Cincinnati USA Regional Health

Transformation Initiative

South Carolina Business Coalition on Health

May 2012

www.TransformCincyHealth.org

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Cincinnati USA Regional Health Transformation Initiatives 2

Cincinnati landscapeFertile ground for change

Extensive health systems– 30+ hospitals

– 5,000 physicians

– Active collaborations Strong experience with

innovative pilots National healthcare IT leader Engaged employer base (GE, P&G, Kroger, Fifth Third, etc.)

Greater Cincinnati Health Care Project

Health LeaderKickoff 3/26

• Call to Action • VOC• Host by Collaborative• GE Facilitate• Cross Industry

Representation• Develop Strawman &

Guiding Principles for Project

• VOC• Verify Strawman• Revise Strawman• Broaden Audience

• Cross Functional Membership

- Chamber - Academy of

Medicine - Health Council - Health

Collaborative - Health Bridge• Develop Strategy• Develop Plan

• Conduit for Improvements/ Efforts

• Specific Project Implementation

ImmeltChamber

Presentation

CommunityHealth Care

Summit — May

SteeringCommittee

ExistingInitiatives/

Venues

GMT• Community

Guidance Team• Keep Project on

Course

VisionMissionScopeBusiness Case

Define

Old Process MapBaselineQFDParetoDefect DefinitionTarget

Measure

Variation DriversPerformance

ObjectivesKey performance

IndicatorsCritical to Process

Factors

Analyze

ToolsIncentivesFundingAcceleratorsEnablers

Improve

Contract Language

Payment Reform

Control

Process: Inclusive, Open, Transparent

2010

Cincinnati Regional Health Transformation Aims

1. Better health2. Better care3. Lower cost

Estimated impact through 2014 (not all inclusive): • 20% improvement in diabetic outcomes • 10% fewer Emergency Department visits• Cost reduction = $500MM+

Cincinnati USA Regional Health Transformation Initiatives 5

How we operate…Regional Health Transformation Sustainability Model

Cincinnati USA Regional Health Transformation Initiatives 6

Social Innovation meets Healthcare Innovation in Cincinnati: Collective Impact for Health

1. Common Agenda2. Shared Measurement3. Mutually Reinforcing Activities4. Continuous Communication5. Backbone Support

Cincinnati USA Regional Health Transformation Initiatives 8

Common Agenda:3 Aims 5 Strategic Priorities

Foundational Goals Healthymagination

3 AimsCommunity Leaders Voice of Customer

Population Health

Experience of Care

Per Capita Cost

Strategic Priorities

Primary Care – specifically Patient-Centered Medical Home

Health Information Exchange that is interoperable across the community and informs the Quality Improvement and Payment Innovations work.

Quality Improvement support for primary care and transitions in care.

Public Reporting that makes quality, price and patient satisfaction transparent and enables consumer engagement.

Payment Innovations that rewards value, using shared savings components.

1

5

4

3

2

Access

Quality

Cost

Shared Measurement: Progress ReportAim Focus Area Measure

Baseline Current Goal Timeline MeasureSteward

Better Care

Optimal Diabetes Care

Diabetes Composite Measure: percent of patients in control of their Diabetes

28% 29% 35% 05/2013

M. Kennedy

Optimal Asthma Care

Percent of “high-risk” pediatric asthma population rated “well-controlled” by physician and parent

28.6% 75.6% 80% 12/2012

K. Mandel

Patient Experience Patient rating of understanding post-hospital instructions (indicator of care coordination)

82% 82% TBD TBD

N. Strassel

Disparity in Care Percent of acute care CES hospitals submitting all three Race, Ethnicity and Language fields accurately and consistently

56% 94% 90% 6/2013 N. Strassel

Access to Primary Care

Percent of the community reporting that they have a usual source of medical care

84% 84% 95% 2020

United Way Bold Goal

Patient Safety Percent reduction in regional rate of Patient Falls (with Injury) and Pressure Ulcers in local hospitals.

.115 falls /1,000; 2.0 pressure ulcers/10,000

.13 falls /1,000; 2.8 pressure ulcers / 10,000

.07 falls /1,000; 1.2 pressure ulcers/10,000

12/2012 N. Strassel

Electronic Health Records Use

Percent of primary care providers that are “meaningful users” (M3) of electronic health record technology

M 1 – 0%M 2 – 0%M 3 – 0%

M1 – 75%M2 – 58%M3 – 0.4%

Meaningful Use (M3) - 60%

2013

D. Groves

Better

Health

Body Mass Index Percent of adults whose BMI is ≥ 30 (BMI is a healthy weight estimate based on height and weight)

30.9% 30.9% 30.6% 2020 J. Chubinski

Tobacco Current smokers29% 29% 12% 2020

J. Chubinski

Mental Health Percent of adults who report good mental health60% 60% N/A N/A

J. Chubinski

Self-reported Health Status

Percent of adults who report being in “excellent” or “very good” health 50% 50%

70% 2020 J. Chubinski

Percent of primary caregivers who report their child’s health status to be “excellent” or “very good”

87% 87% N/A N/A J. Chubinski

Colon Cancer Screen Percent of patients aged 50 – 75 who have received the appropriate colorectal cancer screening

TBD 05/2013 M. Kennedy

Infant MortalityNumber of infant deaths within the first year of life per 1,000 live births (14 county service area)

8.4 8.5 6.0 2020

Ted Folger

Number of infant deaths within the first year of life per 1,000 live births (Hamilton County)

11.1 10.4 6.7 12/2012

Ted Folger

Substance Abuse Percent of adults who report binge drinking in the last month (in a single sitting, 5+ drinks for men; 4+ drinks for women)

19% 19% 24% 2020

J. Chubinski

Lower Cost

Total Cost of CareTotal annual per capita cost of patients with diabetes TBD 05/2013

M. Kennedy

Total annual per capita cost (14 county service area) TBD 05/2013

M. Kennedy

30-day Readmissions Percent reduction in heart failure all-cause readmission rates. 23.63% 23.46% 21.27% 01/2012

N. Strassel

Emergency Department Visits ED visits per 1000 population TBD 05/2013 M. Kennedy

Mutually Reinforcing Activities

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Continuous Communication: TransformCincyHealth.org

Cincinnati USA Regional Health Transformation Initiatives

Cincinnati USA Regional Health Transformation Initiatives 12

Resulting in better care…

Cincinnati USA Regional Health Transformation Initiatives 13

% high-risk pediatric asthma patients rated “well-controlled”

by MD and parent

2010 2011 2012 Goal0%

20%

40%

60%

80%

100%

Optimal Asthma Care

2009 201020%

25%

30%

35%

40%

Optimal Diabetes Care

Non-PCMH PCMH

% diabetes patients meeting following goals:

1) A1C < 8 2) BP < 140/903) LDL < 1004) Tobacco free

Resulting in lower cost…

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2007 2008 2009 2010600,000

800,000

1,000,000

1,200,000

1,400,000

999,448

1,092,435

1,169,703

1,068,459

Emergency Department Visits

Actual ED visits in ‘10 were 185k less than projected; 100k less than ‘09

*Projected at historical trend of 7%; Estimated cost per ED visit = $1,100

1,252,436*

$200M saved vs. projected