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Testing Population Health Models of Care

SIMUL8 Director of Healthcare, Claire Cordeaux, discusses her experiences of developing and implementing population health strategies in the UK National Health Service, Canada, and Australia.

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Testing Population Health Models of Care

  1. 1. Testing Population Health Models of Care Claire Cordeaux: Executive Director, Healthcare Brittany Hagedorn: U.S. Healthcare Lead _________
  2. 2. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Presenters Brittany Hagedorn US Lead Healthcare, SIMUL8 Claire Cordeaux Executive Director, Healthcare SIMUL8, background UK NHS, original developer of Scenario Generator
  3. 3. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Agenda • Strategic planning for health delivery networks • Understanding an attributed population • The healthcare delivery network as flow through the system • Testing new models of care: impact on finance and capacity utilization • Creating the business case
  4. 4. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 What is population health? Noble, D Improving population health one person at a time? Accountable care organisations: perceptions of population health—a qualitative interview study, BMJ Open 2014
  5. 5. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Planning Services for an Population • Who is in my attributed population? • What are their service needs, based on demographics and disease prevalence? • How do we make sure we can meet the demand without excessive cost?
  6. 6. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Whole System Analysis Understand the Population Flow through care model Capacity Utilization & Cost of Care • What is our current state? • How do we implement best practices? • What are the financial and clinical impacts of a new care model? • Where am I going to have high/low capacity utilization?
  7. 7. 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 ATTRIBUTED POPULATIONS Understand the Population
  8. 8. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Characterizing a Population 1. Population Size 2. Demographics 3. Disease Prevalence
  9. 9. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Population Size (Senior Care)
  10. 10. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Age-banded disease prevalence
  11. 11. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Demographic Effects (Maternity Care) Population 1.17m Conception rate by female age- band Annual births @ 13,000 % split for uninsured etc. annual growth + 3.6%
  12. 12. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 • A state transition model considers the likelihood of a particular patient moving between acuity levels. • Severity and number of conditions determines which services are required by that individual patient. Disease Prevalence (Chronic Conditions)
  13. 13. 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 FLOW THROUGH A SYSTEM Examples Understand the Population Flow through care model
  14. 14. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 How does the population interact with health services? • From the first point of contact • Flow through services for a particular care bundle or disease progressions • Emergency and/or scheduled • Patient behaviours are influenced by – Lifestyle – Distance to service – Payor/insurance – Health need
  15. 15. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Dementia Care
  16. 16. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Hepatitis C Simulated ProgressionActual Disease Progression
  17. 17. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Standard Maternity Pathway
  18. 18. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 High Complications for Uninsured
  19. 19. 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 TESTING NEW MODELS OF CARE Avoiding Costly Maternity Complications Understand the Population Flow through care model Capacity Utilization & Cost of Care
  20. 20. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Reaching Uninsured Mothers • Toronto has a population of uninsured maternity patients • They have poor access to proper prenatal care, and thus experience high rates of complications • These patients are eventually served, at a high cost when complications arise
  21. 21. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Maternity Bed Capacity • 180 beds • Length of stay 2-15 days C-section, 1-5 days vaginal 48% utilization • Minimum delays
  22. 22. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Impact on capacity if no uninsured? - Less 1 % utilization - Less $400k
  23. 23. 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
  24. 24. 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 TESTING NEW MODELS OF CARE Costing reduction of unscheduled admissions by increased access to primary care Understand the Population Flow through care model Capacity Utilization & Cost of Care
  25. 25. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Toronto Food Bank To reduce ED visits Mt. Sinai hospital partnered with the local food bank. ED visit costs $1.16m
  26. 26. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Hypothesis to Test • Goal: increase access to health services for food bank users and reduce ED visits from this group ($1.1m+) • 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?
  27. 27. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Care Model Change Scenario • 4,676 visits per year • 1 nurse – operating 48 hours a week Cost Implications • 1 hour (cost of $100) per new appointment, • 15 minutes ($50) follow up appointment • Emergency Room visit $500 If patients have to wait more than 24 hours to see a nurse at the food bank, they will revert to visiting the ER.
  28. 28. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Business Case ED visits reduced Costs reduced overall (including nursing, mental health services and primary care) to $850k Saving $300k
  29. 29. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Add a second nurse • Reduces overall costs to $830,850 • Fewer ED visits • More nurse consultations
  30. 30. 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 TESTING NEW MODELS OF CARE Reducing Emergency Admissions by Seniors Understand the Population Flow through care model Capacity Utilization & Cost of Care
  31. 31. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Urgent Primary Care • As the population ages, there is greater need for unscheduled care. • Access to urgent primary care: – Reduces emergency visits. – Reduces inpatient admissions. – Avoids readmission penalties.
  32. 32. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Hypothesis: 24/7 Primary Care • By creating a 24/7 service, primary care can be provided for seniors with acute care needs • Assumptions: – To avoid an ER visit, 3 primary care visits are needed, over 3 days, 10-60 minutes per visit – Staffed by experienced nurses and therapists
  33. 33. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Clinical Assumptions • Clinical review indicated a potential avoidance of 4,855 emergency visits • Rerouting to Primary Care Locality Hubs: – 50% of ambulance calls – 50% of care home – 50% of out of hours – 50% of primary care
  34. 34. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Simulated Pathway Cost of admission £23m Bed occupancy 318-412 ave 376
  35. 35. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Validation Simulation Historical Data Ratio Elective admissions 1,813 1,810 1.00 Day case 7,196 7,233 0.99 Regular attenders 155 158 0.98 First outpatients 53,657 53,692 1.00 First telephone outpatients 3,322 3,321 1.00 Follow up outpatients 199,394 200,786 0.99 Follow up telephone outpatients 6,639 6,637 1.00 ED attendance 16,181 16,456 0.98 Walk in attendance 5,644 5,569 1.01 Emergency admissions 10,467 10,353 1.01
  36. 36. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Year 1 Impacts Total Service Volumes £7m savings Bed occupancy 355-318 ave 273
  37. 37. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Year 1 Staff Utilization With 5 FTEs on call 24/7, the anticipated patient volumes would result in 85% utilization. This is adequate staffing for year 1.
  38. 38. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 5 Year Volume Projections Existing vs New models of care
  39. 39. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 5 Year Staff Projections At the end of year 2 resources start to struggle to keep up with demand, and the service will become unmanageable by year 3. One additional FTE 24/7 (equivalent of 3 staff), hired in year 3, will bring service levels back in line with access targets.
  40. 40. 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 CONCLUSIONS Understand the Population Flow through care model Capacity Utilization & Cost of Care
  41. 41. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Key Take-Aways • Providers are taking on increased financial risk for patients’ utilization of services • Payors need to understand the financial impacts across providers for attributed population • Simulation enables you to – Evaluate investments in a risk-free environment, – Reduce financial risk, – Improve clinical outcomes, and – Manage healthcare costs per patient.
  42. 42. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 • Strategic planning for healthcare delivery networks • Answer system wide questions quickly to inform strategic decisions • Pre-built pathways of care • Pre-populated data for immediate scenario testing • Developed with NHS Institute UK • 80% of UK NHS, Europe, Canada, Australia, Qatar Simulation Software
  43. 43. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 Benefits of Scenario Generator • Validate strategic decisions • Minimal historical data requirements • Quick to learn and understand • Complete an evaluation in under 4 days • Engage stakeholders through visualization
  44. 44. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 4 Day Challenge • Provide us with your new model of care to test and high level data • We will provide you with the results • 50% discount to first ACO applicant
  45. 45. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 QUESTIONS • Please forward any topics you would like to see covered to claire.c@simul8.com • Continue the discussion on SIMUL8 in Health – LinkedIn Group • July Workshop – Simulating Bed Capacity
  46. 46. 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 QUESTIONS & DISCUSSION Understand the Population Flow through care model Capacity Utilization & Cost of Care

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