Disruptive Collaboration in Healthcare: The Role of Informatics

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1 Disruptive Collaboration in Healthcare: The Role of Informatics Troy Trygstad PharmD MBA PhD Director of the Network Pharmacist Program and Pharmacy Projects Community Care of North Carolina

2 A Disclaimer

3 The Times they are a Changin

4 The End of Trivial Pursuit April 12, 1955 Pediatric Dosing of Dextromethorphan

5 What is a Disruptive Technology? Clayton Christensen MBA DBA Author of the Innovator s Dilemma and Will Disruptive Innovations Cure Health Care (with Bohmer and Kenagy) Healthcare may be the most entrenched, change averse industry in the United States Create then embrace a system where a clinician s skill level is matched to the difficulty of the medical problem Invest less money in high end, complex technologies and more in technologies that simplify complex problems Create new organizations to do the disrupting Overcome the inertia of regulation

6 What is Disruptive Collaboration? Intra or Inter Institutional Data, Process, and Human Resource sharing that creates a cheaper, less complex, and more effective products and services the innovation is not the product or the service, but rather the collaboration itself

7 Ok, but what are we trying to fix?

8

9 Is it Any Wonder Why the Current System Fails? Pharmacy Hospital HH/Rehab/SNF Clinic MTM Comprehensive X MTM Med Rec X X Fully Informed Prescribing Inadequate, Misaligned or Non-Existent Payment Systems for Pharmaceutical Care *Also Incredibly C0st-inefficient in Today s HIT/HIE Environment*

10 Why do we need to fix it?

11 Arithmetic Modified from: Congressional Budget Office June/August 2010: The Long Term Budget Outlook, Page 68. Available at

12 More (and even scarier) Arithmetic Congressional Budget Office June 2009: Chapter 2, The Long Term Budget Outlook for Medicare, Medicaid and Total Health Care Spending, Figure 2-1 Available at

13 Everything Old is New again? (Not Really) Managed Care 1.0: Focus on Unit Cost and Number of Units Supply Side Levers Managed Care 2.0: Focus more on reducing Number of Units -(Particularly Sick Care Units) Demand Side Levers

14 Tenets of Health Reform (Regardless of ACA) Reduced Cost Shifting and Increased Sharing of Risk Increased Focus on Prevention Increased Accountability Increased Cross-Setting and Inter-Entity Collaboration Increased Capture, Exchange and Application of Data (to accomplish all of the above)

15 The Result? Patient-Centered Medical Home The Health Home The Medical Neighborhood The Accountable Care Organization Global Payment and Quality Contracting Shared Savings Contracting

16 Medical Home style Collaborations Medical Home Hospital Pharmacy Physician-Patient Panel Third Party Technology and Analytics Other Clinicians HH/Rehab/SNF

17 What s Informatics Got to Do with It? Informatics to support Supply Side Management Transactions Claims Adjudication/Eligibility Analytics Audits and Recoupment Provider Interface Prior Approval Form/Formulary Consumer Interface None! Informatics to support Demand Side Management Transactions Care Alerts, Intervention Prompting, Logistics Analytics Targeting and Triage Provider Interface Best Practice Clinical Decision Support Consumer Interface Active Participant in Care Team

18 The Need for a Data Composite cool artifacts in collections of.html

19 Data foils cool artifacts in collections of.html

20 360 View of the Patient cool artifacts in collections of.html

21 Lots of foils Needed for Complete Picture Claims Eligibility ADTs Immunizations Prescription Orders Labs

22 Medication Management Data Example Fill History Discharge List Active Chart List Patient Interview Long Term Care List Home Health List

23 Focus on Positive Predictive Value PCP List Discharge List Fill History Napalm Alerting Targeted Alerting Drug A Drug A No Alert Stop Note Drug B Drug B Gap CM Note Drug C Gap Stop Note Drug D Drug D No Alert Start Note

24

25 Whoever put this ad together should get a raise!

26 Disruptive Collaboration Pharmacy Hospital HH/Rehab/SNF Clinic MTM Comprehensive Med Rec MTM Fully Informed Prescribing Involves Multiple provider types involved in multiple settings

27 The Pharmacy Home Project Drug Use gathering Example Ambulatory Case Manager I have a patient with continually elevated HgA1C Patient Those pills upset my stomach and give me gas Medical Chart We ve been prescribing Metformin for a year and a half now Drug Claims It doesn t look like they have been filling any diabetes medications Example of an unmet treatment goal resulting from an adherence related drug therapy problem

28 The Pharmacy Home Project Drug Use gathering Example Institutional/Transition Event (MI, Stroke, MH Crisis) PCP Visit What did they tell you to take and how? (Profile X) Intake Regimen I m on Drug A, Drug B and Drug C (Profile # 1) Hospital Regimen (Medication Administration Record) (Profile # 2) PCP Visit It looks like they told you.and you seem to be doing X Discharge You are supposed to take (Profile # 3) Correct Drug Use Profile Correct Drug Use Profile?

29 Data Use Case: Event-Based Pharmacy Home Process (Hospital Discharge: Medication Reconciliation Plus) Patient Identification Problem Identification Problem Resolution/ Identification Problem/Provider Identification Problem Identification Hospital Transitional Care Manager (TCM) Network Network Pharmacist (PharmD) Home Primary Care Manager (PCM) Network Network Pharmacist (PharmD) Clinic CCNC Physician (PCP) Is Patient Enrolled? Discharge Medication List? Prescription Fill History? Adherence? Patient Medication Taking *Behavior *Active List *Challenges Informatics Center Which Prescribers? Which Problems? Medical Chart Active Medication List? Plan for Resolution. Administrative Claims Data Other Care Team Members Health Information Exchange Provider/Extender Derived Data

30 Collaboration Across Credentials, Setting and Geography Hospital Transitional Care Manager (TCM) Home Primary Care Manager (PCM) Network Network Pharmacist (PharmD) Clinic CCNC Physician (PCP) Meets with Patient, Gathers Discharge instructions, Counsels and Refers to PCM Meets with Patient at Home, Gathers Drug Use inventory, Assessment and Self Management Reviews All Medication Lists (Discharge, Home, Claims) for Discrepancies Visit Scheduled, PCP Receives Problem List and Care Coordination Plan

31 Exchange Only Strategy vs. Co Mural Strategy Health Information Exchange Participant Participant Participant Participant Participant Health Information Exchange Portal Portal Portal Portal Portal Participant Participant Participant Participant Participant

32 Data Repository/Capability that combines Admin and Clinical Data Data must be sourced from all providers in catchment area (including FL!) Data persisted and accessible outside of an encounter Must have Dashboard/Reporting Service to Represent /Make Sense of Data Patient Linkages Attributions, Assignments -Who is Responsible for What? Revenue/Risk Programs/Initiatives Other Providers Surrogates Patient Service Linkages Who acts and on whose orders? Current Utilization Patterns A Maestro Utility Referral and tracking system that goes beyond traditional provider relationships Bi-Directional Tasking and Communication Platform that Supports Collaboration

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