm Beach South Florida ACOs, two of most successful physician-led ACOs in the history of Medicare s Shared Savings Program. In her role as senior advisor, Kelly provides strategic guidance, and works with Aledade s top executives to engage doctors, improve care and safety throughout our ACO network, and deliver doctors a complete suite of resources to operate successful ACOs.

3 Introductions Panelists: Mike Shumer is a well-known healthcare innovator and entrepreneur. He is a frequent expert lecturer about the role of innovation and the future of healthcare delivery in our country. Mike has founded and grown many successful companies in the last 25 years, and he is presently CEO of Crucial Care, an innovative retail medical model that efficiently delivers emergency medicine physician services. Crucial Care is one of the 50 fastest growing companies headquartered in Florida, and is garnering a lot of positive attention by showcasing their high quality that yields greater than $1000 of actuarially validated savings for every patient they treat. This equals an impressive $30 million savings per year for each of their facilities.

4 Introductions Panelists: Dr. Hymin Zucker is Chief Medical Officer for Triple Aim Development Group, a Development Group offering a full range of operational and management services to Accountable Care Organizations (ACO), Physicians groups, and Skilled Nursing Facilities. He recently served as the founding Chief Medical Officer of PBACO, a 32,000 Medicare Beneficiary physician-owned, and funded ACO in Florida and was very instrumental in PBACO achieving a savings of $39.57 Million in the Medicare Shared Savings Program (MSSP) in From 1998 to 2012, Dr. Zucker successfully implemented Advance Primary Care models for a publicly traded Provider Service Network with a Medicare Advantage full risk population in excess of 30,000 patients. He was recognized for initiating the first NCQA Patient-Centered Medical Home certified in Florida.

5 Introductions Panelists: Larry is currently the Chief Executive Officer of Physicians Collaborative Trust ACO, LLC, a Florida based MSSP and Advanced Payment ACO. PCT-ACO currently has 13,000 Medicare beneficiaries in the Central Florida area. Larry is also the CEO of HPOF Holdings, LLC, a Maitland, Florida based healthcare company managing 14 Independent Physician Associations (IPAs) - nine multispecialty and five single specialty statewide IPAs in Florida. HPOF Holdings developed a Health Information Exchange (HIE) to provide analytics, care management, and dashboard reporting for ACOs, MSOs, and IPAs. HPOF Holdings also owns and manages an MSO, providing primary care networks for Medicare Advantage Plans under global risk arrangements.

6 Introductions Panelists: Scott Brown is the co-founder and President of A D Vault, Inc., the creator and operator of MyDirectives and MyDirectives MOBILE. MyDirectives, a digital platform used to create, store, update and retrieve emergency, critical and advance care plans, is the only advance care planning EHR module to have been certified for meaningful use under the HITECH Act. MyDirectives has users in all 50 states and over 20 foreign countries, and it was recently named by PC Magazine as one of the 100 best websites. Prior to co-founding A D Vault in 2007, Scott practiced international transactional law and represented a broad range of industries in connection with corporate, securities and commercial matters.

7 Kelly Conroy, Facilitator Systemic-refers to something that is spread throughout, system wide, such as a body, economy, market or society as a whole. Thoughts and solutions to innovate and improve population health. Coordinating care during emergencies Transitions of care between PCP visits Engagement of PCP in Post acute setting Activating the patient

8 Michael Shumer, CEO Crucial Care Care Coordination Matters even During Emergencies

9 Hymin Zucker, M.D., CMO, Insurance Payer & Physician Coach Triple Aim Development Group Transition of Care: What Goes on Between Visits (PCP)

10 Larry Jones, CEO Physicians Collaborative Trust ACO, LLC (PCT-ACO) Primary Care Physicians Must Be Engagaed with Care Transitions (Post-Acute)

11 Systemic Challenges That Drive Up Cost There were 9.0M Emergency Department visits in Florida in 2013 Over 50% of all ED visits were for conditions that were preventable or avoidable through treatment in a primary care setting 54% of Pediatric ED visits were avoidable 49% of adult Ed visits were avoidable Inappropriate ED visits nationally cost healthcare $38B in 2013 Ed visits do not have access to a complete medical history - driving unneeded testing Lack of notification of Admit, Discharge, Transfer to PCP offices; Inappropriate consults by Hospitalists in inpatient setting Outpatient care in an independent ancillary facility cost ¼ of a hospital owned ancillary facility No control over hospital discharge, SNF referrals, Home Health referrals, and patient management of LOS

12 Scott Brown, President MyDirectives Value Based System: Finding What Patients Value

13 Advance Care Planning The Challenge 40% of adult medical inpatients are incapable of making treatment decisions % of nursing home residents cannot make their own medical decisions. Vast majority of critically ill patients cannot participate directly in decision making. Too few people have advance directives; when directives exist, they re inaccessible; and when you can find them, they re of poor quality and essentially useless. Cancer patients who don t have advance care planning are 7x more likely to be placed on a ventilator and 8x more likely to undergo attempts at CPR prior to death.

14 Electronic storage of advance directives, statements of wishes, health care proxies, or other relevant materials either in the patient s electronic health record or an external database holds promise for solving some current problems with these documents. Institute of Medicine 2014 Report on Improving Quality and Honoring Individual Preferences Near the End of Life

15 MyDirectives users can include video and audio files, upload photos, and attach portable orders for medical treatment (DNR, POLST, MOLST, etc.) to their MyDirectives emergency, critical and advance care plan. MyDirectives focuses on the individual s goals, preferences and priorities for medical treatment. It also includes a place to conveniently store physician and caregiver contact information, as well as healthcare payer account information.

16 Providers instantly access the individual s emergency, critical and advance care plan (ECACP) directly in the EMR/EHR or indirectly via an HIE, in either PDF or C-CDA format.

17 Drivers and Trends in Emergency, Critical and Advance Care Planning (ECACP) Increasing number of elderly Americans with frailty, significant physical and cognitive disabilities, multiple chronic illnesses, and functional limitations. Unsustainable growth in costs of the current healthcare delivery system over the past several decades. Federal Legislation Senior Navigation and Planning Act; Medicare Choices Empowerment and Protection Act HHS/CMS Regulations CMS-3310-P (Meaningful Use Stage 3); CMS-1631-P (Physician Fee Schedule); CMS-3260-P (Long-Term Care Facility Reform) Humana, BaylorScott&White Health, Coordinated Care Oklahoma, Chesapeake Regional Information System for our Patients

18 Results of Effective Emergency, Critical and Advance Care Planning (ECACP) ECACP discussions are not harmful to patients, nor do they result in greater anxiety or depression among patients or caregivers. Nursing home residents who engage in ECACP have less frequent hospitalization (less frequent readmissions), improved patient and family satisfaction, and 33% lower costs of care. Patients who engage in ECACP are 3x more likely to have their medical treatment wishes known and followed, and their family members suffer significantly less stress, anxiety, and depression. ECACP and having an advance directive reduces bereaved family members concerns about physician communication or lack of information.

19 Keys To Effective Emergency, Critical and Advance Care Planning (ECACP) Understand and accept that consumers your patients and members want to talk about ECACP. Involve the Primary Care Physician. Start the process early, before frailty, chronic or terminal illness, or a catastrophic health event. Standardize workflows. Leverage technology. Take Away: Value-based payment systems will not work unless providers and payers value what matters to consumers and patients. Making Your Wishes Known with an Advance Care Plan

20 Four Take-A-Ways 1. Care Coordination Matters even During Emergencies 2. Transition of Care: What Goes On Between Visits (PCP) 3. Primary Care Physicians Must Be Engaged with Care Transition (post-acute) 4. Value Based System: Finding What Patients Value (Scott Brown)

21 Thank you!