AHRQ’s Health Care Innovations Exchange held a Web event on Promoting the Spread of Health Care Innovations on April 9, 2013. For more information, visit https://innovations.ahrq.gov/events/2013/04/promoting-spread-health-care-innovations.

1. Promoting the Spread of Health CarePromoting the Spread of Health Care
InnovationsInnovations
Web SeminarWeb Seminar
April 9, 2013April 9, 2013
Follow this event on TwitterFollow this event on Twitter
Hashtag: #AHRQIXHashtag: #AHRQIX

2. Using the Webcast ConsoleUsing the Webcast Console
and Submitting Questionsand Submitting Questions
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Click the Q&A widget to get
the Q&A box to appear
To submit a question, type
question here and hit submit.

3. Accessing PresentationsAccessing Presentations
 Download slidesDownload slides
from consolefrom console
– Click on theClick on the
“Download“Download
Slides” widgetSlides” widget
for a PDFfor a PDF
versionversion
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4. What is the Health CareWhat is the Health Care
Innovations Exchange?Innovations Exchange?
 Publicly accessible, searchable database of health policyPublicly accessible, searchable database of health policy
and service delivery innovationsand service delivery innovations
 Searchable QualityToolsSearchable QualityTools
 Successes and attemptsSuccesses and attempts
 Innovators’ stories and lessons learnedInnovators’ stories and lessons learned
 Expert commentariesExpert commentaries
 Learning and networking opportunitiesLearning and networking opportunities
 New content posted to the Web site every two weeksNew content posted to the Web site every two weeks
Sign up atSign up at http://www.innovations.ahrq.gov under “Stayunder “Stay
Connected”Connected”
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5. Innovations ExchangeInnovations Exchange
Web Event SeriesWeb Event Series
Archived Event MaterialsArchived Event Materials
Available within two weeks under Events & PodcastsAvailable within two weeks under Events & Podcasts
at http://www.innovations.ahrq.govat http://www.innovations.ahrq.gov
Next EventsNext Events
Thursday, April 25, 2013 1-2 pm ETThursday, April 25, 2013 1-2 pm ET
Payment Models that Support Medical Home andPayment Models that Support Medical Home and
Accountable Care Organization Principles: Maryland’sAccountable Care Organization Principles: Maryland’s
ExperienceExperience
Thursday, May 9, 2013 1-2 pm ETThursday, May 9, 2013 1-2 pm ET
A Close Look at Care Coordination: West Virginia’sA Close Look at Care Coordination: West Virginia’s
ExperienceExperience
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6. Today’s Event ModeratorToday’s Event Moderator
Ronie Nieva, PhDRonie Nieva, PhD
Vice President, Westat and Editor-in-Chief of theVice President, Westat and Editor-in-Chief of the
AHRQ Health Care Innovations ExchangeAHRQ Health Care Innovations Exchange 6

7. Essentia HealthEssentia Health
Linda Wick, RN, CNPLinda Wick, RN, CNP
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Manager, Heart Failure ProgramManager, Heart Failure Program

8. RespondentRespondent
Janell Moerer, MBAJanell Moerer, MBA
Group Vice President, Strategy andGroup Vice President, Strategy and
Business Development, Centura HealthBusiness Development, Centura Health

9. Essentia HealthEssentia Health
Heart Failure ProgramHeart Failure Program
 First visit 5-7 days after discharge
 Cardiology oversight – once per year
 Patients managed in clinic: 4-7 office visits
the first year
 Registered nurses do case management: use
protocols, manage home telescale data, follow
up on lab/test data, and triage phone calls

10. Program ComponentsProgram Components
 CoachingCoaching
 EducationEducation
 SupportSupport
 Consistency of care providerConsistency of care provider
 Immediate feedback on health choicesImmediate feedback on health choices
 Prescheduled follow-up appointmentsPrescheduled follow-up appointments
 Relationship building with patient/familyRelationship building with patient/family
 Multidisciplinary team approach to careMultidisciplinary team approach to care
 Engaged/passionate staffEngaged/passionate staff

11. TripleTriple Aim
 OutcomesOutcomes
– Use of guideline directed medications/devices
– Total yearly admissions/30 day readmissions
 Patient SatisfactionPatient Satisfaction
 Reduced Cost of CareReduced Cost of Care
– Total yearly admissions/30 day readmissions
– Reduce duplication of testing
– Using the right provider at the right time for the
right diagnosis

12. SHOW ME THE MONEY!SHOW ME THE MONEY!

13. Readmission RatesReadmission Rates
Note: 6 month rates for heart failure patients
N=294-229 FY2005-2010

14. Essentia Health St. Mary’s
Hospital Readmissions
0
10
20
30
40
2010 2011 2012
Nat'l Avg
All Cause
HF

15. “Times They are a Changing”
 Essentia Health is an Accountable Care
Organization
 CMS Bundled Payments for Care
Improvement Initiative
 Primary care is using health care home
model: stable Heart Failure Program
patients discharged to primary care
physician

16. Challenges:Challenges:
Administrative Buy-InAdministrative Buy-In
 Ongoing challenge of administrative
buy-in
 Dialog changed once organization
became an Accountable Care
Organization: risk/benefit
 Demonstrate how model fits Triple Aim
 Markets within the organization have
different priorities
 NCQA accreditation process fits model

17. Challenges: Provider Buy-InChallenges: Provider Buy-In
 Progress with physician and provider
buy in: show data on outcomes
 Culture changing from physician-
centered to patient-centered
 Culture changing from individual
provider-based to team-based care
 Other chronic disease programs
changing to Heart Failure Model within
Essentia

18. Challenges: WorkforceChallenges: Workforce
 Sustaining workforce with potential
nursing shortage
 Clear staffing roles
 Inclusion/exclusion criteria for patients
 Using Telehealth technology

19. Scale Up and SpreadScale Up and Spread
 Added Telehealth video visits to remoteAdded Telehealth video visits to remote
sitessites
 Added program staff to neighborhoodAdded program staff to neighborhood
clinicsclinics
 Developed interface with primary careDeveloped interface with primary care
case managers: shared care plancase managers: shared care plan
 Integrated home scale data intoIntegrated home scale data into
electronic medical records with optionselectronic medical records with options
for coverage from other sitesfor coverage from other sites

20. Closing ThoughtsClosing Thoughts
If everything seems under control, you’re
not going fast enough –
–Mario Andretti

21. RespondentRespondent
Janell Moerer, MBAJanell Moerer, MBA
Group Vice President, Strategy andGroup Vice President, Strategy and
Business Development, Centura HealthBusiness Development, Centura Health

22. Comments and ConsiderationsComments and Considerations
 Continuity of leadership and passion forContinuity of leadership and passion for
the service has assisted growth andthe service has assisted growth and
adoptionadoption
 Data beginning to reflect intendedData beginning to reflect intended
impact to new value equationimpact to new value equation

23. Impact of Changing EnvironmentImpact of Changing Environment
 Transformation and disruption of the normTransformation and disruption of the norm
has accelerated adoption and scalehas accelerated adoption and scale
 Fee-for-service payment toFee-for-service payment to
bundle/Accountable Care Organizationbundle/Accountable Care Organization
 Change in value equation: outcomes/costChange in value equation: outcomes/cost

24. Shift to Team-Based CareShift to Team-Based Care
 Emphasis on team-based care: patient-Emphasis on team-based care: patient-
centered medical homes/health homescentered medical homes/health homes
 Heart Failure Program and team areHeart Failure Program and team are
more “part of” the delivery vs. “separatemore “part of” the delivery vs. “separate
from” due to emphasis on team-basedfrom” due to emphasis on team-based
care.care.

25. Overarching QuestionsOverarching Questions
 Where does this program need to resideWhere does this program need to reside
in the short term, mid-term, and long-in the short term, mid-term, and long-
term?term?
 Who should “own” it? Accountability?Who should “own” it? Accountability?
 How are the physician championsHow are the physician champions
engaged in development and adoptionengaged in development and adoption
with peers?with peers?
 How will guardrails for compliance withinHow will guardrails for compliance within
the delivery system be addressed?the delivery system be addressed?

26. Key ConsiderationsKey Considerations
How will the challenges and opportunitiesHow will the challenges and opportunities
change due to the transformation ofchange due to the transformation of
payment and care delivery?payment and care delivery?
Administrative buy-inAdministrative buy-in
Physician adoptionPhysician adoption
Delivery system needs and compositionDelivery system needs and composition
Data gathering to data aggregation andData gathering to data aggregation and
segmentationsegmentation
New competitorsNew competitors

27. Key ConsiderationsKey Considerations
How and what will the Heart Failure ProgramHow and what will the Heart Failure Program
need for innovation and to accelerateneed for innovation and to accelerate
adoption with sustainable value?adoption with sustainable value?
Community partnerships i.e. parish nursing,Community partnerships i.e. parish nursing,
community emergency medical servicescommunity emergency medical services
Telehealth to clothing with monitoring devices;Telehealth to clothing with monitoring devices;
iHeart FailureiHeart Failure
Technology partnershipsTechnology partnerships
Retail competitors and opportunitiesRetail competitors and opportunities
Patient/consumer experience and literacyPatient/consumer experience and literacy

28. Transformation to ValueTransformation to Value
SHOW ME THE MONEY!

29. Questions?Questions?
Click me to get Q&A boxClick me to get Q&A box
to appearto appear

30. The Innovations ExchangeThe Innovations Exchange
 Visit our Web site:Visit our Web site:
http://www.innovations.ahrq.gov/ andhttp://www.innovations.ahrq.gov/ and
Scale Up and Spread VideosScale Up and Spread Videos
 Follow us on Twitter:Follow us on Twitter:
#AHRQIX#AHRQIX
 Send us email:Send us email:
info@innovations.ahrq.govinfo@innovations.ahrq.gov
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