80% by 2018 forum iii · provider nurse (rn, lpn, rma) ... pmpm incentive for achieving pcmh...
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80% by 2018 FORUM III
Workshop: Patient Navigation Sustainability Mary Gay C
How to Pay for Screening Navigation Toolkit
Lead Developer: Andrea (Andi) Dwyer Co-Director: Colorado Colorectal Screening Program Steering Committee Member NCCRT The University of Colorado Cancer Center
Microsite Supported by University of Colorado
http://pntoolkitresources.weebly.com/
The Toolkit is formatted in initial draft in PDF Format Save To Your Device, Active Links Print Out Evaluate!!! PLEASE!
This Toolkit is timely as there is not one direct way to pay for navigation and requires dedicated planning
There is a wealth of data to show improvement in health outcomes and cost savings with inclusion of patient navigation
Many states, regions and cities have accomplished success in payment-many are struggling
This Toolkit aims to pull real world examples, evidence and opportunities to ensure colorectal cancer screening patient navigation is a reality for those who navigation the most
DISCLAIMER: This guide was made possible in part by funding from the Centers for Disease Control and Prevention Cooperative Agreement Number 5U38DP004969-02 and 03. The views expressed in the material do not necessarily reflect the view of the Department of Health and Human Services.
Special thanks to American Cancer Society, The National Colorectal Cancer Roundtable with support from the Centers for Disease Control for supporting this effort
Chapter 1: Ignites Sustainability Themes….
Chapter 2: Provides evidence and defines patient navigation for colorectal cancer screening: • Defining Quality Patient Navigation • Professional and Public Health
Guidelines Which Illustrate Evidence • Evidence to Suggest ‘IT WORKS!’ • How to Apply This Information to
Sustain Efforts and Make the Case for
States: Colorado South Carolina New York City Alaska New Hampshire Each Demonstrates: • Setting • Detail about Approach • Lessons learned • HOW TO! • Connects to all the other Chapters
and themes in sustainability to see how it all fits together!
Chapter 3: The Details About Setting and Approach
Perspectives on the Policy Resources in the Toolkit and how this resource can help educate and inform policy work The opportunities with the National Colorectal Roundtable for Advancement of policy work for patient navigation
To Get Started: Grants and foundational support might be a means to begin There are possible methods for payment through accountable care opportunities, the ACA and perhaps allowable codes for care coordination Making the business case can also be a viable and sustainable approach, Chapter 6 can tell you how!
Answer: EVALUATE
Chapter 1: Data-Key to sustainability Chapter 2: Data to contribute to evidence Chapter 3: To sustain programs must evaluate Chapter 4: Must monitor data for grants and also many payment approaches Chapter 5: Data is all used for quality and accreditation Chapter 6: Cost analysis must have evaluation data Chapter 7: Policy, organizational and legislative rely on data to make the case
This Toolkit Will: Help people in different settings and
different phases think about payment and sustaining patient navigation
Give examples of what programs and initiatives
have worked with patient navigation at the core
Additional Resources Will: Provide greater insight about how to initiate
specific programs
Inform how to manage and supervise patient navigators
Many other opportunities
(See Chapter 9)
Chat Today Email Me: [email protected] 303.724.1018 http://nccrt.wpengine.com/about/provider-education/paying-for-screening-navigation-toolkit/
Thank You!!
This resource was made possible in part by funding from the Centers for Disease Control and Prevention Cooperative Agreement Number 5U38DP004969-03. The views expressed in the materials and by speakers and moderators do not necessarily reflect the official policies of the Dept. of Health and Human Services.
Questions Watch Us: To follow NCCRT on social media: Twitter: @nccrtnews Facebook: http://www.facebook.com/coloncancerroundtable For more information contact: [email protected]
Franklin G. Berger Ph.D. Colorectal Cancer Prevention Network
Center for Colon Cancer Research University of South Carolina
Educate Nature of CRC and importance of screening Colon prep instruction/FIT instruction (Poop on Demand) Expectations day of procedure (Steve Harvey video)
Support Address barriers, fears and concerns Reminder calls to increase compliance
Coordinate Address issues/barriers (cultural, economical and social) Understanding of outcomes
Evaluate Collect and analyze data on patient navigation processes Collect and analyze data on screening procedure, quality and outcome.
Patient Navigators aim to increase CRC screening in uninsured and medically underserved communities. Our Patient Navigators assist patients in accessing education, awareness, screening, and specialized care.
Patient Navigators contribute to:
• Increasing overall screening rates • Improving colonic preparation quality (Bowel Prep
quality)
• Increasing compliance to screening (% of completion)
• Improving screening outcomes (PDR, ADR, Cecal Intubation)
• Reducing specialized care cost of late stage CRC treatment.
The CCPN developed a virtual database that collects information on CRC screening and patient navigation interventions.
• Information is collected on the number of patient interaction by the Navigator (# of calls to and from patients, # of in person visits, # of intervention to seek care/address barriers).
• Information on screening modality selection. • Information is collected on referrals to
specialized care, and/or follow up visits.
The CCPN developed a virtual database that collects information on procedure quality outcome:
• Provides colonoscopy reports outcomes (quality of colonic prep, Polyp Detection Rate, Adenoma Detection Rate, cecal intubation rate).
• Provides pathology report outcomes (type of lesions, screening interval).
• Improving screening outcomes (PDR, ADR, Cecal Intubation).
Registry Data Collection Elements
Patient demographics Medical history Medication usage Behavioral measures Eligibility criteria Navigation details Colonoscopy Details Pathology Findings Polyp tissue consent
In a nutshell:
Patient navigation saves downstream healthcare costs, and provides assistance
to patients to increase compliance.
That is the key argument to funding patient navigation.
Once you have all this information…..
….where do you get the funds from to support Patient navigation?
Grants/Contracts Corporate giving Foundations Public Sector Philanthropic Organizations Private Donors
FEDERAL: •National Institutes of Health… Program administration, research, fiscal management.
•Centers for Disease Control… Implementation of evidence-based interventions to increase CRC screening.
STATE: • South Carolina General Assembly… Patient navigation, screening services, awareness and education.
CORPORATE/FOUNDATIONS: •BlueCross/BlueShield of SC Foundation… patient navigation and screening /clinical services.
• The Duke Endowment… patient navigation, program management, evaluation, electronic registry
• BlueCross/BlueShield of SC, CVS Caremark, SCANA, Genentech, American Cancer Society, CVS Caremark…messaging, awareness, PSAs, billboards
CULTIVATION/ADVOCACY/FUNDRAISERS: •Private donations…Awareness, education and engagement
• SC Gastroenterology Association…Champions/Advocacy, screening services
Know from whom you request funding, and what they are interested in. Talk to them in a language they understand. Emphasize the benefits of patient navigation on outcomes:
Increasing compliance and productivity associated with screening Reducing disease incidence, Saving lives, Decreasing health care costs associated with late stage treatment.
“How many lives are saved? How many $$$ are saved?” Funders like to leverage each other, with each wanting to know that others have “skin in the game”. Engage champions: survivors/family members, academics, physicians/GIs, legislators.
Bottom line….patient navigation saves lives and saves money. Make that case (DATA) with: • Your hospital system • Your CEO, CFO and CMO’s • Your health plans • Your MCO’s • Your Health Services Departments • Your legislators
Academics make a living writing grants and proposals. Engage and champions and survivors as appropriate!
Thank-you notes (esp. to legislators) from grateful program beneficiaries build support.
Engage champions and survivors as appropriate!
Annie Thibault, MS Community Outreach Director 803-543-9608 [email protected] Franklin G. Berger, PhD Director, CCCR 803-777-1231 [email protected]
Beulah, Hazen, Killdeer, and Center, North Dakota
Chastity L. Dolbec, RN, BSN, Director of Patient Care & Innovation
2016 Patient Demographics
10,052 unique patients 61% Private Insurance 18% Medicare 21% Uninsured / Medicaid
39,050 visits
Physician/Mid-Level Provider Lead
⇕ Provider Nurse (RN, LPN, RMA)
⇕ RN Care Coordinators / BHCC / Community Care Coordinator
⇕ Certified Nursing Assistants
⇕ Support Staff – lab, radiology, reception, med recs, certified
coders and billers, behavioral/mental health
Coal Country Community Health Center (FQHC)
⇕ Sakakawea Medical Center (CAH)
⇕ Mercer County Ambulance
⇕ Beulah Drug and Hazen Drug
⇕ Knife River Care Center (Skilled LTC)
⇕ Custer Health (Public Health)
Preparing the Foundation to Pay for Screening Navigation One Step at a Time…
BCBS – MediQhome (2010-2011) ◦ Care Management Fees for PCMH principles ◦ Population Health Management – Chronic/Preventative Addition of RN Care Coordinator – initial step taken
CMS FQHC APCP (Advanced Primary Care Practice) PCMH Demonstration (2011-2014) ◦ 500 FQHCs awarded – PCMH transformation (NCQA) ◦ PMPM incentive for achieving PCMH recognition Educational resources to guide transformation Addition of support staff (certified nursing assistants) and
RN Care Coordinators (Patient Navigators)
Expanded Services - Increase in demand = Increase in Provider teams (2012 to current) ◦ 23.04 FTE in 2012 compared to 35.95 FTE in 2016
HRSA PCMH Supplemental Funding (2011 – 2012) ◦ Patient engagement and outreach
HRSA Quality Improvement Funding (2015 – 2017) ◦ Patient engagement and outreach ◦ FluFIT campaign – community approach ◦ Expanded Care Coordination throughout all four clinics ◦ Addition of Administrative Position – Community and
Patient Engagement Director
CMS AIM Funding – Caravan Health (2016 - current) ◦ MSSP – Track 1 Accountable Care Organization ◦ Additional reimbursement for services provided
(prepaid shared savings) Revenue generated through Annual Wellness Visits
(W2M, IPPE, Subsequent) TCM, CCM services
National Colorectal Cancer Roundtable (2016) ◦ 80% by 2018 National Achievement Grand Prize
Award Continued work with outreach and engagement FluFIT, Colorectal Cancer Screening projects
DSHII (Delivery System Health Information Investment) Funding (2016-2017) ◦ Population Management Software purchase ◦ Improved efficiencies of navigation overcoming EMR challenges
PCMH QI Supplemental Funding (2017 & Beyond) ◦ Further funding supporting navigation efforts
ND DoH – Division of Cancer Prevention & Control ◦ Electronic Health Record Project Grant ◦ ECHO Project – Extension for Community Healthcare Outcomes
PCMH QI Supplemental Funding (2017 & Beyond) ◦ Further funding supporting navigation efforts
How did we step off the curb?
Team Approach
EQUALS Sustainability
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Administrative Support ◦ BOD, Admin Team including Medical Director
Medical Home Team Engagement ◦ Provider-led ◦ RN Care Coordinators ~ Patient Navigators (dual role) ◦ RN/LPN/MA ◦ Support staff
Quality Champion ◦ Innovative QI Projects ◦ Tracking
Collaboration = Success in Improving Patient Outcomes Partnerships with Community Organizations
Medical Neighborhood ◦ FQHC (four clinics) Comprehensive Care Coordination
In-reach / Out-reach Screening Diagnose Refer & Treatment Transitions in Care
◦ Critical Access Hospital (CAH) Direct Link to Colonoscopy Referrals On-site surgeon, CRNA, visiting surgeons Transitions in Care
◦ Public Health Preventative screening, FluFIT Transitions in Care
◦ Pharmacy FluFIT
◦ Long Term Care – Skilled Nursing Facility Comprehensive Care Coordination Transitions in Care
Navigation EQUALS Improved Health Outcomes ◦ 100% review of all patients – yearly at a minimum (most
often 2X/year) CRCS – Feb and Sept review for Innovation projects in March
and October Recall protocol – three attempts over 4 months (letters and
phone calls) ◦ Tracking of referrals/consults (colonoscopy) ◦ Direct link to referring surgeon (local CAH) Care Coordination / Navigation closes the loop
◦ Innovative approaches to patient engagement Social media Newspaper Community Engagement
Partnership with local American Cancer Society Chapter ◦ North Dakota Colorectal Cancer Roundtable Clinical Expertise
80% by 2018 Initiative Toolkits and Resources
Flufit.org Annual Flu FIT campaign within Medical Neighborhood FQHC, CAH-RHC, Public Health, Pharmacy
Emphasis on Team Based Care Through the Delivery of… Evidence-based Clinical Guidelines
Sharing of Best Practices – CCCHC presentations Standardized Job Descriptions
Clearly defined responsibilities for navigation Team approach – all share in responsibility of navigation
Partnership with PCA, NDDoH, & ACS – EQUIP (ECHO Collaborative
Quality Improvement Project for Cervical Cancer Screening ◦ Interactive Distance Learning series to develop QI plan ◦ ACS Representative – Shannon Bacon (Coach)
Partnership with NDDoH and QIO (Quality Health Associates of ND) ◦ Electronic Health Record Enhancements to Improve Cancer Screening Rates
Lab information system interface Staff hours for training – new population health management software
CCCHC Local Partnerships ◦ Local Business Employee Health and Wellness programs ◦ FluFIT ◦ Get Your Pink On – Mammo Marathon ◦ Pap & Pamper – Cervical Cancer Awareness Month
Community Supported Event ◦ 1st Annual Women’s Day – Fall 2017
Focus on all three cancer screening measures with community support
0
20
40
60
80
100
2012 2013 2014 2015 2016 2017
CRCS Breast Cervical
MSSP - ACO Quality measures ◦ CRC screening ◦ Decrease in Potentially Preventable ER Visits (PPEV) ◦ Decrease in Potentially Preventable Admits (PPA) ◦ Shared Savings
UDS measures ◦ CRC – continued improvement
BCBS Blue Alliance – Rural ACO ◦ Improvement in WCC completion rates ◦ Decrease in PPEV ◦ Decrease in PPA ◦ Shared Savings
NCQA Patient Centered Medical Home recognition Improved Patient Satisfaction
Screening ◦ Two office visits for colonoscopy ◦ Transportation for colonoscopy – identified through our
CHNA Grant Expenditures ◦ Notice of Grant Award – not clearly defined ◦ Change mind – mid cycle of grant award ◦ Time commitments for reporting requirements ◦ Too short of turn around from notice of grant to
implementation/finalization of project ◦ Smaller health centers – Rural America – QI staff wear
multiple hats Similar QI projects from competing organizations ◦ Improve Alignment with other organizations for mutual
outcome
