Reducing total cost of care in final version v3
Transcript of Reducing total cost of care in final version v3
Sutter Compass Connect
Syed S. Ali MD, MBA, SCC
Medical Director
Sutter Compass ConnectReducing the Total Cost of Care(TCOC)
All men by nature desire knowledge.
~Aristotle
Paradigm Shift
Edward Deming, Shigeo Shingo and others perfected the the Toyota production System(TPS) by bringing Statistical Process Control and quality to Japan. Lean as we know it today was born.
We would like to introduce another concept, Patient Activation Measure(PAM).
What lean was to the TPS, PAM would be to population management. With Lean already engraved in our DNA reduction of Total Cost of Care (TCOC) with PHM will be possible.
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What determines your health status?
Failed Strategies
Neither financial Incentives nor information strategies have proven to have sufficient power to change and sustain consumer behavior.
Chronic care models/medical homes emphasize patient- oriented care yet have had difficulty showing success in return on investment.
Self management support programs have shown little improvement in clinical outcomes for those with chronic illnesses.
Trying to find a predictive model to identify patients/consumers before they become high utilizers has been unsuccessful except for AIM, Palliative and Hospice care
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Paradigm shift
Points we will discuss today. How do you measure behavior and effect a change. PAM-Science behind the modality Using systematic measurement to target consumer
activation strategies. The concept of “activation” as an organizing construct to
increase consumer involvement in health. Illustrative data that show how activation levels are
associated with engaging in specific health behaviors. The strategy of measuring activation and calibrating both
the type and the amount of support for consumers is discussed as a way to improve current approaches.
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Paradigm Shift
Tailoring activation to the individual, group, and community level.
Behaviors that are more challenging for consumers are unlikely to be adopted among those who are less activated.
Encouraging behaviors that are more realistic for the individual given the level of activation can improve the efficacy of current efforts.
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The Patient Activation Measure (PAM) – 1. Knowledge– 2. Skill– 3. Confidence
PAM
Background on PAM
PAM went through various development stages. Defining the construct; Development and psychometric testing, including
reliability and validity testing; Determining whether the construct is changeable; Determining whether tailoring activation to specific levels
improve outcomes Psychometric analysis was conducted using Rasch
stochastic measurement models and methods (Andrich,1978; Wright & Masters, 1982; Wright & Stone, 1979), as well as selected classical test theory (CTT) and item response theory (IRT) statistics.
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• 13-question• Based on responses to the survey, each person is
assigned–Activation Score –Level
PAM
Patient Activation Measure (PAM) Items
When all is said and done, I am the person who is responsible for taking care of my health problems.
Taking an active role in my own health care is the most important thing that affects my health.
I am confident I can help prevent or reduce the problems associated with my health condition.
I know what each of my prescribed medications do. I am confident I can tell whether I need to go to the doctor or whether I can take care of
a health problem myself. I am confident that I can tell a doctor my concerns, even when he or she does not ask. I am confident I can follow through on medical treatments I need to do at home. I understand my health problems and what causes them. I know what treatments are available for my health problems. I have been able to maintain (keep up with) lifestyle changes, like eating right or
exercising. I know how to prevent further problems with my health condition. I am confident I can figure out solutions when new problems arise with my health
condition I am confident I can maintain lifestyle changes, like eating right and exercising, even
during times of stress.
Source: Copyright© University of Oregon. All rights reserved.
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Level 1 : May not yet believe that the patient role is important
– PAM Score of 47.0 or lower
Level 2: Lacks confidence and knowledge to take action– PAM Score of 47.1 to 55.1
Level 3: Beginning to take action– PAM Score of 55.2 to 67.0
Level 4: Has difficulty maintaining behavior over time– PAM Score of 67.1 or above
Meaning of #s
Better as
score rises
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Increasing Activation at Group Level
Delivery system could stratify their enrolled patient population by both clinical indicators [example blood pressure or cholesterol levels]as well as their activation level.
This allows for early intervention with patients who have clinical risk factors and who lacks skills to self manage [that is level1 or level 2].
This allows limited resources to be used efficiently. When employed throughout the organization economy of
scale would show real reduction in TCOC.
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PAM baseline vs Recent - Graph
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VR-12 Baseline vs Most Recent
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Impact effort Matrix
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High Impact High Impact
low effort High effort
Low Impact Low impact
Low effort High Effort
Greatest ROI
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Hospital admit
ERPAM
SCC
OB/GYNPedsF.P
PAM
InternalMed.PAM
AncillaryServices
PAM UrgentCarePAM
SNFPAM
Cost Avoidance
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Jan Feb Mar Apr May $-
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
0
50
100
150
200
250
300
350
400
450
500
67 68 78
118
87
Sutter Compass Connect Cost Avoidance(2015)
# of urgent visits to SCCDirect Cost ($1861/day)Total Cost ($3,485/day)
Assumptions:• 17% of patients are admitted from ED• Avg Direct Cost of ED visit = $515/visit• Avg Total Cost of ED visit = $911/visit
• Avg Direct Cost per patient = $1,861/day• Avg Total Cost per patient = $3,485/day• Medicare ALOS = 5.72
YTD Direct Cost Avoidance: $941,030YTD Total Cost Avoidance: $1,743,719