Population health may 2014 hd

Why Model Healthcare Systems Based on Population Need?

Claire Cordeaux: Executive Director, Healthcare

Brittany Hagedorn: U.S. Healthcare Lead

_________

Get the Most from Population Health Initiatives

SIMUL8 Corporation | SIMUL8.com | [email protected] 1 800 547 6024 | +44 141 552 6888

Global Perspectives

Brittany HagedornUS Lead Healthcare, SIMUL8

Simone AtungoDirector Community Development and Integration, Mount Sinai, Toronto

Claire CordeauxExecutive Director, Healthcare SIMUL8, background UK NHS, original developer of Scenario Generator


Housekeeping

• Audio

• Q and A

• Recording available on SIMUL8healthcare.com


Agenda

• Introductions

• Current State of the Art

• Triple Aim Vision

• Case Studies: Simulating Interventions

• Key Takeaways


Healthcare On the Move• Need to reduce cost

– Crunched budgets, – Hiring freezes, – Supply chain initiatives

• Aging population• Post-reform environment• New payer/commissioner and provider

perspectives• Evolving patient expectations

Result is an environment where Population Health Management is greatly needed!


Many Definitions“On the clinical side of a hospital or health system, (population health) often entails tracking patients by disease groups, identifying gaps in care, and addressing them before they result in aggravated conditions, or avoidable admissions and trips to the ED. Aggregated clinical data are essential to managing population health.”

--Health Finance News, April 2014

“…opportunity for health care delivery systems, public health agencies, community-based organizations, and many other entities to work together to improve health outcomes in the communities they serve”

--Soto, M, Population Health in the Affordable Care Act Era, Academy Health, 2013


IHI’s Triple Aim

“Drive the Triple Aim, simultaneously improving the health of the population, enhancing the experience and outcomes of the patient, and reducing per capita cost of care for the benefit of communities.”

Understand your population to improve planning and delivery of

care


Where do we start?

Never Events

Value-Based Care

Aging Popula-

tionPay 4 Perfor-mance

Cost Sharing

Medicare Fee

Schedule

Primary Care

Access

ACO & PCMH

Expanded

Coverage

Readmis-sions & Mortality

Patient Satisfac-

tion

Outcome Measure

s

7 day working

Managing chronic diseases

With a deeper understanding of how the pieces fit together, you can address several needs at once.


Complex Interactions

ChronicDisease

Prevalence

AgingPopulation

ExpandedCoverage

Although each of these drivers is an independent influence, policy and operational decisions would benefit from a combined perspective:

• Related populations.• Similar (and compounding) effects on patient needs.• Overlapping solutions.

Patient acuity increasing.

Disease interactions.

Importance of environmental & social influences.

Scrutiny on costs.


Key Questions

Any population health strategy needs to answer a few questions:

•How much capacity will we need? What will utilization be?

•What effect will it have on lead times / access to appointments?

•How much will it cost? Can that be reduced?

•How will this effect clinical outcomes?


State of the Art: Today


State of the Art: Tomorrow

Use the Scientific Method to make…

•Evidence-Based Decisions that,•Achieve Predictable Results using,•Targeted Changes at,•Lower Cost.

Cycle of Continuous Improvement


New Strategies Needed

These are all valuable disciplines, but none are fully equipped to look at the whole system, where you need to understand demand and address cost, quality, clinical and non-clinical domains, operations, and engagement.

LeanSix

Sigma

EpidemiologyPublic Health


Innovation with SimulationBringing together population health and

service utilization

•Built in demographic data

•Scenario testing to inform decision making

•Risk free, zero cost environment

•Predict results before you invest


What is simulation?

High level flow and operational questions, individual patient variability, graphical visualisation


Dementia Model


• Strategic planning in health and social services• Framework for understanding whole systems• Built-in data for immediate scenario testing• Easy to use for those new to simulation• Developed with NHS Institute UK• 80% of NHS England, Scotland Health Boards

Canada, Italy, US, Australia

Scenario Generator


How the model works

Activity from demographic projections and age-related factors influencing demand

Simulating patient journeys through a set of services depending on need

Whole system, user-configured to represent “what if?” questions


Scenario Generator

PathwaysScenarios

Wholesystemmodel

Simulationresults

Service points, flows

& waits

Servicemodels

Referral patternsCapacityDuration

PopulationDemographyPrevalence

Prevalence/Influencing

factors

Demographicweighting

Population

Constrainedresources

Urgent

Planned

Maternity

Mental Health

Social Care


Sample Applications

• Chronic condition management• Population health needs assessment• Health disparities• Integration of health and social service• Post-acute care coordination• Demand shifting to lower acuity settings

(outpatient, urgent, alternative practitioners)


Modeling Maternity with Mount Sinai

Population

1.17m

Conception rate by

female age-band

Annual births @ 13,000

% split for uninsured

etc.

5 year projections

+ 3.6%


The pathway: insured 41.85%, uninsured 0.35%


The pathway ctd.


Bed Capacity• 180 beds• Length of stay 2-15 days C-section, 1-5 days vaginal 48%

utilization• Minimum delays


Impact on capacity if not uninsured?

• Less 1 % utilization• Less $400k


Impact if 5% fewer elective C sections?

• Less 2 % utilization• Less $37k


Toronto Food Bank

• Increasing access to health services for Food Bank users

• What if a senior nurse service was provided direct to Food Bank users?• How many appointments?• How long will users wait?• If they wait too long, will they attend the ED?• What is the cost?


Toronto Food Bank


Toronto Food Bank

• 4676 visits a year• 1 nurse – operating 48 hours a week• 1 hour ($100) new appointment, 15 minutes ($50)

follow up, ED visit $500• If users wait more than 24 hours, they will attend

ED


Results


Add a second nurse

• Reduces overall costs from $874,650 to $830,850

• Fewer ED visits

• More nurse consultations


Case 2: Radiology Capacity

• What impact does demographic change and new clinical practice have on the demand for CT and MRI over the next 10 years?

• “Clinicians say we must have a new scanner – that’s a £1m decision – and we are in deficit – can we manage without one?”


Scenario 1

Natural population growth

Scenario 2

Population growth +

7% (CT) and 11% (MRI)

Annual Increase

Scenario 3

Population growth +

Annual Increase +

New Clinical Practice

Case 2: Results


How long until we need a new scanner (MRI only, 11%

growth)?1. 2 years?

2. 4 years?

3. 5 years?


Case 2: Results – MRI Details

Demand begins to exceed capacity.

Queues build within the model.

Additional capacity is required to meet demand.

Additional capacity not required until Year 8 – scanners operational 7days.


When do we need a new scanner if they are operational

24/7?1. 5 years?

2. 8 years?

3. 10 years?


Case 2: Results


Case 3: Stable Prostate Cancer

• How many patients require PCP and Outpatient treatments every year?

• Could this care be delivered more efficiently?• What is the impact on costs?• Could breaches in waiting times be avoided?


Case 3: High level pathway

Wait

Access Targets2 week wait to referral62 day wait to treatment


Case 3: Building the pathways

DIAGNOSIS TREATMENT


Case 3: Assumptions

Outpatient clinic capacity is 80 appointments a week including:

– First Visits– Follow Up Outpatients– Treatments


Case 3: PSA Diagnostic Scenario

What if we introduced a second PSA test into primary care?

Scenario:•Current state – after first positive PSA all patients referred to secondary care•Future state – what if two thirds (instead of one third) of patients have second PSA test in primary care?


What if PSA?: before


What if PSA?: before


What is the impact of 2/3rd patients having a second PSA?

Reduce average waiting time (currently 20 days) for initial appointment by:

1.2 days?

2.3 days?

3.5 days?


What if PSA?: after


Case 3: PCP Treatment Scenario

What if PCPs carried out the 6 month PSA/QA with LHRHa?

Scenario:•Current state – patients have 3 monthly LHRHa with PCP and 6 mo. PSA/QA at outpatient clinic•Future state – what if 50% of patients had 6 month PSA/QA test in primary care?


What if PCP LES for treatment?: before

QA and PSA performed in outpatients every 6 months


QA and PSA performed by GP with 6 months LHRHa instead of in outpatients

What if PCP LES for treatment?: after


What is the financial impact?

Is the cost of the patient pathway:

1.Less?

2.More?

3.The same?


User feedback

We will be able to demonstrate to the PCT and PCPs how a simple change to the pathway by adding in a second PSA

test in primary care will prevent the majority of our prostate cancer 62 day

treatment breaches – a real issue in this pathway where diagnostics require a wait between them (TRUS and MRI)


Key Take-Aways• Planning services including population health is

increasingly important in today’s healthcare environment

• There are limited tools available to address the complexity of population health

• Using simulation tools such as Scenario Generator enable health systems to – Make evidence-based investments, – Reduce risk, – Improve clinical outcomes, and – Manage healthcare costs per patient.

Click to edit Master title style


Click to edit Master title styleQUESTIONS

The scientist is not a person who gives the right answers, he's one who asks the right

questions.Claude Lévi-Strauss




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