Measuring Success in a Health Care Plan Sponsored House Calls Program - PowerPoint PPT Presentation

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Measuring Success in a Health Care Plan Sponsored House Calls Program

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  1. Measuring Success in a Health Care Plan Sponsored House Calls Program Bill Zafirau, MD Summa Health Systems Akron, OH

  2. 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

  3. 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

  4. 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

  5. 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)

  6. 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)

  7. 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)

  8. 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)

  9. 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

  10. Questions

  11. 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