Improving Care & Reducing Costs with Hotspotting & - PowerPoint PPT Presentation

Aaron Truchil & Kelly Craig January 13, 2015 ¡ Improving Care 
 & Reducing Costs 
 with Hotspotting & Community-Based Care Management

morning session Agenda 1 About the Camden Coalition 2 What is hotspotting? .1 Using Data .2 Camden findings .3 Segmentation .3 Hotspotting in Action

§1 About 
 the Camden Coalition 
 of Healthcare Providers

Mission: to improve the health of Camden residents by enhancing the quality, capacity, coordination, e ffi ciency, and accessibility of the city’s healthcare delivery system. Vision: to be the first city in the country to bend the healthcare cost curve while improving quality. Theory of Change: CCHP believes that three basic elements are needed to revitalize primary care and improve the healthcare system: data, engagement, and redesign.

Our Board: • Incorporated non-profit • Membership organization • 20 member board Hospitals PCPs Social Services Residents

About the Organization: • 65 sta ff • $5 million annual budget • Mix of foundation, federal grant funding, and hospital support Care Management Clinical Redesign Initiatives Legal & Data, Research External A ff airs & Evaluation Cross-Site Learning & Finance & Workforce Administration Development

Providers Government Switzerland Residents / Community Social Services

§2 Hotspotting: 
 the Camden Coalition’s 
 data strategy


 21% 20% 17% National Health Spending Per Capita ¡ 6% is 60 times what it was 
 in 1960, consuming one fifth 
 5% of personal income and 17% of GDP 65 70 75 80 85 90 95 2000 05 10 2012 1960

$2.63 Trillion 34% 7% National Health Expenditures (CMS Estimates) ($882 billion) 10% Rx Insurance Other (e.g. Home health, Hospitals 20% Nursing, D.M.E.) Professional Services 29%

The mission of CCHP is to improve the health of all Camden residents by increasing the capacity, quality, and accessibility of the city’s healthcare delivery system. A core value of CCHP is to be data-driven Where’s the data in the mission?

: a data driven process for the timely identification of extreme patterns in a defined region 
 of the healthcare system used to guide targeted intervention and follow up to better address patient needs, reshape ine ff ective utilization, and reduce cost.

Claims Claims the observed world Integrated Data Warehouse Health Data

Social Service Data Public Data Other Data ? Housing School Census Property Child Services Justice Integrated Health Plan Data Warehouse the observed world EMR Claims Health Data

§2.1 Camden findings

Camden Hospital Utilization 
 2011 Snapshot total hospital revenue: $108,000,000 total patients with a hospital visit: 43,710 patients visiting multiple hospitals: 41%

the Camden Cost Curve 10% ¡of ¡pa(ents ¡= ¡74% ¡ 10% of patients accounted of ¡receipts ¡ for 74% of receipts 1% ¡of ¡pa(ents ¡= ¡30% ¡ of ¡receipts ¡

Spatial Analysis of Camden Hospital Costs

Spatial Analysis of Camden Hospital Costs Several buildings (e.g.) annually generate $1-$3 million in hospital costs. 6% of city blocks account for 18% of patients and 37% of receipts. January 2002 – June 2008

Who uses Camden’s hospitals most? top ¡diagnoses Respiratory ¡Abnormality Chest ¡Pain ≈ 1% of population Abdominal ¡Pain Sep6cemia >5 chronic conditions Acute ¡Renal ¡Failure Urinary ¡Tract ¡Infec6on averages: Pneumonia Chronic ¡Systolic ¡Heart ¡Failure 57 years old 
 4.5 ED visits 5.3 inpatient 
 hospitalized 54 days____ $673,000 charges $73,143 receipts

¦ § ¨ £ ¤ 201 95 £ ¤ MaineCare Hot Spot Analysis: Kennebec County 201 Etna Plymouth 7/1/2008 - 6/30/2010 Newburgh § ¦ ¨ Dixmont 95 Somerset Franklin Clinton £ ¤ 201 Unity Benton £ ¤ 2 Rome Oakland Vienna Waterville Winslow Albion Waldo Belgrade Mount Vernon Sidney Fayette Vassalboro China Oxford Read fj eld What is a hot spot? £ ¤ 201 A hot spot is any geography where a Wayne ¤ £ large number of high utilizers reside. 202 Augusta Manchester High Utilizers are de fj ned as any £ ¤ Winthrop 201 Windsor individual with 3 or more hospital Hallowell admissions or 6 or more ER visits ¤ £ Androscoggin 202 within 2 years. Hot spots range from Chelsea ¤ £ 201 Farmingdale blue (no hot spot) to red (intense hot Monmouth Randolph spot) West Gardiner ¨ ¦ § 495 Gardiner Knox Pittston High utilizer density Litch fj eld High Lincoln Lincoln ¦ ¨ § 495 £ £ ¤ ¤ 1 £ ¤ £ ¤ £ ¤ £ ¤ Low 1 Sagadahoc New Gloucester

§2.3 Segmentation

Healthcare Does Segment

Longevity, by preventing Physicians' o ffi ces, health healthy accidents, illness, and clinics, occupational progression of early health stages of disease maternal / Prenatal services, Healthy babies, low delivery, and perinatal infant maternal risk care acutely ill Emergency services, Return to healthy state hospitals, physicians' ( likely 
 with minimal su ff ering o ffi ces, medications, and disruption recovery ) short-term rehab services Longevity-limiting Self-management, chronic disease progression, physicians' o ffi ces, conditions accommodating hospitalizations and ER environment visits Support for caregivers, Home-based services, long maintaining function, mobility and care devices, decline skin integrity, mobility, family caregiver training advance planning and support

prenatal healthy babies, services, low maternal maternal / delivery, and infant risk perinatal care self- longevity- limiting management, disease physicians' chronic progression, conditions o ffi ces, accommodating hospitalization environment & ER visits maternal w/ chronic conditions

Intervention Paradigms Hotspotting Traditional Medical Diabetes Failure Heart COPD ESRD

Patient “Typology”, 2011 X patients $ charges 
 $ receipts inpatient visits 0 1 2-3 4 + 2,900 6.6% 
 $132m 14.8% 
 0 . $16m 14.7% emergency visits 26,819 61.0% 
 2,332 5.3% 
 $87m 9.9% 
 $115m 13.0% 
 1-2 . 355 .8% 
 $11m 10.6% $14m 12.9% $165m 18.6% 
 9,010 20.6% 
 $20m 18.6% $298m 33.6% 
 3-5 . $37m 33.8% 2,293 5.2% 
 $90m 10.2% 
 6+ . $10m 9.4%

High Cost 4 ED 3 INP $400k 3 Chronic 55 y.o. 4 ED 0 INP $33k 1 Chronic 40 y.o. 13 ED High Utilization 1 INP $58k 1 Chronic 40 y.o. 1 ED 0 INP <$10k 0 Chronic 40 y.o. Four-cluster solution with per patient averages

Patient Diagnosis Profiles Use/Cost ¡Cluster ¡ pa(ent ¡share ¡ Top ¡primary ¡diagnoses ¡ One-­‑Time ¡ED/Low ¡ 68% ¡ Abdominal ¡pain ¡ Average ¡Cost ¡Popula(on ¡ Back ¡problem ¡ Upper ¡respiratory ¡infec6on ¡ Arthri6s/other ¡non-­‑trauma6c ¡joint ¡disorder ¡ Sprain/Strain ¡ Low ¡Inpa(ent/Medium ¡ 27% ¡ Abdominal ¡pain ¡ ED ¡U(lizing/Medium ¡ Back ¡problem ¡ Cost ¡Popula(on ¡ Upper ¡respiratory ¡infec6on ¡ ¡ Staph/other ¡skin ¡or ¡6ssue ¡infec6on ¡ Arthri6s/other ¡non-­‑trauma6c ¡joint ¡disorder ¡ High ¡ED ¡U(lizing/High ¡ 3% ¡ Asthma ¡ Cost ¡Popula(on ¡ Abdominal ¡pain ¡ Back ¡problem ¡ Arthri6s/other ¡non-­‑trauma6c ¡joint ¡disorder ¡ Upper ¡respiratory ¡infec6on ¡ High ¡Inpa(ent ¡ 2% ¡ COPD ¡ U(liza(on/High ¡Cost ¡ Conges6ve ¡heart ¡failure ¡ Popula(on ¡ Diabetes ¡ ¡ Abdominal ¡pain ¡ Asthma ¡

Why ¡We ¡Don’t ¡Predict: ¡ (now, ¡or ¡maybe ¡ever) ¡ Present: ¡known ¡but ¡misunderstood. ¡Future: ¡changing. ¡ ¡ Wrong ¡6me ¡horizon ¡for ¡savings ¡& ¡quality ¡improvement ¡ ¡ Exis6ng ¡models ¡don’t ¡work ¡well ¡ ¡ More ¡resources ¡to ¡reach ¡fewer ¡pa6ents ¡ ¡

§ 3 Hotspotting 
 in Action

The Problem Camden Coalition of Healthcare Providers

H I G H E R • 52 Y.O. Male • Hep C, CHF, HTN • Homeless • Uninsured • Active substance use • No income Complexity • No Social Support Social • 67 Y.O. Female • 23 Y.O. Male • Hx CHF, HTN, COPD • Hx of Type 1 Diabetes • Depression, Anxiety • Lives with Grandmother • 17 Meds Daily L O W E R • Works as Day Laborer • Work History • Learning Disability • D/C To LTAC ¡ • Daughter Is Primary Caregiver Medical LOWER HIGHER Complexity Variation of Patient Complexity Camden Coalition of Healthcare Providers

Uncoordinated Patient Care

Clinical Interventions 
 PUSH ¡ CARRY ¡ CATCH ¡ upstream ¡ workflows ¡ centralized ¡ refocused ¡efforts ¡to ¡ for ¡ hospital -­‑based ¡ community -­‑based, ¡ redesign ¡primary ¡care ¡ enrollment ¡and ¡ini6al ¡ pa6ent-­‑centric ¡ around ¡ PCP -­‑based ¡ care ¡planning ¡ ac6vi6es ¡ ACO ¡ac6va6on ¡ Camden Coalition of Healthcare Providers

Daily Data Feeds Camden Coalition of Healthcare Providers

Triage Camden Coalition of Healthcare Providers

Bedside Engagement Camden Coalition of Healthcare Providers