View
221
Download
2
Category
Tags:
Preview:
Citation preview
#HASummit14
Session #24: Allina: How this ACO Is Using Actionable Data and an Integrated Care Program to
Improve Outcomes
Ensor Transfeldt, MD, Spine Program Medical Director
Allina Health
Pre-Session Poll Question
On a scale of 1-5, how effectiveis your organization’s ability to deliver coordinated care for complex conditions?
1) Not at all effective2) Somewhat effective3) Moderately effective4) Very effective5) Extremely effective6) Unsure or not applicable
#HASummit14
About the Organization
2
• Dedicated to the prevention and treatment of illness and helping people live healthier lives in communities in Minnesota and western Wisconsin
• Not-for-profit integrated delivery system, Pioneer ACO
#HASummit14 3
The Problem
Low back pain (LBP) is a common and expensive medical problem
• The estimated annual associated costs for patients, employers, and insurers resulting from LBP exceed $100 billion per year in the United States, two-thirds of which are a result of lost wages and reduced productivity
• LBP is one of the most common reasons for missed work
• There are marked variations in spinal surgery internationally and between regions in the United States
#HASummit14 4
The ProblemIn 2010, Allina Health noted a poor grade for their spine surgery performance at some of their facilities on publicly reported data
• The accuracy of the rating was unclear, but Allina did not have good control of or access to their data to determine whether the report was accurate
• Analysis of available data indicated significant variation in outcomes
• Allina lacked a truly integrated, multidisciplinary approach to the treatment of patients with low back pain
• There was a significant lack of physician awareness and engagement in performance and outcomes
#HASummit14 5
Our Approachand
Results
#HASummit14
Surgical Spine Quality Council
Chair: Dr. Mehbod
Medical Spine Quality Council
Chair: Dr. Hillman
Spine Program Development Group
Chair: Dr. Transfeldt
Allina Health Group Executive Committee
6
West Region Committee
East Region Committee
North Region Committee
CKRI Spine Ops Committee
IP Spine Nursing Group
PATIENT DRIVEN
Objective: recommend, prioritize, set goals, strategy, capital, performance oversight, communication
TBD: OP Spine Nursing Group
Allina Health Spine Program Governance
#HASummit14
CONTINUED SPINE CARE PATHWAYACUTE SPINE CARE
PATHWAY
Coordinated Spine Care Model
PREVENTION
Allina Health Spine Care Model
Consumer Education• Payer organizations• Employment groups
Community Education• AH “Back School”• Community Health Fairs
Wellness Organizations• YMCA• Life Time
Primary CareEmergency/Urgent CareSpecialty Care (MD)Specialty Care (non MD)
Return to Primary Care Provider with After Care as needed
Excellian Order:Ambu Consult to Spine Center
No Improvement or lack of resources
Spine Surgery Consult
(if indicated)
Medical Spine Specialist Consult
(MD or Non MD)
Clinical Triage / Care Navigation
Evidence-Based Spine Treatment
Further DX Workup
• Imaging• Labs
Conservative Treatment
• Sx management • Physical therapy• Chiropractic• Integrative medicine
Interventional Treatment
• Injections• Surgery
Chronic Pain Management
• Psychology• Medication
NO
NO
80-90% OF Acute LBP responds to:• Reassurance• Education• Exercise• Physical Therapy
Red Flags:• Suspected Cauda Equina
Syndrome• Suspected Myelopathy• Recent Trauma• Suspected Cancer• LMN Weakness• Suspected Infection
Community wellness programs
Fitness/Activity Programs
Episodic physical therapy or home
program
Self Referral(Telephone or Web Based)
Improved?
YE
S
7
#HASummit14
NO
Clinical Care Guidelines for LBP
Initial Evaluation Evaluation Elements:History and ExamReview Red/Yellow FlagsPain Rating (VAS)Quality of Life Instrument
Core Treatment Plan:Education & ReassuranceEncourage activityPT or Chiropractic Care
YESRed Flag Protocol
Radiculopathy CPGYES
NO
Core Treatment PlanReassess in 2-4 weeks
Continue Core Treatment Plan• Encourage ongoing exercise• Reassess in 4-6 weeks
Low RiskDetermine risk of developing chronic back pain:• Assess Yellow Flags• Keele STarT Back Screening Tool
Re-evaluation
Improving?
Re-evaluation
YES
YESImproving?
Core Treatment Plan, PLUS:• Physical Therapist with clinician trained in
addressing psychosocial issues• Mental Health Screening/Psychology• Consider Spine Center referral• Reassess in 1-3 weeks
Moderate/High Risk
Core Treatment Plan, PLUS:• Reassure & Address Psychosocial Factors• Consider Spine Center Referral• Consider Integrative Medicine Referral• Reassess in 1-3 weeks
Core Treatment Plan, PLUS:Shared Decision Making:• Further workup (Imaging, Labs)• Medications• Spine Center Referral
Self ManagementEncourage fitness/activity program(s)Or PT Home ProgramFollow up as needed
Re-evaluation
Improving?
SPINE CENTER REFERRAL
YES
NO
NO
NO
Red Flags?
Red Flags?
8
#HASummit14 9
The Need for Actionable Data
Implemented a late- binding enterprise data warehouse platform (EDW) to take advantage of available information and provide support for providers and managers.
The EDW aggregates clinical, financial, operational, experience and other data to create consistent views of the data to inform decisions.
The Spine dashboard is used to monitor and manage performance and to drive behavior change.
#HASummit14 10
The Spine DashboardThe Spine dashboard is used to monitor and manage performance and to drive behavior change
#HASummit14 11
The Spine Dashboard
#HASummit14 12
The Spine Dashboard
#HASummit14
Poll Question #2
13
On a scale of 1-5, how effective is your organization at using data to drive behavior change and performance improvement?
1) Not at all effective
2) Somewhat effective
3) Moderately effective
4) Very effective
5) Extremely effective
6) Unsure or not applicable
#HASummit14 14
Results
Implemented a successful, highly collaborative coordinated care program for spine disorders including LBP
Significantly improved access to good data and toward a data- driven culture
Projected $2.7 million in implant savings achieved through standardization
#HASummit14 15
Results – LOS• Achieved a 16% reduction in LOS
Length of Stay
Year Average LOS Volume
2012 4.25 1246
2013 3.97 1146
2014 3.75 1172
Jan-Apr 2015 3.61 398
#HASummit14
Results – Post-Op Complications
16
Year-to-Date 2015 (Jan-Feb)
Mar 14n=24
Apr 14n=18
May 14n=21
Jun 14n=26
Jul 14n=23
Aug 14n=24
Sep 14n=26
Oct 14n=28
Nov 14n=14
Dec 14n=20
Jan 15n=17
Feb 15n=7
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0% 10.6%
7.4%9.1%
10.8%9.7%
10.6% 10.3% 10.6%
6.3%7.7% 8.1%
3.6%
PPC Overall - 2014-2015
PPC Rate (N/D) Goal ≤ 9.3%
3.6% Reduction in post-op complications
#HASummit14 17
Future Plans
• Continue to develop a highly integrated, coordinated, multi-disciplinary, patient-centric approach to patients with spine issues
• Continue to improve quality and availability of data
• Continue drive toward value (high quality, low cost, appropriate care)
• Broadly introduce the fusion risk score (FRS)
• Measure the financial impact of the Spine program
#HASummit14 18
Lessons Learned
1. Data is not only critical for measurement; it can also influence behavior
2. Build an effective multi-disciplinary improvement team 3. Engage and effectively communicate with all stakeholders
involved in the care process you are trying to improve 4. Create a compelling case for change
#HASummit14
Analytic Insights
AQuestions &
Answers
19
#HASummit14
Choose one thing…
20
Write down one thing will you do differently after hearing this presentation
#HASummit14
Thank You
21
#HASummit1422
Session Feedback Survey
1. On a scale of 1-5, how satisfied were you overall with this session?
1) Not at all satisfied
2) Somewhat satisfied
3) Moderately satisfied
4) Very satisfied
5) Extremely satisfied
2. What feedback or suggestions do you have?
#HASummit14 23
Upcoming Sessions
Breakout Sessions – Wave 4 (1:15 PM – 2:00 PM)
26) Panel – How Community Hospitals Thrive with AnalyticsJohn Wadsworth, Vice President, Technical Operations, Health Catalyst
27) Quality Improvement in Healthcare: An ACO Palliative Care CaseDr. Robert Sawicki, MD, Senior Vice President, Supportive Care, OSF HealthcareRoopa Foulger, Executive Director, Data Delivery, OSF HealthcareLinda Fehr, RN, Division Director, Supportive Care, OSF Healthcare
28) Clinical Standards Work To Improve Evidence-Based Care Delivery: A How-To WorkshopCharles Macias, MD, MPH, Chief Clinical Systems Integration Officer, Texas Children’s HospitalTerri Brown, MSN, RN, CPN, Assistant Director, Clinical Outcomes & Data Support; Research Specialist, Center for Research and EBP, Texas Children’s Hospital
29) Five Months to Improvement: How Stanford Built an Improvement Program the Gets ResultsSpencer H. Kubo, MD, Associate Professor of Radiology (Pediatric Radiology), Stanford University Medical Center
30) Breaking Down Silos: Resolving Academic, Medical, and Research Interests Once and for AllSamuel L. Volchenboum, MS, MD, PhD, Assistant Professor of Pediatrics, Director, Informatics Program, The University of Chicago Medicine)
Location
Imperial Ballroom B
Imperial Ballroom A
Grand Salon
Murano
Venezia
Recommended