LEADING THE TRANSFORMATION - Advocate Health Care · 2020-05-12 · conversation by leading the transformation to value-based care. Through our highly evolved clinically integrated

Improving health outcomes and lowering coststhrough people, technology and innovation

LEADING THE TRANSFORMATION

2 | 2018 APP Value Report

2018 Value Report | Reporting on 2017 Results

2018 APP Value Report | 3

CONTENTS

Leaders, Not Followers

About Advocate Physician Partners

Advocate Aurora Health

Results, Not Promises

Life, Not Limits

Proactive, Not Reactive

Prevention, Not Prescriptions

Accolades

Clinical Integration Results

5

6

7

8

12

16

20

24

25



Health care continues to be the subject of both national debate and household conversation. As more Americans find themselves responsible for higher premiums and deductibles, health care costs are hitting home harder than ever. Yet, if we can reduce the cost of care, while improving quality, the debate about who pays the bills— employers, the government, private payers or individuals—becomes less relevant. Advocate Physician Partners (APP) is changing this conversation by leading the transformation to value-based care. Through our highly evolved clinically integrated network of more than 5,000 physicians,12 hospitals and post-acute providers, APP continues to control costs in pursuit of the quadruple aim.

Creating transformational scaleOn April 1, 2018, Advocate Health Care combined with Aurora Health Care to create Advocate Aurora Health—the 10th largest not-for-profit, integrated health care system in the U.S., serving nearly three million patients each year. We believe scale is critical to transforming care delivery, advancing our population health efforts and bringing more value to consumers and employers.

Navigating the changing health care landscapeThe health care industry continues to see significant changes. APP supports our physicians through all major health care policy changes, such as MACRA (Medicare Access and CHIP Reauthorization Act). In 2018, we transitioned our Accountable Care Organization (ACO) to the Medicare Shared Savings Program (MSSP) Track 1+ model.

This agreement with the Centers for Medicare and Medicaid Services (CMS) strengthens incentives for our organization and partnering physicians and hospitals to deliver high quality care at an efficient cost. APP has a strong track record of success with MSSP—saving taxpayers more than $60 million in 2016 and $72 million in 2015 while delivering near-perfect quality outcomes. We believe our success will continue and our physicians will be rewarded for their performance under this new payment model. And most importantly, our patients will benefit.

We also continue to develop our High-Performing Network of aligned physicians, hospitals and post-acute partners who are committed to driving success through value-based contracts with forward-thinking insurance partners. We’re now proud to offer employers access to Advocate’s comprehensive network through three affordable, consumer-friendly products.

Leveraging technology, empowering consumersAdvocate is advancing its work in digital health to respond to consumerism in health care. By leveraging digital technology, we aim to create a frictionless experience both for consumers and providers to drive transformational outcomes–making it easier to direct schedule appointments, adhere to care plans, refer care within network and more.

Read on for more stories of how we are leading the transformation and reimagining the possibilities of health care.

LEADERS, NOT FOLLOWERS.

Lee B. Sacks, MD Chief Medical Officer, Advocate Aurora Health, Chief Executive Officer, Advocate Physician Partners

Don Calcagno President, Advocate Physician Partners


ABOUT ADVOCATE PHYSICIAN PARTNERS

APP’s quality is among the highest nationally: 27 measures exceed the 90th percentile when compared to national benchmarks and an additional 11 are above the 75th percentile

5,000 physicians

Over 1 million lives

in Clinical Integration program

Bending the cost curve MSSP spend better than benchmark by 3.9%

Advocate Physician Partners (APP) brings together more than 5,000 physicians, 12 hospitals and a post-acute network committed to improving health care quality, safety and outcomes for patients across Chicagoland and Central Illinois.

Formed as a managed care and care management collaboration with Advocate Health Care, APP is a national leader in population health and has garnered wide-spread recognition for its innovative Clinical Integration (CI) program to improve outcomes and reduce costs across the continuum.

Why I choose APP as my strategic partner:

“As part of a team of 5,000 physicians, I know my patients have access to high-quality, coordinated care.” – Cathy DiVincenzo, MD, pediatrics

Among the

largest ACOs in the nation


REIMAGINING HEALTH. TRANSFORMING CARE.

70,000 TEAM

MEMBERS

8,100+ PHYSICIANS

Nearly 3M UNIQUE

PATIENTS

27 HOSPITALS

Nearly $2B COMMUNITY

BENEFITS IN 2016

500 OUTPATIENT LOCATIONS

We are now part of something bigger. Something extraordinary. Two national leaders together as one, leading a health care transformation. Advocate Health Care and Aurora Health Care have combined to create Advocate Aurora Health, the 10th largest not-for-profit, integrated health system in the U.S., serving nearly three million people annually. Together, we are committed to reimagining and redefining the possibilities of health. Our combined scale and expertise provides a unique opportunity to achieve efficiencies and advance population health efforts resulting in improved outcomes and lower costs to deliver better value for consumers, communities and employers.


RESULTS, NOT PROMISES.

Advocate Physician Partners’ (APP) forward-thinking Clinical Integration (CI) program brings together over 5,000 physicians and 12 partnered hospitals to drive targeted improvements in health care quality and efficiency. More than 150 clinical performance metrics are tracked in our robust, web-based patient registry system—HealtheRegistries™—that includes over 1 million patients. As we continue to improve, 2017 saw the highest performance in APP history. The CI program has laid the foundation necessary to transform health care through our innovative accountable care model—AdvocateCare®. This comprehensive approach to care ensures the right care is delivered at the right place, the right time and the right cost, from better coordinated care for people with chronic conditions to an expanded geographical footprint with more convenient access.

AdvocateCare® fosters innovation in many ways:

• Encourages us to push the envelope to increase efficiencies and achieve better health outcomes for those we serve—all while bending the health care cost curve

• Incentivizes our physicians and hospitals to achieve breakthrough results

• Drives us to continuously improve year-over-year

Nationally, we’ve set the standard for health care transformation. Organizations across the U.S. emulate our model, including 15 health systems that have contracted with APP to do just that. Over 100 physicians and health care leaders from across the country attend our CI symposium each year. We’re even catching international attention.

Here are some of the ways we leveraged this transformational model to achieve the Quadruple Aim of value: better outcomes, lower cost, and improved patient and clinician experience.

Using data for patient managementMuch of our success can be attributed to a fundamental change in clinical practice, enabled by offices functioning as certified patient-centered medical homes (PCMH), coupled with more meaningful data and less administrative work.

Through HealtheRegistries™, we provide our physicians with robust, actionable information they can use to manage patients in real time—24/7, 365 days a year. Our dedicated field operations team visits with offices regularly to review data and discuss opportunities.

As a result, physicians are conducting patient outreach earlier in the year than ever before.

Achieving the Quadruple Aim

+Better

Outcomes

Lower Cost

Improved Clinician

Experience

Improved Patient

Experience

+

$

Pankaj Patel, MD, MSc Chief Clinical Integration and Quality Officer Advocate Physician Partners

Carrie Nelson, MD, MS, FAAP Chief Clinical Officer Advocate Physician Partners


Reducing variationWhile health care isn’t one-size-fits-all, unnecessary variation in how care is delivered and how services are used can have a significant impact on safety, quality and cost. This is a topic of national discussion, and APP has taken several steps to address clinical variation including a pilot with QURETM

(Quality, Understanding Research and Evidence) Healthcare for oncology.

Over the course of 20 months, 95 percent of APP oncologists participated in a series of online case simulations and group discussions to further drive use of the latest evidence-supported clinical approaches for patients with early breast cancer and late-stage lung cancer. Highlights from the simulations include:

• 39 percent improvement in treatment scores (based on all evidence-based treatment items outlined for a patient, such as chemotherapy, hormone therapy and palliative care)

• 16 percent reduction in unneeded test ordering

• Two-fold increase in physicians developing palliative care plans for late-stage lung cancer patients, in accordance with evidence-based guidelines

• Patient-level claims data was found to correlate with the simulation results, showing declines in potentially unneeded breast cancer testing

The next QURETM initiative will include hospitalists across Advocate. The focus will be on improving quality and cost-effectiveness for patients with sepsis and for patients with multiple co-morbidities (heart failure, COPD, diabetes), both of which are high-volume, high-cost patient populations.

APP also makes great strides each year to reduce variation among our diverse network of providers through the HealtheRegistries™ system and multi-faceted support for electronic medical record (EMR) optimization, patient-centered medical home (PCMH) recognition and Care Pathway implementation.

Bending the health care cost curveAdvocate continues to demonstrate impressive results in bending the health cost curve through better management of patient conditions and care coordination, and increasing use of technology. While U.S. health care costs rose 4.3 percent in 2016,1 Advocate was able to control costs for payers, employers and individuals participating in the MSSP.

For sources of citations, visit advocatehealth.com/valuereport


Here is a snapshot of some of the ways we are reducing health care expense:

• Medicare Shared Savings Program (MSSP): A significant portion of Advocate’s total medical spending is related to the Medicare population. In performance year 2016, using the same care model that delivered quality outcomes and cost savings to the commercially insured, Advocate’s affiliated ACO realized $60.6 million worth of cost savings, as reported by the Centers for Medicare and Medicaid Services (CMS). Ranking among the highest in quality results for the largest group of Medicare beneficiaries, these transformational results were achieved by a reduction in heart failure hospitalizations, reduction in skilled nursing facility and home health expenditures, an increase in preventative primary care visits and better care coordination efforts.

• High-Performing Network Plans (HPN): Advocate HPN plans provide access to our vast network – including more than 5,000 physicians and 400 sites of care, with immediate care options. Employers and consumers benefit from an affordable solution that delivers proven high-quality outcomes, coordinated care and convenient access. As an example, Advocate offers its associates a HPN Exclusive Provider Organization (EPO) plan option and in 2017 EPO enrollment grew by 6 percent while the PPO option saw a slight reduction of 3 percent in members. Impressively, the cost to Advocate for an EPO member associate continues to be less than the cost of PPO member associates. In 2017, the EPO costs were 8 percent less expensive than the PPO product. Advocate's HPN model is available to employers, their employees and consumers in partnership with some carriers.

New, consumer-focused measureWe understand that people don’t want to stay in the hospital or any facility for longer than medically necessary. One of the most powerful measures of success going forward will be to track how many days per year our patients are at home. Through a new “Days at Home” measure, we will focus on getting our patients back to their lives – spending time with their families, heading back to work and doing the things that are important to them as soon as possible.

Learn more about our Clinical Integration program: page 25.

$60.6M in taxpayer savings via MSSP ACO

97% quality score — among the highest in the nation

5,000 physicians

400 sites of care

HPN Plans = Access to


Clinical Integration Program Highlights All results are compared to the most recent NCQA State of Health Care Quality Report.

Diabetes Care Outcomes

$7.34 Million Saved

Saved annually above national performance levels. Savings calculated for just one control outcome—

poor HbA1c—for commercial patients.*

APP’s diabetes initiatives resulted in an additional 29,680 years of life, 47,489 years of sight and

35,617 years free from kidney disease for patients.

*Factoring in savings from the cholesterol and blood pressure control outcomes would significantly increase these annual savings.

Asthma Outcomes

78.3% Control Rate

26.6 percentage points better than national average.

APP’s comprehensive asthma outcomes initiative resulted in $6.1 million annually saved in direct and

indirect medical costs. This includes an additional 56,766 days saved from absenteeism and lost

productivity annually.

Generic Prescribing Initiative

$93 Million Reduced out-of-pocket expense

The APP generic dispensing rate in the commercially insured population was 2% higher

than in the rest of the Chicago area market.

In addition, more than $7 million of overall health care drug expenditures were avoided utilizing lower

cost, equally-effective generics.

Childhood Immunization Initiative

86.7% Administration Rate

for Combination 3 immunizations for all HMO and PPO patients 2 years of age. This rate exceeds the 75th percentile for commercially insured patients.

APP’s rate of immunization for rotavirus-related diseases exceeded national rates by 14.5 percentage

points for commercially insured patients, resulting in savings of over $5.84 million in avoided

hospitalization costs for this one complication alone.

*Savings would increase significantly if all complications related to recommended vaccinations were considered.

Source 1-4 Source 5-8

Source 9-12 Source 13-27



Life Goes On After Heart FailureFor years, congestive heart failure (CHF) has bedeviled health care, driving up costs as distressed patients use a revolving door into emergency rooms. But Advocate is changing that through a new and growing network of heart failure clinics that are part of the Advocate Heart Institute—one of the most comprehensive heart programs in the country.

“When somebody is first diagnosed with heart failure at Advocate, they get comprehensive education and support,” says Azmey Matarieh, MD, Advocate Heart Institute cardiologist at Advocate Sherman Hospital. “They are educated on trigger concerns and coached on medication adherence and on important lifestyle changes, including exercise and nutrition. They are also asked to follow-up regularly with care teams at the clinics.”

LIFE, NOT LIMITS.

Azmey Matarieh, MD and Christina Jackson, ACNS


Meet Doug: Golfer, Grandpa, CHF PatientAt one point, 72-year-old Doug Swanson’s monitoring nurse in the Heart Failure Clinic at Advocate Sherman Hospital feared that his heart would require mechanical assistance—not something a golfer wants to hear. That was about three years ago, when a new technology arrived just in time. That technology is the CardioMEMS device.

“I’m very pleased with the results,” Swanson says. “It’s an easy procedure. I get up in the morning, take a shower, go turn the machine on, and two minutes later it’s ready. I lie down on the pillow for 30 seconds and I’m done.”

The improvement to his quality of life was dramatic. He had spent 90 days in the hospital after CHF diagnosis. Since implantation of the device, heart failure hasn’t put him in the hospital once. His golf game also is doing fine, thank you. Now his concern is less about health and more about how his six grandsons are doing in the many sports they play at school. And that is all a grandpa should have to worry about.

At Sherman Hospital’s clinic, like those across the Advocate system, a team of clinicians maintains close surveillance of heart failure symptoms and fluid levels in patients. This vigilance is combined with continual patient assessment and ongoing research into the best treatments.

The clinic’s results are impressive, with a 3.8 percent 30-day readmission rate among its patients compared to 14.5 percent for all heart failure patients at the hospital, including those not enrolled in the clinic, in 2017.

Working with Dr. Matarieh is advanced practice nurse Christina Jackson, who says treatment alone is not the answer. “Education is extremely important because patients need to be in charge of their health,” she says. “They need to know their symptoms and stick to the action plan that we develop together.”

Identifying and connecting with patients during hospitalizations accounts for much of the clinics’ success across Advocate. Patients are seamlessly referred to clinics for post-discharge follow-up care.

One innovative development for select patients is the CardioMEMS device, a simple arterial implant the size of a pencil eraser that monitors a patient’s heart function so

the care team can determine remotely whether the patient needs to adjust medications or take other steps to manage the condition. A nurse navigator calls patients to have them tweak medication dosages or suggest other interventions.

Once a day the implant communicates with a base station in the patient’s home and relays readings via cell signal to an online site monitored at the clinics.

Hospitalizations for all causes among Advocate patients with the CardioMEMS numbered 243 in the 12 months before implantation and 129 in the 12 months after, a stunning 47 percent drop.

Heart failure clinics are part of Advocate’s effort to build specialty outposts around conditions and diseases that account for repeated hospitalizations, such as clinics for pulmonary rehabilitation, anticoagulation, wound care, memory care and more.

CardioMEMS Device


Taking On The Most Expensive Disease In The U.S.Every 66 seconds, someone in the U.S. is diagnosed with Alzheimer’s—the most common form of dementia—adding to the estimated 5.5 million Americans living with the disease.1

Not only is dementia devastating for patients and caregivers, it is the most expensive disease in the U.S. Nearly $260 billion was spent on Alzheimer’s care alone in 2017.

As research on prevention and a cure continues, finding ways to control costs is paramount. Studies show that effective outpatient management of this patient population is key to bending the cost curve.

APP encourages primary care providers to refer appropriate patients to the Advocate Memory Center, which specializes in Alzheimer’s and dementia management. Led by nationally-recognized neurologist Darren Gitelman, MD, the Center offers comprehensive early evaluation, medical management, therapy, counseling, research trials, and caregiver education and support to effectively diagnose, treat and manage this patient population.

APP is following these patients to understand how this level of specialized management may reduce costly and preventable emergency department visits and hospitalizations, reducing overall cost of care—and improving quality of life for patients and their caregivers.

“My goal is to maintain my patients’ quality of life for as long possible, which means keeping them out of the hospital whenever possible,” says Dr. Gitelman. “Reducing costs allows us to reinvest those dollars in research and clinical trials to prevent and cure this disease, which is the ultimate goal.”


“APP helps me manage the financial burdens of a changing reimbursement landscape.” – Justin LaReau, MD, orthopedic surgery



Going The Extra Mile For Colon Cancer ScreeningIn the fall of 2017, Andrew Albert, MD, lost a patient to colon cancer—cancer that could have been prevented years earlier through screening colonoscopy. He felt helpless. Wearing his heart on his sleeve and a handwritten sign on his back, he rode his bike in scrubs from his office in the Chicago Loop to his home in Lakeview to tell every passerby “Lost a patient to colon cancer. Did not need to happen! Get your colonoscopy!”

Dr. Albert, a gastroenterologist at Advocate Illinois Masonic Medical Center, has gained local, national and international attention for his commitment to raising awareness for colorectal screening. His handwritten sign started a movement on social media using the hashtag #BackOffColonCancer, garnering thousands of likes, shares and comments.

“The more we can make people comfortable with talking about colorectal screening, the more likely they’ll be to get screened,” says Dr. Albert. “We need to take away the embarrassment and fear that is often a barrier to screening.”

Advocate has removed other barriers to screening through its Direct Access Screening Colonoscopy program, which allows medically eligible patients to skip the extra step of meeting with a gastroenterologist or colorectal surgeon before scheduling a colonoscopy. On the physician side, the HealtheRegistries™ system helps APP primary care physicians to track patients who are eligible for screening so they can do proactive outreach.

In 2015, 63 percent of U.S. adults over age 50 completed a colorectal screening.1 Across Advocate, colorectal screenings among patients over age 50 have improved from 68.5 percent in 2016 to 74.1 percent in 2017.

While this improvement is positive, Dr. Albert isn’t resting just yet. “I’ll keep riding, talking and tweeting until we get to 100 percent."



A True Home For Patients And FamiliesEvery morning, the physicians and staff at Southwest Pediatrics huddle in the office to review the day’s patient schedule and make sure all necessary records, equipment and medications are ready.

“We take 5 to 7 minutes each morning to ensure the whole team is prepared to provide safe, efficient care for our patients,” says Prashant Deshpande, MD, pediatrician.

The safety huddle is one of many processes put in place by APP primary care practices that have been recognized as NCQA Patient-Centered Medical Homes (PCMH). It is an extension of the same process that occurs daily at all Advocate sites of care and support centers, demonstrating our laser focus on safety.

PROACTIVE, NOT REACTIVE.

Prashant Deshpande, MD


Since 2015, 97 percent of eligible APP primary care practices have been recognized as PCMHs, with 161 added in 2017 and 81 more on track for recognition in 2018. This journey toward more efficient, streamlined practice has led to more than $10 million in direct savings for 2017 through colorectal cancer screening, asthma control, diabetes control, avoided rotavirus hospital costs and reduced drug prices.

Beyond the efficiency and cost savings, the PCMH serves as a home base for patients–which positively impacts the patient experience. If needs arise, the medical home navigates the system to coordinate care in partnership with specialists and fends off unnecessary or ineffective treatments and tests that could add a financial burden to the patient and family.

“A medical home is not a building, it’s an approach to care,” says Dr. Deshpande. “The medical home is what we are;

the medical home is what you are.” In other words, the patient and his or her family are part of the team, too.

The medical home provides personal outreach and education to each patient, checking to ensure immunizations are completed, answering calls during off-hours, making room in the schedule for patients to come in the office to avoid an unnecessary and costly emergency department visit. Dr. Deshpande’s practice even keeps the office open on Sundays during flu season.

“The process of attaining recognition as a PCMH makes you really look at each patient as an individual to understand their individual needs,” says Dr. Deshpande. “The patient and family is involved in open conversation with the physician and their entire care team. This team approach truly makes the difference.”

PCMH practices produced a 3 percent reduction in

emergency department visits by patients who don’t require

emergency care

“We take 5 to 7 minutes each morning to ensure the whole team is prepared to provide safe, efficient care for our patients.”

– Prashant Deshpande, MD, pediatrics

PCMH providers have an average 5 percent higher clinical integration scores for quality performance,

compared with non-PCMH practices

3

Direct cost savings of $10,089,064 in 2017

for the PCMH patient population


Follow-Up Care In The Palm Of Your HandEngaging patients in self-care is key to improving outcomes and lowering costs, and has been a focus for several years. Advocate recently conducted a pilot that further puts patients’ follow-up care in the palm of their hand—with help and support just a click away.

HealthLoop is a mobile app that guides patients throughout an episode of care to ensure follow-up that extends past the hospital stay. During the first 90 days following discharge—when readmissions are most likely to occur—patients receive automated “check-ins” to ask how they are doing and help them stay on track with their care plan. When patients experience treatment failure or a worsening state of health, HealthLoop notifies the physician and care team. Subsequent intervention allows patients to get attention before their condition leads to an emergency room visit.

Advocate piloted HealthLoop with 2,229 patients undergoing elective hip, knee and spine surgeries over an 18-month period, comparing post-acute outcomes for those who activated the HealthLoop app (activators) to those who did not. Here’s what we learned:

• Patients of all ages are open to using the mobile app

• Post-acute complications and readmissions were all lower than expected for app users

• Significantly less post-acute spending at 365 days post discharge among app users

• Positive feedback from physicians on ease of use in their practice and enhancing their patients’ ability to be actively involved in their care

Following this successful pilot, Advocate is looking to expand use across other surgical specialties. HealthLoop is one of many tools Advocate is employing to lead the way in the mHealth space, utilizing technology to truly transform how we deliver care.

Proactive Screening Reduces RiskLawn Medical Center, a recognized PCMH, implemented routine chlamydia screenings for all patients age 16 - 24 during regular office visits, both as an extension of the Clinical Integration (CI) program and a process improvement initiative. During a one-month period, 10 cases were found that would have otherwise gone undetected—significantly reducing the risk of serious health complications that can arise if left untreated.


Fighting The Nation’s Most Deadly Drug CrisisOpioid overdoses from prescription pills and heroin kill more than 115 Americans every day—a devastating statistic that has grabbed headlines and shined a national spotlight on the issues of addiction and behavioral health.1

More than 20.5 million people are struggling with opioid abuse in the U.S. alone, and despite best efforts, that number is continuing to rise.2

Advocate is doing its part to stem the flow of opioids being prescribed, lowering the risk of dependence and reducing the number of pills sitting in people’s drug cabinets with the potential for abuse. Over the last year, Advocate has seen an 18 percent decrease in the total number of opioid prescriptions issued to emergency department patients and hospital outpatients compared to the year before.

But, there is still work to be done.

In 2017, Advocate launched a system-wide Opioid Addiction Strategy Work Group—bringing together leaders from across departments, disciplines, specialties, and sites—to combine resources and create best practices that can be implemented throughout the Advocate system. From developing prescribing guidelines, to reviewing standing orders in our IT systems, and identifying community resources, this group is working to optimize our approach to battling this epidemic.

Number of Emergency Department and Hospital Outpatient Opioid Prescriptions Advocate Christ, Advocate Condell, Advocate Good Samaritan, Advocate Good Shepherd, Advocate Illinois Masonic, Advocate Lutheran General, Advocate South Suburban and Advocate Trinity

2016 66,660

2017 54,432 18%

decrease



Easing The Transition From Hospital To HomeThere was a time when going home from the hospital meant leaving a place of constant care —with instant help at the push of a button—to feeling alone with a sometimes rocky transition back home.

Not so with a pilot program at Advocate Lutheran General Hospital, which in 2017 established a Care Transition Team designed to guide patients through the transfer from hospital to home. “We’re there to ease the transition out of the hospital,” says Adrianne Rooney, BSN-RN, Care Transition Nurse. “We care about them, and we’re there to make sure they do well.”

PREVENTION, NOT PRESCRIPTIONS.

Ellen Brull, MD and Adrianne Rooney, BSN-RN


Care Transition nurses concentrate on the 30 days after discharge, the red zone of readmission risk. Establishing contact soon after discharge, nurses review medications to ensure no conflicts with new or existing drugs, verify that follow-up appointments have been arranged and even make sure patients have transportation to the doctor.

“We take a global approach to how we can help our patients for the next 30 days,” Rooney explains. “We help them get where they need to be so they can stay healthy and home with their family."

The outreach focuses on patients who are at risk for readmission, including those with the four most common (and costly) causes: acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure and pneumonia.

And it’s working. The readmission rate for patients in the year-old program has dropped 20 percent, resulting in big savings for Medicare and commercial payers and less anxiety for patients. With this success, the program has expanded to Advocate Condell Medical Center.

A key part of the program is communicating hospital information back to the primary care physician. In a recent case, information about a lung nodule—incidentally detected during hospital tests—was not communicated to the primary care physician as it did not relate to the reason for the patient’s hospitalization.

Fortunately, the Care Transition nurse took note of the test result and alerted the primary care physician, Ellen Brull, MD. “The Care Transition Team sent me all her data; otherwise it would have potentially gone unnoticed,” says Dr. Brull. “Now I know to follow-up on the nodule to provide complete care.”

Not only is seamless health care achieved, but patients appreciate the safety net. Patients are grateful for the Care Transition Team’s assistance with the confusion and worry that can occur after a hospitalization.

Care Transition Teams at Advocate Condell Medical Center and Advocate Lutheran General

Hospital contributed to a 20% reduction in hospital

readmissions.

Of 4,805 cases referred to the 30-day program,

81% successfully completed it.

6 Care Transition Team nurses identified 174

opportunities to improve the transition out of

4,805 cases in 2017.


Taking Action On Data To Control AsthmaAsthma costs the U.S. economy more than $80 billion annually in medical expenses, missed work and school days and deaths. Illinois’ asthma expenditures are forecast to increase to $2.2 billion by 2020, contributing to a 53.6 percent growth in asthma expenditures since 2010.

Studies show that medications and patient education reduce asthma-related hospitalizations, emergency department visits and lost days from school and work. So, it is vitally important that people with asthma understand their disease, seek timely and effective management and adhere to their treatment plans.

To help ensure education and compliance across the population it serves, APP uses a combination of technology and the human touch.

Through the HealtheRegistries™ technology, APP equips providers with clear and concise data they can use to steer their patients toward specific tools and interventions, including home-based asthma action plans. Dedicated field operations staff also regularly visit physician offices to review registry data and discuss opportunities for proactive patient outreach.

Extending this data from the office into the community, APP also utilizes specially trained Community Health Workers to connect with patients having trouble controlling their disease. They visit patients at their homes and provide education and other support services such as home environment assessments and assistance with medical equipment.

In 2017, APP deployed Community Health Workers in the Advocate Trinity Hospital market on Chicago’s south side to directly connect with asthma patients at significant risk for adverse events and outcomes. Through this intervention, the asthma control rate for the Trinity PHO rose nearly 16 percentage points in 2017, an increase of more than 30 percent over the previous year, significantly reducing the risk of avoidable emergency department visits and hospitalizations.

Katy Etchingham, APP Care Manager

Safe Care... And A New CarKathy Etchingham, APP care manager, goes above and beyond to address safety issues and reduce barriers to care for her patients. During post-hospital follow-up calls, she has identified and intervened with multiple medication-related errors and problems with equipment or service delivery.

When Kathy learned that a medically complex child was unable to make it to critical follow-up visits due to the parents’ work schedules, she made arrangements for multiple specialists to see the child during a hospital stay.

She secured transportation resources when a father expressed difficulty making it to appointments. She even submitted a contest entry that won the family a new car, easing their transportation worries.

Kathy makes every effort to avoid admissions and readmissions and ensure that if a barrier arises, it is quickly handled, and the patient’s needs are met.



“I’m proud to make health care more accessible and affordable through my participation in APP's extensive network.” – Angela Martine Bell, MD, internal medicine

Extending Care Beyond The Physician Office And HospitalSometimes, the best time and place for care is not in the physician office or the hospital. That is why Advocate and APP have developed one of the most extensive and successful post-acute care networks in the country, including home health, skilled nursing facilities, hospice, palliative care and more. Here are just a few highlights on the post-acute network.

Advocate at HomeIn 2017, home health nurses made more than 347,000 visits across Chicagoland and Central Illinois to provide high-quality care in patients’ homes. These highly trained clinicians provide care for patients with a range of complex medical conditions, helping assure that they are able to safely remain in their homes. Their efforts contribute to Advocate at Home’s ranking in the top quartile, nationally, for preventable readmissions.

Skilled Nursing FacilitiesAdvocate has embedded physicians and advanced practice registered nurses at 44 skilled nursing facilities (SNFs) across Chicagoland and Central Illinois. Goals of the program include managing care and reducing costs, length of stay and readmissions. In the past three years, this program’s direct involvement in post-acute care has led to a number of successes, including reducing average length of stay within the SNF network by 19.4 percent and lower than expected hospital readmissions.

AdvocateCare® CenterOne of the firsts of its kind, AdvocateCare® Center is an outpatient center for Medicare patients with complex health needs. In one extended and coordinated appointment, patients have access to an integrated care team of physicians, advanced practice clinicians, nurses, care managers, licensed clinical social workers, exercise physiologists/trainers, chaplains, and pharmacists. In 2017, enrolled patients experienced an average 30 percent decrease in avoidable hospital admissions, emergency department visits and hospital days.


Ranked among Top 10 Health Systems for Diversity by DiversityInc

Named one the 2017 Top Workplaces by the Chicago Tribune

Recognized as a Best Place to Work by the Daily Herald


“The APP Field Operations team helps me be efficient in my practice so I can focus on my patients.” – Bharti Amin, MD, pediatrics

Four hospitals named Top 150 Best Places to Work in Health Care by Modern Healthcare

9 hospitals honored by the American Heart Association and American Stroke Association for Get with the Guidelines Gold Plus - Stroke

Seven hospitals received Patient Safety Excellence Award from Healthgrades

Eight hospitals are Magnet Recognized for Nursing

Advocate Children’s Hospital received the Highest Rating for Quality by the society of Thoracic Surgeons

Received Visionary Leader Award and System Change Award from Practice Greenhealth

Named one of seven hospital and health systems with Strong Finances by Becker’s Hospital Review

$692 million in charitable care and services

Equity of Care Award from American Hospital Association

ACCOLADES


Clinical Integration (CI) 101 At Advocate, Clinical Integration is a collaborative between our 5,000 APP physicians and 12 hospitals designed to improve health outcomes and increase the value received for the dollars spent by employers on employee health benefits. The program is made possible by funding from all major health insurance plans in the Chicagoland area and the Advocate system. It joins together what would otherwise be a fragmented group of independently practicing physicians into a comprehensive care management program, which also includes our employed physicians. The program is comprised of a common set of quality goals and measures across all insurance carriers. These measures incorporate the most current standards of evidence-based medicine, helping ensure optimal population health management. What is a Patient Registry? This online tool is used to measure and monitor patients in the CI program at an individual or population level. At APP, it is our HealtheRegistries™ system. Physicians can use the system in real time to identify gaps in care and receive recommended targeted interventions. Patients are attributed to a physician based on claims data or after selecting a primary care physician as a requirement in an insurance plan.

We’re Proud to Share Our Results A focus on continuous quality improvement leads us to consistently raise our performance standards each year. APP has evolved to full transparency of clinical performance, creating significant and positive social and peer-driven motivation. This has led to our continued success and breakthrough performance.

CLINICAL INTEGRATION OVERVIEW


2017 CLINICAL INTEGRATION RESULTS

APP 2017 Performance Indicator

APP Clinical Integration Metric <65 Years Old

65+ Years Old Medicaid

INFRASTRUCTURE AND EDUCATION

QI Initiative Reporting Compliance – Early Completion

QI Initiative Reporting Compliance – Early Completion

CHRONIC DISEASE CARE

Asthma Care

19 - 64 years Interventions for Non-Controlled Asthma

5 - 64 years Asthma Control

5 - 64 years Asthma Action Plan

5 - 64 years Asthma Control Test

5 - 64 years Asthma Medication Management

5 - 64 years Asthma Medication Ratio

Pediatric Tobacco Status Assessment

Chronic Obstructive Pulmonary Disease

COPD Bundle

Spirometry Testing

Congestive Heart Failure

Appropriate Medication Outpatient – ACEi or ARBs

Appropriate Medication Outpatient-Beta Blockers

Controlling High Blood Pressure

Blood Pressure Control

Clinical Integration Performance Measures Demonstration Actual performance was compared to the targets for each metric. There are currently over 150 clinical performance metrics that fall in one of six domains: Infrastructure & Education; Chronic Disease Care; Health & Wellness; Efficiency; Care Coordination & Patient Safety; and Patient Experience.

Performance Measures Key

Performance Exceeded 2017 Target

Performance Below Target

Blank cell: No metric/not measured





Diabetes

Annual Eye Exam


Comprehensive Care

HbA1c < 8%

HbA1c > 9%

HbA1c Test

Nephropathy Monitoring

Presence of Statin

Ischemic Vascular Disease/Coronary Artery Disease


Comprehensive Care

Use of Anti-Platelet Medication

Presence of Statin

HEALTH AND WELLNESS

Access to Primary Care

Adolescent Well-Care Visits

Pediatric Access to Primary Care Practitioners

Adolescent Immunizations

Human Papillomavirus Vaccine for Female Adolescents 9-13 years

Meningococcal Vaccine 10-13 years

Tdap/Td Vaccine 10-13 years

Adult Wellness

Body Mass Index

Body Mass Index Follow Up Plan

Exercise Assessment and Counseling

≥ 50 and ≤ 59 years Aspirin Use

≥ 65 years Pneumococcal Vaccination

≥ 65 years Screening for Future Falls Risk

Chlamydia Screening in Women Age 19-24





Annual PCP Visit Over 65

Annual PCP Visit Over 65 - Full Credit

Back Pain

Low Back Pain Imaging

Cancer Screening

≥ 22 and < 65 years Cervical Cancer Screening

Colorectal Cancer Screening

Mammogram Screening

Avoidance of Unnecessary Cervical Cancer Screening In Adolescent Females

Childhood Immunization

Combination Rate 3 Series of Immunization by Age 2

Hepatitis A Shot – 1 vaccination by Age 2

Influenza Vaccination – 2 vaccinations by Age 2

Rotavirus Vaccination

Depression Screening and Follow Up

Depression Screening and Follow Up

Designated Decision Maker for Health Care

Power of Attorney for Health Care

Early Childhood Wellness

Pediatric Developmental Screening Assessment age 1-2 years

Well-child visits in the 3rd, 4th, 5th, and 6th years of life

Well-child visits in the first 15 months of life

Medicaid-Blood Lead Testing Age 0-2

Follow-Up Care for ADHD Medications

Follow-up Care for Children Prescribed ADHD Medication

Influenza Vaccination

Influenza Vaccination

Performance Measures Key

Performance Exceeded 2017 Target

Performance Below Target

Blank cell: No metric/not measured





Maternal Depression Screening

Maternal Depression Screening

Pediatric Wellness

≥ 3 and < 19 years Body Mass Index

≥ 3 and < 19 years Nutrition Assessment and Counseling

≥ 3 and < 19 years Physical Activity Assessment and Counseling

Chlamydia Screening in Women Age 16-18

Tobacco Use

Tobacco Cessation Counseling

Tobacco Status Assessment

Pediatric Tobacco Assessment

EFFICIENCY

AdvocateCare® Index

AdvocateCare® Index

Clinical Documentation Initiative

Clinical Documentation Initiative

Emergency Department Core Measures

Left the ED Without Being Seen

Median Time ED Arrival to ED Departure – Outpatients

Median Time to Pain Management for Long Bone Fracture

Generic Medication Usage

Generic Medication Usage

Secondary Procedure Rate After Elective Hip Arthroplasty

Secondary Procedure Rate After Elective Hip Arthroplasty

Therapeutic Compliance

Therapeutic Compliance

CARE COORDINATION AND PATIENT SAFETY

Care Coordination with Home Care

Care Coordination with Home Care (PHO Level)

Communication SCP to PCP

Follow Up Plan Communicated to Patient

Follow Up Plan Communicated to PCP

Results Communicated to Patient

Results Communicated to PCP





High Risk Medications for Seniors

High Risk Medications for Seniors

Participation in QURE Clinical Vignettes

Oncologist Completion of Online Clinical Vignettes

PHO Attendance in In-Person Session

Participation in RadPeer

Participation in RadPeer

Post Discharge Follow Up Visits

Post Discharge Follow Up Visits

Radiology Turnaround Times

Interventional Radiology Reports < 12 hrs

Screening Mammography Reports - Test Completion to Committed Reports - < 24 hours

Screening Mammography Reports - Test Completion to Report Completion - < 24 hours

Screening Mammography Patient Recall Rate

Screening Mammography Patient Recall Rate

VTE Prophylaxis Power Plan Use

VTE Prophylaxis Power Plan Use

PATIENT EXPERIENCE

Emergency Department Patient Satisfaction - Physicians Care

Emergency Department Patient Satisfaction - Physician's Care (PHO Level)

Outpatient Satisfaction – Primary Care

Outpatient Satisfaction – Primary Care – Courteous and Helpful Office Staff

Outpatient Satisfaction – Primary Care – Getting Timely Care, Appointments and Information

Outpatient Satisfaction – Primary Care – How Well Your Doctors Communicate

Outpatient Satisfaction – Primary Care – Patient's Rating of Doctor

Outpatient Satisfaction – Primary Care – Shared Decision Making

Outpatient Satisfaction – Specialty Care

Outpatient Satisfaction – Specialty Care – Courteous and Helpful Office Staff

Outpatient Satisfaction – Specialty Care – Getting Timely Care, Appointments and Information

Outpatient Satisfaction – Specialty Care – How Well Your Doctors Communicate

Outpatient Satisfaction – Specialty Care – Patient's Rating of Doctor

Outpatient Satisfaction – Specialty Care – Shared Decision Making

Patient Satisfaction – In-Patient Care

In-Patient Satisfaction – Physician's Care (PHO level)


NCQA Performance Measures

APP performance for all patients exceeds NCQA population specific benchmarks

* Commercial All Products Combines HMO and PPO

The tables that follow highlight APP’s performance when compared to available national benchmarks. These results continue to demonstrate top decile or top quartile performance in many performance measures.

Asthma Performance Measures2017 APP

Performance (Patient Level)

2017 NCQA The State of Health Care Quality Published Results

90th Percentile Commercial All Products


90th Percentile Medicare PPO


Asthma 5-64 – Asthma Medication Ratio 77.0% 84.7% 82.2% —— ——

Diabetes Performance Measures2017 APP

Performance (Patient Level)





Diabetes >= 19 and < 65 – % Annual Eye Examinations 61.8% 68.0% 58.9% —— ——

Diabetes >= 19 and < 65 – % HbA1c performed 92.9% 94.3% 92.2% —— ——

Diabetes >= 19 and < 65 – % HbA1c performed < 8 66.6% 65.2% 61.0% —— ——

Diabetes >= 19 and < 65 – % HbA1c performed > 9 or untested 22.1% 22.4% 27.0% —— ——

Diabetes >= 19 and < 65 - Hypertension Control <139/89 mm/Hg 90.0% 76.5% 68.8% —— ——

Diabetes ≥ 40 and < 65 years Presence of Statin 79.0% 66.4% 62.7% —— ——

Diabetes >= 19 and < 65 – Nephropathy Testing 94.3% 92.6% 91.0% —— ——

Diabetes >= 65 – % Annual Eye Examinations 76.1% —— —— 80.4% 74.8%

Diabetes >= 65 – % HbA1c performed 95.3% —— —— 96.8% 95.2%

Diabetes >= 65 – % HbA1c performed < 8 77.6% —— —— 78.8% 73.2%

Diabetes >= 65 – % HbA1c performed > 9 or untested 14.3% —— —— 12.5% 15.3%

Diabetes >= 65 – Hypertension Control <139/89 mm/Hg 91.1% —— —— 75.7% 72.2%

Diabetes ≥ 65 and < 76 years Presence of Statin 87.6% —— —— 74.3% 70.4%

Diabetes >= 65 – Nephropathy Testing 97.5% —— —— 97.63% 96.8%

APP operational definitions include a broader population than NCQA HEDIS metrics.

Controling High Blood Pressure Performance Measures

2017 APP Performance





CHBP >= 60 and <= 85 – Blood Pressure Control < 149/89 mm/Hg 93.1% 75.2% 67.7% —— ——

CHBP >= 19 and < 60 – Blood Pressure Control < 139/89 mm/Hg 86.4% 75.2% 67.7% —— ——

APP 2017 BENCHMARK COMPARISONS


COPD Performance Measures 2017APP Performance





COPD >= 65 – Spirometry Evaluation 78.2% —— —— 43.3% 38.7

COPD >= 40 and < 65 – Spirometry Evaluation 78.6% 49.8% 44.8% —— ——

Adult/Senior Wellness Performance Measures 2017 APP Performance





HW – Adult – >= 65 – Body Mass Index (BMI) 98.3% —— —— 98.4% 97.0%

HW – Adult – >= 19 and < 65 – Body Mass Index (BMI) 97.3% 91.7% 85.8% —— ——

Chlamydia Screening in Women Age 16-24 54.2% 62.35 53.5% —— ——

Cancer Screening Performance Measures 2017 APP Performance





HW – Cancer Screening >= 65 – Colorectal Cancer Screening 77.5% —— —— 78.2% 75.2%

HW – Cancer Screening >= 65 – Mammography Screening 82.4% —— —— 81.5% 78.4%

HW – Cancer Screening 22-64 years – Cervical Cancer Screening 81.1% 81.4% 77.9% —— ——

HW – Cancer Screening 51-65 years – Colorectal Cancer Screening 71.9% 72.2% 66.4% —— ——

HW – Cancer Screening 51-65 years – Mammography Screening 82.8% 79.8% 75.7% —— ——

HW - Non-recommended Cervical Cancer Screening in Adolescent Females 1.2% 0.6% 1.0% —— ——

Early Childhood/Pediatric Wellness Performance Measures




90th Percentile Medicaid HMO


Access to Care – Non-Medicaid Adolescent Well-Care Visits 72.7% 64.7% 53.6% —— ——

Access to Care – Medicaid Adolescent Well-Care Visits 71.2% —— —— 68.1% 59.7%

Medicaid Pediatric Access to Primary Care Practitioners 97.4% —— —— 94.7% 92.4%

Non-Medicaid Pediatric Access to Primary Care Practitioners 97.0% 95.7% 92.8% —— ——

Early Childhood Wellness Medicaid Well-child visits in the 3rd, 4th, 5th and 6th years of life 90.5% —— —— 82.8% 78.5%

Early Childhood Wellness Non-Medicaid Well-child visits in the 3rd, 4th, 5th and 6th years of life 91.8% 87.5% 82.7% —— ——

Medicaid-Blood Lead Testing Age 0-2 80.2% —— —— 86.4% 80.9%

HW - Pediatrics - 3-18 years Body Mass Index 94.9% 85.2% 74.9% —— ——

HW - Pediatrics - 3-18 years Nutrition and Counseling 92.0% 79.8% 70.3% —— ——

HW - Pediatrics - 3-18 years Physical Activity Assessment and Counseling 92.2% 77.1% 64.4% —— ——

NCQA Performance Measures

APP performance for all patients exceeds NCQA population specific benchmarks

* Commercial All Products Combines HMO and PPO



Follow-Up Care for ADHD Medications Performance Measures






Follow-Up Care for ADHD Medications- Medicaid Follow-up Care for Children Prescribed ADHD Medication 85.8% —— —— 69.5% ——

Follow-Up Care for ADHD Medications- Non-Medicaid Follow-up Care for Children Prescribed ADHD Medication 96.2% 50.0% 43.6% —— ——

Childhood/Adolescent Immunizations Performance Measures






Adolescent Immunization – Medicaid – Meningococcal Vaccine 96.6% —— —— 88.9% 85.6%

Adolescent Immunizations – Medicaid – Tdap/Td Vaccine 96.0% —— —— 92.6% 90.3%

Adolescent Immunizations – Non-Medicaid – Meningococcal Vaccine 95.1% 88.9% 84.4%% —— ——

Adolescent Immunizations – Non-Medicaid – Tdap/Td Vaccine 95.5% 93.9% 91.3% —— ——

Adolescent Immunizations- Medicaid- HPV Vaccine 38.9% —— —— 32.9% 27.1%

Adolescent Immunizations- Non-Medicaid- HPV Vaccine 31.3% 22.6% 18.0% —— ——

Childhood Immunization - Non-Medicaid- Flu Shot-2 vaccinations by Age 2 66.9% 77.1% 71.1% —— ——

Childhood Immunization -Medicaid- Rotavirus Shot 89.5% —— —— 78.7% 75.2%

Childhood Immunization -Non-Medicaid- Hepatitis-A Shot-1 vaccination by age 2 93.2% 92.3% 90.0% —— ——

Childhood Immunization -Non-Medicaid- Rotavirus Shot 92.4% 88.0% 85.0% —— ——

Childhood Immunization-Medicaid- Combination Rate 3 Series of Immmunization by Age 2 81.5% —— —— 79.3% 75.9%

Childhood Immunization-Non-Medicaid- Combination Rate 3 Series of Immmunization by Age 2 86.7% 87.0% 82.2% —— ——

IVD/CAD Performance Measures 2017 APP Performance





IVD-CAD >= 19 and < 65 - Presence of Statin 86.8% 85.7% 83.2 —— ——

IVD-CAD >= 65 - Presence of Statin 88.9% —— —— 82.5% 79.7%

Appropriate Utilization Measures 2017 APP Performance





Use of Imaging for Low Back Pain 81.5% 82.4% 79.0% —— ——




Reginald Cantave, APP Field Operations and Sandeep Chandra, MD


LEADING THE TRANSFORMATION.

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LEADING THE TRANSFORMATION - Advocate Health Care · 2020-05-12 · conversation by leading the transformation to value-based care. Through our highly evolved clinically integrated