Why Model Healthcare Systems Based
on Population Need?
Claire Cordeaux: Executive Director, Healthcare
Brittany Hagedorn: ...
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Global Perspectives
Brittany Hagedorn
...
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Housekeeping
• Audio
• Q and A
• Recor...
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Agenda
• Introductions
• Current State...
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Healthcare On the Move
• Need to reduc...
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Many Definitions
“On the clinical side...
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IHI’s Triple Aim
“Drive the Triple Aim...
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Where do we start?
Never
Events
Value-...
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Complex Interactions
Chronic
Disease
P...
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Key Questions
Any population health st...
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State of the Art: Today
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State of the Art: Tomorrow
Use the Sci...
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New Strategies Needed
These are all va...
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Innovation with Simulation
Bringing to...
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What is simulation?
High level flow an...
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Dementia Model
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• Strategic planning in health and soc...
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How the model works
Activity from demo...
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Scenario Generator
Pathways
Scenarios
...
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Sample Applications
• Chronic conditio...
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Modeling Maternity with Mount
Sinai
Po...
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The pathway: insured 41.85%, uninsured...
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The pathway ctd.
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Bed Capacity
• 180 beds
• Length of st...
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Impact on capacity if not uninsured?
•...
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Impact if 5% fewer elective
C sections...
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Toronto Food Bank
• Increasing access ...
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Toronto Food Bank
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Toronto Food Bank
• 4676 visits a year...
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Results
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Add a second nurse
• Reduces overall c...
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Case 2: Radiology Capacity
• What impa...
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Scenario 1
Natural population growth
S...
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How long until we need a new
scanner (...
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Case 2: Results – MRI Details
Demand b...
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When do we need a new
scanner if they ...
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Case 2: Results
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Case 3: Stable Prostate Cancer
• How m...
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Case 3: High level pathway
Wait
Access...
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Case 3: Building the pathways
DIAGNOSI...
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Case 3: Assumptions
Outpatient clinic ...
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Case 3: PSA Diagnostic Scenario
What i...
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What if PSA?: before
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What if PSA?: before
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What is the impact of 2/3rd
patients h...
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What if PSA?: after
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Case 3: PCP Treatment Scenario
What if...
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What if PCP LES for treatment?:
before...
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QA and PSA
performed by GP
with 6 mont...
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What is the financial impact?
Is the c...
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User feedback
We will be able to demon...
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Key Take-Aways
• Planning services inc...
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Population health may 2014 hd

Why Model Healthcare Systems Based on Population Need?
Published on: Mar 4, 2016
Published in: Healthcare      Health & Medicine      Business      
Source: www.slideshare.net


Transcripts - Population health may 2014 hd

  • 1. Why Model Healthcare Systems Based on Population Need? Claire Cordeaux: Executive Director, Healthcare Brittany Hagedorn: U.S. Healthcare Lead _________ Get the Most from Population Health Initiatives
  • 2. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Global Perspectives Brittany Hagedorn US Lead Healthcare, SIMUL8 Simone Atungo Director Community Development and Integration, Mount Sinai, Toronto Claire Cordeaux Executive Director, Healthcare SIMUL8, background UK NHS, original developer of Scenario Generator
  • 3. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Housekeeping • Audio • Q and A • Recording available on SIMUL8healthcare.com
  • 4. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Agenda • Introductions • Current State of the Art • Triple Aim Vision • Case Studies: Simulating Interventions • Key Takeaways
  • 5. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Healthcare On the Move • Need to reduce cost – Crunched budgets, – Hiring freezes, – Supply chain initiatives • Aging population • Post-reform environment • New payer/commissioner and provider perspectives • Evolving patient expectations Result is an environment where Population Health Management is greatly needed!
  • 6. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Many Definitions “On the clinical side of a hospital or health system, (population health) often entails tracking patients by disease groups, identifying gaps in care, and addressing them before they result in aggravated conditions, or avoidable admissions and trips to the ED. Aggregated clinical data are essential to managing population health.” --Health Finance News, April 2014 “…opportunity for health care delivery systems, public health agencies, community-based organizations, and many other entities to work together to improve health outcomes in the communities they serve” --Soto, M, Population Health in the Affordable Care Act Era, Academy Health, 2013
  • 7. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 IHI’s Triple Aim “Drive the Triple Aim, simultaneously improving the health of the population, enhancing the experience and outcomes of the patient, and reducing per capita cost of care for the benefit of communities.” Understand your population to improve planning and delivery of care
  • 8. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Where do we start? Never Events Value- Based Care Aging Popula- tion Pay 4 Perfor- mance Cost Sharing Medicare Fee Schedule Primary Care Access ACO & PCMH Expande d Coverag e Readmis -sions & Mortality Patient Satisfac- tion Outcome Measure s 7 day working Managin g chronic diseases With a deeper understanding of how the pieces fit together, you can address several needs at once.
  • 9. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Complex Interactions Chronic Disease Prevalence Aging Population Expanded Coverage Although each of these drivers is an independent influence, policy and operational decisions would benefit from a combined perspective: • Related populations. • Similar (and compounding) effects on patient needs. • Overlapping solutions. Patient acuity increasing. Disease interactions. Importance of environmental & social influences. Scrutiny on costs.
  • 10. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Key Questions Any population health strategy needs to answer a few questions: •How much capacity will we need? What will utilization be? •What effect will it have on lead times / access to appointments? •How much will it cost? Can that be reduced? •How will this effect clinical outcomes?
  • 11. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 State of the Art: Today
  • 12. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 State of the Art: Tomorrow Use the Scientific Method to make… •Evidence-Based Decisions that, •Achieve Predictable Results using, •Targeted Changes at, •Lower Cost. Cycle of Continuous Improvement
  • 13. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 New Strategies Needed These are all valuable disciplines, but none are fully equipped to look at the whole system, where you need to understand demand and address cost, quality, clinical and non-clinical domains, operations, and engagement. Lean Six Sigma EpidemiologyPublic Health
  • 14. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Innovation with Simulation Bringing together population health and service utilization •Built in demographic data •Scenario testing to inform decision making •Risk free, zero cost environment •Predict results before you invest
  • 15. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 What is simulation? High level flow and operational questions, individual patient variability, graphical visualisation
  • 16. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Dementia Model
  • 17. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 • Strategic planning in health and social services • Framework for understanding whole systems • Built-in data for immediate scenario testing • Easy to use for those new to simulation • Developed with NHS Institute UK • 80% of NHS England, Scotland Health Boards Canada, Italy, US, Australia Scenario Generator
  • 18. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 How the model works Activity from demographic projections and age- related factors influencing demand Simulating patient journeys through a set of services depending on need Whole system, user-configured to represent “what if?” questions
  • 19. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Scenario Generator Pathways Scenarios Whole system model Simulation results Service points, flows & waits Service models Referral patterns Capacity Duration Population Demography Prevalence Prevalence/ Influencing factors Demographic weighting Population Constrained resources Urgent Planned Maternity Mental Health Social Care
  • 20. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Sample Applications • Chronic condition management • Population health needs assessment • Health disparities • Integration of health and social service • Post-acute care coordination • Demand shifting to lower acuity settings (outpatient, urgent, alternative practitioners)
  • 21. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Modeling Maternity with Mount Sinai Population 1.17m Conception rate by female age- band Annual births @ 13,000 % split for uninsured etc. 5 year projections + 3.6%
  • 22. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 The pathway: insured 41.85%, uninsured 0.35%
  • 23. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 The pathway ctd.
  • 24. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Bed Capacity • 180 beds • Length of stay 2-15 days C-section, 1-5 days vaginal 48% utilization • Minimum delays
  • 25. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Impact on capacity if not uninsured? • Less 1 % utilization • Less $400k
  • 26. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Impact if 5% fewer elective C sections? • Less 2 % utilization • Less $37k
  • 27. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Toronto Food Bank • Increasing access to health services for Food Bank users • What if a senior nurse service was provided direct to Food Bank users? • How many appointments? • How long will users wait? • If they wait too long, will they attend the ED? • What is the cost?
  • 28. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Toronto Food Bank
  • 29. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Toronto Food Bank • 4676 visits a year • 1 nurse – operating 48 hours a week • 1 hour ($100) new appointment, 15 minutes ($50) follow up, ED visit $500 • If users wait more than 24 hours, they will attend ED
  • 30. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Results
  • 31. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Add a second nurse • Reduces overall costs from $874,650 to $830,850 • Fewer ED visits • More nurse consultations
  • 32. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Case 2: Radiology Capacity • What impact does demographic change and new clinical practice have on the demand for CT and MRI over the next 10 years? • “Clinicians say we must have a new scanner – that’s a £1m decision – and we are in deficit – can we manage without one?”
  • 33. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Scenario 1 Natural population growth Scenario 2 Population growth + 7% (CT) and 11% (MRI) Annual Increase Scenario 3 Population growth + Annual Increase + New Clinical Practice Case 2: Results
  • 34. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 How long until we need a new scanner (MRI only, 11% growth)? 1. 2 years? 2. 4 years? 3. 5 years?
  • 35. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Case 2: Results – MRI Details Demand begins to exceed capacity. Queues build within the model. Additional capacity is required to meet demand. Additional capacity not required until Year 8 – scanners operational 7days.
  • 36. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 When do we need a new scanner if they are operational 24/7? 1. 5 years? 2. 8 years? 3. 10 years?
  • 37. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Case 2: Results
  • 38. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Case 3: Stable Prostate Cancer • How many patients require PCP and Outpatient treatments every year? • Could this care be delivered more efficiently? • What is the impact on costs? • Could breaches in waiting times be avoided?
  • 39. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Case 3: High level pathway Wait Access Targets 2 week wait to referral 62 day wait to treatment
  • 40. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Case 3: Building the pathways DIAGNOSIS TREATMENT
  • 41. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Case 3: Assumptions Outpatient clinic capacity is 80 appointments a week including: – First Visits – Follow Up Outpatients – Treatments
  • 42. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Case 3: PSA Diagnostic Scenario What if we introduced a second PSA test into primary care? Scenario: •Current state – after first positive PSA all patients referred to secondary care •Future state – what if two thirds (instead of one third) of patients have second PSA test in primary care?
  • 43. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 What if PSA?: before
  • 44. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 What if PSA?: before
  • 45. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 What is the impact of 2/3rd patients having a second PSA? Reduce average waiting time (currently 20 days) for initial appointment by: 1.2 days? 2.3 days? 3.5 days?
  • 46. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 What if PSA?: after
  • 47. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Case 3: PCP Treatment Scenario What if PCPs carried out the 6 month PSA/QA with LHRHa? Scenario: •Current state – patients have 3 monthly LHRHa with PCP and 6 mo. PSA/QA at outpatient clinic •Future state – what if 50% of patients had 6 month PSA/QA test in primary care?
  • 48. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 What if PCP LES for treatment?: before QA and PSA performed in outpatients every 6 months
  • 49. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 QA and PSA performed by GP with 6 months LHRHa instead of in outpatients What if PCP LES for treatment?: after
  • 50. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 What is the financial impact? Is the cost of the patient pathway: 1.Less? 2.More? 3.The same?
  • 51. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 User feedback We will be able to demonstrate to the PCT and PCPs how a simple change to the pathway by adding in a second PSA test in primary care will prevent the majority of our prostate cancer 62 day treatment breaches – a real issue in this pathway where diagnostics require a wait between them (TRUS and MRI)
  • 52. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Key Take-Aways • Planning services including population health is increasingly important in today’s healthcare environment • There are limited tools available to address the complexity of population health • Using simulation tools such as Scenario Generator enable health systems to – Make evidence-based investments, – Reduce risk, – Improve clinical outcomes, and – Manage healthcare costs per patient.
  • 53. Click to edit Master title style SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Click to edit Master title styleQUESTIONS The scientist is not a person who gives the right answers, he's one who asks the right questions. Claude Lévi-Strauss
  • 54. Click to edit Master title style SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Click to edit Master title style • Please forward any topics you would like to see covered to brittany.l@simul8.com • Continue the discussion on SIMUL8 in Health – LinkedIn Group

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