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NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation Chronic Disease Medical Home Collaborative Organization Overview • Vizient is the nation’s largest member-owned health care services company • Vizient aims to improve its members’ clinical, operational, and supply chain performance, empowering them to deliver high-quality and cost-effective care Background The Vizient Research Institute determined that 10% of the population accounts for nearly 65% of health care spend in a given year. This spend is often related to chronic disease or complex episodes of care. Vizient developed the Chronic Disease Medical Home collaborative to help members tackle the biggest problems in delivering care to patients with chronic illness. This program drives members to incorporate program elements that improve patient access, increase coordination or otherwise enhance care quality, such as: • A multidisciplinary care team • 24/7 patient access to the team • Real-time access to all medical record information • Relationships with community physicians and support services • Process that spans all care settings including acute, post-acute, outpatient, and home • Process to address patients’ psychosocial needs as well as their medical needs • Mechanisms to engage the patient and family/ caregivers in self-management Program Details The objectives of the Chronic Disease Medical Home program are to: • Help member organizations develop programs to support and manage seriously ill patient populations • Identify the necessary steps to build a new care model for chronically ill patients • Share experiences and best practices with the Vizient member community To participate, member organizations must submit a Chronic Disease Medical Home team charter, including an executive sponsor, physician sponsors, and a project liaison, among other roles. Vizient does not provide specific goals or a target therapy area. Rather, member organizations prioritize the biggest unmet chronic care needs in their own health systems, develop a model to meet these needs, and create goals and performance improvement measures to track progress. During the collaborative, participating health systems: • Receive a playbook of resources to improve chronic disease management, including: –– Gap analysis and brainstorming tools –– Implementation plans –– Case studies about successful Chronic Disease Medical Homes An Initiative of the 41 | Chronic Disease Medical Home Collaborative
NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation • Participate in monthly calls, during which: –– Member organizations provide updates –– Successful efforts are spotlighted –– Subject matter experts offer best practices –– Members discuss barriers and risk reduction strategies to address them • Contribute to a collaborative-wide listserv with questions and discussion topics At the end of the collaborative, Vizient creates a Knowledge Transfer session that highlights members’ best practices and successes. The information from the Knowledge Transfer is available to 400+ Vizient members enrolled in the broader Performance Improvement (PI) Collaborative Program, so that many provider systems can benefit from the learnings of the core program participants. Value Delivered • Vizient’s Chronic Disease Medical Home program consisted of two cohorts –– Cohort 1 was a 12-month collaborative with 19 members –– Cohort 2 was a 6-month collaborative with 13 members • Both programs concluded as of September 2016, but participating organizations are continuing their work • Program outcomes have not yet been reported; however, other organizations with chronic disease medical homes have achieved: –– 40% reduction in total cost, due to fewer hospitalizations and emergency department visits –– 40% reduction in readmission rates –– 32% reduction in patients with poor glycemic control –– A return on investment of $2.65 for every $1 spent Path Forward • In the existing PI Collaborative programs, Vizient has not enacted any specific requirements for data collection or analysis • For future programs, Vizient will still allow members to decide their own goals and key performance indicators, but is implementing mandatory data reporting to better understand project impact • Vizient is currently establishing survey tools to enable members to submit this data more easily and reduce disparities in data reporting from different databases • Vizient continues to develop other collaborative programs to better manage serious conditions and test clinical delivery changes, including an upcoming effort around palliative care improvement Chronic Disease Medical Home Collaborative | 42
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