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Session 230, February 14, 2019

Big Red Consulting Team

Sloan Program in Health Administration, Cornell University

Centura Health: Population Management Case Study

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Anand Chaudhari, BS, MHA (Candidate)

Madeline Haftel, BS, MHA (Candidate)

Jean Marte, BHSA, MHA (Candidate)

Presenters have no real or apparent conflicts of interest to report.

Conflict of Interest

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As background, the HIMSS Student Case Competition provides opportunities for inter-disciplinary teams comprised of undergraduate, graduate, residents, and Fellows to demonstrate proficiency in understanding of the vast body of knowledge that comprises health information technology. By analyzing a HIMSS-supplied case study, these teams had the opportunity to “design the future” with an eye towards transformative care. In their analysis, teams are to apply recommendations that support current health information technology practices that involve transformative care while coupling recommendations with advocacy outreach at the Federal and State level.

The winning team of the HIMSS Student Case Competition is a group of students from Cornell University’s Sloan Program in Health Administration. The team has analyzed and proposed hypothetical analyses, improvements, and solutions to a 2015 health population case study by a healthcare provider (a previous Davies award winning organization).

The information and commentary provided in connection with today’s presentation solely and exclusively reflect the views and opinions of today’s presenters. There is no affiliation, association, connection endorsement, or sponsorship with the subject organization of the case study or any other organization or entity. The information provided today is solely academic in nature. Any similarities with the healthcare environment today or with any other organization are purely coincidental.

Disclosure Statement

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Agenda

Centura Health Overview1

Case Review

Process Improvement

CMS & Health IT

Community & Hospital Interventions

Recommendations

Financial Impact

Risk Analysis

Conclusion

1 Subject of 2015 Davies Case Study

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Centura Health

Process Improvement

CMS & Health IT

Hospital & Community

Recommendations

Financial Analysis

Risks & Mitigation

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16 Hospitals Across

Colorado and Kansas

Created 1996Catholic Health Initiatives and

Adventist Health Collaboration

Facility and Geography VarietyRange from rural 30 bed hospital to

metropolitan 220 bed Level 1 Trauma

Background

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Problem Statement

“Both Mercy Family Medicine and the ACO are experiencing

high rates of unplanned readmissions. What sustainable value-

based care models can we provide to further mitigate this

problem by targeting workflow processes, technology, and

community advocacy and education?”

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Process

Improvement

Accountable Care

Organizations

Recommendations

CMS & Health

IT

Hospital &

Community

Outreach

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Age: 67 years old

Education: GED

Race: African-American

Insured by: Medicare

City: Durango, CO

Retired

Medical History: Type I Diabetic, Hypertension

Rita Hope1

1 Rita Hope is a fictional patient used for demonstration purposes in this analysis and this data does not represent

actual patient data

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Case Review – Mercy Family

Leverage IT Staff Participate in CPC

Design Risk Stratification Tool

Limited Ambulatory CareHigh Costs

Coordinate Care

Risk Stratification Tool – 95%99.98% Patient Empanelment

Care Coordination$56 PMPM Expenditure Decrease to $603

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Case Review – ACO

Target COPD, HF, DiabetesInterventions for:

Population IDRisk Stratification

ID & Address Care GapsCare Transition

Demand for High Performing NetworksQuality Based Metrics

Reduce Overall Cost of Care

Dedicated TeamReal Time ACO Patient ID

CRM Tracking ToolHF, Diabetes, COPD Readmission Reduction

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Process Improvement

Process Improvement

CMS & Health IT

Hospital & Community

Recommendations

Financial Analysis

Risks & Mitigation

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Quality Reimbursement Programs

Readmission Reduction Program

Hospital Based Purchasing Program

MACRA & MIPS

3% Medicare Reduction

2% DRG Withhold + Bonus

Up to 27% Incentive

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Lean Six Sigma (LSS)

• Structured Process Improvement Methodology

• Allows:

– Defect reduction / waste elimination

• Anything that causes patient dissatisfaction/harm

– Improve discharge procedures

– Strengthen communication between departments

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CMS & Health IT

Process Improvement

CMS & Health IT

Hospital & Community

Recommendations

Financial Analysis

Risks & Mitigation

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Comprehensive Primary Care Plus Initiative (CPC+)

• Advanced Primary Care Medical Home Model

• CPC Model discontinued May 23rd, 2018

• Two tracks:

– Track 1 – old CPC model being adapted to large population

– Track 2 – new CPC+ model with higher cost sharing incentives

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EHR Module & Requirements

• Requires practices 40% or 65% Quality Based Payments

– Paired with 60% or 35% FFS, respectively

• CMS has generated list of EHRs

that support CPC+

• Additional requirements for CPC+

participation requires screening for

following factors:

• Social

• Psychological

• Behavioral

• Incorporate whole health of patient

to value metrics

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Hospital & Community

Process Improvement

CMS & Health IT

Hospital & Community

Recommendations

Financial Analysis

Risks & Mitigation

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Pre-Discharge Intervention

• 1 in 5 Medicare beneficiaries readmitted within 30 days of discharge

costing $26 billion per year

• Plan Addressing behavioral factors pre-discharge reduce readmission

rates:

– Medication Review

– Nutritional Coaching

– Family/Support System Education

– Social Service/Behavior Counseling

• IHI PDSA Cycles will measure and evaluate effectiveness of new

intervention

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Community Advocacy

Focus on increasing quality

of post-discharge patient

engagement and continuing

education

Public education sessions

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Recommendations

Process Improvement

CMS & Health IT

Hospital & Community

Recommendations

Financial Analysis

Risks & Mitigation

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Recommendations

Process Improvement

ACO

Pre-discharge Interventions

Community Advocacy

CMS & Health IT

• Train Project Coordinator to become LSS

Specialist

• Full-Day Workflow Analysis Workshop

• Focus on Patient Satisfaction

• Develop Departmental PI Champions

• Analyze patients pre-discharge

• Convert to CPC+

• Purchase EPIC Instance (Sonnet)

• Hire 2 Behavioral Therapists

• Comprehensive Pre-Discharge

Appointments

• Community Outreach Programs

• Open office hours with BHT

• Focus some resources on Low-Risk Patients

• Design Incentive program using savings from process

improvement/interventions

• Program will include targeted classes, healthy habits

showcase, pain/disease management

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Financial Analysis

Process Improvement

CMS & Health IT

Hospital & Community

Recommendations

Financial Analysis

Risks & Mitigation

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Cost of Implementing Recommendations

Projected New Costs of $715,373

LSS Certification $16,000

Process Improvement Workshop $12,000

Care Coordinators Salary (2) $180,000

MA Data Entry Cost $5,000

Interface with QRDAIII $8,000

New E.H.R. Instance (EPIC) $388,908

First Year Maintenance costs $205,200

Behavioral Therapist Salary (2) $86,600

Staff Training EHR $6,665

Total $908,373

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Risk Tier Attribution Criteria Track 1 Track 2

Average PBPM $15 $28

Tier 1 1st quartile HCC $6 $9

Tier 2 2nd quartile HCC $8 $11

Tier 3 3rd quartile HCC $16 $19

Tier 44th quartile HCC for Track 1;

75-89% HCC for Track 2$30 $33

Complex

(Track 2 only)

Top 10% HCC

OR

Dementia

N/A $100

CPC/ CPC+Utilization

(PBPM) Quality (PBPM) Total (PBPM)

Track 1 $1.25 $1.25 $2.50

Track 2 $2.00 $2.00 $4.00

Track 1 vs Track 2

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Projected Revenue Comparison

Track 1 (old CPC) Track 2 (CPC +) Track 2 (CPC+)

Number of Patients 6,336 6,336 6,336

Projected Revenue $1,140,480 $ 3,105,936 $ 3,105,936

Per Patient Bonus Estimate $1.50 $3.25 $4.00

Total Projected Bonus $9,504 $20,592 $25,344

Total Projected Revenue with Bonus $ 1,149,984 $ 3,126,528 $3,131,280

Profit increase of $2,000,000

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Process Improvement Projected Savings

• Unplanned 30-day Readmission

Reduction

• 97 Readmissions/year

• $3,000 additional cost per

readmission

• $291,000 risk per year

Cost of 97

Unplanned

Readmissions

$291,000/year

Savings due to 40%

Reduction$116,400/year

Savings due to 20%

Reduction$58,200/year

Savings due to 10%

Reduction$29,100/year

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Risks & Mitigation

Process Improvement

CMS & Health IT

Hospital & Community

Recommendations

Financial Analysis

Risks & Mitigation

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RISK• Weak Buy In

• Higher Cost Sharing

• EHR Module

Implementation

• Data Breach

• Workflow Disruption

• Patient Information

Overload

• Patient Non-Compliance

• Effective Use of Limited

Resources

MITIGATION• Provide Data

• Utilize IT to Track Initiative

Progress

• Design Training Schedule

• Bucket Data

• Restructure Discharge

Process

• Provide Information via

Multiple Sources

• Design Incentive Program

with Savings

• Use EHR to Tailor

Services

Risk & Mitigations

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Rita Hope

Process

Improvement

Accountable Care

Organization

CMS &

Health IT

Hospital &

Community

Outreach

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• Anand Chaudhari • Email: ac2762@cornell.edu

• LinkedIn: https://www.linkedin.com/in/anand-chaudhari/

• Madeline Haftel• Email: mah492@cornell.edu

• LinkedIn: https://www.linkedin.com/in/madelinehaftel/

• Jean Marte• Email: jm2686@cornell.edu

• LinkedIn: https://www.linkedin.com/in/jeanmarte/

Questions