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Download Disruptive Collaboration in Healthcare: The Role of Informatics Troy Trygstad PharmD MBA PhD Director of the Network Pharmacist Program and Pharmacy Projects
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Disruptive Collaboration in Healthcare: The Role of Informatics Troy Trygstad PharmD MBA PhD Director of the Network Pharmacist Program and Pharmacy Projects Community Care of North Carolina A Disclaimer The Times they are a‐Changin’ The End of Trivial Pursuit……. • 44‐715‐74 • April 12, 1955 • Pediatric Dosing of Dextromethorphan What is a Disruptive Technology? Clayton Christensen MBA DBA –Author of the Innovator’s Dilemma and Will Disruptive Innovations Cure Health Care (with Bohmer and Kenagy) “Healthcare may be the most entrenched, change averse industry in the United States” • Create‐then embrace‐a system where a clinician’s skill level is matched to the difficulty of the medical problem • Invest less money in high‐end, complex technologies and more in technologies that simplify complex problems • Create new organizations to do the disrupting • Overcome the inertia of regulation What is Disruptive Collaboration? Intra or Inter‐Institutional Data, Process, and Human Resource sharing that creates a cheaper, less complex, and more effective products and services ‐the innovation is not the product or the service, but rather the collaboration itself Ok, but what are we trying to fix? Is it Any Wonder Why the Current System Fails? Pharmacy MTM Hospital X Comprehensive Med Rec HH/Rehab/SNF X MTM X Clinic Fully Informed Prescribing Inadequate , Misaligned or Non-Existent Payment Systems for Pharmaceutical Care *Also Incredibly C0st-inefficient in Today’s HIT/HIE Environment* Why do we need to fix it? Arithmetic Modified from: Congressional Budget Office June/August 2010: The Long Term Budget Outlook, Page 68. Available at http://www.cbo.gov/ftpdocs/115xx/doc11579/06-30-LTBO.pdf More (and even scarier) Arithmetic Congressional Budget Office June 2009: Chapter 2, The Long Term Budget Outlook for Medicare, Medicaid and Total Health Care Spending , Figure 2-1 Available at http://www.cbo.gov/ftpdocs/102xx/doc10297/Chapter2.5.1.shtml Everything Old is New again? (Not Really) Managed Care 1.0: Focus on Unit Cost and Number of Units Supply Side Levers Managed Care 2.0: Focus more on reducing Number of Units -(Particularly “Sick Care” Units) Demand Side Levers Tenets of Health Reform (Regardless of ACA) •Reduced Cost Shifting and Increased Sharing of Risk •Increased Focus on Prevention •Increased Accountability •Increased Cross-Setting and Inter-Entity Collaboration •Increased Capture, Exchange and Application of Data (to accomplish all of the above) The Result? •Patient-Centered Medical Home •The Health Home •The Medical Neighborhood •The Accountable Care Organization •Global Payment and Quality Contracting •Shared Savings Contracting “Medical Home”‐style Collaborations Medical Home Hospital Pharmacy Physician-Patient Panel Third Party Technology and Analytics HH/Rehab/SNF Other Clinicians What’s Informatics Got to Do with It? Informatics to support Supply Side Management Transactions‐‐Claims Adjudication/Eligibility Analytics—Audits and Recoupment Provider Interface—Prior Approval Form/Formulary Consumer Interface—None! Informatics to support Demand Side Management Transactions—Care Alerts, Intervention Prompting, Logistics Analytics—Targeting and Triage Provider Interface—Best Practice Clinical Decision Support Consumer Interface—Active Participant in Care Team The Need for a Data “Composite” http://lawenforcementmuseum.blogspot.com/2010/07/five‐cool‐artifacts‐in‐collections‐of.html Data “foils” http://lawenforcementmuseum.blogspot.com/2010/07/five‐cool‐artifacts‐in‐collections‐of.html 360 View of the Patient ⃝ http://lawenforcementmuseum.blogspot.com/2010/07/five‐cool‐artifacts‐in‐collections‐of.html Lots of “foils” Needed for Complete Picture Claims Eligibility ADTs Immunizations Prescription Orders Labs Medication Management Data Example Fill History Discharge List Active Chart List Patient Interview Long Term Care List Home Health List Focus on Positive Predictive Value PCP List Discharge List Fill History “Napalm Alerting” “Targeted Alerting” Drug A ‐ Drug A No Alert Stop Note Drug B Drug B ‐ Gap CM Note Drug C ‐ ‐ Gap Stop Note ‐ Drug D Drug D No Alert Start Note Whoever put this ad together should get a raise! Disruptive Collaboration Pharmacy Hospital MTM Comprehensive Med Rec HH/Rehab/SNF MTM Clinic Fully Informed Prescribing Involves Multiple provider types involved in multiple settings The Pharmacy Home Project Drug Use gathering Example‐Ambulatory Case Manager “I have a patient with continually elevated HgA1C” Drug Claims Patient “It doesn’t look like they have been filling any diabetes medications” “Those pills upset my stomach and give me gas” Medical Chart “We’ve been prescribing Metformin for a year and a half now” Example of an unmet treatment goal resulting from an adherence‐related drug therapy problem The Pharmacy Home Project Drug Use gathering Example‐Institutional/Transition Intake Regimen Event “I’m on Drug A, Drug B and Drug C” (MI, Stroke, MH Crisis) (Profile # 1) Hospital Regimen PCP Visit “What did they tell you to take and how?……” (Profile X) PCP Visit “It looks like they told you…….and you seem to be doing……” Correct Drug Use Profile X (Medication Administration Record) (Profile # 2) Discharge “You are supposed to take……” (Profile # 3) Correct Drug Use Profile? Data Use Case: Event-Based Pharmacy Home Process (Hospital Discharge: Medication Reconciliation Plus) Patient Identification Problem Identification Hospital Network Transitional Care Manager (TCM) Problem Resolution/ Identification Problem/Provider Identification Problem Identification Home Network Clinic Network Pharmacist Primary Care Manager (PCM) (PharmD) Prescription Fill History? Adherence? Network Pharmacist (PharmD) Patient Medication Taking *Behavior *Active List *Challenges Is Patient Enrolled? Discharge Medication List? Administrative Claims Data Health Information Exchange Provider/Extender Derived Data Informatics Center CCNC Physician (PCP) Which Prescribers? Which Problems? Medical Chart Active Medication List? Plan for Resolution. Other Care Team Members Collaboration Across Credentials, Setting and Geography Hospital Home Network Transitional Care Manager (TCM) Primary Care Manager (PCM) Network Pharmacist (PharmD) Meets with Patient, Gathers Discharge instructions, Counsels and Refers to PCM Meets with Patient at Home, Gathers Drug Use inventory, Assessment and Self‐Management Reviews All Medication Lists (Discharge, Home, Claims) for Discrepancies Clinic CCNC Physician (PCP) Visit Scheduled, PCP Receives Problem List and Care Coordination Plan Exchange‐Only Strategy vs. “Co Mural” Strategy Health Information Exchange Participant Participant Participant Participant Participant Health Information Exchange Portal Participant Portal Participant Portal Participant Portal Participant Portal Participant •Data Repository/Capability that combines Admin and Clinical Data •Data must be sourced from all providers in catchment area (including FL!) •Data persisted and accessible outside of an encounter •Must have Dashboard/Reporting Service to Represent /Make Sense of Data •Patient Linkages •Attributions, Assignments -Who is Responsible for What? •Revenue/Risk Programs/Initiatives •Other Providers •Surrogates •Patient Service Linkages – Who acts and on whose orders? •Current Utilization Patterns •A “Maestro” Utility •Referral and tracking system that goes beyond traditional provider relationships •Bi-Directional Tasking and Communication Platform that Supports Collaboration
