Transforming Healthcare In Arizona Priya Radhakrishnan, M.D. Chief Academic Officer, Honor Health Medical Advisor, Practice Innovation Institute & Jenn Sommers, Director, Practice Innovation Institute 1
Transforming Clinical Practice Initiative (TCPI) TCPI is designed to help clinicians achieve large-scale health • transformation A four year initiative from Oct 2015 – Oct 2019 • Supports more than 140,000 clinician practices in sharing, • adapting & further developing their quality improvement strategies Enables new levels of coordination, continuity, and integration of • care, while transitioning volume-driven systems to value-based, patient-centered, health care services. TCPI participants include: • – 29 Practice Transformation Networks (PTNs) – 10 Support and Alignment Networks (SANs) 2
Practice Transformation Networks (PTNs)
AIMs/Goals: Primary & Secondary Drivers 4
TCPI Phases of Transformation 5
Practice Innovation Institute One of 29 Practice Transformation Networks (PTNs) funded under the • national CMS Transforming Clinical Practice Initiative (TCPI) Four years of funding beginning Oct 2015 to transform the practices of • 2,500 providers in Arizona A collaboration among Health Current, Mercy Care Plan and Mercy • Maricopa Integrated Care Supporting FQHCs, Integrated Health Homes, Clinically Integrated • Pediatric Network (PCCN), Crisis providers, Equality Health Network and Specialty practices 6
In one word - UNIQUE Unique: Crisis services, Specialty Corrections Integrated Practices Health Homes (6) (10) (8) Statewide Health FQHC’s (13) Information Exchange Mercy Care Outpatient Plan/Mercy Behavioral Maricopa Health (10) Integrated Care Pediatric Pii Clinically Equality Health Integrated Network Network (119) 7
Pii - Path to Health Care Transformation Patient & Family Continuous, Data Sustainable Business Centered Care Driven Quality Operations Design Improvement • Patient • QI technical • Practice Engagement assistance management • Access to care • Identifying Data • Service line Source and PDSA augmentation • Use of Data • Linking with • Staff vitality & joy Resources in work • Success with QPP/UDS/VBS 8
How we plan to get there! HIT Platform Services & Data Sources Used by Used by Used by Applications clinicians other staff patients & families Population Health & Claims Care Quotient • • Analytics from Predictive Analytics health • Benchmarking plans, via • Risk Stratification HIE • Care Unify Care Management Claims • • Care Pathways from • Risk Stratification health • Patient Panels plans • Alerts & • Notifications Clinical data Providers, Statewide • • aggregation via direct Health Clinical data connection • Information repository Exchange Direct secure e-mail • (HIE) Provider Portal • (query & response) 9
Application to Behavioral Health Significant representation of BH in TCPI and Pii • New Common Measures – The Behavioral Health Affinity Group – Increasing awareness of the importance of behavioral health and • psychosocial determinants in health care Collaborating with other PTNs and SANs nationally • Both APAs and the National Council – PTNs in NY, LA, CO, MI, IN, ME, CT, NC, and Vizient – Pii Academy provides resources for transformation • Access to TCPI resources – The Behavioral Health Affinity Group and the BH Resource Compilation – Subject Matter Experts – Workshops and Conferences – GOAL: To work with our behavioral health and medical practices • to respond to industry changes and to support their need to be sustainable, thriving practices 10
Application to Behavioral Health Primary Change Driver: Person and Family Centered Care Design • Integrating medical and behavioral health for persons with a Serious Mental Illness – Challenges in administering – Promoting team based care – Focusing on and engaging the member • Collaborative Care Model • Behavioral Health Members in emergency departments • Innovation – Multi-condition BH screening pilot with Community Bridges – Solutions supporting team base care 11
TCPI PFE Program Components Inclusion of the Use of e- Measurement patient voice in technology to of patient practice engage patients health literacy operations & family Assessment to Shared gauge patient decision-making readiness to be among “activated” as a clinicians & partner in their patients care Organized, Enhanced evidence based Access care
Application to Behavioral Health Primary Change Driver: Continuous Data Driven Quality Improvement • Connection to Health Information Exchange (Health Current) • Addition of analytic and decision support tools – Practice management – Practice dashboards – Utilization and cost data including pharmacy – Identifying the high needs, high cost members – ADT alerts – Integration of plan and provider data • Innovation – CMT and Opioids 13
Transformation process Evaluate Design Develop Implement Analysis
Application to Behavioral Health Primary Change Driver: Sustainable Business Operations • Transitioning to value based reimbursement: learning to count accurately, analyze, and document value • Developing the right value based models • Moving from compliance to outcomes • More effective administration of integrated models • Restoring joy in practice 15
Transformational Pathways Diagnose ASSESS Teach with Data
Graduating toward coordinated care • High risk registry • Warm hand offs • Schedule appointments together ( co-located) • Develop combined plan of care • Identify member/peer/family engagement • Post ER/Hospital visit plans • EHR strategy
Operationalizing Integrated Care – Where to Start Evolved Practice Access to Care Care Coordination Patient – Population Continuity of Physician management Care Partnership Sustainable Engaged Data Driven Team Based Business leadership Improvement Care Operations Adapted from Center for Excellence in Primary Care & Transforming Clinical Practice initiative
Opioid Epidemic Solutions: HIE/PMP Integration HIE integration with Arizona’s Prescription Monitoring Program required by • 2016 Az Senate Bill 1283 BEGINNING OCTOBER 1, 2017, THE CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM DATA INTO THE – EXCHANGE… HIE/PMP integration “go-live” - August 1, 2017 • Impact on Opioid Epidemic • – Providers using HIE Portal will be able to access all controlled substance prescriptions from PMP database along with all medical history available through HIE – Aligns with integrated physical and behavioral health information exchange In emergency, providers able to break the glass and access patient’s Part 2 substance abuse data • In other instances, can access Part 2 substance abuse data with patient consent • 21
Successes to Date Alignment with FQHCs, Submitted 6 patient and family • • Collaborative Care Network along engagement performance stories with Healthy Communities for national recognition Collaborative Network on HRSA – Pulmonary Institute grant; successful meeting with – A New Leaf the FQHCs to review technology, – Recovery Innovations transformation, patient and – Desert Senita FQHC family engagement – Community Bridges Training programs coordinated • – Wesley Community & Health with ACP, APA, PCPCC and NP Center Supported Alignment Networks (SAN) 22
SMI population profile Serious Mental Illness (SMI) 20% of population account for half of the cost • Average Total Annual 2/3 have substance abuse problems • Population Cost Per Members Cost 2/3 have 1 chronic medical condition, half have 2, • Person and 1/3 have 3 or more Non-SMI Adults Chronic physical conditions with co-morbid • SMI mental health and substance abuse 25,000 $700m $28k Drive high costs on medical side Adult • High Needs/High Cost Members Complex physical and behavioral health needs • Crisis episodes Non- • Emergency department (ED) and inpatient SMI 450,000 $400m $889 • admissions Adult Substance use/abuse, polypharmacy • Critical psychosocial supports needed • Housing • Top Employment • 20% 4,500 $400m $90k Criminal justice involved • SMI Not engaged or empowered • 23
Partners in Recovery (PIR) Outpatient behavioral health practice serving persons with serious mental • illness (SMI) Started integrating physical and behavioral health care in April 2014 • Currently serves approximately 7,500 members • Has 3 Assertive Community Teams (ACT) – 1 of which is a “M-ACT” or • Medical ACT Team Represents 1 of 6 similar practices serving 25,000 persons in Maricopa • County with SMI 24
PIR Success! OMEGA ACT VARSITY ACT WEST VALLEY M-ACT Team Team Team ACT Team 18% reduction in 10% reduction in psychiatric psychiatric 46% reduction in admissions admissions psychiatric admissions 11% reduction in 39% reduction in 24% reduction in acute acute psychiatric hospitalizations hospitalizations admissions 11% reduction in unnecessary 41% reduction in .2 reduction in emergency room unnecessary unnecessary services emergency room emergency room services services 25
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