presentation title mark carroll, md jon perez, phd july 31 ... · presentation title a conversation...
TRANSCRIPT
Presentation Title
A Conversation On Quality
Mark Carroll, MDJon Perez, PhD
July 31, 2019
What is “Quality”?
The Institute of Medicine defines health care quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."
Current trends …
• Shifting demographics (eg. the “aging of America”)• Hospital consolidations and system mergers• Shift from inpatient to ambulatory• Chronic disease management• The importance of mental health/behavioral health• “Consumer” engagement & “Digital health”• Industry disrupters (e.g. Amazon, CVS)• “Value vs. volume”
“The economics of health care are shaping quality discussions”
“Population Health”
“The health outcomes of a group of individuals, including the distribution of such outcomes within the group.”
Kindig and StoddartAmerican Journal of Public HealthMarch 2003
“The health outcomes of a group of individuals, including the distribution of such outcomes within the group.”
Kindig and StoddartAmerican Journal of Public HealthMarch 2003
By geography or community
“High risk”
“Rising risk”
“Low risk”
By patient medical need
By other characteristics
• Demographic feature, such as age• Examples: Children, elders
• Common need or concern• Examples: People who are homeless or without food security
• Common experience• Examples: Veterans, employees, insurance carrier
• Some combination of considerations• Example: Adults with behavioral health needs who live in “x” community
Perspective of the “4 Ps”
• Payers• Plans• Providers• Patients
The “4th Aim” = Clinician satisfaction or “joy”
Population health is about focusing on:
• specific groups of people
• cross-sector interventions for those groups – i.e. working differently
• the health outcomes, experience & cost of care for those groups of people.
Social “Influences” of Health
Built Environment
Social Context
Access of HealthcareEducation
Economic Stability
“Social Determinants of Health”
Source: CHCS Brief, Dec 2016; adapted from McGinnis et al, Health Affairs 2002: 21(2)
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The Currents are Equally Important
Examples of Outcomes
Hospital readmissionsAvoidable ED visitsAmbulatory visitsSatisfactionStable housingFood securityClinical condition metricsCost of careIntegrated care plan developmentLinkage to community supportsHealth insurance statusTransportation
Institute for Healthcare Improvementwww.ihi.org
Holistic Solutions
https://www.ihs.gov/newsroom/factsheets/behavioralhealth/
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World Health Organization
Mental health challenges are a leading causeof disability worldwide.
Burden of disease by ageBurden'of'disease'by'age'
Orygen has been a global pioneer in early intervention and working with 12–25 year-olds. This age is when 75% of all mental diseases occur.
11Capital project support request to the Ian Potter Foundation
Physical illnesses
Mental illnesses
Annu
al in
cide
nce
per 1
,000
peo
ple
Global Burden of Illness:#1 Health Issue for Young People
Dr. Steven Adelsheim, Stanford Center for Youth Mental Health and Wellbeing
Dr. Steven Adelsheim, Stanford Center for Youth Mental Health and Wellbeing
Major Depressive Episode in Past 12 Months (U.S.)
https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adolescents.shtml
Recent national trends in suicide attempts show significant increases in young adults who have a high school education or less, and those with a
history of anxiety and/or depression
http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2652967
September, 2017
Encounters for SI and SA at US. Children’s Hospitals increased steadily from 2008 – 2015.
http://pediatrics.aappublications.org/content/141/6?current-issue=y
June, 2018
In Arizona, the leading cause of death for children ages 10-14 is:
a. Motor vehicle accidents
b. Infections
c. Respiratory diseases
d. Suicide
In Arizona, the leading cause of death for children ages 10-14 is:
a. Motor vehicle accidents
b. Infections
c. Respiratory diseases
d. Suicide
It is also the 2nd leading cause of death for Arizonans ages 15-34.
Leading Causes of Mortality in Northern Arizona
15 Leading Causes of Mortality N. AZ Arizona Nation
Diseases of heart 172.4 142.2 169.9
Malignant neoplasms 160.4 145.5 163.6
Accidents (unintentional injuries) 79.2 47.4 40.3
Chronic lower respiratory diseases 52 43.5 41.6
Cerebrovascular diseases 32.3 29.6 37.0
Diabetes 23.3 24.1 21.2
Alzheimer's disease 22 32.6 25.4
Intentional self-harm (suicide) 30.3 17.8 12.8
Chronic liver disease and cirrhosis 25.5 14.3 10.2
Influenza and Pneumonia 15.5 9.9 15.3
Nephritis, nephrotic syndrome and nephrosis 10.6 5.2 13.3
Parkinson’s Disease 8.3 8.1 7.3
Essential Hypertension/Hypertensive Renal Disease 7.5 10.9 8.3
Septicemia 7.2 4.9 10.6
Assault (Homicide) 8 5.8 5.8
2011 – 2015 (All Ages) Age-Adjusted Rates *Rates are per 100,000 individuals
N. AZ worse than national or state averages
N. AZ better than national and state averages
N. AZ significantly worse than national and state averages
http://cher.nau.edu/index.php/regional-needs-and-assets-assessment/
28.6
21.7
31.4
32.8
28.7
30.8
12.8
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0 5 10 15 20 25 30 35
Apache
Coconino
Gila
Mohave
Navajo
Yavapai
United States
Northern Arizona
Age-Adjusted Suicide Rate 2011-2015 by County
Suicide Rates in Northern Arizona
http://cher.nau.edu/index.php/regional-needs-and-assets-assessment/
Suicide in Coconino County
38Dr. Marie Peoples, Coconino County Health District
True or false:
Self-reported health status predicts mortality independent of age, sex, smoking, and existing disease, and is more strongly related to mortality than a large number of clinical biological measures.
Answer: True
http://cher.nau.edu/index.php/regional-needs-and-assets-assessment-report-published/
http://cher.nau.edu/index.php/regional-needs-and-assets-assessment-report-published/
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“Teens & Young Adults”
Serious Mental Illness – Page 2 – AZ Dept. of Health ...https://directorsblog.health.azdhs.gov/tag/serious-mental-illness/page/2
“Arizona citizens with a serious mental illness have a life expectancy that’s 30 years less than the general population. These folks don’t die early because of their mental illness; rather, they die from preventable physical health conditions like obesity, smoking, lung disease, stroke and heart disease.”
• Medicaid is the single largest payer for behavioral health services in the US.
• 20% of Medicaid beneficiaries with a behavioral health diagnosis account for almost half of all Medicaid expenditures.
Medicaid and Behavioral Health
AHCCCS Targeted Investments Program
https://www.azahcccs.gov/PlansProviders/TargetedInvestments/
AHCCCS American Indian Medical Home Program
https://www.azahcccs.gov/AmericanIndians/AmericanIndianMedicalHome/
3So what is the role for Critical
Access and Rural
Hospitals in Quality?
“Get Involved in Measurement.”
“Work together to propose some common quality measures for
payers.”
“Don’t wait. Find collaborators and health system partners.”
https://www.azahcccs.gov/PlansProviders/TargetedInvestments/
Directional Document- DRAFTPathfinderHealth
Source: Timothy Dohse
ACO QUALITY MEASURESSource: PathfinderHealth
http://www.buyingvalue.org/
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http://www.buyingvalue.org/
“Users can filter through the over 700 measures included in the “Measure Crosswalk” tab of the Buying Value Measure Selection Tool by each measure’s Domain (e.g., Acute Illness Care, Prevention/Early Detection), Condition (e.g.,
Cardiovascular, Diabetes), Measure Type (e.g., Outcome, Process), Population (e.g., Adult, Pediatric), and Data Source (e.g., Claims, Clinical Data). Each measure now has a Disparities-sensitive Status, which indicates whether there is evidence of
disparity in the provision of care captured by the measure.”
Integrated care approaches are vital.
Inter-disciplinary collaboration will enable shared measurement and data-informed decision-making.
Innovation is a “must”.
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Mental Health First Aid
Proposed Goal for northern AZ:Train 50,000 people in 5 counties over 5 years.
