Rural Health Transformation from Surviving to Thriving
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Transcript of Rural Health Transformation from Surviving to Thriving
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Rural Health TransformationFrom Surviving to Thriving
Toby Freier, PresidentNew Ulm Medical Center
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2.5 million people
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Rural Advantage
Strengths Challenges
- Medical Homes before the buzz
- Comm. Relationships &
support
- Employee & Physician
Engagement
-Cost Efficiency
- Patient Experience
- Quality Measures
- Specialization of healthcare
- Scale and low volume
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Defining Success - Triple Aim
Care Experience
AffordabilityHealth Outcomes
• Readmits• Core Measures• Diabetes• Cancer Screening
• Smoking• Obesity• BP• Cholesterol• Physical
Activity• Nutrition• Stress
• Pricing• Utilization• Coverage• Employers
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New Ulm Medical Center Fact Sheet
• CAH w/ 25 Acute + 20 beds for Mental Health & Substance Abuse
• 50+ Physicians & Providers• Allina Health has hospital, clinic, home
medical equip, homecare, hospice, ambulance, pharmacy, eye care
• 590 employees/physicians
• $80 million revenue• 2300 admissions• 10,500 ER visits• 1900 surgeries• 100,000 clinic visits
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Recognized Performance and Value
Top 20 Rural Hospital Last 3 Years Minnesota Hospital
Association Innovation of the Year and Top Community Health
Initiative
Joint Commission Top Performer on
Key Quality MeasuresAHA NOVA Award
5 Time iVantage Top 100 Hospital
CMS 5 Star Hospital
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Value of Rural Health System
Physicians (Clinics)
Long-term care
Pharmacy
Hospice / Home care
DME
Hospital
Tertiary Care
Hospital
Rural Provider
Clinical Service Lines
Clinical Service Lines
- EHR-Telehealth- Coordinators
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Clinical Access Model
Relationships
Number of people
entrusting us with their
health
Scope of services provided to patients
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Patient Access Model
Primary Care
Urgent care
Team Model
Regional clinic
On-line care
Employer-based
Senior Care
ER / Hospitalist
Specialty Care
Local specialists
Outreach (visiting)
Telehealth
Tertiary based
Community & Hospital
based Health
Services
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Clinical Access Model*Integration and Coordination Key to Achieve Triple Aim
Allina HealthPartners of AllinaNon-Allina
Health Services Breakdown
• $360 million of healthcare
• $270 million attributed to New Ulm Medical Center
• $100 Million Actual System Revenue
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Primary Care Opportunity – GIS Map
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New Senior Care Model(Partnership with 10 Nursing Homes and Assisted Living)
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• Dedicated Provider Team• Partner EHR Access• Family Conferences• Urgent Care Response• Payer Partnership
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Allina Health Clinical Service Lines
Aim: Allina Health’s clinical service lines (CSL) provide consistently exceptional and coordinated care across the continuum of
care and across sites of care.
Oncology - VPCI
Rehab - CKRI Neurology Mother
BabyMental Health
Cardio-Vascular
Integrative Medicine -
PGIHH
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Specialty Access - TeleHealth: Share Expertise to Neutralize
Geography• Cardiology• Stroke Neurology• Mental Health – Pediatrics• Genetic Counseling – Cancer • Pulmonology/Sleep Medicine• Palliative• Perinatology
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TeleHealth Utilization - Wow
400 patient visits in 2015
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TeleHealth Growth vs. Opportunity
20,000+ face to face specialty patient visits in 2015
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Moving Upstream in Medical Staff Recruitment
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Volume to Value for Affordability
5,000+ lives (35%+ of revenue)
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Data Analytics to Drive Improvement(ER Dashboard Below)
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Data Analytics to Drive Improvement
(Diabetes D5 Dashboard Below)
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Medicare ACO Claims Cost by Patient
3084 Attributed Patients• Top 1% accounts for 19% of
spending (30% of spend within Allina)
• Top 5% accounts for 48% of spending (46% of spend within Allina)
• Top 20% accounts for 80% of spending (55% of spend within Allina)
Allina services account for 62% of overall ACO Part A expenses
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Top 10 Most Expensive Patients
Allina Non-Allina Grand Total
$3,352 $389,360 $392,712 $11,649 $316,922 $328,571
$96,081 $56,977 $153,058
$631 $146,436 $147,067
$4,374 $136,107 $140,481
$15,707 $119,850 $135,557
$11,661 $119,845 $131,506
$30,149 $95,347 $125,496
$7,702 $107,496 $115,198
$73,456 $34,295 $107,751
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Allina Health Pioneer ACORural vs. Metro Variances
• 21% lower total annual cost ($1800) for Medicare PMPY in New Ulm (rural) versus Twin Cities (Metro)
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ER Admits Imaging0
20
40
60
80
100
120
140
160
180
New UlmTwin Cities Metro
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Network-based Health Plan
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Redefining our “H” (Critical Access Organizations for Health)
HEALTH CARE
• Prevention & Wellness
• Chronic Illness Care
• Acute Care• End of Life care
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Health EquityStratification by Payer as Socioeconomic
Indicator
Registry Total Patients
# MA/Uninsured
Optimal Care Rate All Other
Payers
Optimal Care Rate MA / Uninsured
Asthma 340 93 73% 69%
Major Depression 187 58 30% 36%
Diabetes (Glycemic Control) 1202 127 67% 59%
Colorectal Cancer Screening 5529 366 76% 57%
Breast Cancer Screening 3317 232 86% 77%
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New Ulm Chronic Illness Hot Spots
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The Heart of New Ulm Project: A Population-
Based Approach To Preventing Heart
Disease
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Positive Improvement in Outcomes Sustained!
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Improvement in LDL Screening and Outcome(Zip code 56073)
2006 2007 2008 2009 2010 2011 2012 2013 20140
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
0%
10%
20%
30%
40%
50%
60%
70%
80%
Tota
l Pati
ents
% LD
L < 1
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Join us in Aggressively Pursuing the Triple Aim
Care Experience
AffordabilityHealth Outcomes
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