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Raising the Bar: Innovative Healthcare Program Fosters Collaboration, Education

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Big Data, Big Discoveries WebSeries …

Big Data, Big Discoveries WebSeries
Live Webcast Feb. 27, 2013

Improving patient care remains a top priority for America's healthcare organizations, but for a group of providers in New Orleans, that bar wasn't high enough. Last year, led by the Louisiana Public Health Institute, several community healthcare providers embarked on a redesign of comprehensive care delivery, called the Crescent City Beacon Community, to improve the overall health of the greater New Orleans community. Though still in its early stages, the project has already received national recognition for excellence, and is being considered as a model for other major urban centers throughout the country. The program has focused on quality improvement for chronic care management in primary practices, enabling transitions of care using health information technology, and promoting consumer engagement through mobile phones.

Check out the slides from this free Webcast to hear LPHI's director, Dr. Anjum Khurshid, explain the component parts of this program, the foundation of which is the Greater New Orleans Health Information Exchange. Inspired by the Affordable Care Act, HIEs are intended to foster collaboration among and between various health care institutions by providing access to electronic medical records. Care coordination systems based on HIEs can greatly improve patient care, while also lowering costs, in part by reducing preventable emergency room visits and fragmentation of the healthcare system. Another innovative component of the program involves an interactive social media campaign designed to educate the New Orleans community about the risks of diabetes.

Sponsored by the BioDistrict New Orleans, this webcast is the first in a series designed to showcase the exemplary projects taking place within the district.

Visit: http://www.insideanalysis.com

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  • 1. RAISING THE BAR Innovative Healthcare Program Fosters Collaboration & Education
  • 2. Big Data, Big Discoveries HOST: GUEST: GUEST: Eric Kavanagh Dr. Anjum Khurshid Jim McNamaraSponsored by:
  • 3. It’s a Complex Situation Regulations in the Affordable Care Act (ACA) Uninsured Americans Legal challenges to the ACA
  • 4. Emerging Solutions Health Information Exchanges (HIEs) Collaboration among health care institutions Social Media for analysis, outreach and education
  • 5. Dr. Anjum KhurshidDirector, Health Systems DivisionLouisiana Public Health Institute
  • 6. Anjum Khurshid, PhD, MD, MPAffDirector, Health Systems DivisionDirector, Crescent City Beacon CommunityLouisiana Public Health Institute February 27, 2013
  • 7. Outline• Crescent City Beacon Community (CCBC) Goals – Clinical Quality Improvement – Transitions of Care through Greater New Orleans Health Information Exchange (GNOHIE) – Consumer Engagement and txt4health• CCBC-BioDistrict Collaboration and Future Opportunities
  • 8. 17 Beacon Communities Bangor Beacon Community Western New York Brewer, ME Beacon Community Buffalo, NY Southeastern Beacon Community of Rhode Island Beacon Minnesota Beacon Inland Northwest Southeast Michigan Community Community Spokane, WA Beacon Community Providence, RI Rochester, MN Detroit, MI Central Indiana Keystone Beacon Beacon Community Community Danville, PA Utah Beacon Indianapolis, IN Greater Cincinnati Community Beacon Salt Lake City, UT Colorado Beacon Community Community Cincinnati, OH Grand Junction, CO Southern Piedmont Great Tulsa Health Beacon Community Access Network Beacon Concord, NCSan Diego Beacon Community Community Tulsa, OK San Diego, CA Delta BLUES Beacon Community Hawaii County Crescent City Beacon Stoneville, MS Beacon Community Hilo, HI Community New Orleans, LA
  • 9. Crescent City Beacon Community GoalsReduce the burden of chronic diseases, mainly diabetes andcardiovascular disease by :o Improving the quality of care for chronic disease patients in patient-centered medical homes, enabled by HITo Reducing healthcare costs by decreasing preventable emergency department and inpatient visits through better coordination of careo Engaging consumers in the healthcare process by using innovative technologies and strategies
  • 10. 3 Cs of CCBC Clinical Care ConsumerTransformation Coordination Engagement Build &Improve Quality Innovate Strengthen HIT
  • 11. Dynamic Framework for a Coordinated System of Care Population Patient Education/ Patient Engagement/ Risk Reduction Disease Management At-risk -- Low risk -- High risk -- Chronic -- Complex Specialty/ ED Visits Preventable Admissions Preventable Diagnostics Patient-Centered Medical Home Emergency (Primary Care System) Inpatient
  • 12. Dynamic Framework for a Coordinated System of Care Population Innovations/Consumer Patient Education/ Patient Engagement/ Engagement Management Risk Reduction Disease At-risk -- Low risk -- High risk -- Chronic -- Complex Specialty/ ED Visits Preventable Admissions Preventable Chronic Care Diagnostics Management Transitions Patient-Centered Medical Home of Care Emergency (Primary Care System) Inpatient
  • 13. Clinical TransformationImproved quality of clinical care for chronic disease patientsthrough improved workflow and health IT population-based disease registries, risk stratification, care management/care team strategies, clinical decision support ClinicalPractice Learning EMR QI SeminarCoaching Collaborative Optimization Innovations Series
  • 14. Positive Trends on Adoption & Outcomes Number of Sites Using Care Management Processes - 2012 Total ED/IP Encounters at ILH 5000 14 14 14 4311 7/2/12 - 1/31/13 January July 12 4000 Sum of ED 11 Sum of IP 10 2842 2826 9 9 9 3000 7 7 2000 1593 1384 4 998 1000 789 720 619 645 575 581 238 295 304 243 148 110 45 67 0 Clinic Clinic Clinic Clinic Clinic Clinic F Clinic Clinic Clinic I Clinic J Care Management Individual Care Registries Stratify DM Care Management Care Management A B C D E G H Staff Plans Patients for DM Patients for CVD Patients Number of Unduplicated Lives in CDR Across the Community Q6 to Q7 Data as of 2/11/2013 Quality Outcomes (October 200,000 2012) 184,796 177,790 179,693 172,733 173,651 Diabetes: A1C testing 180,000 171,293 177,790 181,306 176,118 160,000 171,950 173,073 Diabetes: A1C control (<8.0%) 140,000 126,808 125,887 130,597 Diabetes: Lipid testing 120,000 127,008# of Lives 124,509 126,341 100,000 Diabetes: Lipid control (<100mg/dL) 80,000 Diabetes: Blood Pressure Control (<130/80) 60,000 40,000 Ischemic Vascular Disease: Blood Pressure Control (<140/90) 20,000 Ischemic Vascular Disease: Complete Lipid Profile 0 Coronary Artery Disease: Drug Therapy for Lowering LDL-C * All data from QI Outcome Measure Reports
  • 15. Care Coordination GNOHIE Mirth Mirth Mirth Mail Mirth Care Mirth Results Match (Secure (Care Analytics (CDR) (EMPI) Mail) Mgmt.) (EDW) Electronic Behavioral ED/IP Birth Specialty Health AnalyticsNotification Outcomes Care Referral Integration
  • 16. GNOHIE ArchitectureCurrently connects 23 primary practices and 2 hospitals in GNO
  • 17. Data Security • Encrypted data • HIPAA compliant protocols • Role-based access Central security DataRepository • Restricted administrative access • Patient consent needed • Extensive Auditing capabilities
  • 18. Transitions of Careo Emergency Department/Inpatient Notification: Alerts and clinical information are sent to primary care providers about patient visits to emergency departments and hospital admissions.o Electronic Specialty Care Referral: Referral requests and supporting documentation of the referring primary care provider are sent electronically to the specialist. Specialist’s consult summaries are, in turn, provided electronically to the primary care provider.
  • 19. Pre-ED/IP Notification 9/15/12 Diabetic Ketoacidosis HOSPITAL Discharged HOME Debbie DebbieType 2 DiabetesType 2 Diabetes 9/25/12 Hypoglycemia HOSPITAL Discharged HOME Debbie Debbie PRIMARYType 2 DiabetesType 2 Diabetes CARE 10/2/12 PRACTICE Foot infection HOSPITAL Discharged HOME Debbie DebbieType 2 DiabetesType 2 Diabetes 10/20/12 Kidney Infection HOSPITAL Discharged HOME Debbie Debbie Type 2 Diabetes Type 2 Diabetes
  • 20. ED/IP Notification System 9/15/12 Diabetic Ketoacidosis HOSPITAL Discharged HOME Debbie DebbieType 2 DiabetesType 2 Diabetes 9/25/12 Hypoglycemia HOSPITAL Discharged HOME GREATER NEW Debbie DebbieType 2 DiabetesType 2 Diabetes ORLEANS PRIMARY 10/2/12 HEALTH CARE INFORMATION PRACTICE Foot infection HOSPITAL Discharged HOME EXCHANGE Debbie DebbieType 2 DiabetesType 2 Diabetes 10/20/12 Kidney Infection HOSPITAL Discharged HOME Debbie Debbie Type 2 Diabetes Type 2 Diabetes
  • 21. Number of Unduplicated Patients in CDR as of 2/11/2013 200,000 184,796 177,790 179,693 172,733 173,651 180,000 171,293 176,118 177,790 181,306 160,000 171,950 173,073 140,000 125,887 126,808 130,597 120,000# of Lives 127,008 124,509 126,341 100,000 80,000 60,000 40,000 20,000 0
  • 22. Total ED/IP Encounters at ILH Sum of ED Sum of IP Since5000 July ’12 7/2/12 - 1/31/13 – 3 sites4500 43114000 Since Since3500 Sept. ’12 July ’12 – 3 sites – 1 site3000 2842 28262500 Since Since Sept. ’12 Nov. ’122000 – 2 sites – 3 sites 1593 Since 1384 Since1500 Dec. ’12 Since Sept. ’12 Since – 1 site 998 Nov. ’12 – 1 site July ’121000 789 – 1 site Since – 1 site 720 645 581 Nov. ’12 619 575 500 304 – 1 site 238 295 243 110 148 67 45 0 Clinic A Clinic B Clinic C Clinic D Clinic E Clinic F Clinic G Clinic H Clinic I Clinic J Total ED Encounters = 15,769 Total IP Encounters = 3,564
  • 23. Telemedicine Specialty Care Psychiatry Rheumatology Cardiology Dermatology Pulmonary 1 hospital – 11 General telemedicine Endocrinology Physical specialties with Diabetes Medicine & designated Rehab appointment slots Hepatitis C Pain Management Neurology NephrologyTotal Specialty Consults in Q4, 2012 = 1,394 2
  • 24. Patient Consent OPT-IN MODEL Exception = break the glass1 consent form – applies across all GNOHIE participants PATIENTENGAGEMENT PROVIDER PROVIDER AND ENGAGEMENT WORKFLOW EDUCATION
  • 25. Examples of Patient Materials
  • 26. Community Engagement Consumer Engagement Other CCBC Model Interventions Txt4health Campaign Integration of Other SettingsCommunity Targeted to Actualize Provider “Health Home” Advisory Community Engagement Concept Group Engagement
  • 27. Building Blocks: Text4Health Modules User sends HEALTH to 311 411System collects: System categorizes: HEIGHT HIGH RISK WEIGHT (BMI) MEDIUM RISK AGE LOW RISK GENDER Enrollment ------------------------------- FAMILY HISTORY UNDERWEIGHT DIABETES DIAGNOSIS AT WEIGHT SMOKING STATUS OVERWEIGHT Development of Profile OBESE (Risk Categorization) Goal Setting/Tracking Education/Motivation Local Connections (Weight & Exercise) (According to Risk) (Care & Activities)Enrolled participants in 12 months ~ 1,400
  • 28. Solution Offering and Value Proposition Care Management & Coordination System Solution Offering Value Proposition• Patient- • Chronic Care Improve Quality Centered Management Medical Home System •HEDIS measures for diabetes and cardiovascular People Process Improve Efficiency •Reduce hospital readmissions Data Analysis •Reduce Emergency Room Visits Technology & Information •Reduce Avoidable Hospital Admissions (EMR/HIE) Management •Reduce duplicate testing (e.g. imaging)• Health •Medication management •Engagement Information (Consumer, Prov Exchange ider,) Bend the Medical Cost Bend the Medical Cost Trend Trend • Reduction in per member per month cost
  • 29. Advanced AnalyticsUse predictive modeling, propensity score matching,and other statistical techniques to investigate: • High use of Emergency Department Prescriptive • Avoidable hospital readmissions How can we achieve the best outcomes? • Duplicate procedures and tests Predictive modeling What will or could happen? • Preventable hospital admissions • High-cost patients • Variation in care Descriptive What happened? • Root cause analysis
  • 30. CCBC-BioDistrict Collaboration• To promote research-community-industry collaboration• To develop a real-time, real- world, intelligent, learning system that connects researchers and clinicians• To provide a laboratory for innovation, social entrepreneurship, and translational medicine• To measure and demonstrate impact on patient outcomes and population health
  • 31. Opportunities for Future• Use state-of-the-art health IT infrastructure to coordinate care and evaluate results• Involve leading research institutions and medical centers to use data to inform clinical practice• Develop Public-private partnerships to test new ideas, effective treatments, and innovative technologies• Promote economic development and job creation through workforce training and new business ventures
  • 32. Strength of the System Ownership & Engagement AccountabilityLeveraging Trust Networks Stakeholder-defined use cases and provider-led design
  • 33. Working Together
  • 34. CCBC Receives 2013 “Healthcare Informatics Innovators Award”“A massive effort to improve the health status of theentire New Orleans metropolitan area”“What makes this collaboration worthy of InnovatorAwards recognition is the combination of vision andscope on the one hand, and the successfulleveraging of HIT to achieve those visionarygoals, on the other” -- Mark Hagland Editor-in-Chief, Healthcare Informatics
  • 35. Contact: Anjum Khurshid, PhD, MD, MPAff Director Health Systems DivisionDirector Crescent City Beacon Community Louisiana Public Health Institute 1515 Poydras St, 1200 New Orleans, LA 70112 Phone: 504-301-9800 Email: akhurshid@lphi.org www.lphi.org www.crescentcitybeacon.org
  • 36. Jim McNamaraPresident & CEOBioDistrict New Orleans
  • 37. RECONNECTING NEW ORLEANSA Sustainable Strategy for Job Growth, Economic Development and Better Health Outcomes
  • 38. IbervilleTreme CNIBioDistrict French Quarter CBD
  • 39. VisionBioDistrict New Orleans will become a thriving andhighly livable business, education, science andhealthcare destination, regarded throughout the Cityand the nation as the premier revitalized urban district ofchoice. The BioDistrict will be known for its walkablescale, new and historic neighborhoods, excellentschools and ecosystem support services, vibrantretail, accessible open space and transit, as well as arange of stable and well paying bioscience andhealthcare industry jobs. The BioDistrict will become anational model for urban revitalization, job creation andeconomic and industry development.
  • 40. An Amazing Collaboration working TOGETHER! Economic Development Jobs and training Sustainably Built Environment10/12/12 Civic Leadership
  • 41. Research with Industry value Bioscience Centers of Excellence  Peptides  HIV/AIDS  Infectious Diseases  Cancer  Diabetes and Cardiovascular  Biodefense  Neuroprotection and Rehabilitation  Nano-particle Drug Delivery  Health IT Emerging Centers  Translational Medicine  BioBanking
  • 42. BioDistrict Areas of Concentration
  • 43. • Economic Impacts — Over 20 years, the BioDistrict will generate: • 34,000 direct and indirect jobs created • 3600 annual construction jobs • $4 Billion in Capital Activity • $24 Billion in Economic Activity • $2.45 Billion in years 1-5 • $26.185 Billion in Personal Earnings • $2 Billion in increased Personal Earnings
  • 44. • Economic Impacts — In 20 years, the BioDistrict will generate: • $3.352 Bn in Sate and Local Tax Generated, ($167 m per year) • $1.91 Bn -- State tax - $95 Million annually • $1.44 Bn -- Local tax - $72 Million annually • 11.6 Million Square Feet of New, Absorbed or Renovated Buildings • 2,000+ Housing Units
  • 45. Thank you!