Focus on Population Health in a Changing World Karen M. Boudreau, MD, FAAFP Group Vice President, Enterprise Care Management & Coordination Providence St. Joseph Health Benton Franklin County Medical Society Friday, February 24, 2017 1 Introduction and Disclosures (none) 2
Mission As people of Providence, we reveal Gods love for all. Promise Together, we answer the call of every person we serve: Know me, care for me ease my way. Vision Simplify health for everyone Today, we are a diverse family working to improve and simplify health for everyone.
And, most recently we have included Providence St. Joseph Health Better together More coordinated care Greater emphasis on population health and prevention
New services for our hospitals and clinics Better outcomes and value as a result of shared expertise Increased access to care Continued investment in innovation
Investment in mental health Agenda: What is Population Health? What do we know about Pop Health in Benton-Franklin Counties? How is Pop Health relevant to my practice? What steps can I take? Objectives: 1. Define population health 2. Review the principles of population health management 3. (Have some fun exploring) how those can be implemented into a providers care delivery
Agenda and Objectives 6 What is Population Health? Kindig & Stoddard propose that: population health as a concept of health be defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. (http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.93.3.380 ) National Academy of Medicine (formerly the Institute of Medicine) had embraced this definition for their Roundtable on Population Health, adding:
While not a part of the definition itself, it is understood that such population health outcomes are the product of multiple determinants of health, including medical care, public health, genetics, behaviors, social factors, and environmental factors. ( http://www.nationalacademies.org/hmd/Activities/PublicHealth/PopulationHealthImprovementRT/VisionMission ) In Canada: Population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. In order to reach these objectives, it looks at and acts upon the broad range of factors and conditions that have a strong influence on our health. ( http://www.phac-aspc.gc.ca/ph-sp/approach-approche/index-eng.php )
7 University of Wisconsin Population Health Institute Model The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play. 8
Know our populations PRODUCT LIFE STAGE HEALTH STATUS ENGAGE COMMUNITY
Know our populations Improve Health Outcome CARE SETTING PRODUCT LIFE STAGE HEALTH STATUS ENGAGE
COMMUNITY SERVICES DATA ANALYTICS PREDICTIVE MODELING COORDINATE CARE TOOLS RESOURCES
10 Examples of Pop Health Initiatives National initiatives: Million Hearts Initiative (http://millionhearts.hhs.gov/aboutmh/overview.html ) Healthy People 2020 (https://www.healthypeople.gov/2020/default ) Advisory Committee on Immunization Practices National vaccination guidelines (https://www.cdc.gov/vaccines/schedules/hcp/index.html )
Local initiatives: Nurse Family Partnership ( http://www.nursefamilypartnership.org/locations/Washington ) Crisis Intervention Training for local law enforcement ( http://www.bfcha.org/mental-health/ ) Practice level initiatives: Using EHR/practice management data to understand patient panel disease burden or current smoking rates Annual flu vaccine outreach and vaccine administration clinics Developing gaps in care outreach to improve prevention and chronic disease management/outcomes Partnering with community organizations on key local initiatives 11
Case Discussion Pause #1 5 minutes 2-3 minutes: 1. Talk with 2-3 people around you ? How do you know/describe your patient population ? ? ? ? By payer distribution Age/gender distribution By condition distribution Other ways ? Do you know which patients havent been in to see you in
the past year ? How easily could you get that information ? What is the biggest health challenge faced by the patients in your practice 2 minutes: 2. Would a couple of volunteers share a key comment or two from your discussion? 12 What do we know about Population Health in Benton-Franklin Counties? 13 County Health Rankings
http://www.countyhealthrankings.org/app/washington/2016/rankings/franklin/county/outcomes/overall/snapshot 14 Community Health Needs Assessment 2016 http://www.bfcha.org/wp-content/uploads/2016/06/2016-CHNA.pdf http://www.bentonfranklintrends.ewu.edu/graph.cfm?cat_id=6&sub_cat_id=4&ind_id=6 15 What the communities are saying:
http://bfhd.wa.gov/assessment/CHIP-FINAL2013.pdf 16 Has anyone in the audience participated directly in any of the CHNA/ CHIP or implementation activities? Case Discussion Pause #2 2 min 17 Is Pop Health really different from practicing good medicine? Population Health Value Proposition: Populations:
A coordinated approach for better connected care and keeping people well. Using the wealth of health information available to tailor and prioritize efforts to where they have the most impact.
Improving care for high cost/high need, rising risk and healthy populations should drive success in valuebased payment arrangements and generate additional patient volume and revenue in fee-forservice. Our populations will have better outcomes when we can coordinate their care and when we are invested in helping them to manage their health. Helping move from a health care organizations to health organizations
Identify and prioritize populations with highest needs Tailor interventions based on evidence and learning from the experience of individuals in the population Individuals: Engage with individual patients to achieve person-centered and evidence-based goals Use individual experiences to continually
improve systems 18 Were still mainly on FFS Is Pop Health really relevant here? 1. Joy in Work/Physician Burnout 2. MACRA 3. MACRA 4. MACRA 5. Access/wait times/other practice management challenges 19 Youve seen the headlines
https://wire.ama-assn.org/life-career/medical-specialties-highest-burnout-rates 20 Restoring Joy in Work Why did we become clinicians? W. Edwards Deming pride in work Derek Feeley, IHI: Healthcare is one of the few professions that regularly provides the opportunity for its workforce to profoundly improve lives. Caring and healing should be naturally joyful activities. The compassion and dedication of healthcare staff are key assets that, if nurtured and not impeded, can lead to joy as well as to
effective and empathetic care. http://www.ihi.org/resources/Pages/Publications/Restoring-Joy-in-Work-Healthcare-Workforce.aspx 21 1. Do you see signs of clinician burnout in your community? 2. How are you addressing it? Case Discussion Pause #3 2 min 22 https://www.stepsforward.org/modules/physician-burnout 23 24
How does MACRA relate to Pop Health? 25 Regional Payer Mix (Inpatient) KADLEC 2.28% 40.80% 47.03% TRIOS COMMERCIAL MEDICAID
MEDICARE OTHER 38.48% 52.08% COMMERCIAL MEDICAID MEDICARE OTHER 9.45% 9.90%
52.94% COMMERCIAL MEDICAID MEDICARE OTHER 11.96% Source: Truven (Apprise, 2016). Retrieved on 12/2/16. Annualized based on Q1/Q2. Cases exclude Normal Newborns. 26 As CMS goes, so goes the nation
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/CMS-2016-Quality-Strategy-Slides.pdf 27 What is MACRA? Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is legislation that passed in April 2015. This legislation repealed the Sustainable Growth Rate (SGR) formula that was used to calculate Medicare Part B payment adjustments. MACRA also outlined a new Quality Payment Program which created two new Medicare Part B Payment adjustment tracks:
Merit-based Incentive Payment System (MIPS) Advanced APM participation bonus 2017 is the initial reporting period for MIPS Performance in 2017 will be used to calculate Part B payment rates for 2019 MIPS rate impact for 2019 can be as much as +/-4% 28 The New Merit-based Incentive Program (MIPS) The Merit-based Incentive Program (MIPS) rolls three existing Medicare Physician Fee Schedule payment programs into one budget-neutral pay-for-performance
program. These programs include the Physician Quality Reporting System (PQRS), Meaningful Use, and Value-Based Modifier payment adjustments 29 When does MIPS begin? The first performance year for MIPS is 2017. The data will be reported in 2018 for a Medicare Part B payment adjustment in 2019. 30 Who participates in MIPS? 31
Quality Performance Category The Quality category replaces PQRS and the Quality portion of the Value Modifier which creates an easier transition due to familiarity Category Requirements Select 6 out of 271 potential quality measures to report to CMS One measure must be an outcome measure or a high priority measure A High priority measure is defined as an outcome measure, appropriate use measure, patient experience, patient safety,
efficiency measure or care coordination Groups (TINs) with more than 16 clinicians will also have the AllCause Readmission measure included in their quality score. If a clinician is participating in MSSP or CPC + the quality reporting requirements of those programs satisfy this category. 32 Quality: Final Score The Quality performance score will be calculated by adding up all the points received by the 6 required quality
measures + bonus points divided by the maximum number of points. The number of maximum points is dependent upon the reporting mechanism that was used 33 Improvement Activities (IA) This is a new category
The Improvement Activities category requires attestation that we participate in activities that improve clinical practice. There are 90+ activities to select from in nine subcategories. No group (TIN) has to attest to more than 4 activities 34 IA: Scoring Methodology There is a maximum number of 40 points in the category
There are medium and high weighted improvement activities Medium = 10 points High = 20 points Either 4 medium weighted activities or 2 high weighted activities (or any combination thereof) are required for submission to get the maximum 40 points The final score will be a sum of the total number of points for completed activities, divided by the maximum, multiplied by 100. 35 https://qpp.cms.gov/measures/ia 36 Clinical Practice Improvement Activities Helps with Joy in Work
efficiency Helps improve health outcomes Helps improve practice 37 Do you wish you had more time to see the people who really need you? Do you wish that you had shorter wait times for urgent, routine and wellness/physical exam appointments? Are there people in your practice that you worry about and/or havent seen in a while? Are there other issues that keep you up at night? Are there things happening in your community that, if improved, could make a
difference in your practice? Case Discussion Pause #4: Hows your practice doing? 38 Putting it all together Case Discussion Pause #4 continued In small groups, reflect on: The priorities set out in the CHNA/CHIP The characteristics of your practice population Your wishes and worries about your practice MACRA requirements (quality and improvement activities)
General principles of population health County Health Rankings model Take 5 minutes to sketch out an approach to one population health issue that you could take on Identify the population segment and issue What would you seek to accomplish What would success look like (subjective or measure) What partners/stakeholders could help you How could you involve the population itself in solving the issue What changes might you test 10 min Report out: 2 or 3 groups share their approach with the group
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