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Improving Care and Reducing Costs for PPO Patients: HealthCare Partners ACO Pilot Program

In 2009, Brookings–Dartmouth launched its ACO Pilot Program to support four provider groups to form accountable care organizations (ACOs) with health plans and private payers (as opposed to the Medicare government-supported ACO programs now underway). The provider organizations that are participating all agreed to take responsibility for the overall cost and quality of care for their patients, with their private payer partner.

The chosen organizations are HealthCare Partners, a medical group/independent practice association (IPA) based in Los Angeles, CA.; Monarch HealthCare, an IPA in Orange County, CA; Norton Healthcare, an integrated delivery system in Louisville, KY; and Tucson Medical Center, a community hospital working with independent provider groups in Tucson, AZ.

This preliminary case study conducted by the Commonwealth Fund with Brookings-Dartmouth describes the HealthCare Partners’ experience to date.


Improving Care and Reducing Costs for PPO Patients: HealthCare Partners’ Brookings–Dartmouth ACO Pilot Program

HealthCare Partners, Los Angeles, California

In 2009, Brookings–Dartmouth launched its ACO Pilot Program to support four provider groups to form accountable care organizations (ACOs) with health plans and private payers (as opposed to the Medicare government-supported ACO programs now underway). The provider organizations that are participating all agreed to take responsibility for the overall cost and quality of care for their patients, with their private payer partner.

The organizations chosen are HealthCare Partners, a medical group/independent practice association (IPA) based in Los Angeles, CA.; Monarch HealthCare, an IPA in Orange County, CA; Norton Healthcare, an integrated delivery system in Louisville, KY; and Tucson Medical Center, a community hospital working with independent provider groups in Tucson, AZ.

This preliminary case study conducted by the Commonwealth Fund with Brookings-Dartmouth describes the HealthCare Partners’ (HCP) experience to date. In this report, the researchers reveal the characteristics of HCP and its partner organizations, including Anthem, the payer partner; the organization’s decision to develop an ACO; the steps that HCP has taken to implement the model; as well as the achievements and lessons learned as of this writing.

This report discusses how HCP’s success thus far is attributable to its strong primary care base; culture of accountability; emphasis on prevention and promotion; sophisticated integrated health information technology; care management and care coordination processes; performance measurement and reporting; and experience with risk-based contracts with payers.

For the complete report, please click here.

For a complete list of case studies in this Commonwealth Fund series, along with an introduction and description of methods, please click here.

FOR MORE INFORMATION:

Robert Klein
HealthCare Partners
VP Communications and Marketing
310-630-4126
rjklein@healthcarepartners.com
www.healthcarepartners.com

Virginia Mason Provider-Employer-Payer Collaboratives Target Common Medical Conditions

Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to develop standardized approaches to the care of patients with common medical conditions. Called marketplace collaboratives, these efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients, and providers while improving quality and value. To date, Virginia Mason has implemented clinical value streams for low back pain, headache, large joint pain, and breast concerns not related to cancer screening. The strides made in quality by this approach have been impressive.


Excerpted from:

At Virginia Mason, Collaboration Among Providers, Employers, and Health Plans to Transform Care Cut Costs and Improved Quality, by C. Craig Blackmore, Robert S. Mecklenburg, and Gary S. Kaplan

http://content.healthaffairs.org/content/30/9/1680.full.html

Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to develop standardized approaches to the care of patients with common medical conditions. Called marketplace collaboratives, these efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients, and providers while improving quality and value.

The initial task of the first marketplace collaborative was to define quality. After much deliberation, the collaborative participants decided that quality related to five key factors: patient satisfaction; the practice of evidence-based care; rapid access to care by patients; patients’ rapid return to functioning; and cost. Once the definition of quality was determined, the next step was to identify the optimal, evidence-based care for low back pain, the focus of the first collaborative. Each subsequent marketplace collaborative has selected a different condition to target for improvement. Called “clinical value streams,” these standardized clinical pathways ensure that best practices are followed and unnecessary test and treatments are eliminated.

To date, Virginia Mason has implemented clinical value streams for low back pain, headache, large joint pain, and breast concerns not related to cancer screening. The strides made in quality by this approach have been impressive. For instance, the headache clinical value stream focused on patients with uncomplicated headache in which no other symptoms of concern were present, such as head trauma or fever. These patients typically do not require expensive imaging tests, but many were receiving them anyway. Through the collaborative process, Virginia Mason decreased the use of MRIs by 23 percent, so delays in seeing a doctor because of pending test results were minimized. New policies were implemented that allowed patients to get in to see a doctor the same day as their headache developed in 95 percent of cases. The result has been that patients with headache now score their care at an impressive 91 in terms of patient satisfaction.

At Virginia Mason, collaborative efforts among providers, payers, and employers have lead to improved care delivery according to a common definition of quality. By developing and implementing evidence-based care pathways, quality parameters are being achieved by a decrease in unnecessary care and costs, and with high patient satisfaction and rapid access.

Keywords: access, evidence-based care, clinical pathways, headache, large joint pain, low back pain, quality improvement, payer collaboration, employer collaboration, clinical value streams, marketplace collaborative, Virginia Mason Medical Center, Seattle, Washington.

FOR MORE INFORMATION:

Michelle Peterson
Director, Communications and Public Relations
Virginia Mason Medical Center
100 Ninth Ave, MS GB-ADM
Seattle, WA 98101
(206) 583-6581
michelle.peterson@vmmc.org
http://www.VirginiaMason.org/

Depression Care Curbs Rate of Suicides at Henry Ford

A quality improvement initiative for the Health Alliance Plan members who receive care at Henry Ford Medical Group resulted in dramatically bringing down the rate of suicide in its 200,000 patient population. Over 9 consecutive quarters, there were no suicides among the patients of the Perfect Depression Care Program of the Behavioral Health Services division of Henry Ford, in stark contrast to the 230 suicides expected in an average population of 100,000. The goal of the initiative was to completely redesign care delivery around the six aims outlined in the Institute of Medicine’s Crossing the Quality Chasm report–safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity—in order to reduce the number of suicides to zero. The belief held by the program is that perfect depression care would result in no suicides—not just a reduced risk of suicide.


Excerpted from:
Depression Care Effort Brings Dramatic Drop in Large HMO Population’s Suicide Rate
Tracy Hampton, PhD
JAMA. 2010;303(19):1903-1905.
http://jama.ama-assn.org/content/303/19/1903.extract

“While physicians and other health care workers may not be ableto predict which of their patients will attempt suicide, theycan implement preventive strategies that markedly lower therisk of such tragedies. Now, one pioneering program has demonstratedthe importance of pursuing 2 key approaches at once: carefullyassessing patients for risk of suicide and adopting measuresto reduce the likelihood that a patient will attempt suicide.

The example comes from a quality-improvement initiative that succeeded in substantially bringing down the rate of suicide in a population of about 200 000 members of a large health maintenance organization (HMO). Through the second quarter of last year, the Perfect Depression Care program of the Behavioral Health Services (BHS) division of the Henry Ford Health System resulted in 9 consecutive quarters without any suicides, a dramatic contrast to the annual rate of 89 suicides per 100,000 members at baseline and approximately 230 suicides per 100,000 individuals expected in a patient population . . .”

Keywords: care team; depression; Henry Ford Health System; Michigan; Perfect Depression Care Program; prevention; quality improvement; rate of suicide;

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel.313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org

TeleStroke: Using Technology to Facilitate Care

Approximately 60 percent of stroke patients access their initial medical care within three hours of the onset of symptoms. The TeleStroke program of Cleveland Clinic is a distance health application that will address the issues surrounding time-critical therapeutic intervention.

TeleStroke uses videoconferencing and image transfer to connect Cleveland Clinic stroke specialists with stroke patients located within a 200-mile radius of Cleveland. The TeleStroke program provides 24/7 professional consults to bedside physicians at outlying hospitals for diagnosis and recommendation for treatment and/or transfer. When necessary, these consults — in coordination with existing staff and critical care transport — may result in transfers to Cleveland Clinic for a range of stroke interventions not available at most regional hospitals.

The well-coordinated operations between specialists at Cleveland Clinic and the frontline physicians at regional hospitals are key to the program’s success.Stroke is a significant medical burden, ranking as the third leading cause of death in the U.S. and the leading cause of long-term disability, with more than 700,000 strokes in the U.S. per year. However, significant barriers slow treatment to a large number of patients with non-hemorrhagic stroke: emergency room physicians and non-stroke neurologists are reluctant to administer the proper medicine due to potential complications; and a shortage of neurologists delays acute and consultative care. Therefore, TeleStroke provides an urgent and compelling alternative to having a stroke neurologist always present at the bedside for treatment of acute strokes.

Keywords: access,coordinated care, Cleveland Clinic, Ohio, stroke, telemedicine

FOR MORE INFORMATION:

Megan Pruce
Senior Manager, Communications & Public Affairs
Cleveland Clinic
tel. 216- 445-7452
prucem@ccf.org
www.clevelandclinic.org @ccf.org

Worksite Complementary and Alternative Medicine Group Programs Reduce Chronic Pain

Henry Ford Medical Group experts in complementary and alternative medicine (CAM) have provided worksite programs since 2006 using research-proven CAM therapies. In an effort to improve employee health outcomes, the innovative approach focuses on group treatment and teaching self-care techniques. CAM protocols include chiropractic methods, needling acupuncture, electrical stimulation of acupuncture points, St. John neuromuscular therapy, movement re-education, and mind-body therapy. The Worksite Complimentary Alternative Medicine Programs first focused on back pain, followed by any type of neuromuscular pain, and recently expanded to address stress-related illness. In 2009 the “Stress- and Pain-Free Living” programs offered to Chrysler and Henry Ford Health System employees showed elimination of chronic pain in 45% of participating employees and improvement in 49% with stress-related chronic illnesses with 9% totally resolved (with no need for medication) at program end.


Stress and Pain-Free Living Program at the Worksite

http://henryford.com/body.cfm?id=53038

Aim
To improve employee health outcomes and decrease costs for self-insuring corporations in Michigan by delivering innovative, research-proven, onsite group wellness programs using complementary and alternative medicine (CAM) therapies. The Stress- and Pain-Free Living (SPFL) programs offered to employees of Chrysler and Henry Ford Health System in 2009 were designed to build on the successes of our previous award-winning group programs, “We’ve Got Your Back” program in 2007 for chronic back pain and “Pain Free in 2008” program for all chronic neuromuscular pain.

Measures
Participants reported their stress levels, as well as pain levels, on a 0-10 numeric rating scale before and after participating in the program. Other outcomes tracked included disability (Oswestry Disability Questionnaire), depression (PHQ-9), perceived stress (Perceived Stress Scale), and sleep quality (Pittsburgh Sleep Quality Index).

Changes
Group sessions (up to 84 per group) included education plus intervention for a total of 18-24 contact hours over a 6-7 month period:

  • Guided Relaxation for New Awareness: Learning to relax, breathe properly, to recognize and intervene with stress as well as automatic habits and patterns that have been supporting the persistence of chronic pain.
  • Somatic Movement Education for New Awareness: Simple movement routines to recognize and release over-contracted muscles, which is critical for reducing and eliminating pain.

Home Health Activities: Participants take responsibility for improving their condition by listening to guided relaxation CDs and doing somatic movement routines at home and at work to alleviate pain.
We expanded our partnerships to more Henry Ford Health System locations. This increased the number of employees served.

Results
A total of 421 Chrysler and Henry Ford Health System employees attended group sessions. These employees reported a total of 2,471 pain conditions at the start of the program. Back, shoulder, neck, knee, and hip were the 4 highest reported chronic pain areas.

Stress Elimination: 14% of participants reported elimination of stress by program end. On average, stress levels were reduced from 4.82 at pre to 2.45 at post on the 0-10 scale.

Pain Elimination: Research shows that once pain becomes chronic, it is resistant to intervention. In our previous programs at Chrysler and Henry Ford Health System (“Pain Free in 2008”), 35% of chronic pain conditions were eliminated. In the new Stress and Pain-Free Living programs, 45% of chronic pain conditions were eliminated. On average, pain levels were reduced from 3.73 at pre to 1.35 at post on the 0-10 scale.

Quality of Life Outcomes: Significant reductions occurred in disability, depressive symptoms, and perceived stress, and significant improvement occurred in sleep quality. Of 645 stress-related chronic illnesses reported by participants, 49% were improved and 9% resolved (i.e., completely under control with no need for medication) at program end.

Program Satisfaction: 92% of participants expressed satisfaction with the program and an interest in taking another workplace health program.

Time Involvement: We tested and showed that 18 contact hours offered to Henry Ford Health System employees was as effective at producing significant beneficial results as the 24 contact hours offered to Chrysler employees.

Next Steps/Lessons Learned
Online surveys to determine clinical eligibility for program participation and to facilitate collection of pre-program, interim program, and post-program data make future program development simple and efficient.

Communication and advertising methods enable us to reach a wide group of potential program applicants and participants in a short time period; worksite recruitment is ideal and fast.

Word of mouth advertising is continuing to fuel new programs. We filled 9% of this year’s Henry Ford Health System programs through referrals from previous participants.

Pain-Free in 2008: Worksite Complementary Alternative Medicine Programs

http://www.henryford.com/body.cfm?id=52277

Aim

In 2007, the “We’ve Got Your Back” program offered to groups of Chrysler employees experiencing chronic back pain resulted in elimination of back pain in 55% of the reporting participants at the end of the program. That workplace-based program used a hands-off group intervention involving complementary and alternative medicine (CAM) therapies. For 2008, we aimed to expand the number of chronic pain conditions addressed. The goal was to reduce or eliminate chronic pain in the back, hip, neck, shoulder, other limb joints, and headache, together in the same group of employees, many of whom had more than one pain condition to address. The new programs, offered under the umbrella name of Pain Free in 2008, employed a similar hands-off group approach using CAM intervention; the programs were available to Chrysler employees and expanded to be available to Henry Ford Health System employees.

Measures

• Self-reporting pain areas before and after program interventions.

• Outcomes measures for disability (Oswestry Disability Questionnaire), depression (PHQ-9), perceived stress (Perceived Stress Scale), and sleep quality (Pittsburg Sleep Quality Index).

• Patient satisfaction.

Changes

The Pain Free in 2008 program participants experienced a total of 24 contact hours over a 7-month period. Sessions included:

• Guided Relaxation for New Awareness (a language-based mind-body connection technique) and Somatic Movement Education for New Awareness (a non-languagebased mind-body connection technique).

• Assignment of home “wellness activities” included listening to Guided Relaxation CDs and performing somatic movement education routines. Participants tracked and reported their compliance daily.

• Group feedback from the homework assignments given at each session.

• A lecture/educational component.

We transitioned to online surveys for program eligibility, and pre-, mid- and postprogram health outcomes data collection. We modified the program time based on feedback from the two organizations, which wanted shorter sessions; original 2-hour group classes totaling 12 sessions were redesigned to 1.5-hour group classes totaling 16 sessions.

Results

• A total of 176 Chrysler and Henry Ford Health System employees attended the workplace group sessions (up to 60 per group). A total of 375 pain conditions were reported by the participating employees at the start of the program. Back, neck, hip, and shoulder were the four highest reported chronic pain areas.

• Pain Elimination or Reduction: 35% of pain conditions were eliminated by the end of the programs. Additionally, in over 76% of pain conditions, the pain levels were reduced by at least 20%. These results contradict research reports that once pain becomes chronic, it is resistant to intervention.

• Quality of Life Outcomes: Significant reductions occurred in isability, depressive symptoms, and perceived stress, and sleep quality significantly improved.

• Patient Satisfaction: 82% of participants expressed satisfaction with the program and an interest in taking another workplace health program.

Next Steps/Lessons Learned

The flexibility and effectiveness of this innovative model has the potential to reach many other southeast Michigan workforces and beyond. Specific tools allowed this program model to be easily implemented, tailored, and adapted:

• Online surveys to determine clinical eligibility for program participation and to facilitate collection of pre-program, interim program and post-program data.

• Workplace communication and advertising methods to reach a wide group of potential program applicants and participants in a short-time period; worksite recruitment was ideal and fast.

• Design of a structural pain program that will reach an even broader range of pain sufferers (beyond back pain).

• Effective measurements of program results were critical to this project’s success.

Results were reported to the organizations’ leadership on a regular basis which enabled timely resolution of any program issues and provided a high level of program support.

Team Approach:

This program was a joint effort between the Henry Ford Medical Group’s Center for Integrative Wellness (CIW), Health Alliance Plan (HAP)’s Purchaser Initiatives, Chrysler, and many Henry Ford Health System Departments and Centers including Employee Health and Wellness, Center for Health Promotion, Public Relations, Biostatistics, and the Center for Health, Education, and Wellness. CIW team members led the clinical design and execution of the program. HAP team members provided the program opportunities at Chrysler through the existing client relationship, in addition to the logistical, financial, and organizational coordination of the project. Henry Ford Public Relations coordinated all efforts to recruit employees; Employee Health and Wellness provided funding for several programs; the Center for Health Promotion assisted with health outcomes data collection; Biostatistics provided data analysis; and the Center for Health, Education, and Wellness provided oversight and monitoring of program content in partnership with the CIW. This model leveraged a cross-function of skills and synergies from all involved to build a highperforming, effective, and efficient program to serve the chronic pain needs of participating employees.

For more information about these projects, contact Dr. Robert Levine, Robert A. Levine, PhD, CHt, Director, Center for Integrative Wellness, Henry Ford Medical Group, (248) 342-7555, rlevine1@hfhs.org.

Keywords: alternative medicine, Detroit, CAM, chronic care, chronic pain, Chrysler, complementary medicine, evidence-based medicine, Henry Ford Health System, Michigan, safety, stress value

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel. 313.876.8709
Dangell1@hfhs.org
www.henryfordhealth.org

Integrating Depression Screening and Treatment in Primary Care Clinics

Depression often remains undetected despite its high prevalence. From 2005-2008 Henry Ford developed, tested, and refined a model for integrating depression screening and treatment into primary care clinics. Pilot study outcomes resulted in a 23% detection rate for depression (220/974 patients). Clinical action to positive screenings (treatment or referral) was 90%, and patient refusal for screening was only 1%. The practice model utilized a nurse practitioner experienced in Behavioral Health to serve as coach to the primary care clinic team for implementing depression screening processes and tools. Medical assistants determined patients’ screening eligibility and administered screening tests, and physicians used test results to drive discussion with patients for diagnosis and treatment plans. The Behavioral Health nurse served to reinforce clinical screening and treatment guidelines and also provide psychiatric treatment. Henry Ford integrated two depression screening tools, as well as evidence-based treatment guidelines, into the electronic medical record system for availability to all Henry Ford clinicians.


Integrating Depression Screening and Treatment in Primary Care Clinics
http://www.henryford.com/body.cfm?id=52274

Aim
To improve the detection and appropriate treatment of clinical depression in Primary Care using an integrated, collaborative depression care model.

Measures
In the first month we tracked weekly the number of eligible patients screened (chart audit of all filled appointments).

  • Number of patients screening positive for depression (DST > 10).
  • Disposition of those screening positive (#/% receiving antidepressant treatment versus referred to Behavioral Health Services versus patient refusal, etc.)
  • Clinical outcomes of antidepressant treatment (mean DST change score, % with 50% reduction in DST score, % with DST < 5).
  • Impact on comorbid chronic disease clinical parameters (e.g., pre-post change in LDL and HgA1C).

Changes
Embedded a nurse practitioner experienced in Behavioral Health in the Primary Care clinic to serve as a depression coach/mentor in a team approach.

Trained the team how to use a standardized screening tool for depression (e.g., DST adapted from the PHQ-9) and evidenced-based treatment guidelines. Convened a team that included representation from all clinic roles (e.g., clinic service representative, medical assistant, RN, MD) to help develop a clinic process for depression care that would be sustainable.

Developed screening criteria for high-risk patients.
Moved from a paper process to the DST embedded within the electronic medical record (EMR) system.

Moved to a two-step screening process, using the PHQ-2 followed by the full DST when the PHQ-2 was positive.
Collaborated with Information Technology to build two new note types in the EMR to document the PHQ-2 screening, and worked to build electronic reports to track monthly depression screening rates.

Results
Pilot results indicated that approximately 50% of eligible patients were screened although initial screening criteria were too broad, resulting in over 300 patients being screened in the first month with a 21% detection rate. This led to the process being amended in two ways: 1) screening criteria were streamlined to patients with either CAD, HF, DM, or complaints of depression; and 2) the PHQ-2 was added, with only those positive on the two-question survey going on to complete the full DST. After adding the PHQ-2, detection with the DST rose dramatically to approximately 60% while significantly reducing the time burden on clinical staff. The integrated model led to Primary Care physicians addressing detected depression > 90% of the time, with initiation of an antidepressant in about 70% of the cases.

Clinical outcomes were impressive, with a group mean change in DST score from 15 at baseline to 7 at 24-week follow-up (50% reduction indicates treatment response and a DST score of < 5 indicates remission).

Further subanalysis of patients with comorbid DM showed that for patients whose depression was successfully treated (DST reduction by at least 50%), 65% showed improvement in HgA1C with a group mean pre-post drop in HgA1c of 1.01 (a 1 point drop in HgA1c has been shown in the literature to significantly reduce diabetes complications).

Next Steps/Lessons Learned

  • Produce electronic monthly reports to track PHQ-2 frequency by site and provider; can assess usage trends over time; email these reports to administrators at the pilot sites monthly.
  • Booster (training) sessions at the initial pilot sites at set time intervals to re-review the process.
  • Periodic case conference at sites that have implemented this process to promote continuous learning and collaboration with Behavioral Health Services.
  • Use of the DICE tool with the design team at the beginning was critical to assess the perceived importance of the initiative and likelihood of project success.
  • Involving the clinical staff (end users) was critical to help build the process.
  • Use of multiple PDCA cycles to test the processes developed, and to revise what was not working well, helped the team to make changes quickly as needed.
  • Giving clinical staff frequent data reports helped each to know how they were performing and what positive impact the new process (and their actions) had on patients.
  • Plan to roll out the program across the Henry Ford Medical Group over time.

Contact Information: Terri Robertson, PhD, Project Manager, Center for Clinical Care Design, Henry Ford Health System, 313-874-2495.

Keywords: access, behavioral health, care team, chronic care, Detroit, depression, evidence-based medicine, Henry Ford Medical Center, health information technology, health screening, Michigan, MyHealth web portal, patient support, patient web portal, safety, treatment, value

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel.313.876.8709
Dangell1@hfhs.org
www.henryfordhealth.org

The Henry Ford MyHealth Patient Portal with eVisits

Henry Ford Health System continually works to integrate web technologies into health care delivery. More than 80,000 patient appointments are scheduled by patients online annually. For personalized management of health services, Henry Ford offers patients the MyHealth web portal, a secured site to access test results, to renew and refill prescriptions, and to perform other tasks including eVisits. More than 65,000 requests for test results and prescription renewals are received each year, and more than 3,000 eVisits have occurred since the pilot study in 2006. An eVisit offers patients easy access to health care by providing virtual clinical consultations for non-emergent conditions. Patients with chronic disease especially benefit from eVisits through increased interaction with their physicians for better management of their conditions between office visits.


The Henry Ford MyHealth Patient Portal with eVisits

Henry Ford Health System has long worked to integrate web technologies into the delivery of health care to continually improve the quality, accessibility, and cost-effectiveness of care. In 2008, more than 80,000 patient appointments were scheduled by consumers on the System’s website. For personalized management of health services, Henry Ford offers patients the MyHealth web portal, which has grown to become the largest eHealth portal in the Midwest with 237,000 patients enrolled.

MyHealth provides a private, secure site allowing patients to view customized health information, obtain laboratory and other test results, renew and refill prescriptions, manage billing issues, and participate in eVisits. More than 65,000 requests for test results and prescription renewals are received annually on MyHealth, and 3,000 eVisits have occurred since the pilot of this new service in 2006.

The eVisit offers convenient, cost-effective access to health care by providing virtual clinic consultations. eVisits may be used for non-emergent acute conditions such as stomach pain, and chronic conditions such as diabetes and hypertension. The eVisit begins when an enrolled patient logs into the MyHealth account and selects a non-urgent problem to report to the physician. A series of targeted questions survey the essential information, much as a physician would during a live office visit, and the patient’s responses are sent securely to the physician’s message center. The physician responds with a course of action or schedules an office appointment. eVisits are free of charge for Henry Ford Medical Group HAP members and $20 for other patients.

The eVisit improves patient access and allows physicians to make more frequent adjustments in a patient’s treatment regimen to achieve clinical goals. Patients with chronic disease especially benefit from eVisits through increased interaction with their physicians for better management of their conditions between office visits.

eVisit patients surveyed had among the highest patient satisfaction scores of those using Henry Ford services:

  • 97% strongly agreed that their physician responded to them in a reasonable timeframe and were satisfied with the quality of the response.
  • 100% agreed they would use eVisit again and would recommend the service to others.
  • In a focus group conducted with insured patients aged 40 to 60 years, patients indicated they wanted even more online interaction with physicians in the future.

Physicians surveyed found the eVisit system easy to use, with 100% of respondents agreeing that:

  • The summation of the clinical patient interview provided adequate information to make clinical judgment.
  • They were satisfied with the quality of their interaction with their patient.
  • They would recommend the eVisit to their patients.

Chart reviews done to determine the clinical quality of eVisits showed that:

  • Patients were using the eVisit system appropriately, software worked appropriately, and physicians were answering appropriately.
  • Of 75 eVisit records reviewed, 86% qualified for a HEDIS measure, with these patients showing improved HEDIS measures compared to patients not using eVisits.

Through continually improving MyHealth services, Henry Ford remains at the forefront of transforming the quality of health care for all patients.

Keywords: access, care team, chronic care, Detroit, e-visits, Henry Ford Medical Center, health information technology, Michigan, MyHealth web portal, patient support, patient web portal, safety, treatment, value

For more information on this project, contact Pam Landis, IT Services, Henry Ford Health System, plandis1@hfhs.org.

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel. 313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org

HealthPartners: Closing the Gap in Health Care Disparities (Breast Cancer)

HealthPartners has made significant progress toward reducing the disparity in breast cancer screening rates between white women and women of color. In 2007, the screening disparity between white women and women of color was nearly 13 percent. Since then, the disparity has closed to an average under 5 percent and, at several HealthPartners clinics, the rates are nearly identical or better in patients of color.


More than ten years ago, HealthPartners began groundbreaking work to close a gap in health care and ensure that care and service is of equally high quality for all populations, regardless of a patient’s race or ethnicity, preferred language, private insurance or public program. To identify and address these disparities, HealthPartners leaders established the Cross Cultural Care and Service Task Force in 2001, and, in 2003, the health system developed a plan to collect self-reported patient demographic data to assist us in creating strategies and tactics to improve care and service for our patients.

Reduction in breast cancer screening disparities for women of color

HealthPartners has made significant progress toward reducing the disparity in breast cancer screening rates between white women and women of color. In 2007, the screening disparity between white women and women of color was nearly 13 percent. Since then, the disparity has closed to an average under 5 percent and, at several HealthPartners clinics, the rates are nearly identical or better in patients of color.

To achieve this, HealthPartners developed customized interventions addressing barriers affecting minority populations to better serve patients. For some women, the extra encouragement from the doctor or care team during a clinic visit made obtaining the screening more likely. HealthPartners responded with a same-day mammography program in which patients overdue for a mammogram are offered the service when at the clinic for some other reason. Other interventions include transportation assistance, telephone outreach and special scripting for providers.

mammo

FOR MORE INFORMATION:

Amy von Walter
Director, Corporate Communications
HealthPartners
8170 33rd Avenue South
Bloomington, MN 55425
tel. 952.883.5274
amy.e.vonwalter@healthpartners.com
www.healthpartners.com

HealthPartners’ ‘Care Model Process’ Creates a Patient-Centered Medical Home

HealthPartners Medical Group used its “care model process” to create a patient-centered medical home by developing primary care workflows that provide a consistent clinical experience for patients and their care teams. Standardized processes and clearly defined roles for staff enable the care teams to create a “continuous healing relationship” with patients.


Excerpted from:

Commonwealth Fund’s Case Study: Organized Health Care Delivery Systems HealthPartners: Consumer-Focused Mission and Collaborative Approach Support Ambitious Performance Improvement Agenda By Douglas McCarthy, Kimberly Mueller, and Ingrid Tillmann, Issues Research, Inc.

http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2009/Jun/1250_McCarthy_HealthPartners_case_study_61_for%20PF.pdf

“HealthPartners clinics have adopted a ‘care model process’ that defines a standard set of workflows for delivering evidence-based care. The process establishes consistent practices for care teams which provide a consistent clini­cal experience for patients.Clinic staff members are organized into ‘prepared practice teams’ composed of a physician, a rooming nurse, a receptionist and others such as a pharmacist or dietitian, when needed, to meet patient needs. The goal is to create a ‘continuous healing relationship’ between the care team and the patient by mak­ing the best use of collective team skills, enhancing communication, and ensuring that care is well-coor­dinated and responsive to patient needs.

These teams typically huddle each morning to review their schedule and objectives and plan for the day. Teams plan for patient interactions in defined cycles which include, scheduling, pre-visit, check-in, visit, and post-visit. Defining the elements of the interaction with patients allows the care team to anticipate patient needs, remind patients of health issues, and provide follow-up after the visit.

For example, pre-visit plan­ning may include identifying preventive care services that will need to be provided at the visit and contacting the patient to schedule lab tests before the visit so that results are available for review during the visit. At the patient visit, the team uses the EHR to address the patient’s health maintenance or chronic care needs, prescription refills, and schedule future appoint­ments. Patients receive an “after-visit summary” to promote better adherence to treatment and to receive outstanding lab results by their preferred method of notification (letter, phone, or online).

The care model process enabled HealthPartners Medical Group to become one of the first large multi-specialty group practices in the nation to be recognized as a Patient-Centered Medical Home by the National Committee for Quality Assurance Physician Practice Connections-Patient-Centered Medical HomeTM

Keywords: access, after-visit summary, care coordination, care model process, care team, communication, EHR, electronic medical records, evidence-based medicine, health information technology, HealthPartners Medical Group, medical home, Minnesota, NCQA, patient-centered medical home, patient support, preventive care, team huddles

FOR MORE INFORMATION:

Amy von Walter
Director, Corporate Communications
HealthPartners
8170 33rd AvenueSouth
Bloomington, MN 55425
tel. 952.883.5274
amy.e.vonwalter@healthpartners.com
www.healthpartners.com

Improved Care Transitions for Heart Failure Patients Strive to Reduce Hospital Readmissions at HealthPartners

Through the use of health information technology and hospital-based care managers, HealthPartners’ discharged heart failure patients are successfully transitioned back home. Then the patient’s pri­mary care physician co-manages the patient with a cardiac specialist in the heart failure clinic, using the electronic medical record to facilitate communication and patient reminders.


Excerpted from:

From Commonwealth Fund’s Case Study: Organized Health Care Delivery Systems HealthPartners: Consumer-Focused Mission and Collaborative Approach Support Ambitious Performance Improvement Agenda By Douglas McCarthy, Kimberly Mueller, and Ingrid Tillmann, Issues Research, Inc.

http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2009/Jun/1250_McCarthy_HealthPartners_case_study_61_for%20PF.pdf

Improving care transitions. The HealthPartners Medical Group and Regions Hospital are working together to improve care transitions for patients with heart failure. For example, primary care physicians receive an electronic alert when one of their heart failure patients is admitted to Regions hospital.

When the patient is discharged, the hospital’s care managers notify the medical group’s heart failure clinic and telephone the patient at home to ensure that he or she has a follow-up appointment and is taking the proper medications. The patient’s pri­mary care physician and a cardiac specialist in the heart failure clinic then co-manage the patient with a jointly agreed-upon follow-up schedule, using the EHR to facilitate communication and patient reminders.

“To promote improved care transitions across its network, HealthPartners health plan recently began reporting on hospital readmissions for heart failure patients for each of its cardiology care groups. As part of its per­formance incentive program for contracted providers in its network, the plan has set a goal of reducing readmissions within 30 and 90 days of an initial hospi­talization to 5 percent and 15 percent of these patients, respectively, from current plan wide rates of 7.9 percent and 17.3 percent during 2005–2007. . . .”

Keywords: care coordination, care team, care managers, communication, health information technology, heart failure, HealthPartners Medical Group, hospital readmissions, Minnesota, patient support, safety, treatment, value

FOR MORE INFORMATION:

Amy von Walter
Director, Corporate Communications
HealthPartners
8170 33rd Avenue South
Bloomington, MN 55425
tel. 952.883.5274
amy.e.vonwalter@healthpartners.com
www.healthpartners.com