Boston Medical Center at 20 years. Massachusetts Medical Society October 19, PDF

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Boston Medical Center at 20 years Massachusetts Medical Society October 19, 2016 What you think you know or might remember 1 In fact, you re not wrong Boston Medical Center was formed in 1996 by a merger
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Boston Medical Center at 20 years Massachusetts Medical Society October 19, 2016 What you think you know or might remember 1 In fact, you re not wrong Boston Medical Center was formed in 1996 by a merger between 2 City of Boston public hospitals (Boston City and Boston Specialty and Rehabilitation) and a private, non-profit hospital affiliated with Boston university (University Hospital) Created a private non-profit corporation designed to carry on both Boston City Hospital s public and University Hospital s academic missions BMC is to be the centerpiece of the city s public health network... 2 We have maintained both our public and academic mission since our merger OUR MISSION To consistently provide accessible health care services to all in need of care, regardless of status or ability to pay To preserve its commitment to vulnerable and underserved populations To ensure the availability of a full-range of primary through tertiary medical programs To enhance its role as a major academic medical center, including support for bio-medical, public health, health medical education and basic science research 3 We have extended the reach of our mission through our health plan and affiliated community health centers Mission to provide Exceptional Care. Without Exception. Largest safety net organization in the Northeast USA 496 beds with 26K inpatient admissions and 860K outpatient visits per year Over $300M of research funding Faculty Practice Foundation Multi-specialty academic group practice affiliated with BMC and BUSM Over 700 physicians, 100 non-physician clinicians educators and researchers Comprised of 18 clinical departments 61 residency programs across all major sub-specialties & ~ 800 trainees Coordinated integrated health care delivery network Includes 13 community health centers, BMC, BU School of Medicine Over 160K outpatients clinic visits in 2014 Mission to support BMC in providing care to vulnerable populations Covers over 300K Medicaid and government subsidized lives (QHP) Largest Medicaid Managed Care Organization (MMCO) in Massachusetts 1 Boston University Medical Center Hospital (BUMCH) was founded in 1855, Boston City Hospital (BCH) in BMC was formed by a merger of the two in Together, we are the 3 rd largest health system in Massachusetts Top Health Care Systems in MA (by total revenue) 1. Partners HealthCare 2. CareGroup 3.Boston Medical Center 4. UMass Memorial 5. Steward Health Care 5 You probably know that we disproportionately serve low-income patients ~70% are underserved minorities ~60% black, ~10% Hispanic ~30% do not speak English as their primary language 50% have an annual household income below $20,400 (close to the federal poverty line for a family of 3) 6 But you may not know that we are a full service academic medical center with specific areas of expertise Addiction Medicine Trauma Amyloidosis Cancer Care Head and Neck Cancer Combined Oral and Maxillofacial Surgery & ENT Lung cancer GU Surgical oncology OMFS Sexual Medicine Transgender surgery including reassignment surgery Male infertility and ED Minimally invasive surgery Bariatric Arrhythmia/EP Refugee Health 7 and rank 13 th in the nation in National Institutes of Health research funding Addiction Medicine CTE Cancer Amyloidosis Center for Regenerative Medicine (CREM) Disparities Minority Recruitment CTSI (with BU) 8 Our top-ranked BMC HealthNet Plan serves more than 300,000 members MassHealth Membership: ~195,000 Western ~45,000 Central ~21,000 Northern ~23,000 Greater Boston ~36,000 NH Membership: ~85,000 Southern ~71,000 North ~12,000 MA QHP Membership: ~26,000 Western ~2,300 Central ~1,000 Metrowest ~1,600 Northern ~6,800 South ~5,700 Greater Boston ~5,400 West ~10,000 Capital ~16,000 South ~28,000 East ~19,000 Cape Cod ~3,000 9 How do we do it? 1. Our teams 2. Our commitment to access and value 3. Our nationally and internationally recognized faculty: Richard Babayan, MD, President of the American Urological Association (AUA) Emelia Benjamin, MD, ScM, 2015 Paul Dudley White Award Winner David Coleman, MD, President-elect, Association of Professors of Medicine (APM) Brian Jack, MD, Winner of the 2015 Peter F. Drucker Award for Nonprofit Innovation Thea James, MD, 2014 Schwartz Center Compassionate Caregiver Award Winner Richard Babayan Emelia J. Benjamin David Coleman Brian Jack Thea James 10 We ve made strategic investments in high-quality care Investing in our people Teams training: Simulation Center Next-generation teaching programs Investing in first-rate facilities Major campus redesign will make BMC the most modern campus in Boston Becoming the greenest hospital: 100 percent carbon neutral by and we have a rigorous Quality Improvement agenda We developed a Preventable Harm Index to focus our quality efforts Reviewed performance against multiple external quality measures (e.g. CMS, DSTI, BCBS AQC, MassHealth P4P, Joint Commission) Prioritized 13 metrics that drive the greatest patient care impact 5 select Hospital Acquired Infections (HAI) 8 Patient Safety Indicators (PSI) Weighted the individual metrics to align with CMS Value Based Purchasing (VPB) and Hospital Acquired Conditions (HAC) reduction programs Significant success in Year 1 Additional strategies target other publicly reported outcomes correlated with social determinants of health (e.g. readmissions) 12 What s next: MassHealth reform is critical to address a number of challenges and ensure sustainability for the patients we serve Large and growing portion of State s budget 1 in 4 state residents covered by MassHealth Spending comprises almost 40% of the State s budget Traditional vs. value based payment Incremental (e.g., PCPRI) vs. total payment reform to date Often have to resort to restricting provider rates to control costs Fragmented payors & providers Fragmented coverage: 39% in MMCOs, 33% in FFS, 28% in PCC Fragmented providers with variable ability to take on risk Federal funding structure & levels at risk Federal budget also strained CMS wants to see coverage/performance-based payment models vs. traditional FFS and supplemental pools 13 2 BMC Health System will play an important role in supporting Mass Health reform as an Accountable Care Organization BMCHS Network Risk adjusted PMPM BMCHS ACO Affiliated Community Health Centers FFS moving to risk sharing Contracted providers Drug/alcohol detox/rehab Community health Long-term care SNFs Behavioral health Adult day care Home health care... Out of network providers would be contracted through BMCHP, though preferably at established MassHealth rates 14 BMC Health System has a full range of care management programs to meet patient needs and drive cost savings: Our Health Plan Description of selected BMCHP programs High risk case management Enhanced discharge planning Maternal child health care management Disease management programs Identifies members via a claims-based registry (criteria: 6 ED visits each in of the past 2 years and/or $25k in TME in the past year) On-site teams including RNs, social workers and CHWs Members may access services including transportation and assistance with applications for community resources Dedicated case management staff embedded on-site to ensure smooth transitions of care Identifies members through claims-based registries, screens, and ED/inpatient census Programs include pre-and-postpartum education, newborn care information and parenting classes Assistance with access to community resources including WIC, transportation and car seats Specialized staff members focus on multiple disease dates (e.g. asthma) Staff ensures completion of provider s treatment plan including medication adherence Behavioral health Collaborative BH management program with Beacon Pharmacy Robust formulary management program 15 15 BMC Health System has a full range of care management programs to meet patient needs and drive cost savings: Our Hospital Office- Based Addiction Treatment Palliative Care HIV, Cancer, HepC CM programs Program targets our most complex and highest cost patients Disease- Specific NPs TopCare RN Care Manager Patient Social worker Community Health Worker Integrated Behavioral Health Specialty Pharmacy Primary-care based teams of RN Care Managers, CHWs and social workers play a central coordinating role Based on patient needs, teams can leverage a variety of on-site, Medicaid-tailored programs and resources Readmission Reduction Program SNFs VNAs and PCAs Programs of interest to ACO partners 16 Programs are tailored to our most complex populations Summary of BMC programs Readmissions reduction and super-utilizer care management programs target our most complex and highest cost patients Complex Care Management Behavioral Health Predictive risk assessment tool targets more than 15 clinical variables Robust CM teams are staffed to mirror patients needs (e.g. disease specific RNs, SWs and resource experts) and integrated into primary care IT support including real-time data, documentation, decision support and remote monitoring Early identification of BH needs via screening Patients are co-managed by PCPs and BH teams (consisting of patient navigators, social workers and psychiatrists/psych NPs) Collaboration with pharmacists (for refill management) and off-site counseling services Resources to address psychosocial needs including housing, employment and insurance Substance Abuse Office Based Addiction Treatment (OBAT) program provides medication treatment, assessment, and clinical support to patients with substance use disorders within primary care Project ASSERT facilitates access to primary care for patients with substance abuse disorders or at risk for opioid overdose Addiction Medicine inpatient consult service links patients to outpatient chronic care and substance abuse programs Significant partnerships with community substance use treatment resources 17 Addiction Medicine consults reduce readmissions, admissions, and ED use, while length of stay increases slightly Admission rate Average admissions per year 2.92 Pre-consult After consult day readmission rate Average admissions per year 44.3% 12.2% Pre-consult Index visit After consult 26.8% ED utilization rate Average ED visits per year 10 Pre-consult After consult 6.6 Inpatient length of stay Average length of stay, excluding outliers Pre-consult Index visit After consult 18 Why are we enthusiastic about transformation? MassHealth Reform We want to be part of the solution. It s the right thing to do. Our patients deserve it. It s in our DNA. 19 We are also humble BMC is well-known for health equity but we still have work to do 20 Our simple, practical innovations have an impact on tough medical and health care delivery issues and are national models Hunger: Therapeutic Food Pantry Demonstration Kitchen Homelessness: Elders Living at Home HUES to Home Children s Health: Child Witness to Violence Pieces of Home Substance Abuse Treatment and Prevention: Project ASSERT Project RESPECT Office Based Addiction Treatment Urban Violence: Violence Intervention Advocacy Program Obesity: Jump Rope Clinic Prescribe-a-Bike 21 but taking down the barriers to good health is a journey 22 Thank you. 23
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