Measuring Success in a Health Care Plan Sponsored House Calls Program

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Measuring Success in a Health Care Plan Sponsored
House Calls Program

• Bill Zafirau, MD
• Summa Health Systems
• Akron, OH

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Why Housecalls?

• Approach by SummaCare Health Plan in 2006
• SummaCare expressed interest in having people who
  have multiple chronic illnesses, high
  utilization, but low ambulatory utilization
  managed by physicians and NPs going to the home.
• A partnership between Summa Health Plan And Summa
  Hospital
• SummaCare provided start-up funding and a per
  member per month payment for operation
• Provides Nurse Care Managers
• Consultant Pharmacist
• Data collection/analysis
• Summa Hospital provides office space, staffing,
  and operational support
• Practice transitioned from private practice to
  hospital ownership in 2008
• Hired Consultant from House Calls Solutions

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Summa Health System Akron, OH
St. Thomas

• 6 Hospital System
• 2,027 licensed beds
• 61,800 admissions
• Level 1 Trauma
• 113,059 ED visits
• Community locations
• 4 outpatient health centers
• Wellness Institute
• medically-based fitness
• Health Plan
• 110,000 Covered Lives
• 16,000 Medicare Risk HMO
• Major Teaching Residency and Fellowship Program
• Post Acute /Senior Service Line

Akron City Hospital
SummaCare, Inc
Cuyahoga Falls General Hospital
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The Program

• Around 125 patients presently, selected by
  screening, from 12,000 Medicare Advantage
  patients in Summit County.
• 10x predicated average medicare utilization or
  higher
• Ambulatory sensitive condition (CHF, DM, COPD,
  reccurent aspiration pneumonia)
• Hands-on dependence in 2 ADL or IADLs
• PCP and patient permission (about 50 accept
  enrollement)
• Interdisciplinary team supported by the Health
  Care Plan, Health System, and local AAoA
• Physician
• Nurse Practitioner
• Social Worker/AAoA Case Mananger
• Health Plan Pharmacist
• Nurse Care Manager

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Measuring Success Patient and Caregiver
Perspective

• Annual patient satisfaction survey
• Annual assessment of caregiver stress and social
  support using standardized scales
• Annual Functional Assessment (Katz, Lawton)
• Annual Health Status Self Assessment (SF-36,
  Vulnerable Elderly Survey)
• Rates of institutionalization and site of death
• Monthly Pain (0-10 scale), Nutrition (NSI), and
  Falls Assessments ( Falls per year)

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Measuring Success Health Plan

• Utilization Rates
• Hospitilization
• ER visits
• Total Costs
• of patients dying at home (New for 2009)
• Chronic Disease Quality Measures (Modified ACOVE)
• Costs of Program/Return on Investment (Data being
  run presently)

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Measuring Success Hospital System

• Regulatory Compliance (?JC)
• Medical Education ( of Learners)
• Marketing/Market Share
• Physician Satisfaction/Physician Referral (Mailed
  Survey, In-person Survey)
• Watch for perceived stolen patients
• Downstream Revenue
• Admissions (0.84 per HC patient per year vs
  0.21 for average Medicare enrollee)
• Tests (Lab, Mobile Diagnostics)
• Home Care and Hospice Care (40-50 point
  prevalence utilization)

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Measuring Success Practice Perspective

• Practice Revenue (revenue per FTE equivalent doc
  or NP)
• Practice Efficiency (patients per half day)
• Communication
• Within your practice
• With outside entities
• Employee Satisfaction (Internal Survey)
• Practice Growth ( patients about 125 active
  and 175 since inception)

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Challenges

• Multiple goals from separate entities often
  compete with each other
• Rules and regulations of hospital systems that
  dont make sense or are difficult for a private
  practice
• Too many bosses and not enough workers
• Work-flow and geography are not optimized for
  fee-for-service revenue
• Difficult work environment with employee burnout
  and turnover
• Political challenges

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• Questions

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How Patients are Selected

• SummaCare Medicare (both gt65 yo and younger
  patients on disability) patient database finds
  patients predicted to have at least 10x the
  average utilization
• Must have and ambulatory sensitive condition of
  HTN, DM, COPD, CHF, or aspiration pneumonia
• Must live within Summit County
• Patients are then screened for functional
  dependence (Hands on dependence in one ADL or two
  IADLs)
• Both patient and PCP must consent. (PHC can serve
  as patients PCP if patient desires to switch)
• Limited expansion into Medicare FFS by building
  in 2009
• Possible expansion to commercial population in
  2009