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Measuring Success in a Health Care Plan Sponsored House Calls Program Bill Zafirau, MD Summa Health Systems Akron, OH Why Housecalls? Approach by SummaCare Health Plan in 2006

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measuring success in a health care plan sponsored house calls program

Measuring Success in a Health Care Plan Sponsored House Calls Program

Bill Zafirau, MD

Summa Health Systems

Akron, OH

why housecalls
Why Housecalls?
  • Approach by SummaCare Health Plan in 2006
  • SummaCare expressed interest in having people who have multiple chronic illnesses, high utilization, but low ambulatory utilization managed by physicians and NPs going to the home.
  • A partnership between Summa Health Plan And Summa Hospital
    • SummaCare provided start-up funding and a per member per month payment for operation
      • Provides Nurse Care Managers
      • Consultant Pharmacist
      • Data collection/analysis
    • Summa Hospital provides office space, staffing, and operational support
      • Practice transitioned from private practice to hospital ownership in 2008
      • Hired Consultant from House Calls Solutions
summa health system akron oh
Summa Health System – Akron, OH

St. Thomas

Akron City Hospital

  • 6 Hospital System
    • 2,027 licensed beds
    • 61,800 admissions
  • Level 1 Trauma
    • 113,059 ED visits
  • Community locations
    • 4 outpatient health centers
    • Wellness Institute –
      • medically-based fitness
  • Health Plan
    • 110,000 Covered Lives
    • 16,000 Medicare Risk HMO
  • Major Teaching Residency and Fellowship Program
  • Post Acute /Senior Service Line
    • 8 Certified Geriatricians
    • 12 Geriatric Certified APNs
  • Continuum of Care
    • Acute Care/Acute Rehab/ LTAC/ SNF Beds
    • Home Care/ Hospice/ Home Infusion/ HME

SummaCare, Inc

Cuyahoga Falls General Hospital

the program
The Program
  • Around 125 patients presently, selected by screening, from 12,000 Medicare Advantage patients in Summit County.
    • 10x predicated average medicare utilization or higher
    • Ambulatory sensitive condition (CHF, DM, COPD, reccurent aspiration pneumonia)
    • Hands-on dependence in 2 ADL or IADLs
    • PCP and patient permission (about 50% accept enrollement)
  • Interdisciplinary team supported by the Health Care Plan, Health System, and local AAoA
    • Physician
    • Nurse Practitioner
    • Social Worker/AAoA Case Mananger
    • Health Plan Pharmacist
    • Nurse Care Manager
measuring success patient and caregiver perspective
Measuring Success: Patient and Caregiver Perspective
  • Annual patient satisfaction survey
  • Annual assessment of caregiver stress and social support using standardized scales
  • Annual Functional Assessment (Katz, Lawton)
  • Annual Health Status Self Assessment (SF-36, Vulnerable Elderly Survey)
  • Rates of institutionalization and site of death
  • Monthly Pain (0-10 scale), Nutrition (NSI), and Falls Assessments (# Falls per year)
measuring success health plan
Measuring Success: Health Plan
  • Utilization Rates
    • Hospitilization
    • ER visits
    • Total Costs
    • % of patients dying at home (New for 2009)
  • Chronic Disease Quality Measures (Modified ACOVE)
  • Costs of Program/Return on Investment (Data being run presently)
measuring success hospital system
Measuring Success: Hospital System
  • Regulatory Compliance (?JC)
  • Medical Education (# of Learners)
  • Marketing/Market Share
  • Physician Satisfaction/Physician Referral (Mailed Survey, In-person Survey)
    • Watch for perceived “stolen patients”
  • Downstream Revenue
    • Admissions – (0.84 per HC patient per year vs 0.21 for average Medicare enrollee)
    • Tests (Lab, Mobile Diagnostics)
    • Home Care and Hospice Care (40-50% point prevalence utilization)
measuring success practice perspective
Measuring Success: Practice Perspective
  • Practice Revenue (revenue per FTE equivalent doc or NP)
  • Practice Efficiency (patients per half day)
  • Communication
    • Within your practice
    • With outside entities
  • Employee Satisfaction (Internal Survey)
  • Practice Growth (# patients – about 125 active and 175 since inception)
challenges
Challenges
  • Multiple goals from separate entities often compete with each other
  • Rules and regulations of hospital systems that don’t make sense or are difficult for a private practice
  • Too many bosses and not enough workers
  • Work-flow and geography are not optimized for fee-for-service revenue
  • Difficult work environment with employee burnout and turnover
  • Political challenges
how patients are selected
How Patients are Selected
  • SummaCare Medicare (both >65 yo and younger patients on disability) patient database finds patients predicted to have at least 10x the average utilization
  • Must have and ambulatory sensitive condition of HTN, DM, COPD, CHF, or aspiration pneumonia
  • Must live within Summit County
  • Patients are then screened for functional dependence (Hands on dependence in one ADL or two IADLs)
  • Both patient and PCP must consent. (PHC can serve as patient’s PCP if patient desires to switch)
  • Limited expansion into Medicare FFS by building in 2009
  • Possible expansion to commercial population in 2009