Provider
Rising Nurse Leader Development Program
South Dakota
Christine
Buell
Inventor/Director of Leadership Development, Avera Health Human Resources
605-322-5188
Melissa.Goodwin@ii4change.com
Yes
Innovation Lab and HealthStream
The Rising Nurse Leader Development Program has been licensed by HealthStream, based in Nashville, Tenn. to market and sell to its customers across the United States as part of the Talent Solutions portfolio of programs on their website.
The Rising Nurse program was developed by Christine Buell, director of Leadership Development for Avera. Debbie Kooiker, a consultant on the Avera Leadership and Organizational Development team, has been responsible for implementation of the program. They are billed, respectively, as the innovator and co-innovator, for the product.
After approximately a year-long process with the Innovation Lab, the deal was signed with HealthStream. “When it was signed, I was ecstatic!” Kooiker said. “It gave me the validation that we had a great program that was developed for the right reasons, and now we can potentially share it with other facilities across the U.S. Our team is passionate about developing people, and the thought of being a part of developing others outside of Avera is very exciting.”
The Rising Nurse Leader program targets high-potential, high-performing nurses who are interested in pursuing nursing leadership. During a six-month period, they travel to each of Avera’s six regional locations to take part in classroom-based learning designed around the American Nurses Association curriculum and the Avera Leadership Core Competencies.
The program has had a tremendous impact on Avera. There have been 70 participants during the course of the three years it has been offered. The retention rate among employees who have completed it is 89 percent. Seventeen of those participants – 24 percent – have had promotions.”
“It helps with retention because these are employees who want a lot out of their career. A journey like this can be very satisfactory to them,” Buell said. “They know Avera is going to invest in them and wants them to grow and develop. Furthermore, it helps develop leaders to fill the roles of those who are retiring or leaving the organization for other reasons,” she added.
“We are proud of what the Avera team has accomplished,” said Ryan Kelly, General Manager of the Innovation Lab. “This best of breed program can now be duplicated nationally to help other health care organizations pursue nursing excellence for their staff.”
Many more Avera employee ideas are still being researched and developed by the Innovation Lab, which has evaluated over 2,000 ideas from across its member owner health systems and the general public. Currently, the Lab has taken 10 products to the commercialization phase, which means they are either already available to hospitals and/or consumers through the health care product marketplace or are being developed by a partner to be made available.
“The Innovation Institute’s unique business model allows the employees of non-profit member owner health systems to take new ideas from concept to market through the Innovation Lab at no cost to the employee,” said Joe Randolph, president and CEO of The Innovation Institute. The Innovation Institute current member owners include Avera, Providence St. Joseph Health, Children’s Hospital of Orange County, Bon Secours Mercy Health, and Franciscan Missionaries of Our Lady Health System. This collaborative taps into physicians, employees, and industry business partners to incubate and commercialize new products and ideas through the Innovation Lab. Comprised of three distinct elements – an innovation lab, an investment fund, and a shared services Enterprise Development Group.
The Innovation Lab at Avera – in partnership with The Innovation Institute – provides all Avera employees and physicians with free resources to support innovative ideas. When staff members submit an idea, they find the support and the expert help they need to evaluate the potential of their idea, develop prototypes to test and demonstrate the idea, and determine the best way to take the idea to market.
The Innovation Institute also takes promising ideas to potential partners. If the product makes it to the marketplace, the inventor will receive royalties from sales of the product.
The Rising Nurse program was developed by Christine Buell, director of Leadership Development for Avera. Debbie Kooiker, a consultant on the Avera Leadership and Organizational Development team, has been responsible for implementation of the program. They are billed, respectively, as the innovator and co-innovator, for the product.
After approximately a year-long process with the Innovation Lab, the deal was signed with HealthStream. “When it was signed, I was ecstatic!” Kooiker said. “It gave me the validation that we had a great program that was developed for the right reasons, and now we can potentially share it with other facilities across the U.S. Our team is passionate about developing people, and the thought of being a part of developing others outside of Avera is very exciting.”
The Rising Nurse Leader program targets high-potential, high-performing nurses who are interested in pursuing nursing leadership. During a six-month period, they travel to each of Avera’s six regional locations to take part in classroom-based learning designed around the American Nurses Association curriculum and the Avera Leadership Core Competencies.
The program has had a tremendous impact on Avera. There have been 70 participants during the course of the three years it has been offered. The retention rate among employees who have completed it is 89 percent. Seventeen of those participants – 24 percent – have had promotions.”
“It helps with retention because these are employees who want a lot out of their career. A journey like this can be very satisfactory to them,” Buell said. “They know Avera is going to invest in them and wants them to grow and develop. Furthermore, it helps develop leaders to fill the roles of those who are retiring or leaving the organization for other reasons,” she added.
“We are proud of what the Avera team has accomplished,” said Ryan Kelly, General Manager of the Innovation Lab. “This best of breed program can now be duplicated nationally to help other health care organizations pursue nursing excellence for their staff.”
Many more Avera employee ideas are still being researched and developed by the Innovation Lab, which has evaluated over 2,000 ideas from across its member owner health systems and the general public. Currently, the Lab has taken 10 products to the commercialization phase, which means they are either already available to hospitals and/or consumers through the health care product marketplace or are being developed by a partner to be made available.
“The Innovation Institute’s unique business model allows the employees of non-profit member owner health systems to take new ideas from concept to market through the Innovation Lab at no cost to the employee,” said Joe Randolph, president and CEO of The Innovation Institute. The Innovation Institute current member owners include Avera, Providence St. Joseph Health, Children’s Hospital of Orange County, Bon Secours Mercy Health, and Franciscan Missionaries of Our Lady Health System. This collaborative taps into physicians, employees, and industry business partners to incubate and commercialize new products and ideas through the Innovation Lab. Comprised of three distinct elements – an innovation lab, an investment fund, and a shared services Enterprise Development Group.
The Innovation Lab at Avera – in partnership with The Innovation Institute – provides all Avera employees and physicians with free resources to support innovative ideas. When staff members submit an idea, they find the support and the expert help they need to evaluate the potential of their idea, develop prototypes to test and demonstrate the idea, and determine the best way to take the idea to market.
The Innovation Institute also takes promising ideas to potential partners. If the product makes it to the marketplace, the inventor will receive royalties from sales of the product.
Improved the life of healthcare providers
Provider
NYU Langone Health
New York
Jason
Sherwin
Associate Director of Virtual Health
646-524-0278
jason.sherwin@nyulangone.org
Yes
Epic, Vidyo, Quality Reviews, ThoughtWorks
As telemedicine becomes a growing part of healthcare delivery, interoperability and integration have emerged as critical ingredients for determining the success of and patient satisfaction with a health system’s offering. With this in mind, NYU Langone Health made the strategic decision to partner with Epic Systems and utilize their Open Scheduling API and existing MyChart integration to build the NYU Langone Virtual Urgent Care in lieu of partnering with a third-party telemedicine vendor. Integrating our Virtual Urgent Care directly into MyChart allows our patients and providers to leverage Epic as the enterprise electronic health record for all in-person and telemedicine encounters. All of the patient’s follow up care including labs, imaging, and referrals to specialists are maintained in within the MyChart portal. Furthermore, the strategy has enabled clinicians to follow standardized clinical workflow in Epic.
After a successful pilot with NYU Langone employees in late 2017, we publically launched the NYU Langone Virtual Urgent Care service to millions of adults and children (ages 5 and up) in the New York, New Jersey, Connecticut and Pennsylvania. Commercial insurance is accepted with Aetna, Cigna, Blue Cross Blue Shield, and UnitedHealthcare. We leverage real-time eligibility for immediate insurance verification during scheduling, eliminating the need for front-end registration staff and facilitating proper co-pay collection with the remaining balance billed to insurance.
The entire patient experience is available on any smartphone or tablet using the NYU Langone Health app. Established patients log into the app with their MyChart account credentials. New patients create an account on-the-fly without registrar intervention. During online check-in patients can electronically sign registration documents, verify existing allergies, medications and preferred pharmacy, make a co-payment, and enter a reason for visit which is all reconciled by the provider. Real-time text messaging guides the patient through their journey, and has reduced no show rates from 15% to under 5% since its introduction.
Providers receive push notifications to their smartphone when visits are scheduled and when the patient connects to the virtual room, allowing them to keep track of the schedule from anywhere. They access clinical encounter directly from the EHR and connect to the video visit, and subsequently complete clinical documentation during and after the encounter in a customized clinical navigator. They can enter orders for labs, prescriptions, imaging, and ambulatory referrals for follow up. Letters can also be generated, such as a doctor’s note, which the patient can view in their After Visit Summary.
A large cross-functional team was critical to our success. Health system leadership including our Chief Clinical Officer, CIO, and CMIO, and the Chair of the Emergency Department were influential in driving our strategy. A large IT team of over 20 individuals participated including the dedicated Virtual Health team, analysts from various clinical application teams, as well as an in-house web development team. The clinical service is run operationally by the Department of Emergency Medicine, and the administrative director and medical director were therefore key partners. Our Managed Care and Billing teams developed and executed our reimbursement strategy. Our legal and compliance teams were consulted throughout the implementation. Finally, a dedicated marketing team developed a robust digital strategy for reaching our patient population, which allowed us to exceed our visit volume goals.
We have treated over 7,000 Virtual Urgent Care patients since the launch. Volume has increased rapidly thanks to a growing list of covered benefit plans and a significant investment in digital marketing. Common diagnoses include cough, flu, rash, and sore throat with approximately 65% of our patients receiving a prescription after their visit. Greater than 98% of our patients are able to successfully establish a video connection, which highlights the importance of our real-time Telemedicine Support desk.
We measure patient satisfaction via a post-visit text message survey, and the results are extremely positive. Patient satisfaction with the service is 4.64/5 stars on average. Patients score the ease of use of the technology with a score of 4.59/5 stars, a number that continues to improve as we enhance the product with new features.
The goal of the service was to target patients who would have otherwise been seen in person at a brick-and-mortar urgent care or by their primary care doctor. 81.5% of surveyed patients indicated that they would have been seen in one of these settings, which highlights that the intended patient population is being reached. Only 5.5% of patients said that they would have gone to an Emergency Department for treatment.
After a successful pilot with NYU Langone employees in late 2017, we publically launched the NYU Langone Virtual Urgent Care service to millions of adults and children (ages 5 and up) in the New York, New Jersey, Connecticut and Pennsylvania. Commercial insurance is accepted with Aetna, Cigna, Blue Cross Blue Shield, and UnitedHealthcare. We leverage real-time eligibility for immediate insurance verification during scheduling, eliminating the need for front-end registration staff and facilitating proper co-pay collection with the remaining balance billed to insurance.
The entire patient experience is available on any smartphone or tablet using the NYU Langone Health app. Established patients log into the app with their MyChart account credentials. New patients create an account on-the-fly without registrar intervention. During online check-in patients can electronically sign registration documents, verify existing allergies, medications and preferred pharmacy, make a co-payment, and enter a reason for visit which is all reconciled by the provider. Real-time text messaging guides the patient through their journey, and has reduced no show rates from 15% to under 5% since its introduction.
Providers receive push notifications to their smartphone when visits are scheduled and when the patient connects to the virtual room, allowing them to keep track of the schedule from anywhere. They access clinical encounter directly from the EHR and connect to the video visit, and subsequently complete clinical documentation during and after the encounter in a customized clinical navigator. They can enter orders for labs, prescriptions, imaging, and ambulatory referrals for follow up. Letters can also be generated, such as a doctor’s note, which the patient can view in their After Visit Summary.
A large cross-functional team was critical to our success. Health system leadership including our Chief Clinical Officer, CIO, and CMIO, and the Chair of the Emergency Department were influential in driving our strategy. A large IT team of over 20 individuals participated including the dedicated Virtual Health team, analysts from various clinical application teams, as well as an in-house web development team. The clinical service is run operationally by the Department of Emergency Medicine, and the administrative director and medical director were therefore key partners. Our Managed Care and Billing teams developed and executed our reimbursement strategy. Our legal and compliance teams were consulted throughout the implementation. Finally, a dedicated marketing team developed a robust digital strategy for reaching our patient population, which allowed us to exceed our visit volume goals.
We have treated over 7,000 Virtual Urgent Care patients since the launch. Volume has increased rapidly thanks to a growing list of covered benefit plans and a significant investment in digital marketing. Common diagnoses include cough, flu, rash, and sore throat with approximately 65% of our patients receiving a prescription after their visit. Greater than 98% of our patients are able to successfully establish a video connection, which highlights the importance of our real-time Telemedicine Support desk.
We measure patient satisfaction via a post-visit text message survey, and the results are extremely positive. Patient satisfaction with the service is 4.64/5 stars on average. Patients score the ease of use of the technology with a score of 4.59/5 stars, a number that continues to improve as we enhance the product with new features.
The goal of the service was to target patients who would have otherwise been seen in person at a brick-and-mortar urgent care or by their primary care doctor. 81.5% of surveyed patients indicated that they would have been seen in one of these settings, which highlights that the intended patient population is being reached. Only 5.5% of patients said that they would have gone to an Emergency Department for treatment.
Enhanced the patient experience
Provider
ProviDRs Care
Kansas
Justin
Leitzen
Director of Network Innovations
316-683-0604
justinleitzen@providrscare.net
No
Overview
NexUS is a new product launched by ProviDRs Care in December 2018 for self-funded employers and insurance companies. Our goals with the delivery model were to improve outcomes and lower costs for patients, use data analytics to drive decisions and design a value based model that focused on the major cost drivers of an employer’s health plan.
A group of 3 physicians, all independent practices, met weekly for 2 years with myself and Karen Cox on the development of the model. Using the above goals as the framework for discussions, we looked at other value based models in the market as well as those being offered through CMS. We knew the primary care physician (PCP), member, and employer needed to be at the heart of the model to improve outcomes and drive down costs. We wanted to keep the model simple and actionable for PCPs, knowing that many of these models provide enormous amounts of data to primary care physicians. Additionally, we believed the single biggest flaw in the healthcare system are misaligned incentives between the employer, member, and provider.
Data
We also felt both clinical and claims data was going to be critical for physicians to be successful in the model. As a physician owned PPO, claims have always been something we’ve received. However, it was the clinical data that was going to be new. With a robust Health Information Exchange (HIE) in Kansas, we developed a connection with the HIE that gave us access to EHRs to all hospitals in Kansas. With the data, we developed a database to administer the performance based incentive that includes each of the five domains described in the next section.
Performance Based Incentive
The PCP centric model provides additional incentives to participating PCPs based on their performance in five different domains. The domains consist of 1) Utilization 2) Quality 3) Referrals 4) Site of Service 5) Access. Each domain was then given a weight based on the potential savings opportunities using an analysis completed by an actuarial firm.
Because the product requires members to select a PCP, each PCP is provided a list of their panel of patients. The PCP’s receive a per member per month incentive based on each month’s performance using a rolling 12 months.
Care Navigator
To help support participating PCPs in the model, a Care Navigator (registered nurse) actively identifies and manages the “high risk” population for the PCP and employer. With access to every hospital EHR in Kansas, the care navigator is also able to follow up on all hospital discharges (ER or admission). Along with following up, high risk members are managed through the program to help coordinate care as well as moving them to a state of self-management.
Member Incentives
The other aspect to getting incentives aligned is to ensure members are educated and engaged. Members are also financially incentivized in the five domains previously mentioned. This ensures that both the PCP and member have financial incentives to improve the outcomes within each of the domains.
Outcomes Through July 1, 2019
The below data represents how employers are performing under this model relative to how employers and payers are performing under our traditional model.
Total Lives: 700
Admissions: 37% less
ER Visits: 43% less
PMPM Savings: $158.74
Total Savings through 1st 6 months: $563,680
NexUS is a new product launched by ProviDRs Care in December 2018 for self-funded employers and insurance companies. Our goals with the delivery model were to improve outcomes and lower costs for patients, use data analytics to drive decisions and design a value based model that focused on the major cost drivers of an employer’s health plan.
A group of 3 physicians, all independent practices, met weekly for 2 years with myself and Karen Cox on the development of the model. Using the above goals as the framework for discussions, we looked at other value based models in the market as well as those being offered through CMS. We knew the primary care physician (PCP), member, and employer needed to be at the heart of the model to improve outcomes and drive down costs. We wanted to keep the model simple and actionable for PCPs, knowing that many of these models provide enormous amounts of data to primary care physicians. Additionally, we believed the single biggest flaw in the healthcare system are misaligned incentives between the employer, member, and provider.
Data
We also felt both clinical and claims data was going to be critical for physicians to be successful in the model. As a physician owned PPO, claims have always been something we’ve received. However, it was the clinical data that was going to be new. With a robust Health Information Exchange (HIE) in Kansas, we developed a connection with the HIE that gave us access to EHRs to all hospitals in Kansas. With the data, we developed a database to administer the performance based incentive that includes each of the five domains described in the next section.
Performance Based Incentive
The PCP centric model provides additional incentives to participating PCPs based on their performance in five different domains. The domains consist of 1) Utilization 2) Quality 3) Referrals 4) Site of Service 5) Access. Each domain was then given a weight based on the potential savings opportunities using an analysis completed by an actuarial firm.
Because the product requires members to select a PCP, each PCP is provided a list of their panel of patients. The PCP’s receive a per member per month incentive based on each month’s performance using a rolling 12 months.
Care Navigator
To help support participating PCPs in the model, a Care Navigator (registered nurse) actively identifies and manages the “high risk” population for the PCP and employer. With access to every hospital EHR in Kansas, the care navigator is also able to follow up on all hospital discharges (ER or admission). Along with following up, high risk members are managed through the program to help coordinate care as well as moving them to a state of self-management.
Member Incentives
The other aspect to getting incentives aligned is to ensure members are educated and engaged. Members are also financially incentivized in the five domains previously mentioned. This ensures that both the PCP and member have financial incentives to improve the outcomes within each of the domains.
Outcomes Through July 1, 2019
The below data represents how employers are performing under this model relative to how employers and payers are performing under our traditional model.
Total Lives: 700
Admissions: 37% less
ER Visits: 43% less
PMPM Savings: $158.74
Total Savings through 1st 6 months: $563,680
Reduced healthcare costs
Provider
Maybe
Alabama
BSER
Arsaid@yahoo.com
Arsaida
0530993670
arsaid@yahoo.com
Yes
Dsyy209 and the original resolution was
Arsaid@yahoo.com
Reduced healthcare costs
Provider
Happify Health
New York
Ran
Zilca
Chief Data Science Officer
973-588-2185
rrispoli@coynepr.com
No
Technology That Helps Us Help Ourselves: Talk Therapy in Combination with Augmented Intelligence
Enhanced the patient experience
Provider
Joyhaptics Oy
Outside the United States
Jussi
Tuovinen
CEO, Co Founder
+358 40 589 9132
jussi.tuovinen@joyhaptics.com
No
Hello,
Please check our iXu – the world’s first designer teddy bear that mirrors touch over distance !
https://www.joyhaptics.com
Touch is ten times stronger than verbal or emotional contact, and it affects damned near everything we do. — We forget that touch is not only basic to our species, but the key to it.
Interested in knowing more about the science behind touch? Gallace, A., & Spence, C. (2010). The science of interpersonal touch: An overview. Neuroscience & Biobehavioral Reviews, 34(2), 246–259. https://doi.org/10.1016/j.neubiorev.2008.10.004
We are interested in making an article about the importance of touch and how it can be implemented using modern technology
For more information please contact our CEO & Co-founder
Jussi Tuovinen
Dr Jussi.tuovinen@joyhpaptics.com
+358 40 589 9132
Please check our iXu – the world’s first designer teddy bear that mirrors touch over distance !
https://www.joyhaptics.com
Touch is ten times stronger than verbal or emotional contact, and it affects damned near everything we do. — We forget that touch is not only basic to our species, but the key to it.
Interested in knowing more about the science behind touch? Gallace, A., & Spence, C. (2010). The science of interpersonal touch: An overview. Neuroscience & Biobehavioral Reviews, 34(2), 246–259. https://doi.org/10.1016/j.neubiorev.2008.10.004
We are interested in making an article about the importance of touch and how it can be implemented using modern technology
For more information please contact our CEO & Co-founder
Jussi Tuovinen
Dr Jussi.tuovinen@joyhpaptics.com
+358 40 589 9132
Reduced healthcare costs
Provider
Mid-Delta Health Systems, Inc.
Mississippi
Kentrell
Liddell MD
Vice President of Quality Management & Infection Control
601-519-7680
kliddell@middelta.com
Yes
HomeCare HomeBase
At Mid-Delta Health Systems, Inc., we are very serious about providing high quality patient care and about achieving excellent patient satisfaction. We have always enjoyed positive patient feedback during our internal patient satisfaction surveying. However, we had been looking to solve the problem of decreased patient satisfaction ratings that are reported by external organizations, such as the Centers for Medicare & Medicaid Services (CMS). Such reportings are so important in terms of patient referrals, business growth, maintenance of competitive advantage, satisfaction and retention of highly qualified staff, and so much more.
We took a bold step in November 2018. We developed an aggressive plan that required the collaboration of several departments, including Quality Management, Management Information Systems, Intake, Education, and Marketing aimed at improving our external patient satisfaction ratings. Specifically, we developed a mandatory training program that reiterated the high importance of patient care and patient satisfaction. During the training, we encouraged clinicians to ALWAYS ask patients if there is anything else they can do for them before leaving their homes; if they understand all advice and instructions; and, if there is something the clinician could have done better during the visit. Additionally, we asked clinicians to let patients know to expect either a mail-out survey or a phone call from a quality auditor to discuss the quality of the service they received.
During the initial review of our project's progress, we realized that we were not making the kind of headway we had expected. The reason for this was determined to be that clinicians simply were not asking the questions, because (in 75% of the cases) they were forgetting to do so. We partnered with our electronic health record (EHR) vendor, HomeCare HomeBase to create a reminder screen on the point-of-care devices used by all clinicians that seamlessly integrated the line of questioning into the routine assessment. That intervention worked!
Today, we enjoy a publicly reported 5-star rating for not only Patient Satisfaction, but for the Quality of Care provided by our clinicians as well! (See the attached screenshot of the updated ratings recently published by CMS on its Home Health Compare website.) The success of our initiative further proves that teamwork works.
We took a bold step in November 2018. We developed an aggressive plan that required the collaboration of several departments, including Quality Management, Management Information Systems, Intake, Education, and Marketing aimed at improving our external patient satisfaction ratings. Specifically, we developed a mandatory training program that reiterated the high importance of patient care and patient satisfaction. During the training, we encouraged clinicians to ALWAYS ask patients if there is anything else they can do for them before leaving their homes; if they understand all advice and instructions; and, if there is something the clinician could have done better during the visit. Additionally, we asked clinicians to let patients know to expect either a mail-out survey or a phone call from a quality auditor to discuss the quality of the service they received.
During the initial review of our project's progress, we realized that we were not making the kind of headway we had expected. The reason for this was determined to be that clinicians simply were not asking the questions, because (in 75% of the cases) they were forgetting to do so. We partnered with our electronic health record (EHR) vendor, HomeCare HomeBase to create a reminder screen on the point-of-care devices used by all clinicians that seamlessly integrated the line of questioning into the routine assessment. That intervention worked!
Today, we enjoy a publicly reported 5-star rating for not only Patient Satisfaction, but for the Quality of Care provided by our clinicians as well! (See the attached screenshot of the updated ratings recently published by CMS on its Home Health Compare website.) The success of our initiative further proves that teamwork works.
Enhanced the patient experience
Provider
The Harris Center for Mental Health and IDD
Texas
Wayne
Young
CEO
713-970-7160
Wayne.young@theharriscenter.org
No
The Clinician-Officer Remote Evaluation Program (CORE) is a strategy of responding to mental health crisis calls utilizing a tablet and a HIPPAA compliant technology platform to connect a law enforcement first responder with a mental health clinician via Telehealth in the community at the time of the 911 dispatch. Ten Harris County Sheriff Office patrol deputies were assigned tablets and connect to behavioral health clinicians that work for Harris Center for Mental Health and IDD. Clinicians help the officers decide if the person requires hospitalization or if they can remain in the community. The clinicians arrange for follow-up care and/or mobile crisis outreach teams for immediate community based supports.
Utilizing tele-behavioral health is fairly common today. However, leveraging tele-health interventions with behavioral health clinicians providing clinical support in the field to support law enforcement in responding to 911 crisis calls is a potentially transformative innovation. The potential to scale this intervention is tremendous compared to the traditional 1:1 clinician/officer ratio.
COST SAVINGS RESULTS:
ED Diversion: Forty percent of the calls were resolved on the scene with only 60% resulting in an Emergency Detention Order with transportation to an emergency setting.
FORCE MULTIPLIER: Behavioral health staff members went from 1 clinician supporting one officers to 1 clinician supporting 10 officers with a future plan of 1 clinician support 20 officers.
DEPUTY REPORTED OUTCOMES:
1. 78% of deputies would you have called a traditional CIRT / co-responder team if they did not have an iPad
2. 63% would have transported the consumer to Psychiatric Emergency Room or Hospital ER if they did not have the assistance of the clinician/psychiatrist
3. 73% of the deputies reported the clinician/psychiatrist helped safely deescalate the consumer
4. 77% of the deputies reported the clinician/psychiatrist helped identify/access resources they would not otherwise have identified/accessed
5. 83% of the deputies reported the clinician/psychiatrist helped them decide what course of action take with the consumer
6. 71% of the deputies believed the clinician/psychiatrist helped them handle the call in a shorter period of time than if you responded without the clinician
Utilizing tele-behavioral health is fairly common today. However, leveraging tele-health interventions with behavioral health clinicians providing clinical support in the field to support law enforcement in responding to 911 crisis calls is a potentially transformative innovation. The potential to scale this intervention is tremendous compared to the traditional 1:1 clinician/officer ratio.
COST SAVINGS RESULTS:
ED Diversion: Forty percent of the calls were resolved on the scene with only 60% resulting in an Emergency Detention Order with transportation to an emergency setting.
FORCE MULTIPLIER: Behavioral health staff members went from 1 clinician supporting one officers to 1 clinician supporting 10 officers with a future plan of 1 clinician support 20 officers.
DEPUTY REPORTED OUTCOMES:
1. 78% of deputies would you have called a traditional CIRT / co-responder team if they did not have an iPad
2. 63% would have transported the consumer to Psychiatric Emergency Room or Hospital ER if they did not have the assistance of the clinician/psychiatrist
3. 73% of the deputies reported the clinician/psychiatrist helped safely deescalate the consumer
4. 77% of the deputies reported the clinician/psychiatrist helped identify/access resources they would not otherwise have identified/accessed
5. 83% of the deputies reported the clinician/psychiatrist helped them decide what course of action take with the consumer
6. 71% of the deputies believed the clinician/psychiatrist helped them handle the call in a shorter period of time than if you responded without the clinician
Improved the care of patient populations
Provider
Summit Pacific Medical Center
Washington
Tammy
Moore
Chief Clinical Officer
3603462320
tammym@sp-mc.org
No
Summit Pacific Medical Center (SPMC) is a critical access hospital (CAH) in Western Washington, serving 75,000 residents of the state. Unlike many of our CAH partners who are struggling to thrive in the present healthcare landscape, SPMC has seen exponential growth and success through our innovation efforts. Ranking 38 out of 39 for health outcomes in the state, Grays Harbor County, home to SPMC takes to heart our vision to build the healthiest community in the nation. SPMC opened the doors of our state of the art Wellness Center in January 2019. Defying the odds, SPMC obtained partial funding through partnership with the USDA to build a three-story hub for the community. Unlike a traditional medical office building, the Wellness Center features a demonstration kitchen and cafe, physical therapy and gym centered on a 'fitness for life' philosophy and campaign, access to pharmacy, lab and imaging services and a full floor dedicated to the primary care team. This team, comprised of allopathic and naturopathic primary care providers, includes registered nurse care coordinators, health coaches, nutritionist, pediatric providers and psychiatry. This blended care team atmosphere supported in the elegant design and layout of the floor, allows for peer to peer conversations with the patient at the center. The Wellness Center has a robust number of classrooms for health education opportunities with monthly classes for the community covering a breadth of health care topics. SPMC knows that turning the tide of a community with generational poverty begins with out children. Our Wellness Center features an indoor and outdoor play and learning area. Our playground located on the grounds just outside our activity room used for patients in our swing bed program and healing garden allows a cross generational experience and also features adult exercise equipment right outside to encourage parents to work out while their children play. Through the ground and second floor of our Wellness Center is a rock climbing wall with three routes and auto-belay. Open to our staff for team building as well as our community members, this has been a powerful tool for self-esteem, physical fitness and confidence. SPMC believes that we can improve the health of our community through partnership and by creating a safe, healthy and fun place for our community to come learn, grow, rest and recover. See our video Summit Pacific, Be Part of IT for a peek at what we accomplished and what we are passionate about at: https://youtu.be/TUH4OFhGiNY.
Enhanced the patient experience
Provider
Reliant Medical Group
Massachusetts
Larry
Garber
Medical Director for Informatics
5085273803
Lawrence.Garber@ReliantMedicalGroup.org
No
Reliant found itself in the unenviable position of being kicked out of all clinical sites when their leases ran out in 2019. Faced with building and renovating every office, Reliant took the opportunity to re-evaluate every aspect of how we care for our patients in order to maximize patient experience, quality of care, and operational efficiencies. A two year-long process involving numerous physicians, staff, managers, and patients resulted in multiple innovations that were piloted and are now being used in nine new buildings with excellent results. Innovations include:
• Check-in Kiosks automatically clean screens between patients using ultraviolet light
• Automated “stealth” photography of patients checking in at kiosks or with check-in staff, triggered by the integration of EHR and hidden cameras. This “stealth” photo is visible through the EHR so the Medical Assistant can privately greet the patient in the waiting room without having to call out their name. The photos are automatically deleted each night in order to maximize patient privacy.
• Patient can complete pre-visit questionnaires at home, or using tablets while waiting in the waiting room. The answers to these questions automatically populate the EHR.
• Scales within each exam room so patients can remove their coats and be weighed privately
• Exam room exterior colored light system integrated with the EHR that automatically indicates which healthcare provider’s patient is in the room as a byproduct of opening the patient’s record within the exam room. When the healthcare provider is done seeing the patient, they can easily indicate which staff member should come to the room next by pressing a button. This changes a second colored light to show who needs to come to the room, and automatically sends a text message to the appropriate staff telling them where to go and why.
• The exam room exterior light system also integrates with a motion sensor in the room to indicate when a patient has left so that the room can be cleaned, obviating the need for staff to listen through the door to see if the patient left and closed the door behind them. Similarly the room can be set to a “breastfeeding” status where nursing mothers can stay uninterrupted until the light system senses that the door has been opened.
• All room status lights can also be set using the EHR in order to accommodate providers and staff with disabilities
• All of the exam room statuses are visible in the EHR’s schedule, as well as on 48” “Teamboards” in the staff work area. These “Teamboards” also display how many minutes a patient has been waiting for the provider or staff and flags patients that have been waiting too long. Similarly, because the system is integrated into the EHR, providers that have been seeing a patient longer than their scheduled visit length are flagged in case staff need to check in on the provider.
• Because the light system records more accurate room utilization statistics, providers can use a documentation tool that populates the provider’s actual face-to-face start and end times to help with billing. The statistics can also be used to identify resource bottlenecks. In addition, the system identifies more accurate patient wait times and displays these on the “Teamboards”, in the patient Waiting Rooms, as well as to the central check-in staff so they can alert patients if there is a long wait.
• While the patient waits for the provider in the exam room, a screen saver automatically displays on a 32" monitor a slide show of personal and marketing photos specific to the encounter provider, specialty, site and organization, intermixed with educational slides specific to problems on that patient’s Problem List. This functionality is particularly crucial to give a personalized patient experience despite physicians not having dedicated exam rooms.
• Printers within each exam room so that patients can check-out, making follow-up appointments and reviewing their after-visit summary, in the privacy of the exam room
• Pressing a blue button within the exam room automatically announces throughout the building a “Code Blue” including the room number and department. It also causes the exam room lights in the adjacent hallway to blink sequentially leading to the room in case the code team doesn’t recognize the room number. If the “Code Blue” button is paged outside of office hours, the system also automatically calls for an ambulance.
• Team areas where providers share space with their staff and other providers, yet also have the flexibility to slide glass doors to create sound-dampening cubicles for calling patients or video visits.
The work that our team has done has had a laser focus on leveraging the power of the EHR with integrated technologies in order to provide a magical experience, not only for our patients, but also for our healthcare providers and staff. Indeed, surveys of our staff and providers have shown that the system clearly helps them identify what they need to do next and where. The surveys also showed that they would not want to go back to the old system of plastic flags. In fact, providers and staff that visited our first new site were jealous and looked forward to moving into their new buildings over the subsequent 18 months. Patients too have responded well to the new technologies and given us lots of positive comments.
Our leadership has taken advantage of the more accurate workflow statistics to identify staff shortages and practice variations. Also, an analysis comparing the timestamps recorded by the light system compared to the EHR’s timestamps estimating provider face-to-face time identified 33% more time that the provider is actually with the patient than the EHR knew about. This is explained by the fact that in order to maximize patient experience, we educated clinicians to spend a few minutes talking to the patient before logging into the computer, the only event the EHR is aware of. The system alerts the provider when they could have potentially billed a higher level of service using time-based billing, and with 2 clicks makes that happen. This feature alone has increased revenue enough to pay for all of the digital enhancements in the first year!
This project is worthy of recognition because of the systematic goal-based approach that was taken by our team to redesign how office-based ambulatory care is delivered, and because of how we leveraged interfaces to the EHR in innovative ways. Offices rarely have had the ability to utilize technologies found within hospitals or emergency rooms. However our exam room light system, Teamboards, Waiting Time displays, and stealth cameras that integrate with the EHR, the text messaging system, the overhead paging system, and the ambulance-calling alarm panel were all developed, built, implemented, and interfaced by Reliant Medical Group staff, saving the organization a million dollars compared to less-functional, commercial systems!
• Check-in Kiosks automatically clean screens between patients using ultraviolet light
• Automated “stealth” photography of patients checking in at kiosks or with check-in staff, triggered by the integration of EHR and hidden cameras. This “stealth” photo is visible through the EHR so the Medical Assistant can privately greet the patient in the waiting room without having to call out their name. The photos are automatically deleted each night in order to maximize patient privacy.
• Patient can complete pre-visit questionnaires at home, or using tablets while waiting in the waiting room. The answers to these questions automatically populate the EHR.
• Scales within each exam room so patients can remove their coats and be weighed privately
• Exam room exterior colored light system integrated with the EHR that automatically indicates which healthcare provider’s patient is in the room as a byproduct of opening the patient’s record within the exam room. When the healthcare provider is done seeing the patient, they can easily indicate which staff member should come to the room next by pressing a button. This changes a second colored light to show who needs to come to the room, and automatically sends a text message to the appropriate staff telling them where to go and why.
• The exam room exterior light system also integrates with a motion sensor in the room to indicate when a patient has left so that the room can be cleaned, obviating the need for staff to listen through the door to see if the patient left and closed the door behind them. Similarly the room can be set to a “breastfeeding” status where nursing mothers can stay uninterrupted until the light system senses that the door has been opened.
• All room status lights can also be set using the EHR in order to accommodate providers and staff with disabilities
• All of the exam room statuses are visible in the EHR’s schedule, as well as on 48” “Teamboards” in the staff work area. These “Teamboards” also display how many minutes a patient has been waiting for the provider or staff and flags patients that have been waiting too long. Similarly, because the system is integrated into the EHR, providers that have been seeing a patient longer than their scheduled visit length are flagged in case staff need to check in on the provider.
• Because the light system records more accurate room utilization statistics, providers can use a documentation tool that populates the provider’s actual face-to-face start and end times to help with billing. The statistics can also be used to identify resource bottlenecks. In addition, the system identifies more accurate patient wait times and displays these on the “Teamboards”, in the patient Waiting Rooms, as well as to the central check-in staff so they can alert patients if there is a long wait.
• While the patient waits for the provider in the exam room, a screen saver automatically displays on a 32" monitor a slide show of personal and marketing photos specific to the encounter provider, specialty, site and organization, intermixed with educational slides specific to problems on that patient’s Problem List. This functionality is particularly crucial to give a personalized patient experience despite physicians not having dedicated exam rooms.
• Printers within each exam room so that patients can check-out, making follow-up appointments and reviewing their after-visit summary, in the privacy of the exam room
• Pressing a blue button within the exam room automatically announces throughout the building a “Code Blue” including the room number and department. It also causes the exam room lights in the adjacent hallway to blink sequentially leading to the room in case the code team doesn’t recognize the room number. If the “Code Blue” button is paged outside of office hours, the system also automatically calls for an ambulance.
• Team areas where providers share space with their staff and other providers, yet also have the flexibility to slide glass doors to create sound-dampening cubicles for calling patients or video visits.
The work that our team has done has had a laser focus on leveraging the power of the EHR with integrated technologies in order to provide a magical experience, not only for our patients, but also for our healthcare providers and staff. Indeed, surveys of our staff and providers have shown that the system clearly helps them identify what they need to do next and where. The surveys also showed that they would not want to go back to the old system of plastic flags. In fact, providers and staff that visited our first new site were jealous and looked forward to moving into their new buildings over the subsequent 18 months. Patients too have responded well to the new technologies and given us lots of positive comments.
Our leadership has taken advantage of the more accurate workflow statistics to identify staff shortages and practice variations. Also, an analysis comparing the timestamps recorded by the light system compared to the EHR’s timestamps estimating provider face-to-face time identified 33% more time that the provider is actually with the patient than the EHR knew about. This is explained by the fact that in order to maximize patient experience, we educated clinicians to spend a few minutes talking to the patient before logging into the computer, the only event the EHR is aware of. The system alerts the provider when they could have potentially billed a higher level of service using time-based billing, and with 2 clicks makes that happen. This feature alone has increased revenue enough to pay for all of the digital enhancements in the first year!
This project is worthy of recognition because of the systematic goal-based approach that was taken by our team to redesign how office-based ambulatory care is delivered, and because of how we leveraged interfaces to the EHR in innovative ways. Offices rarely have had the ability to utilize technologies found within hospitals or emergency rooms. However our exam room light system, Teamboards, Waiting Time displays, and stealth cameras that integrate with the EHR, the text messaging system, the overhead paging system, and the ambulance-calling alarm panel were all developed, built, implemented, and interfaced by Reliant Medical Group staff, saving the organization a million dollars compared to less-functional, commercial systems!
Enhanced the patient experience
Provider
Kaiser Permanente
California
Colubus
Batiste
MD
6179995559
steve@islandcreekpartners.com
Yes
Island Creek Partners
The Kaiser Permanente Southern California Team implemented a technology assisted Home Based Cardiac Rehab program. The service allows patients to complete the program at home and track exercise using a wearable. KP nurse case managers coach the patients through weekly phone calls and have access to all data from the wearable. The program has accepted over 3,800 patients with an 85% graduation rate.
Reduced healthcare costs
Provider
Cancer Research Updates
Outside the United States
Dr Geethanjali
Bhas
Founder
00919902890132
geethanjalibhas@gmail.com
No
This is an internationally awarded digital health resource which harnesses the power of social media in global knowledge sharing and demystifying cancer research for patients and the public .It serves as a digital health resource for cross- disciplinary and patient- public debate on cancer research from bench to bedside through creative communication techniques such as music, animation, poetry and art in addition to blogs, journal articles and perspectives. This innovation spans various domains and connects readers and followers across biomedical research, student groups,medical forums, digital health societies, organizations and public health groups on social media , thus bringing diverse voices and viewpoints. Cancer Research Updates has been rated with 5 star rating for its educational quality by the public and patients.. Its digital health service and global presence has been recognized and awarded with the 2019 Digital Health Award - Silver medal award 2019 in the category of social media based innovative digital health resources.
Improved the care of patient populations
Provider
University of Minnesota
Minnesota
Arpit
Rao
Asst Professor; Oncology Quality and Safety Chair
6123012180
raoa@umn.edu
No
The FAME Project for Reducing Chemotherapy-Related Complication in a Large Integrated Healthcare System.
CHALLENGE: Approximately 20% of advanced cancer patients receive treatment that weakens their immune system and increases risk of life-threatening infections. A good proportion of these complications can be prevented using FDA-approved medications. However, usage is highly variable in routine clinical practice and the extent of this complication in the 'real-world' is unknown.
WHO: A collaboration between University of Minnesota, Fairview Health Services (a 6.5bn USD annual revenue health system in MN) and Amgen Inc (a large international pharmaceutical company).
INNOVATION: We leveraged the resources from three large organizations to create a multidisciplinary research team with several PhDs. This became one of the largest collaborations in the oncology space in the country to our knowledge. Our team extracted data from over 50,000 patients to identify over 8,000 eligible patients at risk for this complication and provide granular details into the rates of febrile neutropenia (the life-threatening chemo complication), patients most at risk and helped generate a multi-variable risk model which is planned to be deployed free-of-charge for use by any oncologist around the country.
We presented our findings at one of the largest oncology meetings (ASCO Annual Meeting 2019) and are planning to publish an article soon. Dr. Rao was given the 2018 American College of Healthcare Executives (MN) Regent Innovation Award for his leadership in this project.
Our innovative project provided the blueprint for similar quality improvement projects in our system.
HOW: This two-year project involved creation of a joint-steering committee including senior leadership (VP and above) from all 3 systems. This JSC then pooled necessary talent into a project team (PhD data scientists, analysts, statistician, project manager etc) that worked with IT (EPIC) team at Fairview to retrieve detailed, anonymized, patient-level data. Project timelines were set at inception and rigidly adhered to with weekly calls by project team and monthly JSC calls. Innovation occurred at several levels including industry-healthcare system collaboration, involvement of research partner (University of Minnesota) to conduct detailed analyses beyond a typical QI project, and dissemination of findings at national platforms.
CHALLENGE: Approximately 20% of advanced cancer patients receive treatment that weakens their immune system and increases risk of life-threatening infections. A good proportion of these complications can be prevented using FDA-approved medications. However, usage is highly variable in routine clinical practice and the extent of this complication in the 'real-world' is unknown.
WHO: A collaboration between University of Minnesota, Fairview Health Services (a 6.5bn USD annual revenue health system in MN) and Amgen Inc (a large international pharmaceutical company).
INNOVATION: We leveraged the resources from three large organizations to create a multidisciplinary research team with several PhDs. This became one of the largest collaborations in the oncology space in the country to our knowledge. Our team extracted data from over 50,000 patients to identify over 8,000 eligible patients at risk for this complication and provide granular details into the rates of febrile neutropenia (the life-threatening chemo complication), patients most at risk and helped generate a multi-variable risk model which is planned to be deployed free-of-charge for use by any oncologist around the country.
We presented our findings at one of the largest oncology meetings (ASCO Annual Meeting 2019) and are planning to publish an article soon. Dr. Rao was given the 2018 American College of Healthcare Executives (MN) Regent Innovation Award for his leadership in this project.
Our innovative project provided the blueprint for similar quality improvement projects in our system.
HOW: This two-year project involved creation of a joint-steering committee including senior leadership (VP and above) from all 3 systems. This JSC then pooled necessary talent into a project team (PhD data scientists, analysts, statistician, project manager etc) that worked with IT (EPIC) team at Fairview to retrieve detailed, anonymized, patient-level data. Project timelines were set at inception and rigidly adhered to with weekly calls by project team and monthly JSC calls. Innovation occurred at several levels including industry-healthcare system collaboration, involvement of research partner (University of Minnesota) to conduct detailed analyses beyond a typical QI project, and dissemination of findings at national platforms.
Improved the care of patient populations
Provider
Torrance Memorial Medical Center
California
Shanna
Hall, MBA, BSN, RN , NEA-BC
Vice President of Nursing
310-325-9110 Extension 30023
shanna.hall@tmmc.com
No
The recently released CMS rule regarding discharge planning requires hospitals to create detailed discharge planning evaluations―helping ensure a smooth transition for patients who are moving to the next step in their care, and ideally avoid readmission. Effective discharge planning is also critical to ensuring overall efficiency as patient wait times grow exponentially once capacity moves beyond 85%, and small increases in capacity (via discharges) can result in large reductions in wait times and delays. When utilization is near capacity, planning for the timely transitioning of a few appropriate patients can increase available capacity, have a substantial effect on delays―and improve care.
Torrance Memorial Medical Center in Torrance, CA, launched a discharge efficiency initiative in 2017 called “VIDA” [very important discharge appointment] that incorporated Lean methodology and focused on increasing the number of patients discharged by 11AM. The results realized include:
▪ A decrease in PACU and ED boarding hours
▪ An increase in the number of patients discharged by 11AM went from 80 to an average of 300
▪ The ability to help open up rooms for new patients when capacity reaches the “red zone.”
▪ EVS’s ability to respond to a room in less than 30 minutes went from 29.6% of the time to 61.4% of the time.
▪ When a patient is ready-to-move from the emergency department to when a bed is assigned in less than 15 minutes went from 19.7% of the time to 58% of the time.
Torrance Memorial Medical Center in Torrance, CA, launched a discharge efficiency initiative in 2017 called “VIDA” [very important discharge appointment] that incorporated Lean methodology and focused on increasing the number of patients discharged by 11AM. The results realized include:
▪ A decrease in PACU and ED boarding hours
▪ An increase in the number of patients discharged by 11AM went from 80 to an average of 300
▪ The ability to help open up rooms for new patients when capacity reaches the “red zone.”
▪ EVS’s ability to respond to a room in less than 30 minutes went from 29.6% of the time to 61.4% of the time.
▪ When a patient is ready-to-move from the emergency department to when a bed is assigned in less than 15 minutes went from 19.7% of the time to 58% of the time.
Improved the care of patient populations
Provider
Acadian Ambulance Service, Inc.
Louisiana
Richard
Belle
Project Manager
3375213510
Rbelle@acadian.com
No
Acadian Ambulance Mobile Healthcare Program Summary
We have a business relationship with a provider who operates a chain of healthcare clinics in the greater New Orleans, Louisiana region. This organization manages an HMO population under a capitated payment agreement with a large commercial insurer. The provider had a group of high utilizers of emergency services who were dramatically increasing cost. Additionally, after business hours on call physicians were taking calls from patients with perceived medical crises and seeking direction. In many cases, due to the lack of and unreliability of information related to their complaints, the on call physician would not feel comfortable directing patients to remain in the home or to be seen in the clinic the following day. As a result, physicians were directing patients to call 911 and seek care in an Emergency Department. Medical records illustrated that a significant number of these patients presenting in Emergency Departments could have been treated in the home or seen their physician the following day in the clinic avoiding the costs associated with EMS transport and Emergency Department services. Furthermore, it was identified that a significant number of these patients with a cardiac history were being admitted to the hospital for 24 hour observation unnecessarily driving cost up even higher.
In the spirit of the concept of Mobile Integrated Healthcare discussions between our organizations led to a plan to utilize specially trained paramedics, Mobile Healthcare Paramedics (MHPs), to provide education and support to high utilizer patients and work with case managers to address root causes leading to utilization of emergency services. We also discussed an opportunity to implement a program allowing on call physicians to dispatch an MHP to a patient’s home to assess the patient then provide clinical information which would allow physicians to make better decisions about the care of patients who call with perceived crises. We were confident that many patients could be appropriately managed in the home.
The program we implemented consists of three types of patient encounters.
The first type of patient encounter is called a scheduled education visit. These visits are conducted to complete an environmental assessment, dietary review, medication review, and education on the patient’s disease process focused on proper self-care. The MHP also educates the patient and caregivers about when to access care and the appropriate level of care to access based upon sign and symptoms. For instance, making a clinic appointment versus accessing 911. Documentation of education visits is shared with case managers and physicians.
The second type of encounter is the scheduled MHP visit. These visits are typically follow up visits that occur after a patient sees their physician in the clinic. Assessment, lab work, and sometimes treatment occur during these visits. Scheduled visits ensure treatment goals are being met through follow up in the home, preventing the patient from having to return to the clinic. If the patient is experiencing problems the MHP contacts the patient’s physician for direction on an appropriate course of action.
The last type of visit, called an MHP crisis response, results from a patient calling the on call physician who requests dispatch of an MHP to assess the patient. MHP crisis responses typically result in treatment being provided in the home. The MHP completes a thorough clinical assessment of the patient which includes the use of advanced assessment technology such as 12 lead ECG, waveform capnography, and labs including a Chem 8 (Basic Metabolic Panel). Treatment provided includes but is not limited to IV fluid administration, antibiotics, and medications to treat the patient’s symptoms. In some cases, after the MHP assesses the patient and provides a report to the physician it is determined that the patient should be seen either in the clinic or transported to an Emergency Department. In either case the MHP will initiate treatment while coordinating appropriate transport to the clinic or Emergency Department. If the patient does not have transportation to the clinic we provide van transportation to the clinic. If the patient requires transport to an Emergency Department the MHP will provide care until one of our ambulances arrives and care is transferred to the ambulance crew for transport to the appropriate Emergency Department.
The program has assisted in achieving the IHI Triple Aim for the population served by improving the experience of care, improving the health of the population served, and reducing per capita healthcare cost.
In calendar year 2018 we completed:
• 96 scheduled education visits.
• 232 scheduled MHP visits.
• 521 MHP crisis responses.
Patients who have received services through the program have been overwhelmingly complimentary of the program. Education visits have resulted in a significant decrease in the utilization of emergency services. In one particular case a patient who was accessing emergency services an average of ten times each month for consecutive months has not done so for over a year following completion of a four week education program that involved case management and her physicians. Other patient cases involved socioeconomic issues that were resulting in emergency services utilization. Some issues were addressed by arranging delivery of prescription medications to the patient’s home, a change in medication to a more affordable medication, or addressing environmental factors.
Scheduled MHP visits prevent the patient from returning to the clinic for follow up lab work, assessment, or additional treatment as this can all be done in the home. Conducting these follow up visits in the home not only improves patient experience but also addresses patients missing follow up visits because of transportation issues and non-compliance. This reduction improves patient outcomes and overall health.
Of the 521 MHP crisis responses during calendar year 2018 90% of patients were treated and remained in the home:
• 12 patients were transported to an Emergency Department via ambulance with the MHP initiating initial treatment while awaiting EMS arrival.
• 23 patients were treated in the home but required further treatment and were transported to an Emergency Department via ambulance.
• 467 patients were successfully treated and remained in the home.
• 3 patients chose to seek further treatment at an Emergency Department and travelled via private vehicle.
• 4 patients were transported to the clinic for further evaluation and care via Acadian van transport.
• 8 patients were transported to the clinic for further evaluation and care via ambulance because of limited mobility and inability to travel via van.
Based upon available data we are able to quantify savings resulting from treatment of patients in the home and avoiding Emergency Department costs. Cost savings are divided into two categories, cardiac and non-cardiac patients since there is a difference in Emergency department costs of each. Cardiac cost is $5,000.00 per visit while non-cardiac patient cost is $2,500.00 per visit. Net savings for each patient category not including EMS transport nor inpatient admission costs are as follows.
• $1,148,550.00 - net cardiac patient savings
• $1,032,000.00 – net non-cardiac patient savings
• $2,180,550.00 – net MHP crisis response program savings
The program is staffed with two full time MHPs who are equipped with the same advanced life support equipment as our ambulance crews with the exception of controlled substances. MHPs make scheduled visits and respond to crisis events in a non-emergency vehicle. In the event that a crisis response is required while the MHP is unable to respond due to being on another call an EMS operations supervisor who is also trained as an MHP responds. Our MHPs have completed additional education on chronic disease management and rotations working alongside physicians within the clinics. The relationship and trust that exists between physicians and MHPs is paramount to the success of our program.
We have a business relationship with a provider who operates a chain of healthcare clinics in the greater New Orleans, Louisiana region. This organization manages an HMO population under a capitated payment agreement with a large commercial insurer. The provider had a group of high utilizers of emergency services who were dramatically increasing cost. Additionally, after business hours on call physicians were taking calls from patients with perceived medical crises and seeking direction. In many cases, due to the lack of and unreliability of information related to their complaints, the on call physician would not feel comfortable directing patients to remain in the home or to be seen in the clinic the following day. As a result, physicians were directing patients to call 911 and seek care in an Emergency Department. Medical records illustrated that a significant number of these patients presenting in Emergency Departments could have been treated in the home or seen their physician the following day in the clinic avoiding the costs associated with EMS transport and Emergency Department services. Furthermore, it was identified that a significant number of these patients with a cardiac history were being admitted to the hospital for 24 hour observation unnecessarily driving cost up even higher.
In the spirit of the concept of Mobile Integrated Healthcare discussions between our organizations led to a plan to utilize specially trained paramedics, Mobile Healthcare Paramedics (MHPs), to provide education and support to high utilizer patients and work with case managers to address root causes leading to utilization of emergency services. We also discussed an opportunity to implement a program allowing on call physicians to dispatch an MHP to a patient’s home to assess the patient then provide clinical information which would allow physicians to make better decisions about the care of patients who call with perceived crises. We were confident that many patients could be appropriately managed in the home.
The program we implemented consists of three types of patient encounters.
The first type of patient encounter is called a scheduled education visit. These visits are conducted to complete an environmental assessment, dietary review, medication review, and education on the patient’s disease process focused on proper self-care. The MHP also educates the patient and caregivers about when to access care and the appropriate level of care to access based upon sign and symptoms. For instance, making a clinic appointment versus accessing 911. Documentation of education visits is shared with case managers and physicians.
The second type of encounter is the scheduled MHP visit. These visits are typically follow up visits that occur after a patient sees their physician in the clinic. Assessment, lab work, and sometimes treatment occur during these visits. Scheduled visits ensure treatment goals are being met through follow up in the home, preventing the patient from having to return to the clinic. If the patient is experiencing problems the MHP contacts the patient’s physician for direction on an appropriate course of action.
The last type of visit, called an MHP crisis response, results from a patient calling the on call physician who requests dispatch of an MHP to assess the patient. MHP crisis responses typically result in treatment being provided in the home. The MHP completes a thorough clinical assessment of the patient which includes the use of advanced assessment technology such as 12 lead ECG, waveform capnography, and labs including a Chem 8 (Basic Metabolic Panel). Treatment provided includes but is not limited to IV fluid administration, antibiotics, and medications to treat the patient’s symptoms. In some cases, after the MHP assesses the patient and provides a report to the physician it is determined that the patient should be seen either in the clinic or transported to an Emergency Department. In either case the MHP will initiate treatment while coordinating appropriate transport to the clinic or Emergency Department. If the patient does not have transportation to the clinic we provide van transportation to the clinic. If the patient requires transport to an Emergency Department the MHP will provide care until one of our ambulances arrives and care is transferred to the ambulance crew for transport to the appropriate Emergency Department.
The program has assisted in achieving the IHI Triple Aim for the population served by improving the experience of care, improving the health of the population served, and reducing per capita healthcare cost.
In calendar year 2018 we completed:
• 96 scheduled education visits.
• 232 scheduled MHP visits.
• 521 MHP crisis responses.
Patients who have received services through the program have been overwhelmingly complimentary of the program. Education visits have resulted in a significant decrease in the utilization of emergency services. In one particular case a patient who was accessing emergency services an average of ten times each month for consecutive months has not done so for over a year following completion of a four week education program that involved case management and her physicians. Other patient cases involved socioeconomic issues that were resulting in emergency services utilization. Some issues were addressed by arranging delivery of prescription medications to the patient’s home, a change in medication to a more affordable medication, or addressing environmental factors.
Scheduled MHP visits prevent the patient from returning to the clinic for follow up lab work, assessment, or additional treatment as this can all be done in the home. Conducting these follow up visits in the home not only improves patient experience but also addresses patients missing follow up visits because of transportation issues and non-compliance. This reduction improves patient outcomes and overall health.
Of the 521 MHP crisis responses during calendar year 2018 90% of patients were treated and remained in the home:
• 12 patients were transported to an Emergency Department via ambulance with the MHP initiating initial treatment while awaiting EMS arrival.
• 23 patients were treated in the home but required further treatment and were transported to an Emergency Department via ambulance.
• 467 patients were successfully treated and remained in the home.
• 3 patients chose to seek further treatment at an Emergency Department and travelled via private vehicle.
• 4 patients were transported to the clinic for further evaluation and care via Acadian van transport.
• 8 patients were transported to the clinic for further evaluation and care via ambulance because of limited mobility and inability to travel via van.
Based upon available data we are able to quantify savings resulting from treatment of patients in the home and avoiding Emergency Department costs. Cost savings are divided into two categories, cardiac and non-cardiac patients since there is a difference in Emergency department costs of each. Cardiac cost is $5,000.00 per visit while non-cardiac patient cost is $2,500.00 per visit. Net savings for each patient category not including EMS transport nor inpatient admission costs are as follows.
• $1,148,550.00 - net cardiac patient savings
• $1,032,000.00 – net non-cardiac patient savings
• $2,180,550.00 – net MHP crisis response program savings
The program is staffed with two full time MHPs who are equipped with the same advanced life support equipment as our ambulance crews with the exception of controlled substances. MHPs make scheduled visits and respond to crisis events in a non-emergency vehicle. In the event that a crisis response is required while the MHP is unable to respond due to being on another call an EMS operations supervisor who is also trained as an MHP responds. Our MHPs have completed additional education on chronic disease management and rotations working alongside physicians within the clinics. The relationship and trust that exists between physicians and MHPs is paramount to the success of our program.
Reduced healthcare costs
Provider
Hennepin Healthcare
Minnesota
Heather
Rhodes
Clinical Quality Improvement Specialist
5633491405
heather.rhodes@hcmed.org
No
Hennepin County Medical Center (HCMC) is the largest safety net hospital in the state of Minnesota and a Level 1 Trauma and Burn destination caring for patients across the upper Midwest. Hennepin Health is a county based safety-net ACO in Minneapolis, Minnesota, serving the state’s Medical Assistance and MinnesotaCare programs. After reviewing our hospital readmissions data in an effort to detect and address health disparities, it was noted that our African and African-American populations were more likely to be rehospitalized within 30 days than patients outside of those groups; housing instability proved to be an independent predictor for readmission. These patient characteristics are widely represented within the Hennepin Health Medicaid Accountable Care Organization’s (HH ACO) population and may help explain the discrepancy in readmissions when comparing this cohort to that of the all comer hospital population, 16.7 vs. 13.8%, respectively. Acknowledging that Medicaid patients are more likely to readmit to the hospital within 30 days than Medicare patients or those privately insured largely due to struggles with housing instability, food insecurity, substance use disorder, mental health issues and low health literacy, we set out to further examine the predominant driving factors of readmission plaguing our specific population. Analysis of the ACO’s cohort data highlighted homelessness as a leading risk factor.
Housing instability is a significant issue in Minneapolis and Hennepin County with over 3,000 people considered homeless on a given night. Examination of internal data uncovered that >50% of patients who sought care at HCMC and who were members of the HH ACO were actively or previously homeless. While accepted that housing instability is a leading contributor to high healthcare utilization, we have struggled institutionally to identify patients experiencing homelessness--missing 60% of cases in one evaluation--and to respond to this information in a systematic manner that prompts patient connection to available social services. Furthermore, interviews with hospital staff revealed a sense of overwhelm and lack of knowledge of existing resources and their associated eligibility requirements, feedback that corroborated the finding that 50% of the HH ACO population experiencing homelessness was not connected to HH ACO specific resources. Additionally, providers frequently reported purposefully ignoring insurance coverage information so as to ensure consistent, unbiased care to all patients.
To better serve patients experiencing homelessness, HCMC partnered with the HH ACO to improve service coordination through a small pilot. The hypothesis that ‘if the right staff is involved at the right time, a standard response for assisting HH ACO patients experiencing homelessness will lead to a meaningful reduction in readmissions’ drove further investigation into the current state of care management. We learned that the ACO approved inpatient hospitalizations for up to 10 days without utilization management intervention. This process, while reducing administrative burden, created a delay for referrals to ACO Care Managers (CMs). Recognizing that patients are often discharged before day 10, the existing process resulted in ineffective ‘cold calls’ and struggles to locate patients experiencing homelessness, further hindering successful engagement in care coordination efforts. Moreover, the care management process relied on referrals, limiting the number of eligible patients connected to services as hospital staff was largely unaware of these programs or simply did not have the time to dedicate to this aspect of care transition.
The need for a more proactive approach to identify patients for care management was clear after our review of the existing process. While many healthcare models provide targeted care management for specific disease states (i.e. heart failure), focusing on homelessness presented a unique challenge as it remains uncommon for healthcare organizations to employ a standard process for identifying social determinants.
Our organization developed a novel approach for identification, employing an analytics tool to comb through the electronic health record for common risk factors indicating housing insecurity including patient address corresponding with a homeless shelter, prior Healthcare for the Homeless visits, medical diagnoses of homelessness and previous social assessments from across the health system. Summarized information on a patient’s housing insecurity risk was then displayed on a list of currently admitted ACO patients to identify candidates for targeted case management.
The above learnings and analytic tool were combined in a workflow redesign for an ACO case management assistant who was able to perform file clearance and an in-depth review of each potential patient candidate. As a county employee, the person in this role has access to supplementary databases that provide clues into the housing status of the patient, in addition to a determination of the assistance programs in which the patient has already been engaged. This vetted patient list is then provided to the ACO CMs who perform additional medical record review and then visit the patient in the hospital to confirm eligibility and complete an in-person introduction to outpatient care management. If a patient chooses to pursue outpatient community care management, they are added to the CM’s case load whom they met while hospitalized, improving continuity. Three CMs rotate to perform this work, in addition to their full caseloads, on Mondays through Fridays. The CMs often make multiple visits to each patient while they remain hospitalized, quickly building rapport.
To ensure the pilot progresses smoothly, staff representing both the ACO (CMs, data analyst, Clinical Supervisor) and HCMC (Transitions of Care Lead, Informatics nurse, Medical Director of Healthcare for the Homeless, Inpatient Social Work and Clinical Coordinator leads, and Quality Improvement personnel) participate in weekly one hour meetings at HCMC. Process measures, utilization outcomes and barriers are reviewed by the group; staff communication and troubleshooting occur collectively.
Readmission events are reviewed weekly utilizing an internal report that identifies patients hospitalized with recent admissions within 30 days. This report delivers real time data and affords the group flexibility to adjust aspects of the process, if needed, should unfavorable readmission patterns arise. The confirmatory readmissions data is obtained from an internal database on a two month delay due to allotment of thirty days to elapse for a readmission to occur, followed by time for billing and coding completion. Process metrics are collected manually as are individual service connections, however, these are now being transitioned into a more automated method as the program has reached maturity.
Over 36 weeks of the program 362 patients were screened for eligibility (Figure 1). Sixty five patients were visited while inpatient and agreed to participation in outpatient care coordination services initiated in the hospital; nearly 80% of whom are African or African American and approximately 20% of whom are Native American. At the time of writing, 40 patients engaged in care management for at least 30 days following hospital discharge; the average duration of care management is 4 months. Of the 63 encounters where 30 days has elapsed since discharge, 1 patient has been readmitted to HCMC, and according to claims data, no readmissions have occurred at outside hospitals (Figure 2). While not the primary focus, 9 (14%) patients have been placed in housing, 5 occurring within the first 6 weeks, a feat that commonly takes months to years.
In addition to assisting patients experiencing homelessness navigate the transition period between hospitalization and return to outpatient status, CMs supplied an array of services depending on patients’ needs ranging from provision of transportation vouchers during hospitalization to ensure patients had means to attend follow up appointments to more complex tasks including completion of applications to expedite housing placement.
A naturally derived control group developed out of the patient population who declined intervention or were discharged prior to an inpatient visit by the CM. Of the 47 patients in this group, 8 (17%) have been readmitted to HCMC, highlighting the potential impact of expanding these services to include nights and weekends.
Important to note for other organizations interested in better supporting their patients experiencing homelessness, this program was executed in the absence of any additional staffing or funding. Work was redesigned to gain efficiency and initiate patient contact during hospitalization, a time patients are frequently more open to change and acceptance of help. Provision of housing was not required to appreciate improved outcomes; social support and connection to services appeared to bridge vital gaps that allowed for patient success in the outpatient setting.
In summary, homelessness is a leading contributing factor to hospitalization in our Medicaid Managed Care ACO population. This finding prompted a small pilot program that employs an innovative healthcare technology solution to proactively identify homeless ACO patients and introduce them to outpatient ACO CMs during hospitalization. We’ve found that active screening for homelessness and inpatient initiation of outpatient community care management accelerates connection to social services due to rapid relationship building and avoidance of the challenge to locate patients, resulting in drastic reductions in 30 day hospital readmissions.
Housing instability is a significant issue in Minneapolis and Hennepin County with over 3,000 people considered homeless on a given night. Examination of internal data uncovered that >50% of patients who sought care at HCMC and who were members of the HH ACO were actively or previously homeless. While accepted that housing instability is a leading contributor to high healthcare utilization, we have struggled institutionally to identify patients experiencing homelessness--missing 60% of cases in one evaluation--and to respond to this information in a systematic manner that prompts patient connection to available social services. Furthermore, interviews with hospital staff revealed a sense of overwhelm and lack of knowledge of existing resources and their associated eligibility requirements, feedback that corroborated the finding that 50% of the HH ACO population experiencing homelessness was not connected to HH ACO specific resources. Additionally, providers frequently reported purposefully ignoring insurance coverage information so as to ensure consistent, unbiased care to all patients.
To better serve patients experiencing homelessness, HCMC partnered with the HH ACO to improve service coordination through a small pilot. The hypothesis that ‘if the right staff is involved at the right time, a standard response for assisting HH ACO patients experiencing homelessness will lead to a meaningful reduction in readmissions’ drove further investigation into the current state of care management. We learned that the ACO approved inpatient hospitalizations for up to 10 days without utilization management intervention. This process, while reducing administrative burden, created a delay for referrals to ACO Care Managers (CMs). Recognizing that patients are often discharged before day 10, the existing process resulted in ineffective ‘cold calls’ and struggles to locate patients experiencing homelessness, further hindering successful engagement in care coordination efforts. Moreover, the care management process relied on referrals, limiting the number of eligible patients connected to services as hospital staff was largely unaware of these programs or simply did not have the time to dedicate to this aspect of care transition.
The need for a more proactive approach to identify patients for care management was clear after our review of the existing process. While many healthcare models provide targeted care management for specific disease states (i.e. heart failure), focusing on homelessness presented a unique challenge as it remains uncommon for healthcare organizations to employ a standard process for identifying social determinants.
Our organization developed a novel approach for identification, employing an analytics tool to comb through the electronic health record for common risk factors indicating housing insecurity including patient address corresponding with a homeless shelter, prior Healthcare for the Homeless visits, medical diagnoses of homelessness and previous social assessments from across the health system. Summarized information on a patient’s housing insecurity risk was then displayed on a list of currently admitted ACO patients to identify candidates for targeted case management.
The above learnings and analytic tool were combined in a workflow redesign for an ACO case management assistant who was able to perform file clearance and an in-depth review of each potential patient candidate. As a county employee, the person in this role has access to supplementary databases that provide clues into the housing status of the patient, in addition to a determination of the assistance programs in which the patient has already been engaged. This vetted patient list is then provided to the ACO CMs who perform additional medical record review and then visit the patient in the hospital to confirm eligibility and complete an in-person introduction to outpatient care management. If a patient chooses to pursue outpatient community care management, they are added to the CM’s case load whom they met while hospitalized, improving continuity. Three CMs rotate to perform this work, in addition to their full caseloads, on Mondays through Fridays. The CMs often make multiple visits to each patient while they remain hospitalized, quickly building rapport.
To ensure the pilot progresses smoothly, staff representing both the ACO (CMs, data analyst, Clinical Supervisor) and HCMC (Transitions of Care Lead, Informatics nurse, Medical Director of Healthcare for the Homeless, Inpatient Social Work and Clinical Coordinator leads, and Quality Improvement personnel) participate in weekly one hour meetings at HCMC. Process measures, utilization outcomes and barriers are reviewed by the group; staff communication and troubleshooting occur collectively.
Readmission events are reviewed weekly utilizing an internal report that identifies patients hospitalized with recent admissions within 30 days. This report delivers real time data and affords the group flexibility to adjust aspects of the process, if needed, should unfavorable readmission patterns arise. The confirmatory readmissions data is obtained from an internal database on a two month delay due to allotment of thirty days to elapse for a readmission to occur, followed by time for billing and coding completion. Process metrics are collected manually as are individual service connections, however, these are now being transitioned into a more automated method as the program has reached maturity.
Over 36 weeks of the program 362 patients were screened for eligibility (Figure 1). Sixty five patients were visited while inpatient and agreed to participation in outpatient care coordination services initiated in the hospital; nearly 80% of whom are African or African American and approximately 20% of whom are Native American. At the time of writing, 40 patients engaged in care management for at least 30 days following hospital discharge; the average duration of care management is 4 months. Of the 63 encounters where 30 days has elapsed since discharge, 1 patient has been readmitted to HCMC, and according to claims data, no readmissions have occurred at outside hospitals (Figure 2). While not the primary focus, 9 (14%) patients have been placed in housing, 5 occurring within the first 6 weeks, a feat that commonly takes months to years.
In addition to assisting patients experiencing homelessness navigate the transition period between hospitalization and return to outpatient status, CMs supplied an array of services depending on patients’ needs ranging from provision of transportation vouchers during hospitalization to ensure patients had means to attend follow up appointments to more complex tasks including completion of applications to expedite housing placement.
A naturally derived control group developed out of the patient population who declined intervention or were discharged prior to an inpatient visit by the CM. Of the 47 patients in this group, 8 (17%) have been readmitted to HCMC, highlighting the potential impact of expanding these services to include nights and weekends.
Important to note for other organizations interested in better supporting their patients experiencing homelessness, this program was executed in the absence of any additional staffing or funding. Work was redesigned to gain efficiency and initiate patient contact during hospitalization, a time patients are frequently more open to change and acceptance of help. Provision of housing was not required to appreciate improved outcomes; social support and connection to services appeared to bridge vital gaps that allowed for patient success in the outpatient setting.
In summary, homelessness is a leading contributing factor to hospitalization in our Medicaid Managed Care ACO population. This finding prompted a small pilot program that employs an innovative healthcare technology solution to proactively identify homeless ACO patients and introduce them to outpatient ACO CMs during hospitalization. We’ve found that active screening for homelessness and inpatient initiation of outpatient community care management accelerates connection to social services due to rapid relationship building and avoidance of the challenge to locate patients, resulting in drastic reductions in 30 day hospital readmissions.
Improved the care of patient populations
Provider
The Guthrie Clinic
Pennsylvania
David
Hall
Associate Vice-President
570-887-3410
david.hall@guthrie.org
No
The challenge we face is geographic boundaries and timely access to specialty care. We needed a solution to ensure our patients are able to receive the care they needed WHEN they needed it. The innovation developed into the development of a Virtual Care Division for the system, supported through a shared governance structure across multiple entities. Integration within an electronic medical record, including cloud based platforms, can be daunting. Add the instability of reimbursement for telemedicine services across two states and proving financial feasibility with regards to scalability and growth, peripheral device integration, Physician buy-in and no additional staffing resources, we had our work cut out for us. We developed standard work and a shared vision for better patient care with our Physician colleagues, piloting new technology and learning what process will work best for our population. Through this journey we have developed 14 telemedicine sites across 13 counties split between NY and PA, 25 providers across 9 specialties, and a patient satisfaction survey within the first year! We launched in February 2018, and have completed 700+ clinic to clinic consults. Through technology and our curiosity, we have developed 12 additional programs such as...
Tele-Psychiatry
Tele-Rheumatology, B2B
Remote Patient Monitoring (CHF population)
Tele-Stroke
Mayo Clinic e-consults (store and forward technology)
Skilled Nursing Facility consultation
Genetic Counseling
Bluetooth-enabled peripheral device integration
etc..
99% of our patients surveyed would recommend our telemedicine program to family and friends
Tele-Psychiatry
Tele-Rheumatology, B2B
Remote Patient Monitoring (CHF population)
Tele-Stroke
Mayo Clinic e-consults (store and forward technology)
Skilled Nursing Facility consultation
Genetic Counseling
Bluetooth-enabled peripheral device integration
etc..
99% of our patients surveyed would recommend our telemedicine program to family and friends
Enhanced the patient experience
Provider
St. Joseph Medical Center
Missouri
Ericka
Beeler
Director of Business Development and Marketing
9132211329
ericka.beeler@primehealthcare.com
No
St. Joseph became the first hospital in Kansas City to launch a comprehensive Senior Care Services Program, which includes a senior-friendly emergency room, a $1.6 million, 23-bed inpatient Senior Behavioral Health Center, and an outpatient senior clinic. Overall, the hospital has made more than 40 million in capital improvements, including state-of-the-art radiology equipment, new windows, updated telemetry monitoring system, new call light system, and new hospital beds. As a result, the hospital has received numerous industry-wide awards and recognitions in the past few years for this program. St. Joseph Medical Center in Missouri to pioneer innovates best-practice model to serve the growing population of seniors nationwide. The model has proven so successful it has expanded to other Prime hospitals across the United States, The most recent of which received Geriatric Emergency Department Accreditation this month from the American College of Emergency Physicians. In addition to partnering with geriatric physicians to offer specialized care and patient management, the culture and design of the hospital relates to senior care. The hospital facilities are arranged to accommodate mobility issues, and patients’ sight and hearing are taken into consideration throughout the building and in clinical spaces.
Improved the care of patient populations
Provider
University of Colorado, School of Medicine
Colorado
Matt
Thompson
Clinical Quality Project Manager
303-724-7736
matthew.a.thompson@cuanschutz.edu
No
Background:
The use of subspecialty medical services has risen rapidly, with referrals to specialists more than doubling. Along with increasing referral rates, the quality of communication and coordination between primary care providers and specialists has decreased over time. Patients are faced with poor access to specialists, high costs, and fragmented care. At the same time, organizations are shifting their care delivery models from volume-based care to value-based care.
The University of Colorado, School of Medicine, implemented Project CORE, which aims to improve the quality of care and the patient experience while reducing the overall cost by enhancing communication and coordination between PCPs and specialty physicians.
Through CORE: 1.) Patients have improved access to specialty care, greater convenience, and fewer unnecessary visits, tests, and costs 2.) PCPs have timely access to specialty input, clearer roles in co-management, and improved continuity and comprehensiveness of care for patients 3.) Specialists have a more structured approach to consults and referrals, improved access for higher-acuity patients, and more-efficient referrals and 4.) Leadership sees improved quality, reduced costs, improved access in high-demand specialties, opportunity to extend referral network, increased provider alignment, better position for negotiations with payers, and improved patient and provider satisfaction.
Intervention:
The CORE model uses tools embedded in the electronic medical record system, known as enhanced referrals and eConsults that provide point-of-care decision support. These decision-support tools enhance clinical workflows, improve communication and coordination of care at the interface of primary care and specialty care, and enhance quality and efficiency of care.
The first part of the intervention is the enhancement of the traditional referral process. An enhanced referral provides point-of-care decision support for the referring health care provider through the use of condition and specialty-specific templates within the EMR. These templates convey pre-consultation guidance from specialists at the point of referral, which streamlines the transmission of the clinical question and key diagnostic data. This process maximizes the effectiveness of the first specialty visit, thus preventing unnecessary follow-up visits for reviewing diagnostic tests.
eConsults are asynchronous exchanges initiated by a PCP between that provider and a specialist colleague. In lieu of an in-person visit, a specialist responds through the EMR to a PCP’s inquiry. eConsults are responded to within 72 hours. These exchanges use structured templates within the EMR to create a seamless, point-of-care pathway that facilitates high-quality coordination and communication between providers. For appropriate questions, typically about straightforward, low-acuity issues, eConsults allow for significantly more-efficient specialist input and more cost-effective care delivery. At any time, a specialist can convert an eConsult to a referral. Patients have the option to request an in-person visit rather than an eConsult. In recognition of the effort involved, the PCP who initiates the eConsult and maintains responsibility for care and the specialist who addresses the question each receive credit in the form of 0.5 wRVU. Our PCPs and specialists have embraced this innovative project.
Outcomes:
The University of Colorado, School of Medicine, went live with Project CORE in April 2018, with two specialties. Since that time, we have added 4-6 specialties to the project every quarter, with a goal of having over 30 specialties live with the project by the summer of 2020. Through October 2019, over 2,000 eConsults have been sent. 76% of eConsults have been answered by the specialist, 16% have been converted to an in-person visit, and 8% have been declined due to the question being unclear or other logistical issues. Over 20,000 referrals have been placed using the enhanced referral workflow. This project has been linked with improvement in the lag time associated with in-person appointments with a larger percentage of patients being seen within 15-30 days, as compared to greater than 30 days pre-implementation of the project.
When surveyed, 90% of our responding PCPs have seen value in the project. 80% of respondents said that without the use of eConsults, they would have sent a standard referral or asked a curbside consult. Specialists have been surveyed and nearly 90% of respondents have found eConsults to be valuable to their department, with a common theme of being able to see more acute patients while addressing lower acuity patients via eConsults. Specialists have also found satisfaction in helping PCPs work at the top of their scope.
Data collected from the project has been used nationally in discussions with health plans around the reimbursement of eConsults. Additionally, this project has demonstrated value to patients, PCPs, specialists, and leadership. Modeling based on data from our institution, estimates that patients who can forgo a specialty visit because of an eConsult can save an estimated $103 in expenses related to average out of pocket expenses, transportation expenses, and lost wages for time off work.
The use of subspecialty medical services has risen rapidly, with referrals to specialists more than doubling. Along with increasing referral rates, the quality of communication and coordination between primary care providers and specialists has decreased over time. Patients are faced with poor access to specialists, high costs, and fragmented care. At the same time, organizations are shifting their care delivery models from volume-based care to value-based care.
The University of Colorado, School of Medicine, implemented Project CORE, which aims to improve the quality of care and the patient experience while reducing the overall cost by enhancing communication and coordination between PCPs and specialty physicians.
Through CORE: 1.) Patients have improved access to specialty care, greater convenience, and fewer unnecessary visits, tests, and costs 2.) PCPs have timely access to specialty input, clearer roles in co-management, and improved continuity and comprehensiveness of care for patients 3.) Specialists have a more structured approach to consults and referrals, improved access for higher-acuity patients, and more-efficient referrals and 4.) Leadership sees improved quality, reduced costs, improved access in high-demand specialties, opportunity to extend referral network, increased provider alignment, better position for negotiations with payers, and improved patient and provider satisfaction.
Intervention:
The CORE model uses tools embedded in the electronic medical record system, known as enhanced referrals and eConsults that provide point-of-care decision support. These decision-support tools enhance clinical workflows, improve communication and coordination of care at the interface of primary care and specialty care, and enhance quality and efficiency of care.
The first part of the intervention is the enhancement of the traditional referral process. An enhanced referral provides point-of-care decision support for the referring health care provider through the use of condition and specialty-specific templates within the EMR. These templates convey pre-consultation guidance from specialists at the point of referral, which streamlines the transmission of the clinical question and key diagnostic data. This process maximizes the effectiveness of the first specialty visit, thus preventing unnecessary follow-up visits for reviewing diagnostic tests.
eConsults are asynchronous exchanges initiated by a PCP between that provider and a specialist colleague. In lieu of an in-person visit, a specialist responds through the EMR to a PCP’s inquiry. eConsults are responded to within 72 hours. These exchanges use structured templates within the EMR to create a seamless, point-of-care pathway that facilitates high-quality coordination and communication between providers. For appropriate questions, typically about straightforward, low-acuity issues, eConsults allow for significantly more-efficient specialist input and more cost-effective care delivery. At any time, a specialist can convert an eConsult to a referral. Patients have the option to request an in-person visit rather than an eConsult. In recognition of the effort involved, the PCP who initiates the eConsult and maintains responsibility for care and the specialist who addresses the question each receive credit in the form of 0.5 wRVU. Our PCPs and specialists have embraced this innovative project.
Outcomes:
The University of Colorado, School of Medicine, went live with Project CORE in April 2018, with two specialties. Since that time, we have added 4-6 specialties to the project every quarter, with a goal of having over 30 specialties live with the project by the summer of 2020. Through October 2019, over 2,000 eConsults have been sent. 76% of eConsults have been answered by the specialist, 16% have been converted to an in-person visit, and 8% have been declined due to the question being unclear or other logistical issues. Over 20,000 referrals have been placed using the enhanced referral workflow. This project has been linked with improvement in the lag time associated with in-person appointments with a larger percentage of patients being seen within 15-30 days, as compared to greater than 30 days pre-implementation of the project.
When surveyed, 90% of our responding PCPs have seen value in the project. 80% of respondents said that without the use of eConsults, they would have sent a standard referral or asked a curbside consult. Specialists have been surveyed and nearly 90% of respondents have found eConsults to be valuable to their department, with a common theme of being able to see more acute patients while addressing lower acuity patients via eConsults. Specialists have also found satisfaction in helping PCPs work at the top of their scope.
Data collected from the project has been used nationally in discussions with health plans around the reimbursement of eConsults. Additionally, this project has demonstrated value to patients, PCPs, specialists, and leadership. Modeling based on data from our institution, estimates that patients who can forgo a specialty visit because of an eConsult can save an estimated $103 in expenses related to average out of pocket expenses, transportation expenses, and lost wages for time off work.
Enhanced the patient experience
Provider
University of Louisville Hospital
Kentucky
Chris
Burchett
Director of Capacity
502-855-0348
christbu@ulh.org
No
The University of Louisville Hospital [UofL] is the only level I trauma center and adult burn unit in the Louisville metro region, admitting more than 3,000 patients each year, including 1,500 patients who live outside Jefferson County and its surrounding communities. UofL also includes a top-notch cancer center and a uniquely streamlined, nationally accredited stroke center. UofL set out to improve its operational process not only to save lives and restore health, but to get patients back to enjoying their lives as fully and quickly as possible.
UofL faced a number of challenges in achieving this goal, including:
• Extensive competition between other area health systems for both patients and team members.
• UofL ended its relationship with its parent organization, KentuckyOne Health, in 2017
• Capacity was typically between 88%-105% due to the average length of stay of 6.1 days and ED/PACU boarding—which meant diverting patients was common.
• Members of the nursing team were doing tasks that were not the best use of their skills, thus taking them away from their core mission of caregiving―such as transporting discharged patients. There was also a large footprint for team members to navigate across the hospital.
• Issues in the discharge process included delaying discharges in order to avoid new admissions, a lack of communications between departments and a lack of non-emergency transportation services to support the needs of discharged patients.
A multi-disciplinary black belt team was formed to address challenges within the organization, one of which had to do with technology infrastructure. At the same time, UofL Hospital created an access center, led by the capacity management director who was tasked with addressing capacity challenges.
The team’s initial focus was on improving discharge efficiency, including monitoring the number discharges occurring by 11am and 2pm, completing the necessary tasks pending discharge, and ensuring that a patient has the proper transportation arranged in order to be discharged.
Metrics started being reported across the organization and presented to hospital leadership at a monthly meeting. These meetings resulted in the creation of a multi-disciplinary patient flow council.
Recognizing that prioritization of patient transports was essential to improving the efficiency of the discharge process, UofL placed a registered nurse in the transport manager role. The transport department was further transformed with a process change that involved ensuring patients were actually ready for discharge before a transport request was made. Transport staff was also increased during peak hours of discharge volume. In addition, wi-fi access points were increased to support the shift to improved communication using iPhones.
Another nursing staffing change included having a charge nurse dedicated to assisting with patient downgrades to observation status, discharges and overall patient flow.
Monitors were installed on all units displaying UofL’s Patient Tracking Portal system. This system provides icons illustrating patient status and their progression towards discharge, a critical asset in improving discharge readiness communications among caregivers.
Enhanced collaboration with case management led to the implementation of rapid rounds on all inpatient units, as well as the establishment of a daily afternoon huddle to assess discharge readiness, and if appropriate, start the tasks necessary for discharge. In addition, the discharge order process was revised so that any attending physician can now sign the discharge order rather than just the admitting provider.
Strong support from senior leadership, the dedication of the entire UofL team led by a passionate advocate for patient flow, and the combination of people, process and technology has resulted in the following outcomes in a very short period of time:
• The ability to admit and provide care for 589 additional patients January—September 2019
• A 525-hour reduction in capacity status hours and a decrease in patient length of stay from 6.1 days to 5.3 days
• An increase in discharge compliance from 39% to 56%
• 169 additional OR cases
• An increase in the number of patient transport trips from 3,604 per month to 5,135 per month and decrease in total trip time of more than 5 minutes
Next steps include rounding and continued education to maintain momentum, along with continued analysis of data and process to identify areas of improvement. Soon, UofL plans to add the emergency department as a transport origin and destination to aide in pulling patients out of the ED and onto the units to improve patient flow. UofL is also looking to establish a Command Center that will provide visibility across the entire Louisville UL Health Campus to facilitate care throughout all medical facilities and the community.
UofL faced a number of challenges in achieving this goal, including:
• Extensive competition between other area health systems for both patients and team members.
• UofL ended its relationship with its parent organization, KentuckyOne Health, in 2017
• Capacity was typically between 88%-105% due to the average length of stay of 6.1 days and ED/PACU boarding—which meant diverting patients was common.
• Members of the nursing team were doing tasks that were not the best use of their skills, thus taking them away from their core mission of caregiving―such as transporting discharged patients. There was also a large footprint for team members to navigate across the hospital.
• Issues in the discharge process included delaying discharges in order to avoid new admissions, a lack of communications between departments and a lack of non-emergency transportation services to support the needs of discharged patients.
A multi-disciplinary black belt team was formed to address challenges within the organization, one of which had to do with technology infrastructure. At the same time, UofL Hospital created an access center, led by the capacity management director who was tasked with addressing capacity challenges.
The team’s initial focus was on improving discharge efficiency, including monitoring the number discharges occurring by 11am and 2pm, completing the necessary tasks pending discharge, and ensuring that a patient has the proper transportation arranged in order to be discharged.
Metrics started being reported across the organization and presented to hospital leadership at a monthly meeting. These meetings resulted in the creation of a multi-disciplinary patient flow council.
Recognizing that prioritization of patient transports was essential to improving the efficiency of the discharge process, UofL placed a registered nurse in the transport manager role. The transport department was further transformed with a process change that involved ensuring patients were actually ready for discharge before a transport request was made. Transport staff was also increased during peak hours of discharge volume. In addition, wi-fi access points were increased to support the shift to improved communication using iPhones.
Another nursing staffing change included having a charge nurse dedicated to assisting with patient downgrades to observation status, discharges and overall patient flow.
Monitors were installed on all units displaying UofL’s Patient Tracking Portal system. This system provides icons illustrating patient status and their progression towards discharge, a critical asset in improving discharge readiness communications among caregivers.
Enhanced collaboration with case management led to the implementation of rapid rounds on all inpatient units, as well as the establishment of a daily afternoon huddle to assess discharge readiness, and if appropriate, start the tasks necessary for discharge. In addition, the discharge order process was revised so that any attending physician can now sign the discharge order rather than just the admitting provider.
Strong support from senior leadership, the dedication of the entire UofL team led by a passionate advocate for patient flow, and the combination of people, process and technology has resulted in the following outcomes in a very short period of time:
• The ability to admit and provide care for 589 additional patients January—September 2019
• A 525-hour reduction in capacity status hours and a decrease in patient length of stay from 6.1 days to 5.3 days
• An increase in discharge compliance from 39% to 56%
• 169 additional OR cases
• An increase in the number of patient transport trips from 3,604 per month to 5,135 per month and decrease in total trip time of more than 5 minutes
Next steps include rounding and continued education to maintain momentum, along with continued analysis of data and process to identify areas of improvement. Soon, UofL plans to add the emergency department as a transport origin and destination to aide in pulling patients out of the ED and onto the units to improve patient flow. UofL is also looking to establish a Command Center that will provide visibility across the entire Louisville UL Health Campus to facilitate care throughout all medical facilities and the community.
Improved the care of patient populations
