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Population Health and Quality of Carein the Era of COVID-19
June 17, 2020
CME Credit• Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State
Medical Society to sponsor continuing medical education for physicians. The Bridgeport Hospital Yale New Haven Health designates this live activity for a maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only credits commensurate with the extent of their participation in the various activities.
• This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State Medical Society to provide continuing medical education for physicians.
• The content of this activity is not related to products or services of an ACCME-defined commercial interest; therefore, no one in control of content has a relevant financial relationship to disclose and there is no potential for conflicts of interest.
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Population Health and Quality of Carein the Era of COVID-19
www.ncqa.org/
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COVID-19 cumulative cases in the U.S.
2,124,155 cases on 6/16/20 – up from 1,985,670 cases last week (6/9/20) –116,567 deaths https://coronavirus.jhu.edu/map.html
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https://coronavirus.jhu.edu/data/new-cases-50-states
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Data for Connecticut
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Any good news? • RECOVERY trial - Could steroids help in COVID-19
induced ARDS?
– Risk of death reduced by a third for ventilated pts
– Risk of death reduced by 1/5th for those on oxygen
– Cheap drug: Dexamethasone
• Huge benefit in poorer countries
– Caution with late breaking studies!• Hydroxychloroquine debacle
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Resources• Nuvance
health:https://spark.adobe.com/page/sfiiwxxjnI8yc/• CDC:https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• WHO:https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Johns Hopkins:
https://coronavirus.jhu.edu/map.html
• Othershttps://www.thelancet.com/coronavirus
https://covidactnow.org/
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Population Health and Quality of Care in the Era of COVID-19
Tierney Giannotti, MPA
Senior Program Manager of Population Health
Kindig and Stoddart’sdefinition (2003) “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”1
Focuses on populations “within specific geopolitical area” and goes beyond their clinical health to include “social, economic, environmental, and individual behavioral and genetic traits.”
CDC: Population health brings significant health concerns into focus and addresses ways that resources can be allocated to overcome the problems that drive poor health conditions in the population2
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Defining Population Health
Sources: 1. Kindig D, Stoddart G. What is population health? American Journal of Public Health 2003 Mar;93(3):380-3. 2. Center for Disease Control and Prevention. What is Population Health?
https://www.cdc.gov/pophealthtraining/whatis.html
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Key Changes• Early March: 95% patient visits were in person
• Early April: 96% of visits were via telehealth
• Reduction in incoming call volume and increase in outgoing calls
• Majority of staff working remotely with no layoffs or furloughs
What did not change: Data driven approach to caring for our patients.
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11045 1131410151
8117
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0
2000
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2-Feb 9-Feb 16-Feb 23-Feb 1-Mar 8-Mar 15-Mar 22-Mar 29-Mar 5-Apr 12-Apr 19-Apr 26-Apr 3-May 10-May 17-May 24-May 31-May
Incoming/Outgoing Calls/By Week
Incoming Outgoing
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0
50
100
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ER visits: Current visits compared to prior year
2019 2020
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108.4
95.691.9
80.685.6
76.5 76.9 75.0 75.078.9
74.377.0
93.6
84.1
61.5
24.1
31.8
0
20
40
60
80
100
120
Jan 19 Feb 19 Mar 19 Apr 19 May 19 Jun 19 Jul 19 Aug 19 Sep 19 Oct 19 Nov 19 Dec 19 Jan 20 Feb 20 Mar 20 Apr 20 May 20
ER Visits Per Thousand Member Months
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No Show Rate by Month and Discipline
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Multiple responses to patient needs
Establish COVID Triage Line
Convert Warm Hand Offs to eWHOs
Outreach to patientsa) by condition
b) age
c) utilization
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COVID Triage Line
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Warm Hand Offs
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Patients with chronic conditions
Define the population
Scale the subgroup of patients to meet the operational capacity -> highest of the high risk
Develop and test scripts
Identify who should see the patient (PCP, RN, CDE, etc.)
Obtain feedback iteratively from those reaching out to patients
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Example: Patients with Diabetes
Population: 7,440 patients with diabetes
Subgroup: 866 patients whose last A1c > 9.0 who did not have an upcoming visit scheduled and no visit in the prior 3 months
Assign and Train: 5 Patient Service Associates
Results: 32% of patients were scheduled for a visit with PCP
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Immunizations
• A pause was put in place on immunization of the very youngest patients for several weeks with the plan to catch children up as soon as safely possible
• Required us to be prepared to catch up with all of these families
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Immunization Catch Up
Modifications to process: • Started with nurses calling patients to schedule the visits.• Transitioned to PSAs and Telehealth Outreach Teams
scheduling these.• Cross-reference with the existing process of reaching out to
children who need Well Child Visits to avoid duplication.
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ER Visit Follow Up
• Opportunity: Design, test and implement a workflow to ensure follow up on ER visits and to educate patients on appropriate use of ER
• Design the process to enable tracking of key metrics
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Tracking Results
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Challenge: Patients not engaged in telehealth
• Do they have appropriate access to telehealth?
• Are they aware of the availability of telehealth?
• Were they engaged prior to the pandemic?
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Additional Key Considerations
• Patient satisfaction• Staff satisfaction• Available methods for reaching patients, with
varying results– Live calls– Automated calls– Texts– Portal messages– Website– Social media
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27 * This initiative is supported by 27
