Rural Health Transformation from Surviving to Thriving
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Toby Freier, FACHE
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Rural Health Transformation from Surviving to Thriving
- 1. Rural Health Transformation From Surviving to Thriving Toby Freier, President New Ulm Medical Center
- 4. Defining Success - Triple Aim Care Experience Affordability Health Outcomes 4 • Readmits • Core Measures • Diabetes • Cancer Screening • Smoking • Obesity • BP • Cholesterol • Physical Activity • Nutrition • Stress • Pricing • Utilization • Coverage • Employers
- 5. 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
- 6. 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 6
- 7. Value of Rural Health System 7 Physicians (Clinics) Long-term care Pharmacy Hospice / Home care DME Hospital Tertiary Care Hospital Rural Provider Clinical Service Lines ClinicalServiceLines
- 8. Clinical Access Model 8 Relationships Number of people entrusting us with their health Scope of services provided to patients
- 9. Patient Access Model 9 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
- 10. Clinical Access Model *Integration and Coordination Key to Achieve Triple Aim Allina Health Partners of Allina Non- Allina Health Services Breakdown • $360 million of healthcare • $270 million attributed to New Ulm Medical Center • $100 Million Actual System Revenue
- 11. Primary Care Opportunity – GIS Map 11
- 12. New Senior Care Model (Partnership with 10 Nursing Homes and Assisted Living) 12 • Dedicated Provider Team • Partner EHR Access • Family Conferences • Urgent Care Response • Payer Partnership
- 13. 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 Baby Mental Health Cardio- Vascular Integrative Medicine - PGIHH 13
- 14. Specialty Access - TeleHealth: Share Expertise to Neutralize Geography • Cardiology • Stroke Neurology • Mental Health – Pediatrics • Genetic Counseling – Cancer • Pulmonology/Sleep Medicine • Palliative • Perinatology 14
- 15. TeleHealth Utilization - Wow 400 patient visits in 2015 15
- 16. TeleHealth Growth vs. Opportunity 20,000+ face to face specialty patient visits in 2015 16
- 17. Moving Upstream in Medical Staff Recruitment 17
- 18. Volume to Value for Affordability 18 5,000+ lives (35%+ of revenue)
- 19. Data Analytics to Drive Improvement (ER Dashboard Below) 19
- 20. Data Analytics to Drive Improvement (Diabetes D5 Dashboard Below) 20
- 21. 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 21 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
- 22. Allina Health Pioneer ACO Rural vs. Metro Variances • 21% lower total annual cost ($1800) for Medicare PMPY in New Ulm (rural) versus Twin Cities (Metro) 22 0 20 40 60 80 100 120 140 160 180 ER Admits Imaging New Ulm Twin Cities Metro
- 24. Redefining our “H” (Critical Access Organizations for Health) 24 HEALTH CARE • Prevention & Wellness • Chronic Illness Care • Acute Care • End of Life care
- 25. Health Equity Stratification 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%
- 26. New Ulm Chronic Illness Hot Spots
- 27. The Heart of New Ulm Project: A Population-Based Approach To Preventing Heart Disease
- 28. Positive Improvement in Outcomes Sustained!
- 29. Improvement in LDL Screening and Outcome (Zip code 56073) 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total Patients 2019 2171 2185 4120 2192 3412 3386 4306 4624 LDL < 130 57% 59% 62% 55% 63% 58% 68% 72% 72% 0% 10% 20% 30% 40% 50% 60% 70% 80% 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 %LDL<130 TotalPatients
- 30. Join us in Aggressively Pursuing the Triple Aim Care Experience Affordability Health Outcomes 30
Notas del editor
- Resource Rich! Scarcity of resource brings innovation; more money doesn’t bring innovation Add outline slide.
- Will our care model, care goals, and care standards and systems apply to rural delivery? What happens when not all of the same resources and professionals that are located in metro area? Do they consider rural delivery? 1 million people in rural iowa 5% of population gets hospitalized in tertiary care hospital
- Rural health needs to lead in innovation; and innovation often comes with a scarcity of resources. This can’t just be if we had more money we could accomplish better outcomes for our community. As we think about being accountable for health of population, quality of care – who has the advantage today? Rural or urban? Policies don’t always favor us, but I’ll share more throughout the session on how we can leverage our current means
- We pay our bills, but can they pay theirs? Obesity, smoking, diabetes, etc. Readmits, core measures, infection prevention, smoking, cholesterol, BP, physical activity, nutrition, insured rates, pricing, premiums for employers.
- Margins, clinical trials, care coordination, patient outcomes, stroke response and Noran partnership, primary c-section rates, ped’s mental health, level one and teleheart, holistic care model and evidenced based options.
- Delivery of health care service Health
- Asthma, Diabetes, Depression --- With a community health approach, we can not only identify “hot spots” but can also identify “cold spots.” The hot spot is the individual and the cold spot is the lack of support (lack of green space, access to healthy food choices, unsafe sidewalks, poor air quality, and lack of education/employment/mental health services/primary care access. A community approach that supports healthy living can eliminate cold spots thus eliminating hot spots.
- We pay our bills, but can they pay theirs? Obesity, smoking, diabetes, etc.