Testing Population Health Models of Care

Testing Population Health
Models of Care
Claire Cordeaux: Executive Director, Healthcare
Brittany Hagedorn: U.S. Healthcare Lead
_________

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
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Presenters
Brittany Hagedorn
US Lead Healthcare, SIMUL8
Claire Cordeaux
Executive Director, Healthcare SIMUL8,
background UK NHS, original developer of
Scenario Generator

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

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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

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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?

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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?

Click to edit Master title style
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ATTRIBUTED POPULATIONS
Understand
the
Population

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Characterizing a Population
1. Population Size
2. Demographics
3. Disease Prevalence

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Population Size (Senior Care)

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Age-banded disease prevalence

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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%

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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)

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FLOW THROUGH A SYSTEM
Examples
Understand
the
Population
Flow
through
care model

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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

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Dementia Care

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Hepatitis C
Simulated ProgressionActual Disease Progression

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Standard Maternity Pathway

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High Complications for Uninsured

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TESTING NEW MODELS OF CARE
Avoiding Costly Maternity Complications
Understand
the
Population
Flow
through care
model
Capacity
Utilization &
Cost of Care

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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

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Maternity Bed Capacity
• 180 beds
• Length of stay 2-15 days C-section, 1-5 days vaginal
48% utilization
• Minimum delays

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Impact on capacity if no uninsured?
- Less 1 % utilization
- Less $400k

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Impact if 5% fewer elective C
sections?
- Less 2 % utilization
- Less $37k

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Costing reduction of unscheduled admissions by increased access
to primary care
Understand
the
Population
Flow
through care
model
Capacity
Utilization &
Cost of Care

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

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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?

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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.

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

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Add a second nurse
• Reduces overall costs to $830,850
• Fewer ED visits
• More nurse consultations

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Reducing Emergency Admissions by Seniors
Understand
the
Population
Flow
through care
model
Capacity
Utilization &
Cost of Care

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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.

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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

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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

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Simulated Pathway
Cost of
admission
£23m
Bed occupancy
318-412 ave 376

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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

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Year 1 Impacts
Total Service Volumes
£7m
savings
Bed occupancy
355-318 ave 273

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.

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5 Year Volume Projections
Existing vs New models of care

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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.

1 800 547 6024 | +44 141 552 6888
CONCLUSIONS
Understand
the
Population
Flow
through care
model
Capacity
Utilization &
Cost of Care

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.

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

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

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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

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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

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QUESTIONS & DISCUSSION
Understand
the
Population
Flow
through care
model
Capacity
Utilization &
Cost of Care

Testing Population Health Models of Care

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