The I PiCC Program (Integrated Patient Centered Care)

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The I PiCC Program(Integrated Patient Centered
Care)
Karyn Rizzo RN, CHPN, GCNS
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"
Twice I have asked Alan Greenspan what he
considers the greatest threat to the U.S. economy,
and both times he has answered immediately with a
single word Medicare.
It's a multitrillion-dollar problem that's about
to get dramatically worse.
In the next President's first term, Medicare Part
A will go cash-flow-negative, and it's all
downhill from there.
As the country ages, Medicare and Medicaid will
devour growing chunks of US economic output.
Then by 2070, when today's kids are retiring,
Medicare, Medicaid, and Social Security will
consume the entire federal budget,
with Medicare taking by far the largest share.
"
No Army, no Navy, no Education Department just
those three programs.
Geoff Colvin, Senior Editor, Fortune
Magazine March 4, 2008
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A primary care system on the verge of crisis

• Annual US healthcare expenditures have grown to
  over 2 trillion per year, and are expected to
  double in 10 years
• Only 10 of patients account for nearly 70 of
  healthcare expenditures
• Shift away from PCP reimbursement, fewer MDs
  moving towards primary care role
• Current PCP model does not meet the needs of the
  aging client
• The Drivers are Clear
• Admissions account for the majority of
  healthcare expenses
• 13 of population is 65, yet account for 36 of
  total healthcare expenses
• Re-admissions only exacerbate the problem
• 1 in 5 are readmitted in 30 days
• 75 are preventable and related to medications
• Chronic illnesses causing over-utilization and
  contributing to PCP crisis
• 44 of total healthcare expenditures and second
  biggest driver of admissions

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Project Setting Patient-Centered Medical Home

• Patient-Centered Medical Home (PCMH) model
  accepted by Medicare was developed by NCQA
  staff in concert with the ACP, AAFP, AAO and AOP
  as well as other stakeholders to address
  improvements by the development of specific
  standards in patient centered care
• The PPC-PCMH has 9 standards (see Appendix 4 of
  the NCQA document), each of which has multiple
  elements.
• Major principles of the Patient-Centered Medical
  Home
• Personal MD for each patient
• Physician directed, interdisciplinary teams of
  care
• Whole person orientation acute care, chronic
  care, preventive, end of life
• Coordinated and Integrated Care across all
  elements of health care system and community
• Quality and Safety
• Enhanced Access to Care
• Reimbursement for added value provided to
  patients
• Drawback of PCMH is that it is NOT patient
  centered
• Very heavy focus on EMR

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Extending PCPs reach via IPiCC Pilot
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Why Lead Transitions with PharmD?Dovetail
outcomes (pharmacy intervention)
Dovetail's focus on medications has reduced
readmissions to less than 10 (N100)
Reconciliation Issues
Med Adherence Issues
94 of Dovetail clients have medication adherence
issues identified during initial pharmacy
assessment
75 of Dovetail clients have medication
reconciliation issues identified during initial
pharmacy assessment
ex. med was left off discharge summary
ex. Discharged with med but no Rx
ex. Did not fill Rx, refuses to take med
ex. dosage was changed
ex. warfarin and coumadin
ex. instructions not understood, can't afford meds
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IPiCC is a program that fill gaps in the market
place while addressing the most significant
drivers of cost
10 of patients account for 70 of healthcare
costs the majority of these costs can be
attributed to inpatient admissions Supporting
these patients at the right time in the care
continuum can reduce the incidence of unnecessary
utilization
1. Health Management
2. Transition Support
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Project goals

• Reduce overall healthcare expenses by focusing
  on the most common cost drivers (admissions and
  readmissions and chronic illness)
• Increase patient satisfaction by offering
  personalized, targeted interventions to improve
  overall health from a consistent team of
  healthcare providers
• Increase PCP satisfaction with their job overall
  as well as their ability to care for complex
  patients
• Help primary care practices take steps toward
  Patient-Centered Medical Home accreditation by
  providing specific services identified in NCQA
  guidelines

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Project Timeline and Ramp-Up Schedule
Concept and operations development
Outcomes measures and tracking systems
Patient data collection
Data analysis / program evaluation
Staff hiring and training
Kick-off
Service delivery
Outcomes and recommendations
Implementation strategy
Sep. 08
Jan. 09
Feb. 09
Sep. 09
May 10
Patient Ramp-Up Schedule
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Measuring clinical outcomes
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The clinical centered tool (CCT)

• Collects interventions as well as outcomes
• Embedded SF-36 for pre and post intervention data
• TTM evaluation
• Incorporates all areas of geriatric domain
  concerns
• Has report functionality
• Guides clinicians in using a strength based
  approach to in home coaching (Framing the visit
  in the positive)
• Client centered
• Excel spreadsheet database which allows for great
  flexibility in data collection and
  interpretations

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Value proposition selling complex patient
management to payer and provider groups under
risk contracts
40,000 Medicare Advantage members
Top 5 of highest cost / highest risk
patients 2,000 patients qualify for services 50
accept services 1,000 patients enrolled in
program
Patient Identification
2000 admissions / 1,000 among patient group per
year 1,000 patients in program will have 2000
admissions (10,000 each-AHRQ) 20M problem
(41.66 pmpm)
Size of Problem
1,000 patients enrolled for 4 months each (450
per month) 1.8M program cost (3.75 pmpm)
Program Cost
12 reduction in admissions 2.4 M avoided cost
600K) 15 reduction in admissions 2.25M
avoided cost 3M 25 reduction in admissions
3.75M avoided cost 5M
ROI
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Questions / Discussion