Slides - Healthcare Analytics Summit

Download Report

Transcript Slides - Healthcare Analytics Summit

Session #3 How Geisinger Uses Analytics to Improve Care

Glenn Steele, Jr., MD, PhD President & CEO Geisinger Health System

Healthcare Analytics Summit 2014 Salt Lake City, Utah September 24, 2014

Glenn Steele, Jr., MD, PhD

President & CEO Geisinger Health System

Heal • Teach • Discover • Serve

Where We Are Now (Nationally)

• Unjustified variation in quality, access, and cost of care • Unwarranted and fragmented care-giving • An addiction to perverse payment incentives – Piece rate Medicare/Medicaid payment model  Driving up units of work   Driving up cost Diminishing value and quality • Transition to new payment incentives (predicated on fundamentally new care delivery models)

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission 3

Where Do We Want to Be?

• Affordable coverage for all • Payment for value • Coordinated care • Continuous improvement/innovation • National health goals, leadership, accountability

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2013

Geisinger Health System - Proprietary Not for reuse or distribution without permission 4

Geisinger Health System

An Integrated Health Service Organization Provider Facilities

        

Geisinger Medical Center and its Shamokin Hospital Campus Geisinger Wyoming Valley Medical and its South Wilkes Barre Campus Geisinger Community Medical Center. Scranton, PA Geisinger-Bloomsburg Hospital Geisinger-Lewistown Hospital Marworth Alcohol & Chemical Dependency Treatment Center 2 Nursing Homes >87K admissions/OBS & SORUs 1,761 licensed inpatient beds Physician Practice Group

       

Multispecialty group ~1050 physician FTEs ~670 advanced practitioners 85 primary & specialty clinic sites (52 community practice) 2 outpatient surgery centers ~2.5 million outpatient visits ~400 resident & fellow FTEs ~270 medical students Moody’s Aa2/Stable Standard & Poor’s, AA/Stable Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission

Managed Care Companies

     

~468,000 members (including ~80,000 Medicare Advantage members and 124,000 Medicaid members) Diversified products ~37,000 contracted providers/facilities 43 PA counties Offered on public & private exchanges Members in 5 states

• • • • • • • • •

Transforming Healthcare with Technology

> $190 M invested

(hardware, software, manpower, training)

Running costs:

~4.6% of annual revenue of > $3.6 Billion

Fully-integrated EHR:

52 community practice sites; 5 hospitals; 4 EDs; 4 Surgical Centers; 14 CareWorks retail-based and worksite clinics, walk-in clinics and after hours clinics – Acute and chronic care management – Optimized transitions of care

Networked Patient Portal

- ~234,000 active users (40% of ongoing patients) – Patient self-service (self-scheduling, patient-entered data) – Home monitoring integrated with Medical Home

“Outreach Health IT”

– 6,461 users in 812 non-Geisinger practices – Remote support for regional ICUs – Telestroke services to regional EDs

Active Regional Health-Information Exchange (KeyHIE)

– 19 hospitals, 100+ practices, 634,000 patients consented, publish 600,000+ documents monthly, participants access 900+ patients monthly

e-health (eICU ® ) Programs Keystone Beacon Community

– HIT-enabled, Community-wide care coordination in 5 rural counties

CDIS (Clinical Decision Intelligence System

•

____________________________________________________________________________________

•

GHP:

Data since 2006 and forward of 40 million Health Plan Medical Claims for about 1 million members. The Health Plan has about 120 analytical users accessing the EDW

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary 6

Geisinger Health System Coverage Area 7

The Geisinger “Sweet Spot”

Geisinger Clinical Enterprise

Population Health Innovation to reduce total cost of care

Geisinger Health Plan Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

• • • Data Driven Care Redesign Systems of Care Bundles Transitions of Care Geisinger Health System - Proprietary Not for reuse or distribution without permission

Strategic Priorities

Quality and Innovation

• • Patient Centered Focus – Patient activation (empowerment) – Culture of quality, safety and health

Value Re-Engineering Market Leadership

• Extending the GHS Brand •

Scaling and Generalizing Innovation The Geisinger Family

• Personal and professional well being

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission 9

R

E

-E T

HE

G

EISINGER NGINEERING

V

ALUE

“T

OUCHSTONES

”

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2013

Geisinger Health System - Proprietary Not for reuse or distribution without permission 10

State of the Evidence…

Volume 348(26) 26 June 2003 pp 2635-2645

The Quality of Health Care Delivered To Adults In the United States

McGlynn, Elizabeth A.: Asch, Steven M.: Adams, John: Jeesey, Joan: Hicks, Jennifer: DeCristofaro, Alison: Kerr, Eve A.

BACKGROUND

We have little systematic information about the extent to which standard processes involved in healthcare —a key element of quality —are delivered in the United States.

METHODS

We telephoned a random sample of adults living in 12 metropolita n areas in the United States and…received written consent to copy their medical records…to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventative care …

RESULTS

Participants received 54.9 percent of recommended care.

CONCLUSIONS

The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits are warranted.

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission

Cost/Quality “Correlation”

50th %ile Low Efficiency High Quality High Efficiency High Quality (Dream Suppliers) Low Efficiency Low Quality (Nightmare Suppliers) High Efficiency Low Quality 50th %ile Lower Efficiency/ Higher Cost MD Longitudinal Cost Efficiency Index Higher Efficiency/ Lower Cost (total cost per case mix-adjusted treatment episode) Heal • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission

Cost/Quality ≠ R 2003 Cost or Quality 1993-1994 Hillary-Care

‘

Debate

’

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission

Cost = Quality 2006-2010 GHS Innovations

Geisinger Transformation Initiatives

•

ProvenCare ® for Acute Episodic Care (the “Warranty”)

• •

ProvenCare ® Chronic Disease ProvenHealth Navigator ® (Advanced Medical Home)

• Transitions of Care • PRIDE (Proven Innovation Drive for Excellence)

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission 14

ProvenCare

for Acute Episodic Care ProvenCare

• Identify high-volume DRGs • Determine best practice techniques • Deliver evidence-based care • GHP pays global fee • No additional payment for complications

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission 15

Current as of 4/9/13

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2011

Not for reuse or distribution without permission Geisinger Health System Confidential and Proprietary | 16

ProvenCare

CABG

Clinical Outcomes: Pre vs. Post ProvenCare ® protocols In-hospital mortality Patients with any complication (STS) Atrial fibrillation Permanent stroke Prolonged ventilation Re-intubation Intra-op blood products used Re-operation for bleeding Deep sternal wound infection Post-op mean LOS

Before ProvenCare ® N = 132

1.5 % 38 % 24 % 1.5 % 5.3 % 2.3 % 24 % 3.8 % 0.8 % 5.2 d

After ProvenCare ® N = 715

0.5% 34% 20% 1.3% 4.9% 1.0% 12 % 2.4% 0.18% 5.0d

% Improvement 67 % 11 % 17 % 13 % 8 % 57 % 50 % 37 % 78 % 4 % Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2013

Geisinger Health System - Proprietary Not for reuse or distribution without permission

ProvenCare ® CABG: Reliability & Financial Outcomes Reliability:

• • 40 best practice elements x 715 patients = 28,600 37 missed best practice elements in 24 patients opportunities • 37 / 28,080 = 0.13% elements missed • (715-24) / 715 = 96.6% of all patients had ALL elements delivered

Financial Outcomes – Hospital:

• Contribution margin increased 17.6% • Total inpatient profit per case improved $1946

Financial Outcomes – Health Plan:

• Paid out 4.8% less per case for CAB with ProvenCare ® would have without than it • Paid out 28 to 36% less for CAB with GHS than with other providers

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission 18

ProvenCare

CAB V2.0

 42 ACC / AHA 2011 Class I and IIIh guidelines  25 additional Geisinger consensus-based guidelines  67 Total guidelines adopted and translated into

120 best practices Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission

ProvenCare

Acute Episodic Bundles

Perinatal Thoracic Lung CAB and PCI Bariatric Surgery

•

Clinical Best Practices

•

Workflow Process Redesign

•

Convener for CMMI Bundling Initiative (17 organizations)

•

Corporate Destination Medicine Option Heart Failure Lumbar Spine Hip: Fragility Fracture or Arthroscopy Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Knee Arthroscopy COPD

Geisinger Health System - Proprietary Not for reuse or distribution without permission

Company’s New “Centers of Excellence” Program is First-of-its Kind Partnering with Six of the Nation’s Foremost Health Care Systems to Provide Better Care

We devoted extensive time developing Centers of Excellence in order to improve the quality of care our associates’ receive. We have identified six

renowned health systems that meet the highest quality standards for heart, spine and transplant surgery

. Through these organizations, our associates will have no out-of-pocket expenses and a

greater peace of mind knowing they are receiving exceptional care from a facility that specializes in the procedure they require.

This is the first time a retailer has offered a comprehensive, nationwide program for heart, spine and transplant surgery .” ~ Sally Welborn, senior vice president of global benefits at Walmart

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission 21

Poll Question #1

The

most

important lever to drive default best practice is: a) Real-time data feedback b) A change in provider “sociology” c) Different payment incentives d) Two of the above e) All of the above

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission 22

ProvenCare ® C

HRONIC

D

ISEASE Portfolio of ProvenCare ® Chronic Disease Programs

• Diabetes • Congestive Heart Failure • Coronary Artery Disease • Hypertension • COPD • Prevention Bundle

Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Geisinger Health System - Proprietary Not for reuse or distribution without permission 23

Value Driven Care for 28,355 Patients with Diabetes

Diabetes Bundle Percentage % Influenza Vaccination % Pneumococcal Vaccination % Microalbumin Result % HgbA1c at Goal % LDL at Goal % BP < 140/80

3/06

2.4% 57% 59% 58% 33% 50% 39%

3/07

7.2% 73% 83% 87% 37% 52% 44%

6/14

14.4% 74% 79% 78% 47% 60% 66% % Documented Non-Smokers 74% 84% 85% Heal • Teach • Discover • Serve

Copyright Geisinger Health System 2014

Not for reuse or distribution without permission Geisinger Health System Confidential and Proprietary

Transforming the Management of Diabetes

3 Year Results in 25,000 DM Patients

305 MI’s Prevented

NNT to prevent 1 MI 82 patients

140 Strokes Prevented

NNT to prevent 1 Stroke 170 patients Primary Care Diabetes Bundle Management: Three-Year Outcomes for Microvascular and Macrovascular Events (in press) FBloom; TGraf; WStewart; GSteele, et. al

. (in press) 166 Cases of Retinopathy Prevented

NNT to prevent 1 Retinopathy 152 patients 25

Improving CAD Care for 17,965 Patients

9/06 3/07 6/14

CAD Bundle Percentage % LDL <100 or <70 if High Risk % ACE/ARB in LVSD,DM, HTN % BMI measured % BP < 140/90 % Antiplatelet Therapy % Beta Blocker use S/P MI % Documented Non-Smokers % Pneumococcal Vaccination % Influenza Vaccination 8% 38% 65% 79% 74% 89% 97% 86% 80% 60% 11% 37% 66% 86% 74% 91% 97% 86% 80% 74% 26% 63% 78% 99% 80% 95% 97% 86% 79% 76% Heal • Teach • Discover • Serve

Not for reuse or distribution without permission Geisinger Health System Confidential and Proprietary

Improving Preventive Care for 251,385 Patients

11/07 11/12 6/14

Adult Preventive Bundle 19% Breast Cancer Screening (q 2 yrs 50-74) (discuss q 2 yrs 40-49) Cervical Cancer Screening (q 3 yr Age 21-29) (q 5 yr Age 30-64) Colon Cancer Screening (Colonoscopy q 10 yrs Age 50-74 or FOBT yearly) Prostate Cancer Discussion (Age 50-74) 9.2% 46% 64% 44% 72% 33% 64% 68% 67% 76% 72% 74% 65% 55% 86% Lipid Screening (Every 5 yr M > 35, F > 45) Diabetes Screening (Every 3 yr > 45) Obesity Screening (BMI in Epic) Documented Non-Smokers Tetanus Diphtheria Immunization (every 10 yr) Pneumococcal Immunization (Once Age >65) 75% 85% 77% 75% 35% 84% 47% Influenza Immunization (Yearly Age >18)

**Change in age from Age>50 to Age>18 February 2013

Chlamydia Screening (Yearly Age 18-25) Osteoporosis Screening (every 7 yr Age >65) 22% 52% Alcohol Intake Assessment 84% Heal • Teach • Discover • Zoster Vaccine (Age >60) Serve Not for reuse or distribution without permission

**New Measure February 2013

88% 91% 98% 79% 75% 86% 59% 35% 70% 95% 90% 98% 79% 76% 83% 46% 40% 76% 97% 39%

ProvenHealth Navigator

Innovations in Management of Elderly

• “SNFist” model in targeted nursing homes • Focused on transitions of care and length of stay • Redesigned care model • Smartly utilizing information technologies • Reduced – Admits/1000 – Readmissions/1000 – ER Visits/1000

Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission 28

ProvenHealth Navigator

Results

  Advanced Medical Home deployed in 42 Geisinger and 49 non-Geisinger sites Patients say case managers improved quality: 72%

Admissions (27.5%) Readmits (34.0%) Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission

0% Real Time Population Management

ProvenHealth Navigator® Reduces Cost Trend

95% Confidence Interval -2% • Medical expense trend reduced by -4% -6% -8% Median Estimate Median Estimate 2007-2010, with Rx coverage = 1.7

-10% -12% 95% Confidence Interval

Cumulative percent difference in spending (Pre-Rx Allowed PMPM $) attributable to PHN in the first 21 PHN clinics for calendar years 2005-2009. Dotted lines represent 95% confidence interval. P = < 0.003

Source: Reducing Long-Term Cost by Transforming Primary Care: Evidence From Geisinger's Medical Home Model

(Am J Manag Care. 2012;18(3):149-155)

Partial and Incremental PCMH Practice Transformation: Implications for Quality and Costs Michael L. Paustian, Jeffrey A. Alexander, Darline K. El Reda, Chris G. Wise, Lee A. Green, and Michael D. Fetters

Conclusions.

Estimated effects of the PCMH model on quality and cost of care appear to improve with the degree of PCMH implementation achieved and with incremental improvements in implementation.

PCMHs in Michigan saved $26.37 PMPM comparing those with full implementation of model vs. no implementation, 7.7% savings. Also improved adult quality and adult preventive care.

Very consistent with Geisinger results.

Heal • Teach • Discover • Serve

RESEARCHARTICLE Geisinger Health System - Proprietary Not for reuse or distribution without permission

Poll Question #2

Integrated care for a population of patients has been accomplished: a) Only in vertically integrated payer provider systems b) With CMS via ACO’s c) By partnering with commercial payers d) In none of the above

Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission 32

T

RANSFORMING

H

EALTHCARE WITH

T

ECHNOLOGY

Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission 33

Reengineering Primary & Specialty Care

• ProvenHealth Navigator ® – Advanced Medical Home covers 91sites, serving 151,00 GHP lives and 45,000+ FFS Medicare lives – SNFist model expands to 17 nursing homes – Outcomes: reduced readmissions and improved care coordination, similar cost curve bending at GHS and University of Michigan • PCP & specialists coordinated patient management – CKD/ESRD high risk management and psychiatric care management – Neurology/Dermatology/Endocrine/Cardiology/Autism • Convenient Care redesign of primary care/emergency medicine – 12 urgent care/after hours care sites (and growing rapidly) – Coordinated low cost alternative to ED

Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission

Patient Activation: “Open Notes” – A Transparency and Patient Engagement Pilot

• Expanded in 2013 to 1,100+ Geisinger providers &170,000 patients • Launched in 2010, a 12-month trial of 105 PCPs inviting 19,000 patients to review notes through secure electronic portals (BI Deaconess, Geisinger, Harborview) • Geisinger participation: 24 PCPs, 8,700 patients • Results from first year: – Over 80% of patients opened their notes – Majority of patients reported feeling more in control, better prepared for visits and more likely to take medications as prescribed – 99% of patients and more than 80% of physicians wanted to continue

Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission 35

Innovations in Personalized Medicine

• Bio-banking expanding with unique partnerships to advance genomic medicine (strategic partnership with Regeneron commencing) • Clinical data warehouse grows • Data analytics deployed to identify care gaps, permitting clinical intervention • Focused population health research initiatives – Obesity – Autism and developmental medicine • Institute for Advanced Application created to advance clinical innovation and reengineering of care

Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission 36

Scaling and Generalizing – Experiments

(Geisinger Health System / Geisinger Insurance Operations / xG Health)

GHS:

• Wilkes-Barre • Scranton • Shamokin • Lewistown • Bloomsburg • Harrisburg • Atlantic City

GIO:

• Medicaid MCO • HIX* • New Jersey • Delaware • Maine • West Virginia • 41 Clients

Heal • Teach • Discover • Serve

37 Geisinger Health System - Proprietary Not for reuse or distribution without permission * Health Insurance Exchange 37

Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission 38

From Fee-for-Service to Total Cost of Care ( Residual “Piece Rate”)

Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission 39

Enabling Behavior Change:



Providers



Patients

Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission 40

Poll Question #3

Payment for health care services in your system is: a) Exclusively Fee-for-Service b) Mainly Fee-For-Service but some population risk (upside only) c) Mainly Fee-For-Service but some population risk (upside & downside) d) Fee-For Service now but you’re worried about a move to population risk in the near future e) Unsure or not applicable

Heal • Teach • Discover • Serve

Geisinger Health System - Proprietary Not for reuse or distribution without permission