2. AtlantiCare: Special Care Center
• Faced with escalating care costs, especially for
employees with chronic conditions, AtlantiCare
and the Welfare Fund adopted the AIC-U model
(Special Care Center) and opened the center July
2007 (based on the original white paper)
• Although the Special Care Center originally served
only participants of the Local 54 Fund and
AtlantiCare employees, it has subsequently been
opened up to other patient populations
3. Time to Innovate
• Care was fragmented
• Chronic conditions were not managed
• Payers needed to be partners
• Healthcare needed to be done differently
5. THE 80-20 RULE of Chronic Care
• 80 % of Healthcare Spend
• 20% Patients with Chronic Conditions
SOLUTION
Care while Costs
for patients with Chronic Conditions
6. Innovative Healthcare for Chronic Conditions
• Partnered on solutions
• National innovations/best practices
• Piloted the “SCC” - a patient-centered medical
home for individuals with chronic conditions
• Invitation Only Enrollment (screening form)
• Opened the doors in the summer of 2007
• Enrolled 2,600 patients to date
7. Three Aspects of Care
• High motivated Health
Health Coaches Coaches (medical
assistant, LPN)
Medical Providers • High performing medical
providers
Specialist Network • High Value specialist
network
8. Task at Hand
• Attract Chronic Care Patients to the Practices
– Patients with the highest spend (MedAi 4-5)
OR
• Provide chronic care in their existing practices
– Hot sack services in primed practices - locations
9. Special Care Principles
• Give Patients what they WANT and NEED
– Relationship with their Doctor
– Health Coach support
– Care they can Access
– Provide Pharmacy Services
– Care of the highest Quality
– Reduced Costs
– Electronic care that is Connected
– Care that is Integrated
– Driven by the patient Experience
10. SPECIAL CA RE CEN TER IMPERA TIVES - Tools for R eplica tion
ROLE GOAL OUTCOM E
HEALT H Provide relat ionship based healt h education and Increase patient educati on, pat ient education
COACHE S navigation. engagement and self- care engagem ent
-He lp p eop le clar ify t heir he alth go als, a nd imple me nt management goal att ainment . health i ndicators t hrough ef fective self and team
an d su stain be havio rs, li estyle s, a nd attit ude s th at
f management
ar e co ndu cive to o ptim um hea lth
-G uide pe ople in t heir per son al ca re an d he alth -
ma inte nan ce a ctivities
-Assist pe ople in r edu cing the ne gat ive im pact ma de
on the ir lives by c hr onic c ond itions suc h as
car diov ascula r d iseas e, c ance r, and dia bet es.
WAIV ED To reduce barriers t o care and medications. Reduce barriers to t he right care ambulatory care visits
CO-PAYS at t he right time and at the right Rx Compliance to 99% fi ll rat e
place.
OP EN ACCES S Provide open access scheduling Reduce barriers to t he right care sam e day sick visits
at t he right time and at the right sam e day/next day hospital discharge visit s
place. emergency room visit s - non-em ergent cases
PROACTI VE Eff ective management of on-sit e pharmaceut ical Reduce over utilizat ion of brand util ization of generic medicat ions
THE RAP EUTI C services. medicat ions which result s i n drug costs
ME DICATI ON cost savi ngs.
PROG RAM
INT EGRATE D Provide on-site behavioral healt h servi ces. Increase access, decrease open access to co-located behavioral healt h
BEHAVI ORAL st igma and im prove care and P h-Q 9 scores - decreased symptoms
HEALT H out comes. healt h outcom es wit h reduced sympt oms
CONTI NI UM Eff ective management of pati ent care Improve care management t o emergency room usage
MANAGEM ENT throughout the continuum- inpatient to decrease over utili zation of hospit al ization rates
am bulat ory and services al ong the care rout e. unnecessary services, acute care length of stay
admissions and lengt h of st ay
while improvi ng care outcomes.
11. Barrier Reduction
• Personal health coach for each patient
• Waive visit co-pays
• Waive prescription co-pays when members use the SCC
pharmacies
• Open Access for Sick Call
• Same Day/Next Day Hospital Discharge Appointments
• Access to the care team 24 hours a day, 7 days a week
• Utilize a robust electronic medical record to increase
efficiencies and safety- that could communicate throughout
the continuum of care- reduce unnecessary testing- provide
medication reconciliation
12. Relationship with Doctor
• The Patient-Doctor relationship is paramount
to improving care while reducing costs by
instilling:
– Focus on each and every patient/family need
– Expertise
– Trust
– Proven methods to improve health outcomes
– Key to hire right staff who understand model
13. Health Coach Navigating Care
• The Health Coach Principle is a staffing
model that assigns each patient a personal
educator (also known as a health mentor or
navigator) who shepherds the patient through
their care with:
– Continuous contact
– Health literate patient education
– Real life practical support
– Cultural and linguistic support
14. Access to Care
• Easy to access
– Same day sick visits
– Same day/next day hospital discharge visits
– 24/7 access to a doctor
• Affordable to access
– No or reduced copay to visits if able in plan design
– No or reduced copay for medications
• One-stop access
– Onsite pharmacy services
– Mail order pharmacy
16. Pharmacy Services
• Built a Pharmacy on-site
• Hospital based institutional pharmacy
• Daily communication with team
• Mechanisms to ensure patient pick up
• Monitor compliance
17. Reduced Costs Care
• Focus on supporting patient health which
results in maintaining community living
without ED and hospital stays
• Effective care of chronic conditions CAN be
done in an ambulatory setting if vision is to
support each patient to manage their health
18. Reduced Costs Care
• Know the cost of everything-learn unknown
costs
• Network of care that is cost responsible
• Reduce out of pocket cost for the patients
• Reduce cost to the partner
• Reduce overall PMPM- PMPY
19. Electronic Connected Care
• Electronic medical record
– EMR follows patient through the continuum
• Patient registry
– Optimizes patient and population management
• Accurate patient profile at each contact/portal
• Reduces duplication of testing/procedures
20. Integrated Care
• Team Approach
– Use of “morning huddle” to review care plans
– Each member ‘s input is integral to care
– Each member is invested in the vision of care
• Behavioral Health Services
– Mental health and substance abuse services
– Social services to access community resources
– Focus on reducing depression, anxiety and stress
21. Patient Experience Care
• Desire to feel better
• Want to feel special
• Need to learn about their conditions
• Support to effectively manage life circumstances
• Adopted CG-CAHPS surveying
22. Special Care Center Timeline
Catalyst for Innovation
SCC Model
Second
EMR Opening
SCC Site ACO
Pharmacy pharmacy in
2010 2012
Patient Registry each hospital
Concept Implemented
and Design Enterprise 2013
2007
2006 Implementation
of Registry 2012
2007 AtlantiCare had 3 Primary Care Office- 2013 expanded to 30 Primary Care Office
EMR has 300,000 patients
28. Other Health Outcomes vs Benchmarks
80
%
70
Patients
60
50
40
30
20
10
0
% Patients SBP<140 in HTN LDL<100 in CAD Quit Smoking
in COPD/Asthma
Benchmark 71.3 42.6 15.0
SCC Jul 08 64.1 64.1 19.0
SCC Jul 09 69.1 69.1 19.4
SCC Jul 12 78.6 78.6 26.0
29. Reduction in Smoking Rates
63%
40 Quit Rate
35 63%
Quit Rate
30 Pre SCC
48%
47% Quit Rate
25 Quit Rate Post SCC
20
15
10
5
0
Diabetes CAD COPD All Patients
30. Greater reductions in SBP in minority groups
mmHg
140
135
Pre SCC
130
Post SCC
125
120
115
110
White Black Hispanic Asian
31. Greater reductions in LDL-C in minority groups
mg/dL
110
Pre SCC
100
Post SCC
90
80
White Black Hispanic Asian
32. Greater reductions in HbA1c in minority groups
%
8.2
8
7.8 Pre SCC
7.6
Post SCC
7.4
7.2
7
6.8
6.6
6.4
White Black Hispanic Asian
33. Higher Smoking Cessation rates-minority groups
%
60
50
40
30
20 33% 39% 60%
10
0
White Black Hispanic
34. Reduction in Utilization Measures
50
% 40
30
+43%
20
-22%
10 -23% -8% -15%
0
-10
-20
-30
Office ER Admissions Length Average
Visits Visits of Stay Cost/Day
35. Cost Savings – Large Payer Group at the SCC
• Our large payer group sought controls from a Las Vegas
population with similar age, chronic disease state and
spending pattern
• By definition, the “sickest” patients are outliers who are
difficult to match with controls
• Still, early analysis showed short term savings of $208 per
member per month
– Medication
– Hospital LOS
– ER Utilization
• Later analysis will likely show a greater long term saving as
long term complications are prevented
