Delivering Value-Based Care: Creating the Medical Home

1. Delivering Value-Based Care: Creating the Medical Home IHS Leadership Symposium April 19, 2011 Brad Archer, MD – Medical Director of Advanced Care Innovation Dennis Bussey, DO – Grimes Family Physicians Heather Roberts, DO – Lakeview Internal Medicine Kyla Routson, Senior Operations Manager - IHP Kate LaFollette, Quality Director - PIH

2. Objectives • Recognize how creating the Medical Home through Care Model Redesign supports the IHS strategic vision • Identify the guiding principles for the team-based care model • Understand the components of the care model and implementation strategies • Describe how care packages based on evidence-based medicine improve the quality of patient care 2

3. CURRENT: Volume Individual services Sickness Errors Insulated consumer Tort-defensive Price discount negotiations VALUE-BASED: Outcomes Integrated services Prevention Performance Cost-sensitive consumer Personalized evidence-based Value-based purchasing Incentive Drivers 3

4. Value-Based Strategy 4 Physician Alignment Delivering Value Demonstrating Value Value-Based Contracting

5. Delivering Value Disease Management Continuum Hospice/Palliative Care Advanced Medical Team Home Health Integrated Care Management Primary Care/Specialists Screening/Prevention Disease Management System Risk Stratification Tool Quality Indicators and Metrics 5

6. 6 • Care Model Redesign & Care Packaging • Goal • Redesign care to create the ideal Iowa Health System experience that focuses on the “Best Outcome for Every Patient Every Time” • Fairview Health System • Prototype Clinics • Grimes Family Physicians • Dr. Dennis Bussey, Janell Schlosser • Lakeview Internal Medicine • Dr. Heather Roberts, Heath Hill

7. 7 • Care Model Redesign & Care Packaging Goals • Redesign care and align incentives to produce quality care with a reduction in total cost of care based on defined metrics • Improve clinical quality outcomes aligned with evidence based guidelines • Improve employee, physician, and patient and family satisfaction with care provided through the new model. • Implement a team based care model • Identify, prioritize and sequence five (5) Care Packages that provide enhanced quality with effective cost efficiencies at the identified prototype clinics.

8. Care Model Redesign & Care Packaging 8 Team Based Care Models The fundamental structure or the “track” in which quality care will run Care Packages Quality Care will be designed through the use of Care Packages or “cars” that will run on the track

9. Care Model Redesign & Care Packaging 9 It is when care is redesigned and incentives are aligned to produce quality care with a reduction in total cost of care Adult Preventive Hyperlipidemia Well Child Hypertension Diabetes

10. Team Based Care ModelGuiding Principles • Multidisciplinary teams working at the top of their licenses • Daily team communication for effective team work • Complete planning prior to day of visit • Effective communication to patients and families about their visit • Create and implement a standard rooming process • Create and implement a standard room set-up • Institute standard medication reconciliation process • Practice effective EMR task management process • PDSA (Plan, Do, Study/Check, Act) 10

11. Implementing the Care Model 11

12. Care Model Implementation • Team Formation • Goal: Multidisciplinary team working at top of license • Nursing staff, providers, scheduler, RN, pharmacist 12

13. Care Model Implementation • Co-location • Goal: Effective teamwork 13

14. Care Model Implementation • Phones • Goal: 1st Call Resolution • Lakeview • Reduction in tasks created by staff: -25% • Average Speed to Answer: 39 seconds • Reduction in Outbound Calls: -41% • Grimes • Reduction in tasks created by staff: -25% • Average Speed to Answer: 15 seconds 14

15. Care Model Implementation • Huddles • Goal: Daily communication among entire clinic • Includes front desk staff • PDSA 15

16. Care Model Implementation • Standardization • Goal: Create and implement standard processes • Room Set Up • Medication Reconciliation 16

17. Care Model Implementation • Pre Visit Calls • Goal: Complete planning prior to day of visit • My Nurse • Part of multidisciplinary team • Extension of the clinic • Pre visit calls and proactive outreach • Live with Pre-Visit calls Jan 3, 2011 • Dedicated 800# added to allow for metric tracking 17

18. Care Model Implementation • Pre Visit Call Process 18 Patient calls for a physical Pre-Visit Task created My Nurse calls patient for Pre-Visit Call Information is available in EHR when patient arrives in clinic Day of Visit workflow conducted Patient calls to cancel or change physical Pre-Visit Task is updated

19. Care Model Implementation • Pre Visit Call Surveys 19 • The person I talked to was VERY nice and she made the conversation fun! • Saved time day of visit. • Factual, to the point. Got me mentally prepared for the visit to the office. • Thorough check of my family and medical history. • Shortened my visit by asking fewer questions. • I felt my nurse cared and wanted to know about my health. • Thought that it was an excellent use of time. • It was nice to have those questions asked/answered before the appointment. • I would have liked notice when I scheduled my visit that the nurse was planning to call. • Some of it was repetitive with the info the nurse asked during my visit.

20. Care Packages 20

21. Care Package Implementation • Adult Preventive • Age/Gender specific • 20-25 components to be addressed and documented for every adult physical • For Example…. • Review & Update • Social History, Family History, Surgical History • Screenings • Lipid Screening, Mammography, Colon Cancer Screening, Depression Screening • Immunizations • Flu, Pneumonia, Tdap • Counseling • Alcohol use, Tobacco use, Aspirin, Folic Acid 21

22. Care Package Implementation • Adult Preventive • AP Tool Development • Allscripts panels and flowsheets • AP Workflow • Pre Visit Tasks • Pre Visit Calls • Day of Visit • Weekly Metric Reports 22

23. Care Package Implementation • Next Steps • Hypertension • Hyperlipidemia • Diabetes • Well Child 23

24. Physicians’ Perspective 24

25. 25

26. Questions? • Contact Information • Kate LaFollette, RN, Quality Director, PIH • 515-205-2970 • lafollcs@ihs.org • Mark Mitchell, RN, Senior Manager for Care Redesign, IHP • 515-471-9368 • mitchemj@ihs.org 26