Transcript Recommended Actions Work Group

Welcome!
Howard Epstein, MD, FHM
Chief Health Systems Officer
Institute for Clinical Systems Improvement
A Better State of Health Through the Triple Aim*
* The Triple Aim: Care, Health, And Cost. Berwick DM, Nolan TW and
Whittington J., Health Affairs, May 2008, Vol. 27, No. 3, 759-769.
https://www.icsi.org/_asset/hkt4a4/Accountable-Health-Communities-White-Paper.pdf
https://www.icsi.org/health_initiatives/accountable_health/videos/
$2.5
Trillion
A 2011 Institute of
Medicine report
estimated 30% of
healthcare spending is
non-value added
www.IOM.edu/vsrt
Wedge Model for US Health Care With Theoretical Spending
Reduction Targets for 6 Categories of Waste
1. Failures of Care
Delivery
2. Failures of Care
Coordination
3. Overtreatment
4. Administrative
Complexity
5. Pricing Failures
6. Fraud & Abuse
Source: Eliminating Waste in US Health Care, Berwick, D.,
Hackbarth, A. JAMA. 2012;307(14):1513-1516
Rehospitalization 30 Days after Discharge
20%
Range:
13-23%
$17B
50% no
PCP f/u
Jencks S, Williams MV, Coleman EA. N Engl J Med 2009;360:1418-1428
Hospital Discharge
“Random events connected to highly
variable actions with only a remote
possibility of meeting implied
expectations.”
Roger Resar, MD Senior Fellow
Institute for Healthcare Improvement
Brief History of RARE
• CMS announces penalties
• RARE Planning Committee
• RARE Campaign – Operating Partners
– 83 hospitals
– Supporting Partners: MMA, MNCM, VHA
– > 100 Community Partners
main contributors to avoidable
hospital readmissions
1.
2.
3.
4.
5.
Comprehensive discharge planning
Medication management
Patient and family engagement
Transition care support
Transition communications
Preventable Services: Readmissions
7030
7030
> 28,000
> 78 years!
> $60,000,000.00
www.RAREreadmissions.org
Agenda
 Getting Out and Staying Out: A Patient's Perspective on Reducing Mental Health
Re-Admissions - Melissa Hensley, PhD.
 Family Perspective - Tracey Daniels
 Family Perspective – Sue Hanson
 Recommended Actions for Improved Care Transitions Document – Michael Trangle,
MD, Associate Medical Director, Behavioral Health for HealthPartners Medical Group
 Patient and Family Engagement – Sue Abderholden, Executive Director, National
Alliance on Mental Illness, Minnesota
 Medication Management – Craig Harvey, Director Pharmaceutical Services, Regions
Hospital and Daniel Rehrauer, Clinical Pharmacy Program Manager, HealthPartners
 Comprehensive Transition Planning – Paul Goering, MD, Vice President Allina Mental
Health
 Transition Support - Chris Walker, MSN, RN, MHA Director Inpatient Mental Health
Units & Behavioral Access Nurses
 Transition Communication - Nystrom and Associates
 PPR Data - Mark Sonneborn, MS, FACHE, Vice President, Information Services,
Minnesota Hospital Association
 Team Action Plan
 Wrap Up & Next Steps
Recommended Actions Work Group
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Paul Goering, MD Allina Health
Chris Walker, MSN, RN, MHA CentraCare Health System
Cathy Brouwer, RN Chippewa County Montevideo
Kathy Knight, RN, MA Fairview Health Services
Karen Lloyd, PhD HealthPartners
Terry W. Crowson, MD HealthPartners
Michael A. Trangle, MD HealthPartners
Paul Davis, PhD, LP Lakewood Health System
Jennifer McNertney, MPP Minnesota Hospital Association
Sue Abderholden, MPH National Alliance on Mental Illness
Nancy Houlton, LICSW UCare
Kathy Cummings, BSN, MA ICSI
Joann Foreman, RN, BAN ICSI
RARE Mental Health Collaborative
Planning Committee
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Annie Walsh University of MN Medical Center, Fairview
Jennifer McNertney, Minnesota Hospital Association
Jill Kemper, ICSI
Joann Foreman, ICSI
Kathy Cummings, ICSI
Martha J Aby, DHS
Michael A Trangle, HealthPartners
Nancy Houlton, Ucare
Chris Walker CentraCare
Sue Abderholden, NAMI MN
Terry Crowson, HealthPartners
Janelle Shearer, Stratis Health
Niki Gjeri, UMMC, Fairview
Paul Goering, Allina
Greg Clancy, Allina
Carol LaBine, DHS
Thank You!