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Integrative Health + Data - National Data Institute - Final
- 8. The Root of All Chronic Disease: Stress + Life Style “Choices” Chronic stress – Raises chatecholemines + suppresses the immune system – Increases release of histamines, complicating lung diseases – Increases cortisol, increasing blood glucose and the risk of DM2 – Causes inflammation in the circulatory system – Activates the PNS, contributing the ANS dysfunction – Increases epinephrine, heart rate, and blood pressure The Root of All Chronic Disease: Stress
- 9. Integrative Health Modalities include… • Practices that patients can be trained to do on their own such as meditation, yoga, and relaxation response • Therapies that must be provided to a patient by a licensed practitioner such as acupuncture or biofeedback.
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- 12. Integrative Health Practice Tobacco Use HBP Obesity Inactivity Anxiety Depression DM Pain Meditation X X X X X X X Imagery X X X X X X X Biofeedback X X X X X X X Yoga X X X X X X X X Acupressure X X X X X X X Qi Gong X X X X X X X 6 Evidence Based IH Interventions for 8 Common Chronic Conditions1 12 1From: Russo, Stitcher, & Diener. (2014). The low risk and high return of integrative health services. Journal of Healthcare Financial Management.
- 13. Additional intervention opportunities: 4 Stages of Pain Model Pain Sensation/ Intensity Pain Unpleasant -ness Pain Emotion/ Suffering Pain Behavior Depression Frustration Anxiety/ Stress Fear Anger Pain Observation Response Responsibility Tell Hurt *Model proposed by Melzack & Casey (1968) and Melzack (1975) in the Journal of Pain; Wade, Dougherty, Archer, & Price. (1996), Riley, Wade, Robinson, & Price. (2000). Wade & Hart (2002). Additional intervention opportunities: 4 Stages of Pain Model
- 14. Intervention Anxiety Depression Stress Response to pain Acupuncture X X X X Biofeedback X X X X PMR X X X X Yoga X X X X Hypnosis X X X X Massage X X X X Imagery X X X X Meditation X X X X Qi Gong X X X X Evidence-Based IH Interventions for Stage 3 + 4 Symptoms of Chronic Pain
- 17. Population Health – Paradigm Shifting 17 Based on data and gaps, providers reach out to the patient
- 19. • Treat the whole population, not just individuals actively seeking care • Use data and analytics to make informed decisions for high utilizers • Employ best available evidence to guide treatments • Engage in actionable care management with condition-specific registries. 1Sources: CMS, SAMSHA, CDC, AHRQ Population Health: Providers, Payors, or Public Health?
- 21. Integrative Population Health: Defined 21 Evidence-Based Integrative Health Training Groups Health Behavior Change: Supported by EHR and web-based technology TO IMPROVE: • Chronic illness management • Health promotion • Self-care • Engagement Funded by measured savings Integrative Population Health: Defined
- 29. 29 Results, at one year the following decreased: • 43% Total utilization • 41.9% Clinical encounters • 50.3% Imaging • 43.5% Lab encounters • 21.5% Procedures • 3.6/yr to 1.7/yr ED visits Massachusetts General Hospital’s Integrative Health Groups
- 30. Summary of Reduced Costs Resulting from Integrative Population Health Interventions Decreased • ED Visits • Inpatient costs, pharmaceuticals • Radiology procedure costs • Postoperative LOS • Lab Encounters Increased • Patient Satisfaction • Patient Engagement • Symptom Improvement • Pain, depression, anxiety 30
- 31. The Root of All Chronic Disease: Stress + Life Style “Choices”• Do we even have valid ICD-10 codes for: – The effects of stress? – Lifestyle choices? – Precursors to stress? • If we do, are clinicians documenting & diagnosing patients with it? • Are providers prescribing anything for these patients (besides medications)? • If yes [such as the SMART Program] are we coding this? Do codes even exist for such interventions? • Do we have ANY reliable data around SMART & Lifestyle Management programs? Relevance to the Health Information Professional
- 35. Integrative Health Med-Par Analysis: Patients Who Could Benefit from Integrative Health Interventions 35 Hospital # Discharges % of cases Hospital 1 3,554 98.1% Hospital 2 12,710 96.6% Hospital 3 4,115 97.5% Hospital 4 9,715 97.3% Hospital 5 7,190 97.3% Hospital 6 4,917 96.1% Hospital 7 4,579 97.8% Hospital 8 2,938 97.8% Integrative Health Med-Par Analysis: Patients Who Could Benefit from Integrative Health Interventions
- 36. Integrative Health Med-Par Analysis: Differences: Patients who can be managed with IHI vs those who cannot 36 Hospital ALOS Differential* Charge differential** Hospital 1 1.82 29% Hospital 2 .24 4% Hospital 3 .28 17% Hospital 4 1.25 20% Hospital 5 2 26% Hospital 6 .88 35% Hospital 7 1.86 32% Hospital 8 1.24 18% Integrative Health Med-Par Analysis: Differences: Patients who can be managed with IHI vs those who can’t
- 37. Diagnosis # of 2013 MD Hospital patients with this diagnosis % of IHM patients with this diagnosis % of all hospital patients with this diagnosis High blood pressure/hypertension 311,233 61% 53% Diabetes, Type 2 140,583 28% 24% Alcohol/Drug Related Diagnoses 131,773 26% 22% Coronary Artery Disease 118,482 23% 20% GERD, Gastro-esophageal Reflux 107,704 22% 18% Obesity/weight control 104,895 21% 18% Depression 82,346 16% 14% Arthritis/osteoarthritis 73,230 14% 12% Pain 73,198 14% 12% Anxiety 67,758 13% 12% Top diagnoses in Maryland Hospitals [All-Payer] that Can be Managed with Integrative Care
- 38. Sample Healthcare System Top 10 Evidence-based Integrative Health Practices* 38 Integrative Health Practice Percentage** Yoga 95% Meditation 89% Biofeedback 88% Hypnosis 86% Qi Gong 86% Mediterranean/Anti-inflammatory Diet 81% Relaxation Response 81% Tai Qi 81% Imagery 72% Cognitive Behavioral Therapy 70% **Percent of patients benefiting from integrative health practices who would benefit from this particular intervention Sample Healthcare System: Top 10 Evidence-based Integrative Health Practices*
- 40. Percent of patients who can be co-managed with Integrative Health ALOS differential between patients who can be managed with integrative health versus those who cannot Avg total charge differential between patients who can be managed with integrative health versus those who cannot Integrative Population Health Snapshot: Sample Healthcare System [Med-Par]] 40 96% 0 5 10 15 20 25 1 2 3 4 5 6 7 8 9 All Ages 18 - 64 >64 Percent of patients with >5 chronic conditions that can be managed with integrative health 0 5 10 15 20 25 30 35 40 1 2 3 4 5 6 7 8 All Ages 18 - 64 >64 0 0.5 1 1.5 2 2.5 1 2 3 4 5 6 7 8 All Ages 18 - 64 >64 Amounts are in thousands Days 86 88 90 92 94 96 98 100 1 2 3 4 5 6 7 8 9 All Ages 18 - 64 >64
- 42. Population Health Analytics Target High Utilizers: Multiple Chronic Conditions 42 # of Chronic Conditions for Patient Unique Patients Total Cases Total Charges Average Charge per Patient 8 12 72 $696,816 $58,068 7 63 292 $2,159,642 $34,280 6 154 628 $4,517,694 $29,336 5 268 908 $6,888,829 $25,705 4 412 1,278 $7,660,776 $18,594 3 537 1,556 $7,718,457 $14,373 2 592 1,661 $6,635,607 $11,209 1 428 1,259 $4,379,734 $10,233 Chronic Total 2,466 7,654 $40,657,55 5 $16,487 Of the 2,717 High Utilizers: § 91% of patients (2,466) have at least 1 Chronic Condition § 91% of cases and 96% of charges are associated with patients with Chronic Conditions § 75% of patients (2,038) have at § > 2 different Chronic Conditions Population Health Analytics Target High Utilizers: Multiple Chronic Conditions
- 45. HIM professionals develop standard documentation & coding for IH therapies Diagnosis or Chief Complaint Evidence-Based Support for Treatment Of Diagnosis or Symptom EHR Standardized Format Development Documentation Guideline Development Coding Guideline Development Acute GI Pain Acupuncture X X X Asthma symptoms Yoga, breathing techniques X Cancer pain Acupuncture, massage X X X ChemoTX induced N&V Acupuncture, relaxation training X X X Fibromyalgia Massage therapy X X X Infertility Acupuncture X X X Major depressive disorder Aerobic exercise, yoga X X Migraine Acupuncture, massage, meditation, MBSR, biofeedback, RR X X X Neck Pain Acupuncture X X X Osteoarthritis of the knee Acupuncture X X X CHD – Prevention Transcendental meditation, yoga X Post-operative pain Acupuncture X X X Pregnancy induced N&V Acupuncture X X X Pre-operative anxiety Guided imagery X X X
- 47. Consumer engagement in care and data Engaged patients: • Become their own managers • Take action to maintain and improve their health • Participate in self-care practices • Are more satisfied with their care • On average, generate less costs to the system Consumer engagement in care and data
- 48. EHR Optimization: Sample Patient Action Plan 48 Action What should I do next? Why is this important? You are due for your cholesterol blood test Please go to any XYZ system lab for a blood draw. You do not need to fast UNLESS your provider instructed you to do so. You do not need an appointment for this test. A cholesterol test measures the fats in your blood and helps assess the health of your heart, blood vessels and risk for heart attack or stroke. It can also show if medication you are taking is working You are due for a blood pressure check Go to an XYZ system primary care department for a walk in no cost blood pressure check. No appointment needed. Monitoring your blood pressure is important to your heart health. You are due for a Tdap vaccine. Go to your XYZ medical office and as for a “walk-in” immunization visit or you can get this at your next scheduled visit. The Tdap vaccine protects against tetanus, diptheria and whooping cough. You are invited to participate in an integrative Skills group There is no costs to attend. Call 888-212- 2222 to register for the healthy skills group nearest you. You can also register for the group using this link. Click here to find out more about healthy skills groups and how attendance can benefit you. Learning and practicing the healthy skills can help you manage the symptoms of your high blood pressure. It can also help you manage stress, chronic pain, anxiety, weight gain, and depression. EHR Optimization: Sample Patient Action Plan
- 50. Patients who were given access to their notes: • 84% looked at the notes • 81% reported they felt more in control of their care • 69% reported increased medication adherence • 31% had privacy concerns • 30% shared their notes with others • 99% continued to access their notes after the study concluded
- 51. Patient Engagement & Satisfaction • We are the source of our health information • We want to share our information to: – Experiment with different options to – Improve our own health – Help others • AND, at least some of us are also willing to give up our right to privacy in our health information
- 65. Relevance to the health information professional • Some patients are giving up their right to health information privacy for the greater good • The increased importance of symptoms in genetic research – Documenting – Coding • Coding for health consumer-generated data that is meaningful and useful Relevance to the health information professional