Transcript Transformational Partnerships between Health Systems and

Strategic Investment in Shared Outcomes:
Transformative Partnerships between
Health Systems and Communities
A Convening of a National Health Systems Learning Group
and Senior Health System Leadership
US Dept of Health and Human Services
Washington, DC
April 4, 2013
Welcome & Call to Order
Heidi Christensen
Center for Faith-based and Neighborhood Partnerships
Department of Health and Human Services
White House Greeting and Welcome
Carole Johnson
White House Domestic Policy Counsel
HHS Welcome and Introduction
Acacia Salatti
Acting Director,
Center for Faith-based and Neighborhood Partnerships,
Department of Health and Human Services
Howard K. Koh, M.D., M.P.H.
.
Assistant Secretary of Health
US Department of Health and
Human Services
Setting The Stage:
Making The Business Case For Partnering
With Communities To Transform
Population Health
Nancy Schlichting
Chief Executive Officer,
Henry Ford Health System,
Detroit MI
Sew Up Safety Net, Henry Ford Health System
An Ensemble Of Practices:
Briefing On The Health Systems
Learning Group’s Discovery
Gary Gunderson, MDiv, DMin,DDiv
Vice President Faith and Health,
Professor of Public Health Science and Divinity
Wake Forest Baptist Medical Center
An Ensemble Of Practices:
Briefing On The Health Systems
Learning Group’s Discovery
Kimberlydawn Wisdom, MD, MS
Senior Vice President
Community Health & Equity
and Chief Wellness Officer
Henry Ford Health System
U.S. Surgeon General, HSLG meeting in Detroit, Oct. 2012
Transformative Strategies from
the Top of the Mission to the
Bottom Line
•S h i f t i n g u n m a n a g e d c h a r i t y c a r e i n t o s t r a t e g i e s
for community health improvement
•I n t e g r a t i n g c a r e t o a d d r e s s s o c i a l l y c o m p l e x
residents at the neighborhood level
•E n g a g i n g
communities in transformative
partnerships with shared accountability
Shifting Unmanaged Charity Care into
Strategic Community Health Improvement
Rick Rawson, Chief Executive Officer
Loma Linda University Medical Center Murrieta
Dora Barilla, Dr.PH,MPH,CHES
Director, Community Health Development
Garden on the Go@, IUHealth
Unmanaged Charity Care
“We have evaluated the primary focus of our ‘acute
care’ role and committed to reclaim our original
purpose, that of being trusted community partners in
improving health.”
“We have a history of doing what is needed before it is
required, incented, or penalized.”
Health Systems Learning Group (HSLG) Monograph, April 4, 2013
Quadruple Aim?
Medicare, Medicaid and Mercy (Uninsurable)
Improve the experience of care
2. Improve the health of populations
3. Reduce per capita costs of health care
4. Reduce health disparities
1.
Build a Population and Community
Health Infrastructure
Upstream Design
of the Primary Care Network
Partner with Individuals, Families, and
Community Agencies
Financial Management: Design Economic
Models that Fit our Purpose
Digital and Data Infrastructure
Census Demographics
Health Status Indicators
Service Utilization
Primary Care Network Design
Community Assets
Market Potential
Bridge Clinical Care Management to
Community-Based Prevention
Discussion
 What do you view as critical
institutional readiness?
 What kind of help can we
provide to one another to help
accelerate that readiness?
Integrating Care To Address
Socially Complex Residents At
The Neighborhood Level
Kristen Peachey, MSW, MDiv, DMin
Director, Congregational Health Partnerships
Co-Director, The Center for Faith and
Community Health Transformation
Advocate Health Care
CLOCC, Advocate Health Care partner
Social Determinants of Health
When the external becomes internal:
How we internalize our environment
Allostatic Load
Inadequate
Transportation
Long
Commutes
Stress
Stress
Stress
Housing
High
DemandLow Control
Jobs
Stress
Lack of
access to
stores, jobs,
services
Stress
Lack of social
capital
Stress
Crime
Source: Anthony Iton, MD, JD,
SVP, The California Endowment
Social Complexity
Is Powerful
Culture Shift
 From “Individual” to “Complex People in
Socially Complex Communities”
 From bearing the load alone to
collaborative, cross-sector solutions
 From certitude to curiosity
CLOCC—
Consortium to Lower Obesity
in Chicago Children
•C o n v e n e d B y L u r i e C h i l d r e n ’ s H o s p i t a l O f C h i c a g o
•B r o a d C o l l a b o r a t i v e N e t w o r k A c r o s s S e c t o r s — 3 0 0 0
Participants Representing 1200 Organizations
•D a t a - d r i v e n , E v i d e n c e - b a s e d , C a p a c i t y B u i l d i n g
•C o l l a b o r a t i v e W o r k G r o u p s - - e n v i r o n m e n t a l C h a n g e ,
Public Education, Advocacy, Research, Outcome
Measurement, Program Evaluation
•2 % D e c r e a s e I n O b e s i t y I n C h i c a g o ’ s C h i l d r e n I n 5
Years.
Integrating Care To Address
Socially Complex Residents At
The Neighborhood Level
Margaret Sabin
President and CEO,
Penrose St. Francis
Health System
Sew Up Safety Net for Women and Children, Henry Ford Health System
Partnering to Serve the Community
 Partners: Penrose - St. Francis
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Health Service and Faith
Communities
Mission: “Preach, teach and
heal”
Church touches people at their
most critical junctures
Church holds a deep
understanding of the link
between one’s spirituality and
well being
Church members are
challenging their leaders to
redefine their ministry of
health
Partnering to Serve the Community
 Healthy Church Initiative started
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Fresh look at their health
ministry by building around
wellness rather then disease and
death
Preach on the relationship
between one’s spirituality and
health
Administer “health tool” to
congregation and show results
Proven toolkit of resources to
continue engagement
Provide ongoing support
Partnering to Serve the Community
 Partners: Local hospitals and
fire department.
 Goal: Decrease unnecessary
911 calls and hospital ED visits.
 Paramedics visit patient’s home
completing home safety visits,
medication review, education
and coordinating services with
their PCMH.
 Ongoing evaluation to fill in
gaps of care.
Partnering to Serve the Community
 Partners: Penrose - St. Francis
Health Services, Old North End
Neighborhood
 Included pre and post health
screenings, health risk assessment
survey, 1:1 coaching and access to
our classes.
 Total of 289 participated, 203
completed (70%)
 Improvements validated:
Risk Categories improved in
BMI by 15%, Blood pressure by
35% and Total Cholesterol by
15%.
Partnering to Serve the Community
 Partners: Penrose - St. Francis
Health Services, its employees and
partner physicians
 Tiered network benefit design &
paid PMPM to focus on specific
chronic conditions
 Rewarded employees to participate
 Plan Results: Medical cost trend
decreased by 1.1% for those in the
pilot plan compared to 15%
increase in non pilot program
 Wellness Results: Risk
Categories improved; BMI 9%,
Cholesterol 6%, and BP 3%
Discussion
 What do you view as critical
institutional readiness?
 What kind of help can we
provide to one another to help
accelerate that readiness?
Strategic Investments in Shared Outcomes:
Transformative Partnerships between Health
Systems and Communities
Break
Promotores de Salud, Inova
Summer Feeding Program, Promedica
Gardens on the Go@, IUHealth
Arts of Alignment: Engaging Communities in
Transformative Partnerships with Shared
Accountability
John McConnell, M.D.
Chief Executive Officer
Wake Forest University Baptist Medical Center
Teresa Cutts, Ph.D.
Director Of Research For Innovation
Methodist Le Bonheur Healthcare
Faith Health Event, Methodist Le Bonheur
Why Transformative Partnerships?
Ask the Institute of Medicine.
From “Primary Care & Public Health” (2012):
 Dramatic rise in health care costs leads everyone to innovate.
 Health research reinforces priority of social determinants,
primary care for prevention and condition management.
 Rich data helps all understand and address population health.
 ACA provides overarching opportunity to change the way we
approach health in the U.S.
http://www.iom.edu/Reports/2012/Primary-Care-and-Public-Health.aspx
Transformative Partnerships Help Solve Big
Health Systems Problems
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Uncompensated care
Inappropriate ED use
Readmissions
Spiraling chronic disease
Declining reimbursements
“We need to move from ‘what’s the matter?’
medicine to ‘what matters to you?’”
- Maureen Bisognano, IHI, Out of the Blocks Conference, 2012
How Do We Engage
Great Community Partners?
Short Answer: Be a Great Partner.
Santa Rosa Community Clean-Up, St. Joseph Health System Sonoma County
How Do We Engage
Great Community Partners?
Assess
community health
needs and
assets;
identify partner
roles and
contributions
Community Health Assets Mapping or CHAMP, Methodist Le Bonheur
How Do We Engage
Great Community Partners?
Focus on shared gains opened
up by new policies “with some
assembly required”
•Community Benefit
• ACA, Medicaid expansion,
Healthy People 2020, etc.
San Bernardino County’s Healthy Communities Program, Loma Linda, CA,
How Do We Engage
Great Community Partners?
Assume scale, spread
and sustainability:
MEMPHIS
Memphis
Tri-State
Congregational
Health Network
and
Wake Forest
University Baptist
Medical Center’s
Partnership with NC
Hospital Association
I
How Do We Engage
Great Community Partners?
Choose
measures of
success together
for mutual
accountability
CeaseFire Violence Prevention Program, Advocate Health Care Partner
How Do We Engage
Great Community Partners?
Develop
measurable,
strategic
communications
Sew Up Safety Net for Women and Children, Henry Ford Health System
How Do We Engage the View Out my
Window?
Community and values
become part of normal
strategic vision:
Strategically
analyzing
partnerships such as
the children’s home.
Employees and Faculty
Community Roles are
aligned, strengthened
and leveraged:
Environmental
Service Workers
How Do We Engage the View Out My
Window?
How do we structure
expanded
accountability to our
partners?
Where and how do we
converge with our
competitors?
How can an AMC
pursue discovery to
enhance change and
advance health?
Winston-Salem, NC
Wake Forest University Baptist Medical Center
Discussion
 What do you view as critical
institutional readiness?
 What kind of help can we
provide to one another to help
accelerate that readiness?
CEO Response To
Recommendations
John O’ Brien
Immediate Past President and
CEO of UMass Memorial
Health Care
HOPE Coalition, UMass Memorial
Working Lunch:
“Operationalizing” the Vision
Thomas Strauss
Chief Executive Officer, Summa Health
Douglas Hawthorne
Chief Executive Officer, Texas Health Resources
James Skogsbergh
Chief Executive Officer, Advocate Healthcare
Sally Howard
.
Chief of Staff
Department of Health and Human Services
Blue Button+
Presentation to Senior Leadership
Summit, Health System Learning
Group
Pierce Graham-Jones
Innovator-in-Residence
Dept. of Health & Human Services
April 4, 2013
Untapped Demand for eHealth
•90% agree you should
be able to get your own
medical info
electronically
•2 out of 3 would
consider switching to a
provider who offers
online access
•52% would use a smart
phone to monitor health
•69% track a health
indicator
• 20% have accessed
their health info online
• 10% have a personal
health record (PHR)
•9% have mobile app to
manage health
• 21% of individuals
who track use a form of
technology
Access and Portability of Personal Health Data
Will Help
Consumers will benefit from more access to
their clinical and financial health data. Helps
them:
 Better understand their health and make more
informed decisions
 Make sure that they and all of their care team
members are on the same page
 Improve the accuracy and completeness of the
information
 Plug their data into apps and tools that turns
the information into insights and decisions
supports
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MUS2: Consumer-Mediated Exchange
Stage Two Requirements:
• More than 5% of patients must
send secure messages to their EP
• More than 5% of patients must
access their health information
online (View, Download,
Transmit)
• Every provider must offer View,
Download and Transmit
functions
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In 2010, Department of Veterans Affairs
starts the Blue Button initiative
Now over 88 million Americans can
download their health record from a portal
(CMS, Dept. of Defense, many of you)
Over 1.5 million people across the
country have downloaded their health
record
1
Structure
2
3
Transport
Automatio
n
Direct
Triggers
C-CDA
Electronic
EOB
Office of the National Coordinator for Health
Information Technology
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7/16/2015
What Blue Button+ looks like for Dataholders
(Providers, Payors, etc.)
ANY
Destination
of
Consumer’s
Choice
What Blue Button+ looks like for Developers
and Patients
Meaningful Use Stage 2 and Blue Button+
Blue Button+ gives specific guidance to EHR
companies and providers in meeting the V/D/T
requirements.
Structure
Consolidated CDA (C-CDA)
Section & Fields
Described in Meaningful Use 2
Transmit
Direct Protocol (SMIME/SMTP)
Trust Anchors
Ability To Exchange Anchors
Transmit
Frequency
Trust Anchors
Send once
Transmit
Context
In message body
Transmit
Frequency
Send on change, automation
Anchor Bundles
MU 2
regulations
requires these
for all certified
EHRs
Required for
Blue Button+
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Link
Office of the National CoordinatorQuick
for Health
Information Technology
- Implementation Guide
7/16/2015
Current Adoption
Organization Demonstrating their
Path to Blue Button+ Today
Your Action Items
Share http://bluebuttonplus.org
with your colleagues
Implement Blue Button+ Today
Join our group of adopters
On Technical Innovation: Community
Tools and EHR
Farzad Mostashari, MD, ScM
National Coordinator for Health Information
Technology
Integrating Population Health into
EHRs
Eileen Barsi, Senior Director Community Benefit,
Dignity Health
Rick Rawson, CEO, Loma Linda University
Medical Center Murrieta
Community Need Index
www.Dignity HealthHEALTH.org/cni
Green Valley, AZ 85614
Barrier
Income
Indicator
Elderly Poverty
3%
Child Poverty
8%
Single Parent Poverty
Cultural
Education
Insurance
Housing
Indicator %
8%
Limited English
1%
Without HS Diploma
9%
Unemployed
4%
Uninsured
13%
Renting %
12%
Indicator %
Barrier Score
17%
3
32%
Minority Population
Final CNI Score
Barrier Score
Compton, CA 90220
4
27%
40%
2
1
2
1
97%
5
16%
45%
5
15%
5
32%
38%
4
1.8
4.6
(Low Need)
(High Need)
“ People’s social and economic circumstances affect their health
throughout life, so health policy must be linked to the social and
economic determinants of health.”
World Health Organization
Health Systems Learning Group,
Moving Forward
Fred Smith, Ph.D.
Professor of Urban Ministry, Wesley Theological
Seminary and Faith and Health Consultant
Wake Forest Baptist Medical Center
Health Systems Learning Group,
Moving Forward
Gary Gunderson, MDiv, DMin, DDiv
Vice President,
Faith and Health, Public Health Science
Wake Forest Baptist Medical Center
For more information on
Health Systems Learning Group
THE CENTER FOR EXCELLENCE IN FAITH AND HEALTH
Bit.ly/UG2Kym
or
www.hhs.gov/partnerships