Western Maryland Health System Cumberland, Maryland

Transcription

1 Meeting the Challenge of Healthcare Change Western Maryland Health System Cumberland, Maryland

2 Who We Are Western Maryland Regional Medical Center is a 275-bed hospital located in Cumberland opened in 2009 Network of urgent care clinics and physician practices Skilled nursing facility with 88 beds is part of WMHS Designated Trauma Center, Stroke Center and Cardiac Intervention Center by MIEMSS Has the only Open Heart Surgery program west of Baltimore Over 250 physicians and advance practice professionals on staff 2

3 Located in one of the poorest counties in one of the nation s richest states Region s largest employer with 1830 employees $330 Million in operating revenues for FY14 Over $300 million economic impact on the region annually Self-Pay 5% Commercial 12% Medicaid 13% Other 14% Payer Mix Medicare 56% $36.5 million in Community Benefits for FY2014 Part of a newly formed three health system group in western Maryland called Trivergent Health Alliance 3

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5 Unbalanced Utilization of Resources Analysis by Berkeley Research Group revealed 1,972 patients accounted for $140 million annually Common diagnoses among these patients Heart Failure Diabetes COPD Anticoagulation Medications 5

6 Additional Changes Improve chronic care delivery Increase health & wellness activities on a regional basis Focus on better community access Work collaboratively with community partners Create stronger patient engagement 6

7 Triple Aim Coordinating Council Provides oversight of the value-based care delivery process New initiatives are vetted by the Council Membership: Physicians Wellness C-Suite IT Care Coordination Quality Operations 7

8 Addressing Chronic Health Conditions: Evolution of the Center for Clinical Resources 8

9 Congestive Heart Failure Established Congestive Heart Failure Clinic in 2011 Staffed with Nurse Practitioner, RN, and Support Staff Oversight by Cardiologist Educated patients and monitored them to keep them out of the hospital Provided talking scales to help patients monitor fluid gain 9

10 Diabetes Management Began Patients Pharmacists Partnership (P3) for WMHS employees Expanded the role of dietitians Diabetes self-management classes Medical nutrition therapy classes Approval for insurance payments ADA certification Certified Diabetes Educator Created concept of Diabetes Medical Home 10

11 Diabetes Clinic Opens Staffed program with Nurse Practitioner, RN, certified diabetes educator, dietitian, navigator and registrar. Contracted with Johns Hopkins for oversight, consultation and training Started seeing Type 2 patients from our hospital-owned practices and P3 patients Expanded to all practices 11

12 Anticoagulation Medication Clinic Saw growing number of patients Identified problem of quick response when tests showed patients out of range, especially late at night or on weekends Created a clinic where pharmacists see patients Clinic is open during the day, M-F Pharmacists in hospital available 24/7 Outgrew first location in six months; moved to larger space 12

13 Looking at the Bigger Picture Realized patients had multiple chronic conditions Located space in medical office building where all current clinics could be housed Recommended by CFO to plan clinic as a free service Consistent with goals of TPR TPR seed money available Coordinated plans with system objectives Goals of Total Patient Revenue Appropriate Care in Appropriate Setting Reduce admissions/readmissions Triple Aim Coordinating Committee 13

14 CCR Core Services Diabetes Management Chronic Heart Failure COPD Clinic Outpatient Anticoagulation Clinic Medication Therapy Management 14

15 CCR Staffing CRNPs and RNs (disease specific) Pharmacist Dietitian Respiratory Therapist Office Coordinator Intake Coordinator Identifies and addresses social/economic issues Links patients WMHS & community resources Community Health Workers 15

16 High Utilizers Identified high utilizers of hospital services 8 or more visits in a 12-month period Close to 300 patients Worked with IT to develop an alert when they arrive in the ED or are admitted Notifies Care Coordinators and CCR Visit each one while they are here to encourage use of CCR 16

17 Admissions & Readmissions Initiated process where all patients being registered are asked about CCR Alerted when a CCR patient is readmitted Notified when an inpatient is a candidate for CCR Implemented process for Community Health Workers to visit these patients Try to have appointment date for them scheduled before leaving the hospital Diabetic Education Team 17

18 CCR Results So Far Patients Being Followed By the Center for Clinical Resources Diabetic Patients Congestive Heart Failure Anticoagulation Patients 27 % in Admissions 16 % in ED Visits 36% in Admissions 70% in All Hospital Visits Cost Savings/Avoidance: $4.6 million so far Based on patient s experience one year prior to participation in the CCR and at least one year after being managed by CCR 18

19 Overall Results So Far FY2011 FY2014 Change Inpatient Admissions 15,848 11, % Readmission Rate 14.54% 11.58% 20% Inpt Behavioral Health Admissions 1,248 1, % Readmission Rate 20.9% 12.92% 38% ED Visits 55,183 52, % 19

20 Concluding Thought In the last four years, WMHS has become a very different organization by focusing on a value-based care delivery system and one that has been able to embrace the components of the triple aim of health care reform. It wasn t easy in the beginning, but we are now much better positioned for a challenging health care future. Barry P. Ronan, FACHE President & CEO Western Maryland Health System 20

21 Questions? 21