AcademyHealth ARM 2019 – A Discussion on High-Cost High-Need Patients

Brian W. Powers, MD MBA

Resident in Internal Medicine at Brigham and Women’s Hospital

PGY-2

June 4, 2019

This past weekend I had the pleasure of presenting research at AcademyHealth’s Annual Research Meeting (ARM) in DC. I delivered a talk titled “Complex Care Management for
High-Need, High-Cost Medicaid Patients” which described the design, implementation, and results of a community health worker-led care management program on health care spending and utilization among high-risk Medicaid patients with complex medical and social needs. The program was conducted at CareMore Health in Memphis, TN. We found that the program, which was implemented as a randomized controlled quality improvement trial, significantly reduced total medical spending and inpatient utilization.

My talk was part of a panel/series of presentations on “Care Delivery Innovations for High Cost, High Need Populations,” which was moderated by Laura Hardin from the Camden Coalition and featured presentations from investigators and innovators at:

- Johns Hopkins University

- Clemson University

- Providence VAMC

My co-panelists were inspiring and presented fascinating research that expanded my thinking on complex care management and care models for high-need, high-cost patients. One particularly interesting theme across all of our presentations was that none of the programs discussed, despite having positive impacts on hospital use and medical spending, had an impact on emergency department use. While we did not have a definitive sense of why this may be the case, the observation spurred spirited dialogue.

For trainees interested in health services research, health policy, or health care delivery, the AcademyHealth ARM is a fabulous conference. The talks and posters cover such wide-ranging topics that there is sure to be something for everyone, regardless of interests. Although the scope of the conference can be overwhelming, I have found attendees to be welcoming and engaging. There is always a strong contingent from various Partner’s institutions—this year I ran into a few of my co-residents at Brigham.

I’d encourage everyone to submit an abstract, as there are a wide variety of opportunities for both poster and podium presentations.

Attending the AcademyHealth Annual Research Meeting

Nicole Benson, MD

Fellow, Child and Adolescent Psychiatry, Massachusetts General Hospital and McLean Hospital

PGY-5

June 6, 2019

I was pleased to receive a grant to participate in my first AcademyHealth Annual Research Meeting. As a mental health services researcher, I was looking forward to attending one of the largest meetings that brings together leaders in the field of health care and policy. I was hoping to learn about the latest findings in healthcare service delivery. One of the major benefits of attending this conference for me was to be able to meet likeminded researchers and to learn about their work. I also was looking forward to the opportunity for invaluable networking and mentorship.

 

I saw presentations ranging from how to better integrate social determinants of health into care and research to how disparities in care are evident in mental health care across the lifespan. I particularly benefitted from learning about interventions that are being implemented and tested to evaluate ways to increase access for mental health and substance use disorder treatment.

In addition to being able to attend the meeting, I also participated as a panelist in a policy roundtable to discuss alternative payment models in behavioral health and was selected to present my research in a workshop on behavioral health policy interventions and impacts. Being able to discuss my findings with experts in these areas was a great opportunity for my career development and helped shape my thoughts for more research moving forward.

Attending this conference more than exceeded my expectations. I met many leaders in the field of health services research across all aspects of medicine. It was exciting to hear about innovative ideas for the major issues in our field.

IHI Patient Safety Congress: Learning to Engage all Relevant Stakeholders

Danny Mou, MD

Resident, General Surgery, Brigham and Women’s Hospital

PGY-3

May 15, 2019

I attended the Institute for Healthcare Improvement Patient Safety Congress in Houston. A theme I gathered from this conference involves the importance of understanding the various stakeholders’ perspectives. Nearly all initiatives in the health care systems requires the support and buy-in of many parties. Engaging these stakeholders and understanding their perspectives are critical to successful implementation. For example, developing patient safety event report dashboards often cater to multiple different groups. The clinicians may be interested in their performance in the last 6 months. The nursing staff may require a live feed of events so that they can respond to these events in more real time. The hospital management may require quarterly data to assess long-term trends and decide whether institution-wide quality-improvement initiatives are warranted. These are different types of information that need to be delivered at different time points with different frequencies. Designing a dashboard that displays the relevant data to the relevant party requires talking to members of that party and closely understanding their needs. This type of work was done effectively at the Walter Reed National Military Medical Center, where tailored dashboards were designed to optimize signal and minimize noise for the specified party. With effective end-user feedback, the research group achieved a significant increase in use of the dashboard.

The conference had a number of examples like this in various different settings. It definitely gave me some insight into the nuances of effective implementations science, which is very relevant for all of my QI work.

Value Based Health Care Delivery Seminar - Harvard Business School

Sotirios Nedios, MD

May 30, 2019

Centers of Expertise (COEs) are innovative cross-specialty educational opportunities supported by Partners Healthcare. They complement clinical training by providing residents and fellows with exposure to 4 important areas of health care delivery: global and humanitarian health, health policy and management, healthcare quality and patient safety, and medical education.

In January 2018 and during my Electrophysiology Fellowship in the Massachusetts General Hospital, I had the opportunity to visit the Value Based Health Care Delivery (VBHD) Seminar in Harvard Business School. Prof. Porter, Prof. Teisberg and their team brought together a big group of residents and fellows providing conceptual frameworks for Health Economics and sparking discussions on actual in-depth case studies from around the world. The curriculum included concept presentations, case studies, instructor teaching notes, videos of guest protagonists, and other videos designed to assist instructors in the teaching of the material.

Dr. Sotirios Nedios

Thanks to this seminar I got a better understanding on a variety of topics like Value-Based Health Care, Outcome and Cost Measurement, Patient-Reported Outcomes (PROMs), Overview of Projects etc. I gained valuable knowledge from real-world examples both in advanced (e.g. Partners, Cleveland Clinic, Boston and Texas Children's Hospital) and primary health care (Oak Street Health) in the U.S. and abroad (e.g. Martini Klinik in Germany, OrthoChoise in Sweden, PIH Community Care in Haiti).

This gave me a different perspective on how economics can transform health care by improving value for patients, defined as the outcomes achieved per unit of cost spent. Since significant improvements in value will require major strategic and organizational changes in how health care is delivered, measured, and paid for, it is important for future leaders to get more training on these topics. This will facilitate a new thinking on health care delivery and more meaningful future policy reforms.

By the time I visited VBHD, I had been attending the 1^st DAS-CAM leadership course: “Diploma of Advanced Studies in Cardiac Arrhythmia Management” for almost a year. This course is a joint collaboration between the Maastricht University Medical Center, the European Heart Academy and the European Heart Rhythm Association (EHRA), aiming to train future leaders to deliver state-of the-art cardiovascular services in the next decade and beyond. This program brings together renowned experts to cover topics concerning both content and context of cardiac arrhythmias, including team and unit management, epidemiology/statistics, economics and innovation.

After the VBHD course, I returned refreshed to the DAS-CAM course and actively advocated for more case-based learning and more value-based health care. This resulted in lively discussions about the different health care systems in Europe and about possible ways to move forward. For example the knowledge from VBHD and DAS-CAM has helped me personally to advocate for ultrasound-guided access in the electrophysiology lab both based both on clinical and economic data regarding the value of the patient outcomes and the reduction of costs. I am confident that courses that cover healthcare economics, like VBHD, truly enhance our clinical practice and improve the quality of care provided.

Value Based Health Care Delivery has changed the way I evaluate structural and organizational changes. It has given me the incentive to further develop my interest and my future career towards Health Economics. Experiences like this, esp. while in training, are important because they allow trainees to discover their interests and better plan their next steps. Cross-specialty educational opportunities provide a better armory for future physicians by offering a different perspective. This in turn could be the solution to many problems of the increasingly complex world of health care. After all, “no problem can be solved from the same level of consciousness that created it.”

Value-Based Healthcare Delivery Course

Faith Makka, MSN, MPH

Deland Administrative Fellow

May 30. 2019

During my time at Brigham & Women’s Hospital as a Deland Administrative Fellow, I was afforded several opportunities to participate in educational sessions offered through the Centers of Expertise (COE). My fellowship year was enriched by these experiences which enabled me see the big picture and connect the dots in the complex ecosystem of healthcare.

The Value-Based Healthcare Delivery course offered by the Harvard Business School and taught by world-renown economist and business strategist, Professor Micheal Porter allowed me take a step back to view healthcare from the business lens. The interactive case-based sessions gave me an appreciation for the shifting landscape of health care and the drivers necessary for lowering costs and improving outcomes. The Health Policy course allowed me better understand the dynamic interplay between payors, providers and patients while also highlighting the importance of issues around health equity and disparities. These sessions were great in parallel with the various operational and strategic projects I was involved in, during my fellowship year and I was able to draw on both didactic and experiential learnings concurrently.

I recall a Quality & Safety dinner session where our focus was on medical mistakes from the perspective of providers who were most proximal to the event – the ‘second victim’ as the term has been popularly coined. As a group, we discussed strategies to provide support to providers involved in serious safety events. Insights from our discussion that night lingered in my mind. This and many other experiences re-affirmed to me that I wanted to pursue a career in health care administration that combined a unique synthesis of the following elements: systems thinking, quality improvement, process re-design, operational management, patient safety, human factors engineering and psychological resilience.

Since the completion of my fellowship at BWH, I have gone on to assume the role of Director of Patient Safety at a large medical center where I get the privilege of advancing the culture of safety, facilitating debriefs after serious safety events, conducting analyses to identify root causes of safety events/medical errors, making improvements to care management processes that lead to safer, higher quality care utilizing principles of high reliability (sensitivity to operations, preoccupation with failure, etc). My role exists, in part, to create processes that make it difficult for people to do the wrong things and easy for them to do the right thing using human factors engineering, predicated on the concept that ‘to err is human’. I also am charged with ensuring that there is care for the caregiver and that the proverbial ‘second victims’, who find themselves at the sharp end of health care, are given the care and resources necessary to be successful.

I’ve heard it said before, “You don’t know what you don’t know” –with a deeper level of exposure to the various facets of health care, this affords trainees (residents and fellows) the ability to identify the nexus of their strengths, abilities, interests and passions as they consider the next steps in their career. It’s important to step out of one’s silo and see healthcare through another lens. This leaves us with a new perspective to see how our current or future work will be potentially affected by policies, the regulatory environment, shifting societal trends, emerging technology, psychology, behavioral economics, consumer trends/insights, ground breaking research and the list goes on…. I can confidently say that my participation in the COE sessions have made me a better informed, well-rounded health care administrator who is aware of where I fit into the grand picture of healthcare.