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Welcome!

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.

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Welcome!

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  1. Welcome! Howard Epstein, MD, FHM Chief Health Systems Officer Institute for Clinical Systems Improvement

  2. 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.

  3. https://www.icsi.org/_asset/hkt4a4/Accountable-Health-Communities-White-Paper.pdfhttps://www.icsi.org/_asset/hkt4a4/Accountable-Health-Communities-White-Paper.pdf

  4. https://www.icsi.org/health_initiatives/accountable_health/videos/https://www.icsi.org/health_initiatives/accountable_health/videos/

  5. $2.5 Trillion A 2011 Institute of Medicine report estimated 30% of healthcare spending is non-value added www.IOM.edu/vsrt

  6. Wedge Model for US Health Care With Theoretical Spending Reduction Targets for 6 Categories of Waste Failures of Care Delivery Failures of Care Coordination Overtreatment Administrative Complexity Pricing Failures Fraud & Abuse Source: Eliminating Waste in US Health Care, Berwick, D., Hackbarth, A. JAMA. 2012;307(14):1513-1516

  7. 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

  8. 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

  9. Brief History of RARE • CMS announces penalties • RARE Planning Committee • RARE Campaign – Operating Partners • 83 hospitals • Supporting Partners: MMA, MNCM, VHA • > 100 Community Partners

  10. main contributors to avoidable hospital readmissions • Comprehensive discharge planning • Medication management • Patient and family engagement • Transition care support • Transition communications

  11. Preventable Services: Readmissions 7030 7030 > 28,000 > 78 years! > $60,000,000.00 www.RAREreadmissions.org

  12. 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

  13. Recommended Actions Work Group • 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

  14. RARE Mental Health CollaborativePlanning Committee • 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 • NikiGjeri, UMMC, Fairview • Paul Goering, Allina • Greg Clancy, Allina • Carol LaBine, DHS

  15. Thank You!

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