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Outcomes Data
1. LOWER READMISSIONS2. LESS ER USE3. SATISFACTION
• Patient• Staff
4. IMPROVED BIOMETRICS• Diabetes• Blood Pressure• Weight Loss
5. BEHAVIOR CHANGE6. STAFF PRODUCTIVITY7. COST SAVINGS
Seven parameters tested in Care Kit studies to date
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Statistical reliability: The probability that the results were due to chance is less than 1%An improvement greater than 15%. The American Society of Quality Control says this level of change is breakthrough innovationA validated measurement. When you measure one way, then measure another way and get the same result, your initial measurement is valid.Success where others have failed. If you achieve results where national authorities say results are hardest to achieve
What Makes an Outcome Compelling?
Results are replicated. When you not only do it once, but over and over and over and over and…
>99%
>15%
✔
On the outcomes report slides that
follow, watch for a Ribbon Symbol
to see which of these 5 reasons
make that outcome
compelling
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95%
0
7.4%
BEFORE: Vitas Medical Center NJ had used books from the American Lung Association, so clinical accuracy was assured.
WITH CARE KITS: Distributing the Care Kits, with no other changes or interventions, •More than doubled adherence•Eliminated readmissions•Reduced ER use by 72%
Persistence 6 mo 44%
Readmissions 16%
Use of the ER 26%
Asthma Care Kits aloneEliminated Readmissions
BEFORE AFTER
EVIDENCE that CLINCAL ACCURACY by itself is not adequate
for effective PATIENT
COMMUNICATION
The probability that the outcome was chance is less than 1%. That means if you adopt Care Kits, it’s 99% likely you’ll see comparable results See Appendix for calculations
>99%
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• Data collected from each group at 6 months• Study designed & conducted by hospital staff
BEFORE: Northwest Community Medical Center had failed to change behavior with a year-long Disease Management program
Heart Failure Care Kits Changed Behavior
Weighing Daily
Taking Blood Pressure
Medication Compliance
27%
14%
77%
86%
14% 59%
BEFORE AFTER IMPROVEMENT
514%
321%
185%
EVIDENCE: CARE KITS ARE
MORE EFFECTIVE AT ENGAGEMENT
BEFORE AFTER
The probability that the outcome was chance is less than 1%. That means if you adopt Care Kits, it’s 99% likely you’ll see comparable results See Appendix for calculations
>99%
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J Reeves, MD Director Nevada State QIO
J Ambulatory Care ManagementV36, No. 2, pp. 108-120 March 2013
Multiple Conditions in a Medical Home Care Kits saved $1.5 million
TOTAL MEDICAL COST
Blood pressure Cholesterol Blood sugar
Emergency Room visits
In-hospital days
Health Plan net savings exceeded $56 PMPM $1.5 million / 1000 members
Member savings = 30% lower out-of-pocket cost than the alternate PPO plan
54%
“Breakthrough Innovation” says the American Society for Quality
>15%
712 participants 24 months
85% better scores
23% lower
16% fewer visits
Imaging services 35% lower use
fewer days
COMPARED TO BASELINE YEAR
Prescription cost per member 18% lower cost
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Discharge Teaching Time Care Kits Improve Quality & Productivity
144% improvement in standardization
of time spent at discharge
“Breakthrough Innovation” says the American Society for Quality
>15%
Care Kits
Care Kits
Care Kits
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BEFORE AFTER
17%
0% 0%
92%
ER Returns Readmissions in less than 31 days
After Prostate Surgery Care Kits eliminated ER Returns and ReadmitsControl and Intervention Groups were concurrent
BEFORE AFTER
in less than 31 daysSt. Joseph Mercy HospitalAnn Arbor Michigan
“Breakthrough Innovation” says the American Society for Quality
>15%
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TIME OUT!
“These results are not credible. They’re too good.” “There must be flaws in the study designs.”
Communication Science researchers shadow hundreds of patients at home, in the workplace and around the community. For each condition, they find the problem preventing adherence and they fix it just as the consumer products industry has done for decades. Observational research increases consumer products sales by giant proportions. Why not health care?
The model for fixing adherence is not clinical, where a new treatment may improve a condition by a small percentage.The model is mechanical, where you take a broken machine to the mechanics and they fix it.
But let’s not argue. Set up your own study for Care Kits. See for yourself, on your own terms
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AFTER BEFORE
XX CSI
Over 140/90 88%
Below 140/80 12%
Employer Wellness Initiative: Prior year home visit program had failed
Home visit outcome: 12% in controlCare Kit outcome: 88% in control
All readings confirmed at clinic after six months
6%
88%
Hypertension Care Kits
performed 6 X better than face-to-face visits
Results were measured one way, then confirmed by measuring a different way = valid results
✔
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We took them on in South Carolina using outcomes analysis software
CMS: “Truckers are the most difficult employee group to effect behavior change.”
Multiple Conditions Care Kits are the first to achieve ROI with Truckers
Return on InvestmentFor every $1 the trucking company invested, they received $1.79 in savings
--to our knowledge, the first successful trucker health intervention
Success exceeding levels previously achieved by all others
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Diabetes Care Kits could
serve well as curriculum for classes
P= 97%
CARE KITCLASSES
9.3 8.7
New York City
Cleveland, OH Readmissions
in 30 days 10.4% <1%
9.6% 5.9%Emergency in 30 days
Head-to-Head with Diabetic Education Classes
CARE KITCLASSES
Impact after three months
A1c Score
Care Kits were >90% better at preventing readmits
39% better at preventing ER returns
Care Kits brought down A1C numbersafter classes had not impacted population
Success exceeding levels previously achieved by all others
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Success exceeding levels previously achieved by all others
Patient Satisfaction Care Kitsachieved 33% higher scores “Were you satisfied with the materials for self care?” “Did they help you manage your condition?”
Hypertension
Yes – 94.9% No – 2.9%
Diabetes
Yes – 93.6% No – 6.4%
CAD
Yes –100%University of Pittsburgh Health Plan
Press-Ganey national 5-year average = 72%Care Kit UPMC 5-year average = 96%
Heart Failure
Yes – 97.3% No – 1.8% Asthma
Yes – 92.5% No – 2.5%
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AMA said getting >33% of the population to comprehend = impossible
154 Patients from Orthopedic and Abdominal Surgery Nurses called one week after discharge, “Were you able to follow your instructions without asking anyone for help or calling back the doctor or the hospital?”
Before Care Kits
After Care Kits
“How satisfied were you with discharge?”
Before Care Kits
After Care Kits
35%100%
92%
4%
RUSH Medical Center “Patient Satisfaction”
Hospital Peer Review Journal September 2000
Post Surgical Dressings Care Kits outperformed Education Committee
Success exceeding levels previously achieved by all others
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St. Joseph, Lexington KY
St. Joseph, Elgin IL
NWC, Arlington Hts. ILDRG 127 ONLY
NWC, Arlington Hts. ILALL CHF-RELATED DRGs
Aurora, Milwaukee WI
Great Plains, Elk City OK
Mercy Hospital, Chicago
VA, Ann Arbor MI
BEFORE AFTER REDUCED BY
6.4% 4.0% 38%
16.7% 7.7% 54%
13.2% 8.7% 34%
22.2% 6.3% 72%
8.6% 2.2% 73%
23.4% 6.9% 74%
>28% 0% 100%
90 daysThompson-Reuters Statistical Analysis
Heart Failure Care Kits Reduce or Eliminate Readmissions
58.2% 35.5% 39%
30 days
60 days
When you achieve outcomes over and over and over and over again
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Summary: Compelling ResultsStatistical Reliability
Breakthrough Innovation
Validated Measurement
Exceeded authorities’ threshholds
for success
We have achieved >99% reliability in Diabetes, Hypertension, HF, Asthma, Post-Surgery, et.al.Our worst performance, 34% = more than
double the “breakthrough” definition. Many outcomes >70%, even 100%
Self-reported confirmed by clinic measurement Self-reported confirmed by software analysis Self-reported confirmed by Thompson-ReutersCMS: Truckers most resistant; achieved ROI
National average 72%; Care Kit average 96%
AMA prediction = 66%; Care Kit result = 92%
“If you were a drug, you’d be approved”--F. I. Orkin, former Corporate Director of Quality and Regulatory, Baxter Healthcare
Replicated Results Dozens of studies, all with breakthrough results
>99%
>15%
✔
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√
READMISSIONS
P >99%
USE OF THE ER
Appendix: Statistical Reliability
P >99%
P >99%
PERSISTENCE at 6 MONTHS
As many times as you repeat a study, statistics says 99% of the outcomes will fall within + or – 3 standard deviations of the initial result. The chance of a result outside ±3Σ is less than 1%
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1550 Barclay BoulevardBuffalo Grove IL 60089847-850-7500www.carekit.com
Michael Weiss President
Shirley Grey RN MSN VP Health Plans
Carol Outland RN MSN VP Home Care
Judith Farah Director of Operations
Sylvia Aruffo PhD Chief Content Officer
7.10.13