Cuban American Medical Society Presentation[1]

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Mercy Hospital Freedom Program “Hospital Based Preventive Care Program coupled with Patient Financial Incentives”
William D. Kirsh, DO, MPH
Medical Director, Department of Preventive Medicine

Published in: Health & Medicine, Business
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  • Q1 - August, September, October - 2004 Q2 - November, December, January Q3 - February, March,April - 2005 Q4 - May, June,July – 2005 Present - June 13th, 2007
  • Q1 - August, September, October - 2004 Q2 - November, December, January Q3 - February, March,April - 2005 Q4 - May, June,July – 2005 Present - June 13th, 2007
  • Q1 - August, September, October - 2004 Q2 - November, December, January Q3 - February, March,April - 2005 Q4 - May, June,July – 2005 Present - June 13th, 2007
  • Cuban American Medical Society Presentation[1]

    1. 1. Prevention Pays Mercy Hospital’s experience with a community based, patient centric, clinical prevention program The Mercy Freedom Program
    2. 2. I think clinical prevention programs work?
    3. 3. The Mercy Freedom Program was established as a patient centric, hospital based community program focused on prevention and utilizing financial incentives to motive patients to comply with nationally recognized clinical preventive care standards. Preventive Care Disease Case Management Clinical Care Patient
    4. 4. Program’s interventions <ul><li>Empowers patients to actively participate in improving their health outcomes </li></ul><ul><li>Generates individualized disease-specific “road maps” to implement preventive healthcare guidelines </li></ul><ul><li>Provides discounted prescriptions as incentives for compliance with clinical standards </li></ul><ul><li>Develops a community based, patient generated electronic health record </li></ul>
    5. 5. Legislative corner stone <ul><li>Section 340b of the Public Health Service Act (PHS) - enacted 1992 </li></ul><ul><ul><li>Limitation on Prices of Drugs Purchased by Covered Entities </li></ul></ul><ul><ul><li>Covered Entities </li></ul></ul><ul><ul><ul><li>Government (i.e. Veteran Hospitals, State, County) </li></ul></ul></ul><ul><ul><ul><li>Disproportionate Share Hospitals (> 10 %) </li></ul></ul></ul><ul><ul><li>Medications dispensed must be for those patients that are active members of the system </li></ul></ul><ul><ul><ul><li>outpatient use only </li></ul></ul></ul>
    6. 6. Legislative corner stone <ul><li>Covered Patients </li></ul><ul><ul><li>Active patients of the institution (i.e. active medical record) </li></ul></ul><ul><ul><li>Covered Prescriptions must be from a Physician that is a member of the system. </li></ul></ul><ul><li>Controls and Audits </li></ul><ul><ul><li>Safeguards to prevent diversion </li></ul></ul>
    7. 7. Program’s targeted population: <ul><li>Underinsured/uninsured motivated chronically ill patients with expensive, limited, minimal or no drug benefit coverage </li></ul>Preferred Provider Organizations (PPO) Medicare Indemnity
    8. 8. The program adopted preventive care standards <ul><li>US Preventive Service Task Force Guide to Clinical Preventive Services , 2nd Edition </li></ul><ul><li>Clinical preventive services recommended as “A,” reflecting strength of evidence in support of the intervention </li></ul><ul><li>Clinical Evidence , 8 th edition </li></ul>
    9. 9. Preventive care strategy <ul><li>Interventions </li></ul><ul><li>Primary Prevention </li></ul><ul><li>Secondary Prevention </li></ul><ul><li>Tertiary Prevention </li></ul><ul><li>Determinants </li></ul><ul><li>Age/Sex </li></ul><ul><li>Age/Sex </li></ul><ul><li>Disease-specific preventive healthcare “road maps” </li></ul>
    10. 10. Disease states as defined by the US Preventive Services Task Force Hypertension Elevated Blood Cholesterol CVD (Primary Prevention) Osteoporosis Arthritis Chronic Renal Failure (CRF) Thyroid Disease Glaucoma Congestive Heart Failure (CHF) Depression Asthma/Stable COPD CVD/Transient Ischemic Attacks (TIA) Diabetes (DM) CVD (Secondary Prevention Atrial Fibrillation (AF)
    11. 11. Developed a software system to generate an individualized preventive care road map <ul><li>A road map is a list of preventive care interventions such as tests, procedures, and screenings defined by the US Preventive Services Task Force that are based on the patients age, gender, and self reported health history. </li></ul>
    12. 12. How to get patients motivated to do clinical prevention
    13. 13. Theory: Clinical prevention programs work by offering financial incentives Time in months, (longevity of a user) Number of patients Cash Third Party Payor (insurance coverage and/or Part D)
    14. 14. The Mercy Freedom Program <ul><li>The prevention program empowers patients to actively participate in their health outcomes and utilizes pharmacy discounts (340b) as an incentive to comply with national preventive care standards. </li></ul><ul><li>The software system developed can be easily applied to other interested hospitals </li></ul>
    15. 15. Attracting patients <ul><li>Community announcements in local media </li></ul><ul><li>Developed patient awareness programs at the hospital </li></ul><ul><li>Education programs for physicians and hospital employees </li></ul><ul><li>Individual meetings with key medical and hospital professional staff </li></ul><ul><li>Word of mouth </li></ul>
    16. 16. Individualized health assessment <ul><li>A telephonic health assessment generates a disease specific road map </li></ul><ul><li>The road map is the foundation of the reminder and compliance system </li></ul>
    17. 17. Software automatically generates patient reminder letters and voice activated out bound calls <ul><li>Quarterly reminders to patients to meet specific attributes in their individualized road map </li></ul><ul><li>Quarterly calls to patients reminding them to refill Rx medications </li></ul>
    18. 18. Medical Information <ul><li>Patient self reports clinical information </li></ul><ul><li>Establishes an electronic health record (includes clinical and pharmacy data) </li></ul><ul><li>Documents a patient specific preventive care “road map” signed by “attending” physician </li></ul><ul><li>Software applies a comprehensive compliance and monitoring system to meet program and government regulations </li></ul>
    19. 19. <ul><li>Tracks medication utilization </li></ul><ul><li>Provides all out patient drug purchase information to the “attending physician” </li></ul><ul><li>Helps eliminate potential adverse drug interactions </li></ul><ul><li>Provide disease state and drug specific information </li></ul>Pharmacy Information
    20. 20. Is there enough time for physicians to motivate and educate patient on prevention?
    21. 21. Clinical prevention program works by giving financial incentives Time in months, (longevity of a user) Number of patients Cash Third Party Payor (insurance coverage and/or Part D)
    22. 22. * Cohort is the population of patients who joined the program within the quarter
    23. 23. The average % of enrolled patients who survived categorized by morbidity status
    24. 26. <ul><li>Empowers individuals to actively participate in improving their health outcomes </li></ul><ul><li>Generates an individualized tool (a disease-specific “road maps”) for patients’ use to meet preventive care guidelines </li></ul><ul><li>Provides discounted prescriptions </li></ul><ul><li>Better compliance with prescription medications due to lower acquisition costs and regular reminders </li></ul>Patient Benefits
    25. 27. Physician Benefits <ul><li>Applied Technology </li></ul><ul><ul><li>Creation of electronic health record </li></ul></ul><ul><ul><li>Tracking of patient’s age, sex, and morbidity specific preventive care interventions </li></ul></ul><ul><ul><li>Patient specific prescription medication and clinical referrals reported quarterly </li></ul></ul><ul><ul><li>Documentation of preventive care compliance to nationally accepted standards </li></ul></ul>
    26. 28. Physician Benefits <ul><li>Flexibility </li></ul><ul><ul><li>Opportunity to prescribe medications regardless of formulary or cost to patient </li></ul></ul><ul><ul><li>Ensures documentation of quality indicators for future pay for quality/pay for performance programs </li></ul></ul><ul><ul><li>Improves patient education </li></ul></ul><ul><ul><li>Increases regularly scheduled chronic care office visits </li></ul></ul>
    27. 29. Weighing time and money
    28. 30. Prevention Pays What is the Return on investment (ROI)? Patient Attending Physician Hospital Earning a return Benefits medically by obtaining preventive interventions <ul><li>Revenue per office visit </li></ul><ul><li>Meets “Pay for Performance” measures </li></ul><ul><li>Revenue per out patient procedure </li></ul><ul><li>Increase use of high profit interventions </li></ul>Avoiding a cost Reduce prescription drug costs Reduce “risk” of poor patient care Reduce risk of high cost care (low profit)
    29. 31. Outcomes <ul><li>Improved health and reduced morbidity </li></ul><ul><li>Better educated patients </li></ul><ul><li>Reduced personal healthcare costs </li></ul><ul><li>Hospital becomes an important patient advocate </li></ul>

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