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