Presentation Title Mark Carroll, MD Jon Perez, PhD July 31 ... · Presentation Title A Conversation...

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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)

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/

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

Global Burden of Illness:#1 Health Issue for Young People

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/

0 5 10 15 20 25 30 35

Apache

Coconino

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/

“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/

“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”.

Mental Health First Aid

Proposed Goal for northern AZ:Train 50,000 people in 5 counties over 5 years.

Presentation TitleThank you

Mark.Carroll@narbha.org

Presentation Title Mark Carroll, MD Jon Perez, PhD July 31 ... · Presentation Title A Conversation...

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