14 November 2018

World Diabetes Day




Today, November 14, is designated as World Diabetes Day to unite the global diabetes community to produce a powerful voice for diabetes awareness and advocacy. According to the World Health Organization (WHO), over 425 million people are currently living with diabetes, prevalence is continuing to rise, and one in two people currently living with diabetes is undiagnosed.

Living with diabetes is a daily struggle, but many organizations have worked to create programs to decrease the struggle of those impacted. Ms. F, a 62-year-old African-American female with diabetes who relies on getting her nutrition from a food pantry, is a great example of someone that has benefited from these programs. Ms. F struggled with making proper food choices, adherence to proper medication, and transportation to make regular doctors’ appointments.

Through part of PCCI’s Connected Communities of Care program which shares patient’s information between providers and community-based organizations, Ms. F’s health and social service providers were able to connect and share information regarding her condition. When Ms. F visited the food pantry, staff members were aware of her diabetes. This knowledge enabled the staff to effectively guide her through her diet choices. This pilot program between three food pantries and Parkland Health & Hospital system helped many patients in taking the steps needed to control their disease.

In addition to limited access to healthy food choices, many patients in underserved communities have limited access to transportation. This challenge has made the remote monitoring of patients a critically important component in managing diabetes. PCCI is partnering with Parkland Health & Hospital System’s Global Diabetes Initiative to explore innovative approaches to improving the care of diabetic patients with foot ulcers which can lead to amputations if unresponsive to care. By acquiring data from home glucose monitoring devices and making real-time changes to treatment without physically having to see the patient, the (soon to be launched) study aims to create a sustainable remote glucose monitoring care system. This system will improve glucose control, promote faster healing of foot wound, and reduce long-term healthcare utilization and ultimately, reduce the burden cost of care for individuals and families.

Resources:

https://www.worlddiabetesday.org/

https://www.idf.org/e-library/epidemiology-research/54-our-activities/455-world-diabetes-day-2018-19.html

https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

1 October 2018

Parkland RITE program targets prevention of hospital infections and improved sepsis care




Hospital-wide effort reduces infection rates, saves lives

DALLAS —Each year sepsis strikes approximately 1.7 million people in the U.S. and more than a quarter million die from the condition, making it a major cause of death. Healthcare-associated infections (HAI) contribute to about 25 percent of these deaths. According to infection prevention experts, many hospitals are trying different approaches to reduce healthcare-associated infections, improve care of patients presenting with sepsis, and save lives. In 2013, Parkland Health & Hospital System launched an innovative hospital-wide program to reduce HAI and sepsis-related deaths, called RITE (Reduce Infections Together in Everyone).

In the first five years, the multi-disciplinary program has achieved impressive results, reducing rates of infection each year since the program was launched. The net estimated impact of the RITE program is more than a thousand infections prevented and approximately $17,781,000 in cost avoidance.

“Providing quality care begins with providing safe care,” said Parkland’s Chief of Infection Prevention, Pranavi Sreeramoju, MD. “We targeted catheter-associated urinary tract infections and central line-associated blood stream infections hospital-wide, surgical site infections following eighteen different types of surgical procedures, and patients presenting with signs and symptoms of sepsis to our emergency department.”

Parkland’s prevention approach centered on standardizing care of patients at risk for these complications; engaging healthcare personnel by talking to them and exploring barriers to adoption of best practice; standardizing curriculum on how to prevent HAI and improve sepsis care; use of medical informatics tools such as early warning system for sepsis developed by Parkland Center for Clinical Innovation; use of best practice alerts and order sets in the electronic medical records; and improving workflows.

According to Dr. Sreeramoju who is also Associate Professor of Internal Medicine at UT Southwestern Medical Center, Parkland’s RITE initiative forged a new approach to prevention by leaning on one part medical science and two parts social science.

“It’s been said about infection prevention that we know what to do – that’s the medical science. The biggest challenge for hospitals remains getting everyone to do the right thing, all the time,” she said. “Something as basic as hand hygiene requires constant vigilance in a hospital setting. So we decided to focus on identifying the most effective ways to influence behavior and make best practices easier to adhere to.

“We took a ‘high touch’ approach to working with staff, spending time analyzing interactions among multi-disciplinary caregivers, and we gave front-line staff the opportunity to provide input that could help us improve our infection prevention strategies,” Dr. Sreeramoju explained.

The scope of the RITE initiative is massive. Parkland Memorial Hospital has more than 40,000 inpatient discharges and 244,000 emergency department visits annually. Approximately 2,500 patients present to Parkland’s ED with suspected sepsis each year.

During Sepsis Awareness Month in September, organizations like the Sepsis Alliance, one of the nation’s leading sepsis patient advocacy groups, hope to increase public and healthcare professionals’ knowledge about this dangerous and vexing health risk. In a 2016 report, the Sepsis Alliance stated that “even though hospitalizations are increasing, a majority of Americans still don’t know what sepsis is or how to treat it.” The most recent Sepsis Alliance Awareness Survey found that less than one-half of all adult Americans have ever heard of sepsis. And the number is even lower among younger adults.

To learn more about services at Parkland hospital, visit www.parklandhospital.com

Contact

Parkland Health & Hospital System
Catherine Bradley
469-419-4400 catherine.bradley@phhs.org

PCCI
Lindsey Nace
214-590-3887 lindsey.nace@PCCInnovation.org

4 September 2018

Family Doc to “Design Doc”!




“Hey doc, don’t you miss being a family doctor?”  is a frequently asked question over cocktails and during client meetings. My response is always the same, “Actually, I am still serving patients but in a very innovative way and on a much larger scale for better health and social impact. I am now a “Design doc.”

Positive Promotion

After 15 gratifying years of service as a traditional family doctor, I now enjoy taking care of patients by designing healthcare solutions that result in better patient experiences, lower costs, and increased quality. My new career as a “design doc” has been very rewarding.

Design with a Cause

Like any designer, impactful ideas put both the big picture and intricate details into context simultaneously. Taking into consideration questions like: How does a doctor think? What are a patient’s expectations, needs, and goals? And what are the high-precision treatment options available? Begin the innovative process of designing scalable healthcare solutions.

Care and Collaboration

By approaching solutions from a “design doc” perspective, I collaborate with healthcare executives, frontline care teams, services providers, and members of the communities we serve to combine the “art” of medicine with clinically engineered artificial intelligence. The result of these collaborations and insights are solutions that can augment clinical decision making at the point of care and facilitate timely coordination of care beyond the walls of service providers and into the community.

Same Goal, Different approach

Quality of patient care has always been top of mind both during my time in the clinic and my new role at the Parkland Center for Clinical Innovation (PCCI). I went from providing patient care to enabling providers to better care for their patients and the community through PCCI’s innovative solutions.

Learn more about PCCI’s careers, or stay up-to-date with our recent news by following us on FacebookTwitter and LinkedIn!

Photo via Thinkstock by Getty Images. Item number: 857015410.

23 August 2018

Healthcare Informatics: PCCI Combines Predictive Modeling, Patient Engagement to Address Pediatric Asthma




Over three years, effort leads to 31 percent drop in ED visits and 42 percent drop in admissions for pediatric asthma cohort

25 July 2018

8 Takeaways from the West Coast Payer and Provider Summit Addressing SDOH for Complex Populations




While the importance of addressing social determinants of health (SDOH) is now a common theme in reputable conferences, learnings are growing richer and more intense. In June, The West Coast Payer and Provider Summit to Address Social Determinants of Health for Complex Populations was an industry gem hosted in Scottsdale, AZ. Here is a recap of what I felt were some of the biggest takeaways from the summit.

1. Purpose Driven Change-Leadership Workshop by David Shore, PhD, Harvard

Throughout the summit weekend, many workshops were presented by thought-leaders in the space. David Shore’s workshop was a veritable delight of new twists on old themes to jog the mind and start a new race for transformative change within one’s sphere of control. Some key points included:

  • Spending extra time shaping questions to ask increases the efficiency at arriving at solutions
  • Project life cycles should be front-end loaded with interrogations of reality and refuting assumptions
  • Conduct a sequence of smaller projects that feed into a cohesive program instead of long drawn out projects
  • It’s only innovation if you effectively solve meaningful problems, which you can scale and spread
  • Sustain with the “Science of Spread” methodology
  • According to research, the optimal size of a project team is seven to eight people – if it takes more than two pizzas to feed your team lunch, you have too many people!
  • Many interesting points of view of healthcare providers regarding SDOH
    • While 40-50% see their important influence on outcomes, 70-90 % don’t necessarily think it’s their job to respond to those needs.
  • A personal favorite: go beyond lessons learned to lessons leveraged!

2. Extensions of the Triple Aim Statement Reframing the Importance of SDOH

First, we had the Triple Aim, then quadruple and now… the quintuple aim:

  1. Cost
  2. Quality
  3. Patient Experience
  4. Provider experience
  5. Equity\SDOH

As this Triple Aim Statement continues to expand, what do you envision to be the sixth?

3. Social and Healthcare Platforms

Early stage entrants working on cloud platforms to connect care, patient created and social data are seeing encouraging early gains. Below are some notable platforms to keep an eye out for:

 The Real-World Education Detection and Intervention (REDI) Platform:

  • Currently deploying in border towns along southwest Texas by UT Austin Lynda Chin, MD’s team in collaboration with PWC (pro bono), AWS, and Walmart
  • They report a 1.7% decrease in Hgb A1 c of diabetics in an integrated data sharing program with remote monitoring

ORCHWA Platform:

  • An Oregon 1115 Waiver project is driving to get large numbers of community health workers across the state to document on and create closed-loop referral
  • They focused more on the human aspects of this and it seems that they may still be in technology development

4. Powerful Visualizations for Action

This was a “blow you away presentation” with some truly powerfully meaningful novel approaches driven by Jason Cunningham, MD, CMO of West County Health Centers. Below are suggested steps one can take to innovate the virtual world of healthcare:

  • Use a mix of vendors to include Tableu, Unifi + KUMO + Argis
  • Create visualizations for actions. For example, zip code areas affected by wildfires were targeted and cross referenced with their patient list allowing the ability pinpoint their patients for proactive outreach
  • Allow for early identification and replacement of lost belongings including medications, medical supplies, and strong patient experience feedback approval

5. Early findings and Interesting Metrics to Prove the Value of SDOH Intervention

While the consensus opinion and extensive research clearly indicate the magnitude and causal nature of SDOH’s influence on health outcomes, quality, and cost, most interventions depend on unique funding streams. This is because ROI hasn’t been proven to hit mainstream reimbursement.  Examples include:

  • WellCare Insurance Plan reported a decrease of $2,400 per year per member for those who received social needs interventions versus those who did not
  • Sutter Health used a Health Equity Index to target risk populations affected by disparities and used the index to prove intervention effects
  • Kaiser Permanente created a patient “feelings of hope” scale
  • Special Needs Plans (SNP) used a “Loneliness scale,” which contributed to disease progression and longevity to target and monitor at-risk individuals

Return on investment is largely focused on health outcomes, but how can we measure the social outcomes of Social ROI?

6. Speeding Up Patient Transport

Getting patients where they need to go, when they need to go is a top priority that has an impact on not only outcomes but patient experience in terms of ease and convenience. Just think about your own stress when your car is in the shop, stress can agitate any clinical state. Interesting approaches to speeding up patient transport include:

  • Ordering patient transport through referrals in their EHR
  • Superimposing public transport routes onto patient location density and using the information to advocate for new routes

7. New Term – “Patient Disengagement”

Patient engagement often is a “catch-all” bundled term. But new ways of disentangling the terms unlocks possibilities, such as:

  • Disengagement Vulnerabilities- a method of enumerating characteristics of individuals and their circumstances that can interfere with engagement to target and develop personal connectedness
  • Tangible incentives are used to increase participation and encourage healthy choices

8. Payer Pressing Mobile Engagement for the Homeless Who Are “Not Ready to be Housed”

“Housing first” advocates began changing the landscape and the dialogue on the all-too-common reality of homelessness. One size doesn’t fit all in this multidimensional problem. A notable example is the homeless and housing resource team created by ANTHEM Indiana Medicaid. If patients aren’t ready to be confined by walls, the program provides a cell phone and a mobile app to engage them with online tools.

Learn more about PCCI’s collaborations, or stay up-to-date with our recent news by following us on Facebook, Twitter and LinkedIn!

12 June 2018

The Increasing Importance of Social Determinants of Health




IMPACT ON HEALTH OUTCOMES

Over the last few years, it has been very clear from research that Social Determinants of Health (SDOH) variables have a major impact on health outcomes. It is estimated that close to 80% of health outcomes are impacted by SDOH. With the rise of population-based risk contracts in both the commercial and government sector, it is essential for both providers and payers to collaborate in the identification of best practices to address these SDOH variables. This is especially relevant as providers such as hospitals assume greater risk in arrangements with plans throughout the country such as Accountable Care Organizations (ACO) and bundled payments.

NATIONAL INTEREST AND PROGRESS

Many national associations such as the American Hospital Association (AHA) and America’s Essential Hospitals have developed resources and launched learning collaboratives for hospitals and health systems to address these variables such as food insecurity, housing, and transportation. Health system innovation and care-redesign models driven by organizations such as Healthbox and AVIA have launched collaboratives and forums to educate and address SDOH initiatives. The May 3, 2018, Healthbox forum discussion on “Challenging the Status Quo of Social Determinants” visually captured the opportunities and challenges ahead into one image (Figure 1):

Social Determinants of Health

Figure 1: Image captured during Healthbox Executive Panel Discussion, May 3, 2018. Chicago, IL

These variables have always been a focus of many health systems in terms of articulating their benefit to the community, but now they have particular importance given the rise of more population risk contracts.

Several major barriers have impeded the industry’s progress in addressing SDOH variables: funding and regulations. Fortunately, we have begun to see opportunities in both areas emerge in 2018!

MEDICARE UPDATES AND THE BENEFITS OF SOCIAL DETERMINANTS OF HEALTH DATA

Medicare Advantage (MA) has a regulation titled “Uniformity Standard” that requires all of the plan’s benefits, including cost-sharing, be the same for all plan enrollees. On April 2, 2018, the Centers for Medicare & Medicaid Services (CMS) outlined several widespread changes in this regulation that both providers and plans have advocated for over the last several years in their 2019 Medicare Advantage Call Letter. CMS expanded the flexibility of lifting the uniformity of supplemental benefit to allow different segments of an MA plan to offer specific benefits to a targeted population like diabetics. This can begin in CY 2019 (January 1, 2019) after the plan designs are approved by CMS. An example could be reduced cost sharing for foot or eye exams. In their official bids that were submitted by the June 4, 2018 deadline, the MA plans can include any of these supplemental benefit elements. Hopefully, providers will see many of the plans deciding to include these additional benefits in their MA bids to address the SDOH variables.

Additionally, in the Bipartisan Budget Act (BBA) that was passed in early 2018, Congress has taken it further by extending the lifting of the uniformity of the supplemental benefits to all chronically ill members of the MA plans effective January 1, 2020. This reinforces the need for us to gain valuable lessons during 2019 in order to determine what works and what doesn’t before it is transitioned to a broader population.

The Chronic Care Act of 2018 extended the Center for Medicare & Medicaid Innovation’s (CMMI) Valued-Based Insurance Design Model to all 50 states in 2020. This model was launched in 2017 to allow Medicare Advantage plans to offer supplemental benefits and reduced cost-sharing to seven conditions including Coronary Artery Disease or Congestive Heart Failure. The model focuses on four approaches:

  1. Reduced Cost Sharing for High-Value Services
  2. Reduced Cost Sharing for High-Value Providers
  3. Reduced Cost Sharing for enrollees participating in disease management
  4. Coverage of additional supplemental benefits such as transport or meal delivery

The creation of more supplemental benefits will enhance the quality of services we provide for our patients especially in terms of addressing the SDOH. Encouraging the inclusion of these targeted supplemental benefits will allow us to partner with payers to improve the health of the country in a more innovative way.

ADDRESSING SDOH WITH HEALTHCARE PROVIDERS AND COMMUNITY RESOURCES

At PCCI, we have been directly involved in national and state-driven education forums, presentations, and roundtables directed to design and deploy local models for the Connected Communities of Care program (previously known as the Information Exchange Portal) that bring together providers, payers, philanthropic organizations, community-based organizations (CBO), and local/state government entities. While most markets continue to be in a learning mode, significant and tangible activities are being initiated in a number of municipalities, including Dallas, Raleigh-Durham, Louisville, Detroit, Chicago, Phoenix, Salt Lake City, as well as across whole regions. For example, North Carolina recently requested proposals for the development of a North Carolina Resource Platform via the Foundation for Health Leadership & Innovation. The goal of this multi-year program is to connect over 3,000 statewide community-based organizations via technology, and facilitate SDOH. This will be completed through a programmatic coordination of referrals between healthcare providers and community resources to comprehensively identify and address the needs of individuals across the state. On a broader level, the Accountable Health Communities Model deployed in 2017 is engaging 31 organizations across the country to address a critical gap between clinical care and community services in the current healthcare delivery system. This is being done by testing the process of systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries through screening, referral, and community navigation services to see if it will impact healthcare costs and reduce healthcare utilization.

SUCCESS IN SIX TRACKS

Our experience over the last five years across Dallas tells us that models will need to address six tracks to be successful: Governance, Legal, Technology, Clinical Workflows, CBO Workflows, and Sustainability (Figure 2). The maturity and evolution of the models need to develop and be staged within a multi-year deployment framework (concentric circles in Figure 2 represent the progression and evolution of the model with outer circles representing mature and more sophisticated models).

Social Determinants of Health

Figure 2: Connected Communities of Care program multi-year deployment framework

There is also a critical upfront readiness and deployment/implementation assessment that is important in order to stage the deployment of a Connected Community of Care program. This broad representation of the community’s fabric is critical to ensure that:

  1. A community is ready to undertake the operational and financial requirements associated with deploying a Connected Communities of Care program
  2. The healthcare and social needs of the community are at the forefront of the customized design of the platform (something most for-profit technology vendors offering an out-of-the-box solution either cannot do or fail to do properly)
  3. The design is sufficiently flexible to adjust as the healthcare or social needs of the community change

Addressing SDOH is finally moving from a “buzz” word to implementation pilots. While we talked a lot about population health over the last 10 years, doing population health without a truly engaged and “Connected Community of Care” is like focusing on rescuing people from drowning in a river vs. building a bridge so they can cross it safely. As we continue this journey, let us make sure we build a bridge that adapts to the needs of each community and has emerging local and national models of care to ensure sustainability. We don’t want to end up with a bridge like the Choluteca Bridge in Honduras, connecting nothing to nowhere.

Acknowledgments: Valinda Rutledge, PCCI Executive Advisor and Lindsey Nace, PCCI Marketing and Communications have contributed to this article.

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