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Transforming WhatcomHealth CareA Case Study

July 28, 2011 Larry A. ThompsonExecutive Director

Whatcom Alliance for Healthcare Access

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WAHA PROGRAMS AND INTIATIVES

• Access Counseling Services (insurance and direct to care)

• Statewide Health Insurance Benefits Advisors (SHIBA) HelpLine

• Whatcom Project Access

• Nonpartisan analysis for decision makers …Communities Connect

• Convene community leaders, system stakeholders and elected officials

Health Insurance & Care Connection

Health Policy Education

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WHATCOM ALLIANCE FOR HEALTHCARE ACCESS (WAHA)

• Whatcom health leadership since 2002

• Access Mission: Serves about 4% (9,000 people) of the population

annually

• Stewardship Mission (Policy) Transforming Whatcom Health Care Project

• Long community history of collaboration

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WHAT IS THE CASE FOR CHANGE?

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Association between Medicare spending and quality ranking -- U.S. States

Baicker and Chandra, Health Affairs, web exclusives

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Source: International Federation of Health Plans 2010 report (www.ifhp.com)

 

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Transforming Whatcom

Health Care

Providers(30)

A COMMUNITY PROCESS

Business(6)

Consumers(6)

Insurance(4)

Local Government

(4)

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• St. Luke’s Foundation• Mt. Baker Imaging• Brigid Collins Family Support Center• Northwest Justice Project• Bellingham-Whatcom Chamber of Commerce and Industry• Whatcom Counseling and Psychiatric Clinic• Whatcom County Medical Society• Whatcom County• City of Bellingham

• PeaceHealth St. Joseph Medical Center• PeaceHealth Medical Group• Northwest Regional Council• Family Care Network• Regence Blue Shield• Group Health Cooperative• Interfaith Community Health Center• Sea Mar Community Health Center• Mount Baker Planned Parenthood

SOME OF THE PARTICIPATING ORGANIZATIONS

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PROJECT TASK FORCES

Project Steering Committee

Financial Issues

Task Force

Consumer Task Force

Information Systems

Task Force

Delivery System

Task Force

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Improving Improving Each

Population Patients’ Experience

Health Of Care

Reducing

Per Capita

Costs

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GUIDING PRINCIPLES FOR A FUTURE HEALTH SYSTEM

• Governance should be community based

• Health is a lot more than medical care

• Future system must be transparent and accountable

• IT should help us do better

• Keep administration simple and non-redundant

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GUIDING PRINCIPLES FOR A FUTURE HEALTH SYSTEM

• Financial incentives should reward quality and efficiency

• Providers must be better organized

• All need to be served

• Integrated, coordinated care is critical

• Care delivery will be patient centered

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FUTURE WHATCOM HEALTH SYSTEM

MEDICAL NEIGHBORHOOD

(ACO)

COMMUNITY HEALTHENVIRONMENT

PATIENT

MEDICAL HOME (PCMH)

Patient: All services are centered on the patients’ needs

Medical Home (PCMH): The primary care provider team that maintains an ongoing relationship with the patient and assures access to needed care

Medical Neighborhood (ACO): A group of providers working as a team with the goal of improving quality and improving value for patients

Community Health Environment: The determinants of health such as behavior patterns, social circumstances, environmental exposures, and genetics

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ORGANIZATIONAL MODEL OF THE WHATCOM

COUNTY HEALTH CARE SYSTEM: TWO LEVELS

Whatcom Community Health Association (WCHA)

Accountable Care Organization – Whatcom County

• Plans the health system and aggregates dollars from various sources to support care delivery

• Organizes providers to integrate care around best practice care models. • Accountable to the WCHA for cost and quality

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Potential organizational composition of ACO-W and its relationship to other parts of the health system

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Building Blocks

• Certified Patient Centered Medical Homes

• 6 Point Community Care Management System

• IT Infrastructure:– EMRs– HIE– Patient Portals– Care Coordination System– Analytics

• New Health Plan Contracts– Global Budgets

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DELIVERY SYSTEM REFORM

• Patient-Centered Medical Homes

• Improved Care Coordination

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ALL PATIENTS SHOULD HAVE A MEDICAL HOME

•The medical home is a team of providers who have a whole person orientation

•All medical homes meet the NCQA criteria

•Patients have access to care when they want/need it

•Medical homes provide for self-care and link to community resources

•Medical homes demonstrate continuous quality improvement

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Mental Health/Behavioral Health Integration

• 4 quadrants approach

•PMPM and case management fees

•Payment in mixed providers sites

•Private Sector Therapists

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A CARE COORDINATION SYSTEM

• One inclusive system, not 20 silos

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CARE COORDINATION SYSTEM

1. Uses clinical data to assess needs

2. Is built upon Patient-Centered Medical Homes

3. Includes a case management system for the very ill

4. Aids transitions between settings

5. Supports patients and families as they engage in improving their own healthcare

6. Includes an IT-based care tracking solution

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Population Management and Care Coordination

5% of the population

Level 3

Level 3 Complex comorbidity Access multiple providers and settings Case management utilized Identified through predictive models PCMH in the loop but not principal care coordinator

Level 2 Identified by predictive modeling Generally 1 or more chronic conditions Often transitioning care settings: hospital to home, nursing home to hospital, etc. May benefit from patient activation May benefit from disease management protocol Managed mainly in PCMH but may access community care coordinator

15% of the Population

Level 2

80% of thePopulation

Level 1

Adapted from Kaiser Permanente

Level 1 Many patients need logistical assistance from a referral coordinator Some patients need access to disease management programs Some patients will choose self-care activities Some patients will need referral to community resources

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IT VISION

TODAY• Groups of doctors and hospitals keep their own records.

• Data is kept by individual organizations and is unavailable for making care improvements

• Some patients have access to their clinical information and use it to make health improving decisions.

FUTURE SYSTEM• The same clinical information is available to all doctors and providers across the country.

• Aggregate clinical and financial data is available and is used to continuously improve care and increase efficiency.

• All patients understand they can access their clinical information and understand the community resources that can empower them to manage their own health care.

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HEALTH INFORMATION TODAY

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HEALTH INFORMATION TOMORROW

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KEY EXISITING IT GAPS

• About 35% of practices lack complying EMRs.

• Local system lacks interoperability.

• Patient portal capability spotty.

• System-level analytic capability non-existent.

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HEALTH CARE FINANCIAL REFORM

• We can’t go on this way!

• Payment methods drive the delivery of care

• Change will be gradual, but we must make a start

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TODAY’S DOCTOR

• I get paid according to the number of services I provide.

TOMORROW’S DOCTOR

• I get paid according to the health outcomes I produce and the efficiency of my practice.

32Robert Wood Johnson Foundation, The Synthesis Project

MEDICARE SPENDING FOR BENEFICIARIES WITH FIVE OR MORE CHRONIC CONDITIONS

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GENERAL TIMELINE FOR CREATING AN ACCOUNTABLE CARE COMMUNITY

12/2010 7/2011 7/2011 – 6/2012

Phase I Initiate Stakeholder Build initial PCMH,

Feasibility “Go/No Go” Care Coordination, &

Assessments decision IT capabilities

7/2012 7/2012-6/2014 7/2014

Initial Small Continue Demo Project

Pilot('s) building (10,000+

launches infrastructure enrollees)

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Building Blocks

1.Patient Centered Medical Home Collaborative

2.Care Coordination System Build

3.Data Warehousing Software

4.MS/SU care delivery and financial integration

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Candidate Populations for Early

(mid 2012) Limited Pilot Projects

• Dual Eligibles (Medicare/Medicaid)

• PeaceHealth Self Insured’s

• Individual Insurance Coverage

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SUMMARY

Among the area’s health care leadership, the following beliefs are prevalent:

•The current health care system is not sustainable.

•This community has learned a great deal in the past 25 years and

is now poised to move forward more aggressively.

•The highest probability of creating a sustainable system is to build

it from the ground up here locally.