Le Bonheur CHAMPChanging High-Risk Asthma in Memphis through Partnership

Susan C. Steppe, LAPSW, Project Director

CMS Disclaimer StatementThe project described was originally supported by Grant Number 1C1CMS331046 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services and is currently supported by Le Bonheur Children’s Hospital. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the independent evaluation contractor.

CHAMP Leadership

• Dr. Christie Michael, Medical Director, PI• Dr. Dennis Stokes, PI• Susan Steppe, LAPSW, Project Director, Co-

Investigator• Christina Underhill, Ph.D., Project Evaluator,

Co-PI

Emergency Department Utilization

– Shelby County had 4,688 ED Visits in 2013, rate of 192.6/10,000

– State of Tennessee had 15,229 ED Visits in 2013, rate of 102.1/10,000

– 31% of all ED visits in 2013 occurred in Shelby County.

Data from the TDOH, Division of Planning and Assessment. Hospital Discharge Data System, (2013). Nashville, TN

Steps in Building Program

• Identify high risk patients/engage quickly• Identify barriers to adherence– Lack of Knowledge/Skill– Belief system– Social determinants

• Build high-risk asthma clinic and community interventions to address.

• ENGAGE THE FAMILIES

Defining High-Risk Asthma

• NHLBI- by asthma history, social history, and comorbidities

• Issues to consider– Level of control, adherence and use of self-

management strategies, overall RISK– Heavy users of the hospital system

• Pools the sickest children with the greatest health disparity into one clinic

Obstacles and Opportunities inHigh-Risk Asthma

• Adherence with medical regimen – moving the needle

• Self-management skills• Fragmented care/information sharing• Access to care• Social determinants of health

Basics of CHAMP

• CMS Innovation Project• Serves Medicaid recipients in Shelby County, TN ages

2-18 years• High system utilizers: ED visits, hospitalizations, and

PICU• Key Components– Registry– High-risk clinic– Community team– Community partners

Chief Aims of CHAMP

1. Reduce emergency department utilization by 15% from baseline by June 30, 20152. Reduce hospitalizations and observations by 15% by June 30, 20153. Produce desired results at lower cost

Components of the Program

• Medical Team– Sub-specialty clinic – Dr. Christie Michael, A&I with

Pulmonology support– Dedicated RN and RT– 24/7 call line (71%)– Sick call triage and follow-up

• Community Based Team– 5 Community Health Workers to enroll/engage– Home visits/environmental/ meds. rec./referrals– Schools and PCPs

CHAMP PictureIdentify patients from EMR report.Engage and enroll in home setting.

Initial Clinic Visits Develop POC

Asthma Education Access to 24/7 call line3, 6, 9 month appts.Sick call as needed

Access to 24/7 call line

Sick Call TriageCall back to 24/7 calls

Connect to PCP

Home Environmental AssessmentMedication Reconciliation

Reinforce Asthma EducationProvide POC to schools. Home visits to reinforce asthma education and do meds. rec., address

social concernsCase Management CMWYNM

CHAMP Data Registry – UTHSC BMI• Record of all CHAMP team activity • Woven in work flow– use of I-pads• Selected medical data is imported or entered from the EMR• Monthly download of TennCare Encounter data on all

enrollees• Research tool for population studies • A powerful tool for case management and reporting on

outcomes– Medication flag – Recent encounter overview for quick reference – Ability to make prior hx “snapshot” available to PCPs

Quarterly ED Utilization *

33.6% reduction over 11 quarters.

* This data is drawn from TennCare encounter records but has not been independently verified.

3rd 2013 4th 2013 5th 2013 6th 2013 7th 2014 8th 2014 9th 2014 10th 2014 11th 2015 12th 2015 13th 20150

5

10

15

20

25

Asthma-Related Emergency Department UtilizationPercent of Participants

CHAMPBaselineMedianGoalLinear (Goal)Linear (Goal)Linear (Goal)Linear (Goal)Pe

rcen

t Util

izing

ED

527 Patients

ED Utilization – 6 months*

GoalLessThan15% of BL

43.4% reduction in 6-month utilization over 11 quarters (10 reporting periods).

* This data is drawn from TennCare encounter records but has not been independently verified.

Avoidable Hospitalizations*

* This data is drawn from TennCare encounter records but has not been independently verified.

Quarterly Hospital/Obs.*

GoalLessThan15% of BL

48.1% reduction in the percentage of children hospitalized per quarter, over 11 quarters.

* This data is drawn from TennCare encounter records but has not been independently verified.

3rd 2013 4th 2013 5th 2013 6th 2013 7th 2014 8th 2014 9th 2014 10th 2014 11th 2015 12th 2015 13th 20150.0

2.0

4.0

6.0

8.0

10.0

12.0

Asthma-Related Hospitalizations and Observations

CHAMPBaselineMedianGoal

Perc

ent o

f Par

ticip

ants

Hos

pita

lized

Exacerbations*

* This data is drawn from TennCare encounter records but has not been independently verified.

27.18% reduction in exacerbations over the 11 quarters of operation.

4th 2013 5th 2013 6th 2013 7th 2014 8th 2014 9th 2014 10th 2014 11th 2015 12th 2015 13th 20150.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0

450.0

500.0

Asthma-Related Exacerbations

CHAMPBaselineMedianGoal

Rate

of E

xace

rbati

ons p

er 1

000

Asthma-Related Cost of Care*• Comparison of pre and during CHAMP• Figures drawn from actual TennCare payments

(not charges)• Baseline calculated in Q8 is $3812 cost per child

per year.• Average during CHAMP cost of care through Q 13

is $1976• Average 49.7% cost reduction per year, per child

*This has not been independently verified by a third party.

CHAMP Receives EPA Award

2015 National Environmental Leadership Award in Asthma Management

May 7, 2015 in Washington, D.C.

What have we learned?• Education is Exceedingly Important• Education is NOT ENOUGH• Importance of complete picture of a patient

and their individual needs/barriers• Access to care remains a problem• Use of technology and “simple” ideas• Change involves building trust – winning the

right to influence and serve

Future Directions

• Use electronic tools Identify, track, and RESPOND

• Enhance connections with primary providers• 24/7 capability• CHAMP asthma registry would be a useful

statewide tool

Future of CHAMP

• Won a technical assistance award to work with Green and Healthy Homes Initiative (GHHI)- environmental interventions

• GHHI involves constructing framework for funding through:

SOCIAL INNOVATION FUNDING• Value Based Care Options – scale up/ add new

populations• Other funding sources (NIH, foundation)

CHAMP TEAM

CMS StatementThe project described was supported by Grant Number 1C1CMS331046 from the and Human Services, Centers for Medicare & Medicaid Services and is currently funded by Le Bonheur Children’s Hospital. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the independent evaluation contractor.