Tending to Problems in Care Coordination: Experience of Care Management Plus .

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The Care Management Plus Team. OHSUDavid Dorr, MD, MSK. John McConnell, PhDKelli RadicanIntermountain HealthcareCherie Brunker, MDColumbia UniversityAdam Wilcox, PhD. Consultative boardTom BodenheimerLarry CasalinoEric Coleman Cheryl SchraederHeather Young. Contextual analysis. Ms. Vieraa 75-year-old lady with diabetes,systolic hypertension, mellow congestive heart disappointment, joint pain and as of late analyzed deme
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Financed by the John A. Hartford establishment Initial advancement at Intermountain Healthcare Addressing Problems in Care Coordination: Experience of Care Management Plus Presented by: David A. Dorr, for the Care Management Plus group Date: Sept 27 th , 2007

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OHSU David Dorr, MD, MS K. John McConnell, PhD Kelli Radican Intermountain Healthcare Cherie Brunker, MD Columbia University Adam Wilcox, PhD Advisory board Tom Bodenheimer Larry Casalino Eric Coleman Cheryl Schraeder Heather Young The Care Management Plus Team

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Case ponder Ms. Viera a 75-year-old lady with diabetes, systolic hypertension, gentle congestive heart disappointment, joint inflammation and as of late analyzed dementia.

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Ms. Viera and her parental figure come to center with a few issues, including hip and knee torment, inconvenience taking every last bit of her present 12 meds, wooziness when she gets up around evening time, low blood sugars in the morning, and a late fall.

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Ms. Viera\'s office visit And Out in the corridor: The guardian secretly notes he is depleted cash is running low for extra drugs. In what capacity can Dr. Smith and the essential care group handle these issues?

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Care Management Plus fills in center crevices in numerous facilities through a proactive, adaptable framework. In 15 essential care centers at Intermountain Healthcare Larger foundation: Electronic Health Record, quality concentration

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Care Coordination and Care Management Adapted from Closing the Quality Gap: Volume 7 Care Coordination

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Care Management Plus can make a restorative home. Mind Managers go about as a guide, facilitator, and aide to encourage patients getting composed, touchy care. Execution Measurement CMP: Tracking database makes reports Clinic: works with payers to change repayment Evidence-based practice CMP: installs certain ailment conventions Clinic: agreement about approach and support Collaborative care arranging CMP:Care administrator works with patient, family, and catalyzes arrange Clinic: Refers fitting patients for mediation. Wellbeing Information innovation CMP: Provides pop. administration and adaptable updates Clinic: Creates tolerant outline Planned visits CMP: appraisal and structure a portion of preparing, conventions Clinic: has procedure for less serious organized visits. Quality change CMP: group approach some portion of appraisal, CM preparing Clinic: must focus on estimation and change

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Patient Worksheet Chronic conditions Medications Allergies Functional status Preventive care rundown Pertinent labs Pertinent exams Wilcox, Proc of AMIA Symp, 2005 Passive updates Organized by disease

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Population Tickler

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What was the impact of CMP on patient results? Contemplate outline: Retrospective companion Comparison of care oversaw (CM) patients (7 centers) with patients from comparative facilities w/out care chiefs (n=4) CM patients coordinated to controls on key qualities Outcomes Mortality, malady control, passing, hospitalization Efficiency

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Guideline Adherence in Diabetes: Results * p<0.01 Dorr, HSR, 2005

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Odds of kicking the bucket were diminished essentially. Dorr, AcademyHealth, 2006

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Odds of affirmation (any cause) were decreased by 27-40% for patients with complex diabetes. OR=0.56; p=0.013 OR=0.65; p=0.036

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Care Management Plus has different advantages… quality and effectiveness For the essential care bunch who can enhance productivity through enhanced Patient self-administration/strengthening Efficient clinical procedures from complex care through the administer to patients and society Fewer intensifications = bring down expenses Dorr, AJMC, 2007; Dorr, AcademyHealth, 2007

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Problems in making Care Coordination

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Variability of results crosswise over projects and populaces Care Management Plus has comparable issues crosswise over populaces: particular advantages are attached to particular populaces. From the Medicare Coordination of Care Demos, 2 year Summary Report, March 21 st , 2007; accessible from cms.gov

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Reliability: Lack of a system for depicting contrasts By program portrayal By what a patient really gets (\'measurement\') Dorr, JGIM, 2007

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Reimbursement and Cost Neutrality

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Thank you! CMP Contacts: David Dorr (PI) dorrd@ohsu.edu 503.418.2387 Kelli Radican (Project chief) radicank@ohsu.edu 503.494.2567 or visit www.caremanagementplus.org

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Care administration shifts by power and capacity for various populaces and requirements. < 1% of populace Caseload 15-45 Care Management Plus Caseload 250-350 3-5% of populace Caseload 90-350 half of pop. Case stack ~1000

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Description as "measurements" Different medications = broadness Amount Different administrations = expansiveness Amoxicillin 500mg One pill po q6hrs x 7 days Dispense #28 Duration Amount Education 1 hr Every 3 weeks x 6 mos Dispense: CM Frequency Duration Frequency Dorr, JGIM, 2007; Adapted from work by Huber et al

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Physicians were more proficient through better documentation, a slight increment in visits, and an adjustment by and by example. Doctors who alluded to care administrators: 8% more gainful Than companions in same center Non-client User 8% Dorr, AJMC, 2007

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CMT database - illustration

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Steps to Implementation Initial Contact (email, telephone call, gathering meeting) Introduction (In person visit or telephone visit) Readiness Assessment (round out however much as could reasonably be expected) Plan for Implementation (Review Readiness Assessment, IT appraisal) Training 2 days in person two months on the web/remove Implementation/Follow-up - Continued follow-up - Evaluation (achievement of Program, boundaries to Implementation, and so forth) Enrollment - Hire a Care Manager - Sign an agreement - Register for preparing IT execution

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