Provider
University of Mississippi Medical Center
Mississippi
Julio
Cespedes
Director of Strategy Development
601 613 3640
JCespedes@umc.edu
No
Mississippi has some of the most difficult and multi-spectrum issues to access to care in the country. This is no different in the area of Dermatology. We created a unique teledermatology program that centers around the primary care provider and is coupled with education that long term transforms the primary care workforce to make enhanced clinical decisions regarding dermatological care. It has massive potential to completely redesign and transform how initial access to dermatology optimally looks. Please review attachments for more details.
Improved the care of patient populations
Provider
HealthEast/Fairview Health Services
Minnesota
Todd
Smith
Family Physician/Former CMIO
tasmith@healtheast.org
tasmith@healtheast.org
Yes
UbiCare
Like all hospitals, the HealthEast/Fairview system is juggling competing pressures to drive down operating costs, meet regulatory requirements for healthcare, and improve patient outcomes and satisfaction.
With the trend toward bundled insurance payment initiatives, leading with CMS’ Comprehensive Care for Joint Replacement, it is more important than ever for healthcare providers to integrate strategies that prevent readmissions and complications and ensure patient satisfaction and a positive hospital experience.
We recognize that while time spent in the hospital or with healthcare providers is critical, it is also the shortest point in a care episode. We hypothesized that extending the reach of our care and proactively engaging patients into their homes and everyday lives could positively affect outcomes for our hospitals, staff and patients.
In our innovation, we tested this hypothesis by using a mobile patient engagement tool among adults undergoing total knee or hip replacement surgeries. The tool was designed to prepare patients educationally and emotionally for their surgery and post-op recovery using a series of easy-to-read email and text messages from the time they were scheduled for surgery through 6 months post-op. We automated enrollment by connecting to our EMR system to, and patients could opt out if desired.
The study took place across our 4-hospital system and proved both statistically significant impact on length of stay and emergency department visits as well as positive impact across all key metrics, including readmissions, discharge to home and day-of-surgery cancellations. Among the 2,027 Total Joint Replacement patients (720 hip patients and 1,307 knee patients) who received the intervention, higher engagement was associated with positive changes in all outcomes, including:
Statistically significant cost-savings and efficiencies gained:
- 25% of a day reduction in LOS for hip replacement patients
- 13% of a day reduction in LOS for knee replacement patients
- 50% reduction in emergency room visits by hip replacement patients who were highly engaged
Plus, as high engagement correlated with low risk, we were able to identify at-risk patients earlier, enabling us to stratify patients and provide additional support and attention as needed.
Importantly, there was no distinction in usage across insurance types: 71% of patients were highly engaged, regardless of whether publicly (Medicare/Medicaid) or privately insured, showing that digital connections in patient’s homes and communities crosses perceived socioeconomic barriers.
And, our patients love it. In 2019, 92% reported feeling better prepared for appointments and 91% reported feeling more confident to manage their care. Their comments speak to the impact that the digital education program has on their sense of connectedness and preparedness:
“I've been receiving your messages for the duration of my second hip replacement. I can't say enough about the sense of involvement and reassurance that came with each of your messages. Your program is terrific and shows how valuable contact via email can be. For my first hip, I attended a class which was very good but it was a one-time exchange. Your emails were very perceptive about what stage I was at in the process and what to expect. Very well structured! I felt as if someone was talking to me.”
“The timeliness and the subject matter was great. The frequency was also good. I felt very informed and could always contact the surgical team if I had any questions. FANTASTIC EXPERIENCE for me. Thanks”
This study showed how proactively connecting with and guiding patients from pre-care through post-care has helped our health system strategically impact those factors that affect their bottom lines. Better preparing patients, through direct, digital education and expectation-setting, results in shorter hospital stays and fewer post-discharge emergency room visits and readmissions.
The bottom-line: Our interactive, mobile connection delivered to patients improves both hospital cost metrics and patient outcomes. Our innovative program proves that patients really are the secret weapon to impact cost and performance metrics while also achieving good outcomes.
1. “Doctors Are a Broken Record We Don’t Comprehend >80% of the Time,” by Dave Chase, Forbes, Oct. 14, 2012 – http:// www.forbes.com/sites/davechase/2012/10/14/doctors-success-hinges-on-transactor-to-teacher-transition/
With the trend toward bundled insurance payment initiatives, leading with CMS’ Comprehensive Care for Joint Replacement, it is more important than ever for healthcare providers to integrate strategies that prevent readmissions and complications and ensure patient satisfaction and a positive hospital experience.
We recognize that while time spent in the hospital or with healthcare providers is critical, it is also the shortest point in a care episode. We hypothesized that extending the reach of our care and proactively engaging patients into their homes and everyday lives could positively affect outcomes for our hospitals, staff and patients.
In our innovation, we tested this hypothesis by using a mobile patient engagement tool among adults undergoing total knee or hip replacement surgeries. The tool was designed to prepare patients educationally and emotionally for their surgery and post-op recovery using a series of easy-to-read email and text messages from the time they were scheduled for surgery through 6 months post-op. We automated enrollment by connecting to our EMR system to, and patients could opt out if desired.
The study took place across our 4-hospital system and proved both statistically significant impact on length of stay and emergency department visits as well as positive impact across all key metrics, including readmissions, discharge to home and day-of-surgery cancellations. Among the 2,027 Total Joint Replacement patients (720 hip patients and 1,307 knee patients) who received the intervention, higher engagement was associated with positive changes in all outcomes, including:
Statistically significant cost-savings and efficiencies gained:
- 25% of a day reduction in LOS for hip replacement patients
- 13% of a day reduction in LOS for knee replacement patients
- 50% reduction in emergency room visits by hip replacement patients who were highly engaged
Plus, as high engagement correlated with low risk, we were able to identify at-risk patients earlier, enabling us to stratify patients and provide additional support and attention as needed.
Importantly, there was no distinction in usage across insurance types: 71% of patients were highly engaged, regardless of whether publicly (Medicare/Medicaid) or privately insured, showing that digital connections in patient’s homes and communities crosses perceived socioeconomic barriers.
And, our patients love it. In 2019, 92% reported feeling better prepared for appointments and 91% reported feeling more confident to manage their care. Their comments speak to the impact that the digital education program has on their sense of connectedness and preparedness:
“I've been receiving your messages for the duration of my second hip replacement. I can't say enough about the sense of involvement and reassurance that came with each of your messages. Your program is terrific and shows how valuable contact via email can be. For my first hip, I attended a class which was very good but it was a one-time exchange. Your emails were very perceptive about what stage I was at in the process and what to expect. Very well structured! I felt as if someone was talking to me.”
“The timeliness and the subject matter was great. The frequency was also good. I felt very informed and could always contact the surgical team if I had any questions. FANTASTIC EXPERIENCE for me. Thanks”
This study showed how proactively connecting with and guiding patients from pre-care through post-care has helped our health system strategically impact those factors that affect their bottom lines. Better preparing patients, through direct, digital education and expectation-setting, results in shorter hospital stays and fewer post-discharge emergency room visits and readmissions.
The bottom-line: Our interactive, mobile connection delivered to patients improves both hospital cost metrics and patient outcomes. Our innovative program proves that patients really are the secret weapon to impact cost and performance metrics while also achieving good outcomes.
1. “Doctors Are a Broken Record We Don’t Comprehend >80% of the Time,” by Dave Chase, Forbes, Oct. 14, 2012 – http:// www.forbes.com/sites/davechase/2012/10/14/doctors-success-hinges-on-transactor-to-teacher-transition/
Reduced healthcare costs
Provider
HeartCare Imaging
Florida
Chelsey
Lucas
Market Development Manager
5617466125
clucas@heartcareimaging.com
No
HeartCare Imaging directly provides diagnostic services to patients throughout rural America. We'd appreciate your review of our submission and thank you for your time.
Improved the care of patient populations
Provider
Nathan Adelson Hospice
Nevada
Karen
Rubel
President and CEO
(702) 796.3112
krubel@nah.org
No
Nathan Adelson worked to address the challenges and burdens of life-limiting diseases on patients, clinicians, and our healthcare system through an interdisciplinary team palliative care approach. The organization aimed to improve quality of life for both patients and their families. Palliative care is appropriate at any stage of a serious illness and is not tied to prognosis. It can be offered alongside curative care and typically has one or more severe medical conditions and/or functional decline requiring assistance with activities of daily living, which typically leads to at least one hospitalization in the prior 12 months and other gaps. In addition, 5% of the sickest patients in the United States account for >50% of costs, with the largest portion spent in the final months of life generally in-patient care. Through our new model of care, we can reduce gaps and cost to care. This new care approach led to earlier adoption of hospice care, reducing the risk of escalated hospital use, improved communication and adherence to care goals and reduced overall healthcare utilization and ultimately, providing higher patient care. We did this through advanced care planning, red flag symptom management, medication management, follow-up on care, engagement and self-management, and utilizing advanced technology.
Taking steps toward integrated care consisted of heavy involvement with our EHR partner to optimize our technology to effectively meet the needs of the pilot programs, coding needs, clinical design and workflow, and explicit claim specifications. Internally, it took a dedicated resource and internal facilitator to ensure Nathan Adelson could handle the additional investment, infrastructure and feasibility for the program. Ultimately, their advanced illness management included:
Office Staff (Admission Assistant, Coordinator, and Office Manager)
Clinical Staff (Chaplains, RN Navigators, Social Workers, Nurse Practitioner, Medical Director)
Interdisciplinary Team (IDT) Meetings (Weekly and Bi-weekly externally)
The care model approach identified advanced illness diagnosis and evidence of active decline which may have included data such as: Two admits/ED visits in the last six months; Progressive and significant decline in last three months (measured by ADL limitations or proxy measures such as DME use); and/or
Nutritional decline (i.e. weight loss). All patients received weekly services from the Nathan Adelson team along with the following average minimum visit standards:
• All patients receive at least two home visits per month
• All patients receive at least two telephonic calls per month
• Patients’ cases reviewed through an IDT conference at least once per month
• PCPs updated at least once per month on their patient’s care plans and as the patient’s status changes
• As well as additional home visits, telephonic visits, and care coordination calls conducted according to patient need
Nathan Adelson’s integrated approach to reduced costs and increase savings came through factors like reduced inpatient utilization, reduced intensive care unit admissions, improved appropriate utilization of hospice, increase quality outcomes; increased patient caregiver satisfactions. These benefits became Nathan Adelson core competencies and include:
• Providing care to patients at wherever they call home
• Connecting patients to needed resources
• Serving the whole person and their caregivers
• Coordinating patients’ care to prevent unnecessary utilization of acute care services
• Effective pain and symptoms management to ensure better quality of life
• Leveraging latest technology to connect and monitor to patients
Through a truly holistic care approach utilizing the full interdisciplinary team and technology proven results to improve the care in patient populations including historically expensive and hard to manage late-stage and advanced illnesses.
Taking steps toward integrated care consisted of heavy involvement with our EHR partner to optimize our technology to effectively meet the needs of the pilot programs, coding needs, clinical design and workflow, and explicit claim specifications. Internally, it took a dedicated resource and internal facilitator to ensure Nathan Adelson could handle the additional investment, infrastructure and feasibility for the program. Ultimately, their advanced illness management included:
Office Staff (Admission Assistant, Coordinator, and Office Manager)
Clinical Staff (Chaplains, RN Navigators, Social Workers, Nurse Practitioner, Medical Director)
Interdisciplinary Team (IDT) Meetings (Weekly and Bi-weekly externally)
The care model approach identified advanced illness diagnosis and evidence of active decline which may have included data such as: Two admits/ED visits in the last six months; Progressive and significant decline in last three months (measured by ADL limitations or proxy measures such as DME use); and/or
Nutritional decline (i.e. weight loss). All patients received weekly services from the Nathan Adelson team along with the following average minimum visit standards:
• All patients receive at least two home visits per month
• All patients receive at least two telephonic calls per month
• Patients’ cases reviewed through an IDT conference at least once per month
• PCPs updated at least once per month on their patient’s care plans and as the patient’s status changes
• As well as additional home visits, telephonic visits, and care coordination calls conducted according to patient need
Nathan Adelson’s integrated approach to reduced costs and increase savings came through factors like reduced inpatient utilization, reduced intensive care unit admissions, improved appropriate utilization of hospice, increase quality outcomes; increased patient caregiver satisfactions. These benefits became Nathan Adelson core competencies and include:
• Providing care to patients at wherever they call home
• Connecting patients to needed resources
• Serving the whole person and their caregivers
• Coordinating patients’ care to prevent unnecessary utilization of acute care services
• Effective pain and symptoms management to ensure better quality of life
• Leveraging latest technology to connect and monitor to patients
Through a truly holistic care approach utilizing the full interdisciplinary team and technology proven results to improve the care in patient populations including historically expensive and hard to manage late-stage and advanced illnesses.
Improved the care of patient populations
Provider
Memorial Sloan Kettering Cancer Center
New York
Yeneat Ophelia
Chiu
Director, Design Strategy & Innovation
646-449-1594
chiuo@mskcc.org
No
OVERVIEW: In October 2018, Memorial Sloan Kettering Cancer Center (MSK) launched a pilot program called InSight Care which enables seamless connection with its patients wherever they are, whenever they are in need. The program aims to:
- Enhance MSK’s exceptional care
- Focus on keeping patients, their caregivers, and our care teams connected at all times through various communication techniques
- Deliver predictive, anticipatory and proactive care for patients on active treatment
- Maximize the physical, psychological, and emotional comfort of patients
WHAT CHALLENGE? Most current oncology-care models cannot effectively manage patients at home and holistically support all of these patients’ complex needs and harsh side effects while on treatment. Specifically, cancer patients receiving chemotherapy, on average, have one unplanned hospital admission and two emergency department (ED) visits a year. This is often a result of:
1. Patients being ill equipped to manage side effects at home
2. Patients assuming little can be done and do not seek assistance until their symptoms worsen requiring an admission or Urgent Care Center (UCC)/ED visit
3. Limited access/communication with providers in a timely way to address their symptoms early before they worsen, or patients may feel that they do not want to overburden their providers with symptoms which prevents them from reaching out.
Many times, these UCC/ED visits or hospital admissions could have been avoided with proactive monitoring and symptom management. Monitoring and managing patient reported outcomes (PROs) has been recommended for oncology patients on active treatment, though it is time and resource intensive.
Additionally, hospital admissions and/or UCC & ED visits often reduce patients’ quality of life and delay their treatment schedules. These acute admissions are expensive, accounting for 48% of total cancer care expenditures.
WHAT INNOVATION ENTAILED? InSight Care seeks to identify high-risk patients and provide digitally enabled, proactive, coordinated care before they need hospitalization. This is driven by:
Digital Connections: Patients are kept in line of sight beyond the MSK walls by lowering barriers for patient communication with team members, and leveraging three interlocking elements:
1.) A novel risk prediction model/analytics framework
2.) Digital monitoring (through PROs and increased communication channels)
3.) Digital team-based care
Patient Reported Outcomes: Patients receive a daily symptom assessment via portal secure message, asking patients to report on 10 symptoms typically associated with chemotherapy treatment. Based upon the patient’s response, an alert is generated (determined by clinical thresholds), prompting the dedicated clinical team to evaluate the symptom data in conjunction with clinical judgment.
Dedicated Clinical Team: The InSight Care Extended Care Team (XCT) provides proactive and coordinated care for enrolled patients by assessing symptoms reported by the patients and implementing appropriate interventions. The XCT acts as an extension of the primary oncology team, ensuring that care is connected and coordinated at all times.
Increased Communication Channels: Throughout the patient’s experience within InSight Care, the XCT will regularly interact with patients and caregivers through the following modalities:
- Patient Portal secure messaging
- Telephone
- Televisits
From an operational perspective, here is a brief snapshot as to how the program works:
1. New chemo patients are identified
2. Risk model reviews the key data points to assess patient’s risk and identifies patients as high risk or lower risk
3. Medical oncologist reviews the patient’s risk score and determines if patient would be appropriate for the program, based on eligibility criteria and clinical judgment
4. If deemed good fit for the program and meets eligibility criteria, patient is onboarded and enrolled in InSight Care
5. Patient receives symptom assessment and completes daily
6. XCT reviews the symptoms reported by the patient and provides appropriate interventions and communication channels, in collaboration with the medical oncologist
HOW GENERATED RESULTS?
As of August 2019, 106 patients have participated in the program since the pilot launched. On average, patients complete more than 50% of the daily symptom assessments. Over the course of the pilot, the most common symptom generating a red alert and requiring immediate follow-up was pain (64% of participating patients reported severe pain during their enrollment). Patient interviews show that they have valued the speedy response to problematic symptoms, the 24/7 access to clinicians, and the convenience of avoiding in person visits. The pilot was not designed to study the program’s impact on acute hospital visits, but the data suggest a positive effect. Upon initial review, the pilot cohort has experienced fewer acute care episodes than a similar unenrolled high risk patient group.
More broadly, future work will focus on confirming these findings and building new insights, focusing on several key areas, including: iteration of the care delivery model, expansion to larger patient population with other cancer types, evaluation of impact on outcomes, and assessment of optimal frequency of PRO collection and alert thresholds. This learning model also encourages iterative patient and provider feedback which promotes continuous program improvement.
- Enhance MSK’s exceptional care
- Focus on keeping patients, their caregivers, and our care teams connected at all times through various communication techniques
- Deliver predictive, anticipatory and proactive care for patients on active treatment
- Maximize the physical, psychological, and emotional comfort of patients
WHAT CHALLENGE? Most current oncology-care models cannot effectively manage patients at home and holistically support all of these patients’ complex needs and harsh side effects while on treatment. Specifically, cancer patients receiving chemotherapy, on average, have one unplanned hospital admission and two emergency department (ED) visits a year. This is often a result of:
1. Patients being ill equipped to manage side effects at home
2. Patients assuming little can be done and do not seek assistance until their symptoms worsen requiring an admission or Urgent Care Center (UCC)/ED visit
3. Limited access/communication with providers in a timely way to address their symptoms early before they worsen, or patients may feel that they do not want to overburden their providers with symptoms which prevents them from reaching out.
Many times, these UCC/ED visits or hospital admissions could have been avoided with proactive monitoring and symptom management. Monitoring and managing patient reported outcomes (PROs) has been recommended for oncology patients on active treatment, though it is time and resource intensive.
Additionally, hospital admissions and/or UCC & ED visits often reduce patients’ quality of life and delay their treatment schedules. These acute admissions are expensive, accounting for 48% of total cancer care expenditures.
WHAT INNOVATION ENTAILED? InSight Care seeks to identify high-risk patients and provide digitally enabled, proactive, coordinated care before they need hospitalization. This is driven by:
Digital Connections: Patients are kept in line of sight beyond the MSK walls by lowering barriers for patient communication with team members, and leveraging three interlocking elements:
1.) A novel risk prediction model/analytics framework
2.) Digital monitoring (through PROs and increased communication channels)
3.) Digital team-based care
Patient Reported Outcomes: Patients receive a daily symptom assessment via portal secure message, asking patients to report on 10 symptoms typically associated with chemotherapy treatment. Based upon the patient’s response, an alert is generated (determined by clinical thresholds), prompting the dedicated clinical team to evaluate the symptom data in conjunction with clinical judgment.
Dedicated Clinical Team: The InSight Care Extended Care Team (XCT) provides proactive and coordinated care for enrolled patients by assessing symptoms reported by the patients and implementing appropriate interventions. The XCT acts as an extension of the primary oncology team, ensuring that care is connected and coordinated at all times.
Increased Communication Channels: Throughout the patient’s experience within InSight Care, the XCT will regularly interact with patients and caregivers through the following modalities:
- Patient Portal secure messaging
- Telephone
- Televisits
From an operational perspective, here is a brief snapshot as to how the program works:
1. New chemo patients are identified
2. Risk model reviews the key data points to assess patient’s risk and identifies patients as high risk or lower risk
3. Medical oncologist reviews the patient’s risk score and determines if patient would be appropriate for the program, based on eligibility criteria and clinical judgment
4. If deemed good fit for the program and meets eligibility criteria, patient is onboarded and enrolled in InSight Care
5. Patient receives symptom assessment and completes daily
6. XCT reviews the symptoms reported by the patient and provides appropriate interventions and communication channels, in collaboration with the medical oncologist
HOW GENERATED RESULTS?
As of August 2019, 106 patients have participated in the program since the pilot launched. On average, patients complete more than 50% of the daily symptom assessments. Over the course of the pilot, the most common symptom generating a red alert and requiring immediate follow-up was pain (64% of participating patients reported severe pain during their enrollment). Patient interviews show that they have valued the speedy response to problematic symptoms, the 24/7 access to clinicians, and the convenience of avoiding in person visits. The pilot was not designed to study the program’s impact on acute hospital visits, but the data suggest a positive effect. Upon initial review, the pilot cohort has experienced fewer acute care episodes than a similar unenrolled high risk patient group.
More broadly, future work will focus on confirming these findings and building new insights, focusing on several key areas, including: iteration of the care delivery model, expansion to larger patient population with other cancer types, evaluation of impact on outcomes, and assessment of optimal frequency of PRO collection and alert thresholds. This learning model also encourages iterative patient and provider feedback which promotes continuous program improvement.
Improved the care of patient populations
Provider
University of Mississippi Medical Center
Mississippi
Amanda
Lucas
Program Manager
205.335.2090
aolucas@umc.edu
No
Mississippi's access challenge to healthcare, especially in extremely rural communities is great. This problem is especially difficult for pediatric populations that have mental health issues, as there are very few child psychiatrists in the state.
With insufficient support systems in schools, emotional/behavioral issues can escalate and can negatively affect academic outcomes (eg, grades, attendance, and grade promotion). With an impending worsening of the current shortage of child and adolescent psychiatrists, it is critical to provide innovative strategies that can maximize efficiency and effectiveness while expanding the availability of these services to children and adolescents.
In the Surgeon Generals report on Children's Mental Health and in the report released by the Presidents New Freedom Commission on Mental Health, schools are recognized as the major setting for providing mental health care to youth and as critical in enhancing service use. In fact, 70% to 80% of children and adolescents who do receive mental health care receive that care in the school setting.
The University of Mississippi Medical Center aimed to address this crisis through telehealth interventions in schools. These digital health tools were integrated into the school's framework to provide dynamic, consistent access to resources that could address issues that historically may have been viewed as a behavior issue that is to be addressed by exclusionary interventions like suspension that do not have an evidence-base as a viable intervention for mental health issues.
This is not to say every behavior issue in the educational setting is a diagnosable mental health condition, but where there is a more serious clinical need, this model has potential to completely transform the intervention paradigm for such conditions in the school setting, providing a child, guardians, and teachers access to resources that can positively affect the condition.
Initial results in the 30+ months of the intervention showed extremely promising results. Children with access to the interventions saw drastic reductions in minor and major disciplinary incidents in the classroom.
Please see attachments for more details.
With insufficient support systems in schools, emotional/behavioral issues can escalate and can negatively affect academic outcomes (eg, grades, attendance, and grade promotion). With an impending worsening of the current shortage of child and adolescent psychiatrists, it is critical to provide innovative strategies that can maximize efficiency and effectiveness while expanding the availability of these services to children and adolescents.
In the Surgeon Generals report on Children's Mental Health and in the report released by the Presidents New Freedom Commission on Mental Health, schools are recognized as the major setting for providing mental health care to youth and as critical in enhancing service use. In fact, 70% to 80% of children and adolescents who do receive mental health care receive that care in the school setting.
The University of Mississippi Medical Center aimed to address this crisis through telehealth interventions in schools. These digital health tools were integrated into the school's framework to provide dynamic, consistent access to resources that could address issues that historically may have been viewed as a behavior issue that is to be addressed by exclusionary interventions like suspension that do not have an evidence-base as a viable intervention for mental health issues.
This is not to say every behavior issue in the educational setting is a diagnosable mental health condition, but where there is a more serious clinical need, this model has potential to completely transform the intervention paradigm for such conditions in the school setting, providing a child, guardians, and teachers access to resources that can positively affect the condition.
Initial results in the 30+ months of the intervention showed extremely promising results. Children with access to the interventions saw drastic reductions in minor and major disciplinary incidents in the classroom.
Please see attachments for more details.
Improved the care of patient populations
Provider
Excelera Health
California
Deedee
Le
Director of Corporate Development
7149801011
Deedee.le@excelerahealth.com
No
Excelera Health, a sustainable healthcare corporation, is taking strides to transform healthcare delivery by unifying data, managing cost and taking initiative to close the gaps in care. As healthcare expenditure exponentially increases, the current health model struggles to manage cost without compromising the delivery of high-quality service for the aging population. With their advanced AI and genomics platform, as well as an aligned network of doctors, Excelera Health has the capability to reduce health expenditures by as much as 40% annually. Just by treating their patients as a priority.
With 10,000 people turning 65 years old every day in the United States and with 80% of medical expenses occurring in an individual’s last decade of life, healthcare expenditure is expected to only rise exponentially. While only 13% of America’s current population is 65 years and older, by 2030, this number is expected to rise to around 18% as the last of the Baby Boomers turn 65 years old. As a result, there is an ever-increasing need for medical resources and support. Though the United States spends an estimated $3.3 trillion annually on healthcare, United States health outcomes fall short as American tax dollars are being used to compensate for inefficiencies in care rather than higher quality care. Are we as a country prepared to take care of the aging population?
When we imagine our current health system, we often picture crowded emergency rooms, long waits and rushed visits from frantic, time-bound medical personnel—we envision a reactive care system, a system that waits for problems to arise before jumping into action. To amend this, providers look to technological developments that are either not applied at a quick enough pace, or produce a surplus of data that is not converted to actionable insights. Though physicians want to provide proactive care, they simply do not have the bandwidth and clinical insight to do so without proper support. As a result, patients often go to multiple care providers that may not have all the data necessary to manage their condition and give the best care possible.
The transition from a reactive care system to a proactive care system, one that predicts the onset of a problem and intervenes before symptoms arise, is a gradual one—one that will not be fully reformed in time to meet the needs of healthcare’s current trajectory. In the coming years, the United States will face significant challenges to meet the needs of the aging population. Unfortunately, the current health model is not designed to manage cost without compromising the delivery of high-quality service and can sink under pressure of the challenges ahead.
Healthcare’s Current Trajectory
1. The United States healthcare spending is predicted to increase from $3.6 trillion to $5.5 trillion by 2025.
2. The US physician supply does not match the demand (910,000 needed versus the 815,000 projected to be available by 2025). There are fewer medical personnel for an increasing number of patients.
3. The Medicare Trust Fund will be fully depleted by 2026. Currently, there are only minimal solutions that we can implement in order to alleviate this quick progression.
The time is now to address population health and that is exactly what Excelera Health is doing.
Transforming Healthcare
Excelera Health, a health technology company based in Newport Beach, California, is revolutionizing the healthcare delivery system by unifying data, managing cost, and taking initiative to close the gaps in care. Built around a shared core vision, this team of high-performance leaders and advisors focus on taking a more proactive approach to medicine to add clinical and economic value to the U.S. in a novel way. Aware of the trajectory of healthcare, Excelera Health seamlessly integrates artificial intelligence, interoperability, population health management programs and new genetic sequencing technology to strategically address the problems and needs of the aging population. “We aspire to be the world’s first sustainable healthcare corporation. Our goal is really to provide excellence in healthcare and to do that in the most efficient, rapid and cost-effective way possible. We leverage technology, we leverage the human heart and human motivation. We do pretty much everything that we can to rebuild healthcare the way at least we believe it should be,” Sanjay Patil, CEO of Excelera Health, states. So how exactly is Excelera Health transforming healthcare?
Clinical Impact
Fundamentally devoted to the well-being of those they serve, Excelera Health has shown a relentless commitment to excellence and an immense dedication to earning trust through empathy. Transforming healthcare encompasses the delivery of exceptional service at every point of connection with a patient. Excelera Health does this by using multiple platforms to remove barriers, make care more accessible and personalize the way care is being delivered—by making the patients a priority in all they do, Excelera Health saves and changes lives.
As shown by their Chronic Condition Improvement Program (CCIP), Excelera Health uses their health insurance entities as a platform to implement a business model and to take a stand to do right by their members. For instance, Medicare Part D has a coverage gap where members may have to pay a higher percentage of their prescription drug costs despite being covered by insurance. Aware that several senior patients cannot afford care and medication, Excelera has created a unique formulary of approximately 800 drugs to cover their patients’ pharmaceutical expenses. Essentially, members of the program pay $0 copay on preapproved mail-order prescription medications even during their coverage gap. What’s more, under the CCIP program, the company provides tailored care by sending providers such as nurse practitioners, to patient homes to ensure that their patients receive necessary assessments and screenings. So why does Excelera Health go above and beyond to care for their patients? “It’s the right thing to do. Our patients are our priority and the health plan is an agent of change in the industry. As other health plans rethink their personal model and mirror us, we are going to transform healthcare together,” relates Jerry Arellano, head of Network and Membership Growth.
Going above and beyond is the standard of care for Excelera Health. Under the Excelera ecosystem is a capitated physician network incentivized to manage population and give precise treatment. What sets Excelera Health apart is their interoperable system. All clinical data from the EMR system, claims data from CMS, as well as laboratory and pharmacy data, are all integrated into one system—EPIC. Unlike any other independent provider group in the industry, providers in network with Excelera Health have access to this unified database of comprehensive patient records. Utilized by five-star rated providers that care for a variety of demographics, interoperability is making patient care more efficient, thorough, and precise. With a concierge “white glove service” attitude, the physicians in the network go to extreme lengths to provide care. Stories of physicians buying gas generators out of pocket to make sure that a patient’s oxygen machine and chest tube suction machine stay functional during an electrical outage are not uncommon. Sharing the vision of creating relationships founded on trust, both Excelera Health and the physicians in network exemplify what care should look like.
With the opening of their genomics laboratory in 2019, Excelera Health provides patients with pharmacogenomic (PGx) testing to provide physicians applicable clinical insights that they can leverage to provide the precise patient care. Since many individuals 65 years and older take multiple medications concurrently, serious medical issues ensue due to adverse drug-drug interactions. PGx testing, which is proven to significantly decrease mortality and hospital readmissions, prevents harmful drug interactions, overdoses and potential opioid dependence. Moreover, it eliminates the trial-and-error process on finding the right medication and thus reduces the overall medication cost for both the patients and the health industry. Genomics and clinical data, partnered with artificial intelligence technology, gives Excelera Health predictive analytics and predictive modeling capabilities. The industry can eagerly anticipate Excelera Health’s future application of these predictive models that touch on subject matters such as remission rates, social determinants of health, development of certain conditions as well as genetics, for different patient populations.
Economic Impact
Excelera Health uses health insurance entities as a platform to implement a business model that reduces waste, utilizes technology, and leverages comprehensive data while incentivizing physicians to keep people healthy. Surprisingly, this model not only revolutionizes the way healthcare is being delivered to patients, but also has significant positive economic advantages for the United States. While PGx testing alone is predicted to save around $4,382 per poly-pharmaceutical patients in 60 days, Excelera Health’s advanced AI and genomics technology, as well as an aligned network of doctors has the capability to reduce health expenditures by as much as 40% annually.
Every aspect of Excelera Health’s ecosystem was built with the intention of creating a sustainable care system that advances predictive and precision medicine. Developing their own next generation healthcare insurance information technology and services platform, Excelera Health is able to reduce administrative costs by streamlining physician workflow through improvements to EHR efficiency. Each year, the United States spend approximately $248 billion in excess on administrative costs. By embracing technology including advanced analytics and artificial intelligence, Excelera Health is not only optimizing the administrative issues plaguing the healthcare industry, but also increasing overall efficiency for providers to do what they are called to do. Take care of their patients.
Here for Good: Lasting Impact
With Excelera Health, healthcare costs no longer have to be one of the top financial concerns for American families. Patients can live with the understanding that they will not only receive the best possible care, but also know that they will be able to afford it. Healthcare reform is starting now and by integrating their technology and provider platform, Excelera Health’s sustainable healthcare corporation has immense potential to change not only the cost of care, but also the way that care is delivered. Simply by doing the right thing.
With 10,000 people turning 65 years old every day in the United States and with 80% of medical expenses occurring in an individual’s last decade of life, healthcare expenditure is expected to only rise exponentially. While only 13% of America’s current population is 65 years and older, by 2030, this number is expected to rise to around 18% as the last of the Baby Boomers turn 65 years old. As a result, there is an ever-increasing need for medical resources and support. Though the United States spends an estimated $3.3 trillion annually on healthcare, United States health outcomes fall short as American tax dollars are being used to compensate for inefficiencies in care rather than higher quality care. Are we as a country prepared to take care of the aging population?
When we imagine our current health system, we often picture crowded emergency rooms, long waits and rushed visits from frantic, time-bound medical personnel—we envision a reactive care system, a system that waits for problems to arise before jumping into action. To amend this, providers look to technological developments that are either not applied at a quick enough pace, or produce a surplus of data that is not converted to actionable insights. Though physicians want to provide proactive care, they simply do not have the bandwidth and clinical insight to do so without proper support. As a result, patients often go to multiple care providers that may not have all the data necessary to manage their condition and give the best care possible.
The transition from a reactive care system to a proactive care system, one that predicts the onset of a problem and intervenes before symptoms arise, is a gradual one—one that will not be fully reformed in time to meet the needs of healthcare’s current trajectory. In the coming years, the United States will face significant challenges to meet the needs of the aging population. Unfortunately, the current health model is not designed to manage cost without compromising the delivery of high-quality service and can sink under pressure of the challenges ahead.
Healthcare’s Current Trajectory
1. The United States healthcare spending is predicted to increase from $3.6 trillion to $5.5 trillion by 2025.
2. The US physician supply does not match the demand (910,000 needed versus the 815,000 projected to be available by 2025). There are fewer medical personnel for an increasing number of patients.
3. The Medicare Trust Fund will be fully depleted by 2026. Currently, there are only minimal solutions that we can implement in order to alleviate this quick progression.
The time is now to address population health and that is exactly what Excelera Health is doing.
Transforming Healthcare
Excelera Health, a health technology company based in Newport Beach, California, is revolutionizing the healthcare delivery system by unifying data, managing cost, and taking initiative to close the gaps in care. Built around a shared core vision, this team of high-performance leaders and advisors focus on taking a more proactive approach to medicine to add clinical and economic value to the U.S. in a novel way. Aware of the trajectory of healthcare, Excelera Health seamlessly integrates artificial intelligence, interoperability, population health management programs and new genetic sequencing technology to strategically address the problems and needs of the aging population. “We aspire to be the world’s first sustainable healthcare corporation. Our goal is really to provide excellence in healthcare and to do that in the most efficient, rapid and cost-effective way possible. We leverage technology, we leverage the human heart and human motivation. We do pretty much everything that we can to rebuild healthcare the way at least we believe it should be,” Sanjay Patil, CEO of Excelera Health, states. So how exactly is Excelera Health transforming healthcare?
Clinical Impact
Fundamentally devoted to the well-being of those they serve, Excelera Health has shown a relentless commitment to excellence and an immense dedication to earning trust through empathy. Transforming healthcare encompasses the delivery of exceptional service at every point of connection with a patient. Excelera Health does this by using multiple platforms to remove barriers, make care more accessible and personalize the way care is being delivered—by making the patients a priority in all they do, Excelera Health saves and changes lives.
As shown by their Chronic Condition Improvement Program (CCIP), Excelera Health uses their health insurance entities as a platform to implement a business model and to take a stand to do right by their members. For instance, Medicare Part D has a coverage gap where members may have to pay a higher percentage of their prescription drug costs despite being covered by insurance. Aware that several senior patients cannot afford care and medication, Excelera has created a unique formulary of approximately 800 drugs to cover their patients’ pharmaceutical expenses. Essentially, members of the program pay $0 copay on preapproved mail-order prescription medications even during their coverage gap. What’s more, under the CCIP program, the company provides tailored care by sending providers such as nurse practitioners, to patient homes to ensure that their patients receive necessary assessments and screenings. So why does Excelera Health go above and beyond to care for their patients? “It’s the right thing to do. Our patients are our priority and the health plan is an agent of change in the industry. As other health plans rethink their personal model and mirror us, we are going to transform healthcare together,” relates Jerry Arellano, head of Network and Membership Growth.
Going above and beyond is the standard of care for Excelera Health. Under the Excelera ecosystem is a capitated physician network incentivized to manage population and give precise treatment. What sets Excelera Health apart is their interoperable system. All clinical data from the EMR system, claims data from CMS, as well as laboratory and pharmacy data, are all integrated into one system—EPIC. Unlike any other independent provider group in the industry, providers in network with Excelera Health have access to this unified database of comprehensive patient records. Utilized by five-star rated providers that care for a variety of demographics, interoperability is making patient care more efficient, thorough, and precise. With a concierge “white glove service” attitude, the physicians in the network go to extreme lengths to provide care. Stories of physicians buying gas generators out of pocket to make sure that a patient’s oxygen machine and chest tube suction machine stay functional during an electrical outage are not uncommon. Sharing the vision of creating relationships founded on trust, both Excelera Health and the physicians in network exemplify what care should look like.
With the opening of their genomics laboratory in 2019, Excelera Health provides patients with pharmacogenomic (PGx) testing to provide physicians applicable clinical insights that they can leverage to provide the precise patient care. Since many individuals 65 years and older take multiple medications concurrently, serious medical issues ensue due to adverse drug-drug interactions. PGx testing, which is proven to significantly decrease mortality and hospital readmissions, prevents harmful drug interactions, overdoses and potential opioid dependence. Moreover, it eliminates the trial-and-error process on finding the right medication and thus reduces the overall medication cost for both the patients and the health industry. Genomics and clinical data, partnered with artificial intelligence technology, gives Excelera Health predictive analytics and predictive modeling capabilities. The industry can eagerly anticipate Excelera Health’s future application of these predictive models that touch on subject matters such as remission rates, social determinants of health, development of certain conditions as well as genetics, for different patient populations.
Economic Impact
Excelera Health uses health insurance entities as a platform to implement a business model that reduces waste, utilizes technology, and leverages comprehensive data while incentivizing physicians to keep people healthy. Surprisingly, this model not only revolutionizes the way healthcare is being delivered to patients, but also has significant positive economic advantages for the United States. While PGx testing alone is predicted to save around $4,382 per poly-pharmaceutical patients in 60 days, Excelera Health’s advanced AI and genomics technology, as well as an aligned network of doctors has the capability to reduce health expenditures by as much as 40% annually.
Every aspect of Excelera Health’s ecosystem was built with the intention of creating a sustainable care system that advances predictive and precision medicine. Developing their own next generation healthcare insurance information technology and services platform, Excelera Health is able to reduce administrative costs by streamlining physician workflow through improvements to EHR efficiency. Each year, the United States spend approximately $248 billion in excess on administrative costs. By embracing technology including advanced analytics and artificial intelligence, Excelera Health is not only optimizing the administrative issues plaguing the healthcare industry, but also increasing overall efficiency for providers to do what they are called to do. Take care of their patients.
Here for Good: Lasting Impact
With Excelera Health, healthcare costs no longer have to be one of the top financial concerns for American families. Patients can live with the understanding that they will not only receive the best possible care, but also know that they will be able to afford it. Healthcare reform is starting now and by integrating their technology and provider platform, Excelera Health’s sustainable healthcare corporation has immense potential to change not only the cost of care, but also the way that care is delivered. Simply by doing the right thing.
Enhanced the patient experience
Provider
UPMC
Pennsylvania
Brock
McDermott
Lead Process Analyst
4124546124
mcdermottb2@upmc.edu
Yes
American Well
UPMC Provides a wide variety of virtual services through the UPMC AnywhereCare platform, including virtual urgent care services. UPMC Health Plan has gone live with a comprehensive telehealth pay policy as of Dec. 1, 2019.
Reduced healthcare costs
Provider
Kaiser Permanente Colorado and Colorado Permanente Medical Group
Colorado
Richard
Sharpe, Jr.
Chair, Interregional Clinical Practice Group for Radiology
303-764-5205
Richard.E.Sharpe-Jr@KP.org
No
TITLE: Creation of a Patient-centered Radiology Findings Tracking and Management System
WHAT was the challenge you were looking to solve?
Radiology imaging studies are commonly dictated by the radiologist and transcribed into free-text reports. These free-text reports are transmitted to the electronic medical record (EMR) as non-structured, non-codified free-text reports. The lack of structure limits the ability to consistently and accurately identify patients with potentially significant imaging findings from patients with nonsignificant findings. Patients with significant imaging findings may require follow-up imaging studies, surveillance, and or other evaluations at prescribed intervals. However, no system was in place to ensure that adequate surveillance and additional evaluations consistently occurred. Therefore, it is difficult to ensure compliance with recommended follow-up for the patients. As a result, significant incidental imaging findings that are overlooked represent a significant patient safety and quality of care risk which could result in belated diagnoses and delays in treatment.
In Kaiser Permanente Colorado (KPCO) we began a program to identify patients with significant incidental imaging findings and created an automated imaging finding tracking and management system.
Kaiser Permanente is an integrated healthcare system which operates in 8 regions across the United States. Kaiser Permanente Colorado is one of regions. Kaiser Permanente has over 630,000 members who are cared for by over 1,200 physicians and 6,000 ancillary staff.
WHO was involved in the innovation?
Richard E. Sharpe, Jr., MD, MBA, Chair, Interregional Clinical Practice Group for Radiology
Mary Jo Strobel, BSN, Director Clinical Quality Oversight
Ted E. Palen, PhD, MD, MSPH, Informatics Physician Investigator
Juanita R. Redfield, MD, Clinical Quality
Sarita G. Baker, MD, Quality and Risk Management
Jennifer Cummins, Project Manager, Quality, Risk & Patient Safety Department
Wendolyn S. Gozansky, MD, MPH, Vice President and Chief Quality Officer
Joseph Crimando, Senior ManPopulation Health Technology
Glenn K. Goodrich, Biostatistician
WHAT did the innovation entail?
We created a patient-centered radiology significant imaging finding tracking and management system. We did this by standardizing radiologist interpretation and management reports. The KPCO radiologists employ direct dictation-to-text software to generate the radiology reports. The KPCO Department of Medical Imaging collaborated with many specialties in KPCO and other Kaiser regions to create practice parameters to enable concise, consistent, and standardized management of various imaging findings. Standardized dictation “macros” were developed which were integrated into the imaging voice recognition, dictation-to-text software system. This system produced standardized imaging reports used to identify patients with significant imaging findings which in turn are used to assign the patient to a specific care plan (Care Track). When the radiologist says, “macro incidental,” the system populates instructions for the findings tracking management tool. The system has been enabled to capture organ specific incidental findings for: aortic aneurysms, adnexal cysts, adrenal nodules, kidney nodules, liver nodules, lung nodules, pancreatic nodules, and thyroid nodules. The dictation macro also allows the radiologist to add a description of the finding, a diagnosis, and follow-up recommendations into the radiology report.
The imaging finding(s)/diagnosis is automatically placed on the patient’s problem list within their EMR chart. The patient is also entered into the tracking surveillance system which automatically places appropriate follow-up orders (imaging studies) into the EMR order-entry system. Soon (by the end of 2019) the system will also send notifications directly to the patient of their need for follow up imaging, auto-order for follow up imaging study as recommended by surveillance guidelines and enter the tracking information into the Care Gap population management Tracking tool.
This creates an electronic safety net to ensure follow-up occurs and enables metric based reporting for the management of both patients and system performance.
We have also instituted natural language processing (NLP) of external radiology reports (which did not contain the standardized dictation tracking language). The NLP was implemented to identify significant incidental findings within external radiology reports so that these patients’ significant findings could also be incorporated into the radiology findings tracking and management system.
WHAT were the results?
The Kaiser Permanente Interregional Clinical Practice Group (IRCPG) for Radiology IRCPG created approximately ten workgroups consisting of multispecialty care providers specific to each practice parameter and tasked them with standardizing the diagnosis and management of each incidental finding/condition. To improve the reliability of diagnostic workups, follow-up care and surveillance of patients with incidental imaging findings, we implemented the radiology findings tracking and management system in other Kaiser regions.
This included; practice recommendations in collaboration with appropriate clinical partners and structured report usage by identifying barriers, improvement needs, opportunities, and successful practices for the following findings: abdominal aortic aneurysms, adnexal cysts, adrenal nodules, kidney nodules, liver nodules, lung nodules, pancreatic nodules, and thyroid nodules.
The implementation of the system has resulted in an increase in the number of tracked imaging findings over time.
For the Kaiser Permanent Colorado region alone during 10/15/2018 through 3/24/2019 we identified 583 radiology reports that contained at least one imaging finding that was a significant that it required entry into the patient tracking and management system.
Using standardized radiology reports and automatic entry of significant radiology findings into a tracking and management we will identify more patients with significant imaging findings. We hope to reduce delayed and missed diagnoses and increase appropriate surveillance and management of these patients. With the result being better quality patient care and outcomes.
WHAT was the challenge you were looking to solve?
Radiology imaging studies are commonly dictated by the radiologist and transcribed into free-text reports. These free-text reports are transmitted to the electronic medical record (EMR) as non-structured, non-codified free-text reports. The lack of structure limits the ability to consistently and accurately identify patients with potentially significant imaging findings from patients with nonsignificant findings. Patients with significant imaging findings may require follow-up imaging studies, surveillance, and or other evaluations at prescribed intervals. However, no system was in place to ensure that adequate surveillance and additional evaluations consistently occurred. Therefore, it is difficult to ensure compliance with recommended follow-up for the patients. As a result, significant incidental imaging findings that are overlooked represent a significant patient safety and quality of care risk which could result in belated diagnoses and delays in treatment.
In Kaiser Permanente Colorado (KPCO) we began a program to identify patients with significant incidental imaging findings and created an automated imaging finding tracking and management system.
Kaiser Permanente is an integrated healthcare system which operates in 8 regions across the United States. Kaiser Permanente Colorado is one of regions. Kaiser Permanente has over 630,000 members who are cared for by over 1,200 physicians and 6,000 ancillary staff.
WHO was involved in the innovation?
Richard E. Sharpe, Jr., MD, MBA, Chair, Interregional Clinical Practice Group for Radiology
Mary Jo Strobel, BSN, Director Clinical Quality Oversight
Ted E. Palen, PhD, MD, MSPH, Informatics Physician Investigator
Juanita R. Redfield, MD, Clinical Quality
Sarita G. Baker, MD, Quality and Risk Management
Jennifer Cummins, Project Manager, Quality, Risk & Patient Safety Department
Wendolyn S. Gozansky, MD, MPH, Vice President and Chief Quality Officer
Joseph Crimando, Senior ManPopulation Health Technology
Glenn K. Goodrich, Biostatistician
WHAT did the innovation entail?
We created a patient-centered radiology significant imaging finding tracking and management system. We did this by standardizing radiologist interpretation and management reports. The KPCO radiologists employ direct dictation-to-text software to generate the radiology reports. The KPCO Department of Medical Imaging collaborated with many specialties in KPCO and other Kaiser regions to create practice parameters to enable concise, consistent, and standardized management of various imaging findings. Standardized dictation “macros” were developed which were integrated into the imaging voice recognition, dictation-to-text software system. This system produced standardized imaging reports used to identify patients with significant imaging findings which in turn are used to assign the patient to a specific care plan (Care Track). When the radiologist says, “macro incidental,” the system populates instructions for the findings tracking management tool. The system has been enabled to capture organ specific incidental findings for: aortic aneurysms, adnexal cysts, adrenal nodules, kidney nodules, liver nodules, lung nodules, pancreatic nodules, and thyroid nodules. The dictation macro also allows the radiologist to add a description of the finding, a diagnosis, and follow-up recommendations into the radiology report.
The imaging finding(s)/diagnosis is automatically placed on the patient’s problem list within their EMR chart. The patient is also entered into the tracking surveillance system which automatically places appropriate follow-up orders (imaging studies) into the EMR order-entry system. Soon (by the end of 2019) the system will also send notifications directly to the patient of their need for follow up imaging, auto-order for follow up imaging study as recommended by surveillance guidelines and enter the tracking information into the Care Gap population management Tracking tool.
This creates an electronic safety net to ensure follow-up occurs and enables metric based reporting for the management of both patients and system performance.
We have also instituted natural language processing (NLP) of external radiology reports (which did not contain the standardized dictation tracking language). The NLP was implemented to identify significant incidental findings within external radiology reports so that these patients’ significant findings could also be incorporated into the radiology findings tracking and management system.
WHAT were the results?
The Kaiser Permanente Interregional Clinical Practice Group (IRCPG) for Radiology IRCPG created approximately ten workgroups consisting of multispecialty care providers specific to each practice parameter and tasked them with standardizing the diagnosis and management of each incidental finding/condition. To improve the reliability of diagnostic workups, follow-up care and surveillance of patients with incidental imaging findings, we implemented the radiology findings tracking and management system in other Kaiser regions.
This included; practice recommendations in collaboration with appropriate clinical partners and structured report usage by identifying barriers, improvement needs, opportunities, and successful practices for the following findings: abdominal aortic aneurysms, adnexal cysts, adrenal nodules, kidney nodules, liver nodules, lung nodules, pancreatic nodules, and thyroid nodules.
The implementation of the system has resulted in an increase in the number of tracked imaging findings over time.
For the Kaiser Permanent Colorado region alone during 10/15/2018 through 3/24/2019 we identified 583 radiology reports that contained at least one imaging finding that was a significant that it required entry into the patient tracking and management system.
Using standardized radiology reports and automatic entry of significant radiology findings into a tracking and management we will identify more patients with significant imaging findings. We hope to reduce delayed and missed diagnoses and increase appropriate surveillance and management of these patients. With the result being better quality patient care and outcomes.
Improved the care of patient populations
Provider
HCA / North Florida Regional Medical Center
Florida
Kayihura
Manigaba
Clinical Pharmacy Manager
352-333-4362
kayihura.manigaba@hcahealthcare.com
No
Acid suppressive therapy in the inpatient setting is associated with C. difficile infection, and hospital acquired pneumonia. Chronic proton pump inhibitor (PPI) has shown to increase risk of acute kidney injury, osteoporosis-related fractures, vitamin B12 deficiency, dementia, and mortality. Studies have shown that chronic PPI therapy is unnecessarily continued in approximately 50% of patients in hospital or long-term healthcare settings. North Florida Regional Medical Center (NFRMC) implemented a physician approved, pharmacist-driven protocol aimed to reduce inappropriate use of acid suppressive therapy. After 3 months post-implementation of this protocol, the monthly utilization of PPI at NFRMC declined by 16%. The days of PPI therapy (DOT) per 1000 patient days in November 2019 were 264 compared to 315 DOT/1000 patient days in July 2019. Attached is a copy of the implemented protocol titled " De-Prescribing Acid Suppressive Therapy". For patients who do not meet the PPI criteria outlined in this protocol, pharmacists are allowed to switch PPI to H2 receptor antagonist (an alternative with less risk for C. difficile infection and hospital acquired pneumonia) if there is another evidence based indication for acid suppressive therapy. Pharmacists are also allowed by this protocol to discontinue PPI if there is no evidence based indication for acid suppressive therapy. This story highlights the positive impact of multidisciplinary collaboration in reducing PPI utilization.
References:
1. Wombwell E, Chittum M, Leeser K. Inpatient proton pump inhibitor administration and hospital acquired clostridium difficile infection: evidence and possible mechanism. Am J Med. 2018;131(3):244-249.
2. Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors. Can Fam Physician. 2017;63:354-364.
3. Hussain S, Siddiqui AN, Habib A, et al. Proton pump inhibitors’ use and risk of hip fracture: a systematic review. Rheumatol Int. 2018;38(11):1999-2014.
4. Haastrup P, Thompson W, Sondergaard J, Jarbol D. Side effects of long-term proton pump inhibitor use: a review. Basic Clin Pharmacol Toxicol. 2018;123:114-121.
5. Krag M, Marker S, Perner J, et al. Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU. N Eng J Med. 2018;379(23):2199-2208.
6. Cook D, Fuller H, Guyatt G, et al. Risk factors for gastrointestinal bleeding in critically ill patients. N Eng J Med. 1994;330(6):377-381.
7. American Society of Health System Pharmacists (ASHP) (1999) ASHP therapeutic guidelines on stress ulcer prophylaxis. Am J Health Syst Pharm 56: 347–379
8. Arai N, Nakamizo T, Ihara H, et al. Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients. PLoS One. 2017;12(1):e0169300.
References:
1. Wombwell E, Chittum M, Leeser K. Inpatient proton pump inhibitor administration and hospital acquired clostridium difficile infection: evidence and possible mechanism. Am J Med. 2018;131(3):244-249.
2. Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors. Can Fam Physician. 2017;63:354-364.
3. Hussain S, Siddiqui AN, Habib A, et al. Proton pump inhibitors’ use and risk of hip fracture: a systematic review. Rheumatol Int. 2018;38(11):1999-2014.
4. Haastrup P, Thompson W, Sondergaard J, Jarbol D. Side effects of long-term proton pump inhibitor use: a review. Basic Clin Pharmacol Toxicol. 2018;123:114-121.
5. Krag M, Marker S, Perner J, et al. Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU. N Eng J Med. 2018;379(23):2199-2208.
6. Cook D, Fuller H, Guyatt G, et al. Risk factors for gastrointestinal bleeding in critically ill patients. N Eng J Med. 1994;330(6):377-381.
7. American Society of Health System Pharmacists (ASHP) (1999) ASHP therapeutic guidelines on stress ulcer prophylaxis. Am J Health Syst Pharm 56: 347–379
8. Arai N, Nakamizo T, Ihara H, et al. Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients. PLoS One. 2017;12(1):e0169300.
Improved the care of patient populations
Provider
Houston Methodist Hospital System
Texas
Courtenay
Bruce
Program Director & Associate Professor
281-620-9040
crbruce@houstonmethodist.org
Yes
MedTrak of Philadelphia, PA
Please see attachment below in supporting documentation--the document titled "innovation intro" answers all 4 questions (What the challenge was; who was involved in the innovation; what the innovation entailed; how it generated results)
Enhanced the patient experience
Karen Boren
Provider
Karen
Boren
+1 503-494-3229
Oregon Health & Science University - Technology Transfer Office
Oregon
Trina
Voss
Technology Development Manager
5034949839
vosst@ohsu.edu
No
Trauma-related hemorrhage is a leading cause of death among adults under 45 years old, as well as children of all age groups. The diagnostic challenge is determining the volume of blood loss or conversely, the volume of blood remaining in circulation. OHSU startup QuantiPort, Inc. has developed a system for measuring blood volume quickly and accurately. This helps identify patients who have lost significant blood volume as well as to detect ongoing blood loss. The QuantiPort Blood Volume Measurement Device (Blood Volume MD) provides advance warning and a valuable head start for physicians to initiate emergency therapeutic intervention prior to patient decompensation, overt shock and death. Using a mini-spectrophotometer with a small display module that docks onto an adhesive patch over the skin, the device measures the dilution and elimination of an injected tracer to determine blood volume in about 7 minutes. In addition to total blood volume, other diagnostically relevant information is reported, including red cell and plasma volume, hemoglobin, hematocrit and venous oxygen saturation.
Improved the care of patient populations
Kali Lux
Provider
Kali
Lux
+1 855-659-7734
Workit Health
Michigan
Kali
Lux
Head of Marketing
855 659 7734
Kali@workithealth.com
No
Workit Health is an addiction healthcare company offering online, on-demand evidence-based addiction treatment including telehealth medication for opioid use disorder. We partner with healthcare organizations to deliver an innovative digital health solution that blends the best of human-centered design, technology, and science. Through our mobile and web apps, members meet with clinicians, counselors, and coaches and work on completing self-set recovery goals. Our interactive curriculum of over 1,000 engaging online courses keep members on track in the comfort of home. We offer 24/7 recovery that fits into daily life, designed by experts.
Improved the care of patient populations
Marvin Sackner
Provider
Marvin
Sackner
+1 305-333-8811
Sackner Wellness Products LLC
Florida
Marvin
Sackner
President
305-333-8811
artchive@msn.com
No
Conventional healthcare has become too expensive as a solution to the many human-made epidemics and adverse lifestyles of today. These include the worldwide, high prevalence of the "sitting disease" leading to type 2 diabetes, heart disease, and high blood pressure as well as opioid addiction and chronic pain. A major contributing cause to such issues is physical inactivity in the workplace and home whose solution seems simple – get out of the chair often and walk about for a few minutes every hour but this requires behavioral change, difficult for most adults to attain. Activity monitors and compliance with exercise guidelines will not solve this problem whose duration occurs throughout the day. Accordingly, we fabricated a low-cost, portable, self-administered, passive simulated jogging device known as the Gentle Jogger® (JD) which incorporates microprocessor controlled, DC motorized movements of foot pedals placed within a chassis to repetitively and effortlessly tap against a semi-rigid surface for simulation of locomotion activities while the subject is seated or lying in a bed. It weighs about 4.5 kg with chassis dimensions of 34 × 35 × 10 cm. It is placed on the floor for seated applications and secured to the footplate of a bed for supine applications. Its foot pedals rapidly and repetitively alternate between right and left pedal movements to actively lift the forefeet upward about 2.5 cm followed by active downward tapping against a semi-rigid bumper placed within the chassis. In this manner, it simulates feet impacting against the ground during selective speeds of locomotor activities Each time the passively moving foot pedals strike the bumper, a small pulse is added to the human circulation as a function of pedal speed, 175 to 190 steps in place per minute. This action produces release of several beneficial mediators into the circulation, the chief one being nitric oxide. This allows the user to “sit without guilts!” We have already published scientific papers on JD acutely reducing the elevation of blood pressure that takes place within minutes associated with the “sitting disease” and improvement in heart rate variability. A recently submitted a paper for consideration of publication entitled “Passive Simulated Jogging Device Improves Glycemic Indices in Type 2 Diabetics and Healthy Subjects” demonstrated effectiveness of JD as a standalone device or in conjunction with medications for prevention and treatment of type 2 diabetes.
JD has American Patent Approval: U.S.9,622,933 Passive Simulated Jogging Device, approved April 18, 2017 and Foreign Patent Approvals in Australia, Canada, China, Israel, Mexico, Russia, South Africa. U.S. Registered Marks: Gentle Jogger®, Don’t Sit Still®, Movement is Everything®
Prototypes have been made but it has not yet been manufactured as a commercial product. It is planned to be marketed as a wellness device driven by home and office consumers when funded:1) avoidance of costly, at times rude, difficult to schedule usual healthcare, 2) self-administered, hands-on, safe, preventive and therapeutic approach to health, 3) effortless, effective technology while sitting during computer operation and television viewing without multitasking, 4) portable, easily moved, and has small footprint and 5) publications of scientific proof are in scientific domain and others are pending review.
The attributes of JD as a wellness device include 1) safe, noninvasive, portable, low-cost wellness technology, operated in seated or supine postures that passively produces bodily movements from contraction of skeletal muscles while increasing the same beneficial substances as exercise, e.g., nitric oxide, prostacyclin, and antioxidants, 2) meets FDA criteria as wellness products and is not regulated by FDA (2016 internet statement) and could be brought to market without delay and 3) FDA suggestions for primary intended use: prevention and living well with high blood pressure, heart disease & type 2 diabetes.
U.S. Market Size for Annual Costs for Physical Inactivity Conditions where Gentle Jogger is Indicated: 1) High Blood Pressure 103 Million Adults; $131 Billion (2017), 2) Type 2 Diabetes 29 Million Adults; $480 Billion (2014), 3) Heart Disease, Stroke, Peripheral Arterial Disease 120 million Adults; $317 Billion (2011), 4) Fibromyalgia 14 Million Adults; $12-$14 Billion (2017), Chronic Pain 100 Million Adults; $635 Billion (2012) treatment & lost productivity and 5) Opioid Addiction 12 million Americans misuse opioids; approximately 2 million Americans misuse them severe enough to be categorized as an opioid use disorder (OUD). Five Americans die of an opioid overdose every hour. Financial cost of the morbidity and mortality associated with opioid misuse $504 Billion annually.
JD has American Patent Approval: U.S.9,622,933 Passive Simulated Jogging Device, approved April 18, 2017 and Foreign Patent Approvals in Australia, Canada, China, Israel, Mexico, Russia, South Africa. U.S. Registered Marks: Gentle Jogger®, Don’t Sit Still®, Movement is Everything®
Prototypes have been made but it has not yet been manufactured as a commercial product. It is planned to be marketed as a wellness device driven by home and office consumers when funded:1) avoidance of costly, at times rude, difficult to schedule usual healthcare, 2) self-administered, hands-on, safe, preventive and therapeutic approach to health, 3) effortless, effective technology while sitting during computer operation and television viewing without multitasking, 4) portable, easily moved, and has small footprint and 5) publications of scientific proof are in scientific domain and others are pending review.
The attributes of JD as a wellness device include 1) safe, noninvasive, portable, low-cost wellness technology, operated in seated or supine postures that passively produces bodily movements from contraction of skeletal muscles while increasing the same beneficial substances as exercise, e.g., nitric oxide, prostacyclin, and antioxidants, 2) meets FDA criteria as wellness products and is not regulated by FDA (2016 internet statement) and could be brought to market without delay and 3) FDA suggestions for primary intended use: prevention and living well with high blood pressure, heart disease & type 2 diabetes.
U.S. Market Size for Annual Costs for Physical Inactivity Conditions where Gentle Jogger is Indicated: 1) High Blood Pressure 103 Million Adults; $131 Billion (2017), 2) Type 2 Diabetes 29 Million Adults; $480 Billion (2014), 3) Heart Disease, Stroke, Peripheral Arterial Disease 120 million Adults; $317 Billion (2011), 4) Fibromyalgia 14 Million Adults; $12-$14 Billion (2017), Chronic Pain 100 Million Adults; $635 Billion (2012) treatment & lost productivity and 5) Opioid Addiction 12 million Americans misuse opioids; approximately 2 million Americans misuse them severe enough to be categorized as an opioid use disorder (OUD). Five Americans die of an opioid overdose every hour. Financial cost of the morbidity and mortality associated with opioid misuse $504 Billion annually.
Reduced healthcare costs
Sathiqu Sathiqu
Provider
Sathiqu
Sathiqu
+1 437-547-8595
Nil
Washington
Mohamedthambi
Sathiqu
Cheap and best electronic fan regulator
8754637955
Maricar_mohamed@yahoo.com
No
Cheap and best electronic fan regulator
Reduced healthcare costs
Lee Steere
Provider
Lee
Steere
+1 860-614-8254
Hartford Hospital
Connecticut
Lee
Steere
Unit Leader
860-614-8254
Lee.Steere@hhchealth.org
Yes
Funding for the study was provided by Nexus Medical, LLC
In the USA, there are more peripheral intravenous catheters (PIVCs) sold than there are people at 350 million per year. PIVC failure rates average 53% with 1 out of every 2 catheters failing prior to completion of therapy. Since routine replacement of PIVCs is ineffective at decreasing complication rates, hospitals across the world continue to move away from replacing PIVCs routinely to only removing when clinically indicated (when symptomatic or when no longer needed).
At Hartford Hospital, an 867-bed, level one trauma center, in the heart of Connecticut, the Intravenous (IV) Team wanted to change their policy of replacing PIVCs every 72-96 hours to replace only when clinically indicated. In order to do this, they performed a study that compared a Vascular Access Specialty Team (VAST) inserting PIVCs using a best practice bundle vs. the generalist model, with the end goal of showing better patient outcomes, reduction in harmful IV related complications and overall cost savings. The aim of the study was to have 1 PIVC per patient stay. Being a Lean hospital, the IV Team used Lean methodology to create a best practice bundle they would implement for this study. The bundle, known today as the PIV5Rights, was created to address the 5 known causes of PIVC failure – infiltrations, phlebitis, infection, occlusion and inadvertent removal.
P = Right Proficiency (ultrasound guided PIVC trained RN).
I = Right Insertion (use of ultrasound or vein viewer to place PIVCs in order to strive for 100% first stick success).
V = Right Vein and Catheter (forearm placement; right vein to catheter ratio of both diameter and length).
5 = Right Supplies and Technology (Procedural kit for compliance; 22G, 1.75 inch catheter; anti-reflux needleless connector; chlorhexidine skin preparation; anti-microbial bordered securement dressing).
R = Right Review and Assessment (assessment performed daily by a VAST, which includes assessing dressing integrity and flushing to assure PIVC patency).
A protocol was written and approval was received from the hospitals administration. The study, a prospective, multi-modal comparator study, was conducted on a 47-bed medical unit. All new admits to the unit were approached within 24 hours and if they were willing to participate, written consent was obtained. At that time, the present PIVC was assessed. If the PIVC was asymptomatic and properly placed per institutional protocol, it was left in place (group 1). If the site was symptomatic or not inserted correctly per institutional protocol, it was removed and a new site was placed by a member of the IV Team using the best practice bundle approach (group 2). The study was powered for 85% to detect a difference in mean dwell time of 1.5 days (6 vs. 4.5). To achieve this power the study sought to enroll 211 catheters, including a 5% anticipated attrition rate for post enrollment exclusions.
This study was conducted over a period of 15 months. Outcomes of the PIV5Rights Bundle using a trained vascular access nursing team for insertion and management (group 2) achieved a statistically significant result of 89% (n = 113) of catheters achieving end of therapy. Results of the generalist model (group 1) reflected PIVC dwell time to end of treatment in only 15% (n = 94) of catheters. Mean dwell time (±SD) for group 2 was 71.4 ± 58.8 hours, with an upper level of 333.2 hours (13.88 days), vs. group 1 at 29.6 ± 18.0 hours with an upper level of 11.0 hours (4.6 days).
A financial analysis was conducted using the results of this study and presented to the hospital’s Chief Nursing Officer (CNO) with the goal of receiving approval to implement a VAST placing all PIVCs on all inpatient units. A baseline annual cost per bed for IV Therapy was conducted, looking at labor and supply costs. The calculation of extended dwell time and reduced complication rate represented an economic difference of group 1 current work cost per bed of $4,781 vs. $1,405 cost per bed of group 2 VAST. This cost reduction per bed for house-wide implementation reflected a reduction of $3,376 dollars per bed per year and projected $2.9 million in annual savings. With these results, the CNO of Hartford Hospital granted approval for the IV Team to centralize all PIVC insertions on the inpatient units using the IV Team and this bundled approach.
By centralizing ownership of vascular access with the team for insertion, management, securement and tracking the PIV5Rights Right Approach made for the Right Results in transformation of hospital infusion therapy practices.
At Hartford Hospital, an 867-bed, level one trauma center, in the heart of Connecticut, the Intravenous (IV) Team wanted to change their policy of replacing PIVCs every 72-96 hours to replace only when clinically indicated. In order to do this, they performed a study that compared a Vascular Access Specialty Team (VAST) inserting PIVCs using a best practice bundle vs. the generalist model, with the end goal of showing better patient outcomes, reduction in harmful IV related complications and overall cost savings. The aim of the study was to have 1 PIVC per patient stay. Being a Lean hospital, the IV Team used Lean methodology to create a best practice bundle they would implement for this study. The bundle, known today as the PIV5Rights, was created to address the 5 known causes of PIVC failure – infiltrations, phlebitis, infection, occlusion and inadvertent removal.
P = Right Proficiency (ultrasound guided PIVC trained RN).
I = Right Insertion (use of ultrasound or vein viewer to place PIVCs in order to strive for 100% first stick success).
V = Right Vein and Catheter (forearm placement; right vein to catheter ratio of both diameter and length).
5 = Right Supplies and Technology (Procedural kit for compliance; 22G, 1.75 inch catheter; anti-reflux needleless connector; chlorhexidine skin preparation; anti-microbial bordered securement dressing).
R = Right Review and Assessment (assessment performed daily by a VAST, which includes assessing dressing integrity and flushing to assure PIVC patency).
A protocol was written and approval was received from the hospitals administration. The study, a prospective, multi-modal comparator study, was conducted on a 47-bed medical unit. All new admits to the unit were approached within 24 hours and if they were willing to participate, written consent was obtained. At that time, the present PIVC was assessed. If the PIVC was asymptomatic and properly placed per institutional protocol, it was left in place (group 1). If the site was symptomatic or not inserted correctly per institutional protocol, it was removed and a new site was placed by a member of the IV Team using the best practice bundle approach (group 2). The study was powered for 85% to detect a difference in mean dwell time of 1.5 days (6 vs. 4.5). To achieve this power the study sought to enroll 211 catheters, including a 5% anticipated attrition rate for post enrollment exclusions.
This study was conducted over a period of 15 months. Outcomes of the PIV5Rights Bundle using a trained vascular access nursing team for insertion and management (group 2) achieved a statistically significant result of 89% (n = 113) of catheters achieving end of therapy. Results of the generalist model (group 1) reflected PIVC dwell time to end of treatment in only 15% (n = 94) of catheters. Mean dwell time (±SD) for group 2 was 71.4 ± 58.8 hours, with an upper level of 333.2 hours (13.88 days), vs. group 1 at 29.6 ± 18.0 hours with an upper level of 11.0 hours (4.6 days).
A financial analysis was conducted using the results of this study and presented to the hospital’s Chief Nursing Officer (CNO) with the goal of receiving approval to implement a VAST placing all PIVCs on all inpatient units. A baseline annual cost per bed for IV Therapy was conducted, looking at labor and supply costs. The calculation of extended dwell time and reduced complication rate represented an economic difference of group 1 current work cost per bed of $4,781 vs. $1,405 cost per bed of group 2 VAST. This cost reduction per bed for house-wide implementation reflected a reduction of $3,376 dollars per bed per year and projected $2.9 million in annual savings. With these results, the CNO of Hartford Hospital granted approval for the IV Team to centralize all PIVC insertions on the inpatient units using the IV Team and this bundled approach.
By centralizing ownership of vascular access with the team for insertion, management, securement and tracking the PIV5Rights Right Approach made for the Right Results in transformation of hospital infusion therapy practices.
Reduced healthcare costs
christine vanzandbergen
Provider
christine
vanzandbergen
+1 215-615-0641
penn medicine
Pennsylvania
christine
vanzandbergen
AVP Applications
2156150641
christine.vanzandbergen@pennmedicine.upenn.edu
No
Medical imaging is a core diagnostic component used routinely across the world. In addition, imaging is one of the most costly components of patient care historically fraught with redundancy due to constraints with image sharing among providers. Recognizing that the need for providers and patients to seamlessly share images has never been more apparent, Penn Medicine embarked on an cutting edge initiative to support image viewing function within our external physician portal, PhysicianLink, beginning in August 2018. The new functionality now allows referring physicians outside of the Penn Medicine system to securely view radiology images through a link in the patients EHR. Historically, physicians outside the institution who referred patients to Penn Medicine for diagnostic radiology studies, could only review the text results of those studies. Now, along with the diagnostic result, a link appears that permits the external provider to launch a PACS image directly using the same clinical imaging viewer as the health system. To ensure a successful deployment and adoption of this technology a multidisciplinary team of IT professionals, physicians, radiology leaders and physician outreach liaisons were engaged as part of the project team.
The PhysicianLink imaging integration is a huge satisfier for external providers and patients. Penn Medicine is part of an elite group of organizations offering this advanced form of data sharing and the first in the northeast region. In the first year over 7,000 images have been viewed by providers that otherwise would have only had access to reports or required a more costly, less secure method of obtaining these images such as CD/DVD.
Karen Pinsky, CMIO at Chester County Hospital notes, “PhysicianLink enables our referring providers to access important clinical information for their patients. Practicing clinicians gain context by viewing actual images to support clinical decision making - rather than simply reading the interpretations. Patients appreciate that their referring provider has a deep dive view of their data.”
Having the actual images brings tremendous value to office based practitioners who are part of a patient’s care team and patients who now have an additional opportunity to look at the images alongside of their provider.
Penn Medicine’s PhysicianLink Radiology Image viewing is another breakthrough in technology development that gives providers and patients alike a technical edge in providing patient care.
Benefits Realized:
• Immediate access to images after the exam is performed with no wait time for a DVD to be produced and delivered
• Clinical decisions can be informed by timely image availability, without having to rely solely on the diagnostic report, resulting in improved patient care
The PhysicianLink imaging integration is a huge satisfier for external providers and patients. Penn Medicine is part of an elite group of organizations offering this advanced form of data sharing and the first in the northeast region. In the first year over 7,000 images have been viewed by providers that otherwise would have only had access to reports or required a more costly, less secure method of obtaining these images such as CD/DVD.
Karen Pinsky, CMIO at Chester County Hospital notes, “PhysicianLink enables our referring providers to access important clinical information for their patients. Practicing clinicians gain context by viewing actual images to support clinical decision making - rather than simply reading the interpretations. Patients appreciate that their referring provider has a deep dive view of their data.”
Having the actual images brings tremendous value to office based practitioners who are part of a patient’s care team and patients who now have an additional opportunity to look at the images alongside of their provider.
Penn Medicine’s PhysicianLink Radiology Image viewing is another breakthrough in technology development that gives providers and patients alike a technical edge in providing patient care.
Benefits Realized:
• Immediate access to images after the exam is performed with no wait time for a DVD to be produced and delivered
• Clinical decisions can be informed by timely image availability, without having to rely solely on the diagnostic report, resulting in improved patient care
Improved the care of patient populations
Improved the care of patient populations