Deb Evans is the MVC Site Engagement Manager
A recent article published in the PM& R journal discussed ways in which two communities used an alert system to help target and address gaps in population health management. The authors noted that pivotal actions for reducing hospital readmissions and avoidable emergency department visits include communication that is more timely and focused, along with better chronic disease management using health technology. One tool being used by some health systems is an electronic alert system that notifies the provider or site daily about a patient’s ED visit or hospital admission. Through these alert systems health care organizations can better coordinate care to help identify high and frequent utilizers and those patients that might benefit from increased intervention.
Current alert systems have three main steps:
- Visit to the ED or hospital admission triggers an Admission (A), Discharge (D), Transfer (T) message;
- Patient information is matched to participating site patient list and a secure messaging system sends an electronic alert; and
- The participating site receives the electronic alert
In addition, on a daily basis, participating sites receive a list of the patient alerts in a secure email message and can work on stratifying patient risk and conduct follow-up as needed. Healthcare facilities using the alert system have integrated:
- Pharmacists to follow up on medication changes and additions or if a patient has a complicated medication list;
- Behavioral and substance abuse centers to provide follow up or discharge planning help by a case manager;
- Academic student health clinics to follow up on high-risk patients, ensure specialist referrals are made and education about available services;
- Follow up by community health workers or a Care Coordinator for the uninsured, underinsured and vulnerable populations and/or
- Monitoring chronic pain and pain medication management for potential abuse.
Adopting an electronic alert system may help to provide healthcare facilities with
- Quicker and more appropriate engagement with high utilizers of the health care system
- Method to identify target populations and the ability to risk stratify patients
- Ability to track and measure outcomes and evaluate the effectiveness of interventions
- Increased care coordination among providers and specialists
- Facilitation of cost savings
The use of the HealthLINC technology was tested in two communities in Indiana and South Carolina. The main goal of this technology is to enhance communication between hospitals and providers. Although Indiana and South Carolina sites have begun to successfully use this technology, it is no stranger to Michigan hospitals. Since 2010, The Michigan Health Information Network (MiHIN) Shared Services has helped provide a variety of technological services and opportunities for hospitals, one being ADT message software. MiHIN strives to accomplish its goal of improving healthcare experiences by supporting the statewide exchange of health information data among appropriate stakeholders. To meet its mission, MiHIN partners with a variety of Michigan Health Information Exchanges (HIEs) such as PatientPing, Southeast Michigan Health Information Exchange (SEMHIE), Upper Peninsula Health Information Exchange (UPHIE) and many others, to help disseminate real-time ADT messages. This service can be very valuable in better understanding the many pieces involved in a patient’s care story.
Shiyuan Yin is the Research Associate at MVC
This past Semi-Annual was my first MVC collaborative-wide meeting. I appreciated the opportunity to meet members of the Collaborative in-person and would like to share some takeaways from the presentations and breakout sessions.
The November 2017 meeting focused on the emergency department (ED) as a location to improve health care value, including strategies for reducing preventable ED utilization and unnecessary hospital admissions. In addition, the new MVC Obstetrics Initiative led by Dr. Dan Morgan aiming to address variation in obstetric care was launched. Below is a brief summary of each speaker’s presentation and breakout session discussion.
- Obstetrics Initiative Dr. Dan Morgan introduced the new MVC Obstetrics Initiative (OBI) and emphasized the tension in the existing obstetric practice. Not only is cesarean delivery often associated with increased rates of complications and higher cost than vaginal delivery, the triple aim of “patient experience, reduced costs, and population health” is also rarely met.
With a focus on the health of maternal and neonatal outcomes, OBI will:
- Develop labor & delivery practices that value, and support intended vaginal birth for low-risk patients
- Promote best practices for labor & delivery
- Improve the culture of care, awareness, & education
Leveraging the data available in MVC, OBI will:
- Determine hospitals’ cesarean delivery rates for “low” and “non-low” risk groups with proper risk adjustment.
- Recruit obstetric champions and enable peer-to-peer Michigan hospital comparisons regarding rates of vaginal and cesarean delivery as well as maternal and neonatal outcomes.
- Identify and support dissemination of strategies shown to promote vaginal births and reduce cesarean delivery rates for low-risk births.
The afternoon breakout session discussed how to use the MVC online tool at michiganvalue.org to review hospital’s obstetric reports. If you have any questions regarding the MVC OB initiative or would like to join this effort, please contact firstname.lastname@example.org.
- The Michigan Emergency Department Improvement Collaborative’s (MEDIC) PATH Initiative: Co-Directors for MEDIC, Drs. Keith Kocher and Michelle Macy, provided an overview of its Program on Alternatives to Hospitalization (PATH) quality initiative designed to provide decision support in the ED for diagnosis and treatment as well as coordinate admission decisions. During the breakout session, representatives from Beaumont and Michigan Medicine shared their experiences implementing the PATH initiative. Through the PATH program, Michigan Medicine revised its admission decision-making process for atrial fibrillation patients. As part of Beaumont Royal Oak’s engagement in PATH, the hospital implemented a Gold Card program for patient follow up and a pediatric observation program to ensure bed spaces for emergent cases. Favorable outcomes in both patient satisfaction and cost reduction have been noticed at both hospitals. For more information about MEDIC and its PATH program, please visit: http://medicqi.org/.
- Michigan Medicine’s Complex Care Management Program: Donna Fox, RN, and Heather Rye, LMSW, shared how they develop plans for patients with multiple comorbidities and integrate the ED clinicians in follow-up visits with patients and primary care physicians. The breakout session focused on specific strategies for building relationships with patients in the context of varying health systems. The value of cold calls to providers and inviting them to hospitals for monthly meetings to review patient cases was suggested as a mechanism to initiate coordinated care. More information on Michigan Medicine’s Complex Care Management Program may be found on its website: http://www.med.umich.edu/aco/index.html.
- Population-based approach to high ED utilization: Lauran Hardin, MSN, RN-BC, CL, is the Senior Director for Cross Continuum Transformation and the Camden Coalition. Prior to serving in this role, Lauran was Director of a Complex Care Center at Mercy Health St. Mary’s in Grand Rapids that created a cross continuum program coordinating patient care with providers across the county. An extensive root cause analysis of patient medical records allowed for targeted interventions and streamlined communication through the Complex Care Map. In the breakout session, the group discussed how the same interventions were effective on high ED utilizers regardless of payer type. For hospitals looking to implement a similar program, it was suggested to use a patient-specific story to physicians, or residents and fellows. When building the business case for a complex care program it was recommended to review length of stay and admission data layering based on greatest risk and to include the health system’s own employees in the analysis. Hospitals interested in integrating complex care into clinician education may visit: https://www.camdenhealth.org/programs/student-hotspotting/ for additional resources. More information on the complex care program and support, please visit: https://www.camdenhealth.org/ or https://www.nationalcomplex.care/.
All presentation materials are available on the MVC Registry under the “Resources” page. If you have any further questions or need further information about any of the speakers or content, please contact the MVC Coordinating Center at email@example.com.
We are excited to support the Collaborative’s work on the 2018 Value Coalition Campaigns and look forward to seeing you at our next meeting on April 20th, 2018 at the Radisson Hotel Lansing at the Capitol.