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LOYOLA RECOVERY FOUNDATION, INC.

LOYOLA RECOVERY FOUNDATION, INC. Health System Innovation: Supporting Recovery in a post ACA Environment Long Island Recovery Conference November 15, 2013. AGENDA. Brief Review of Loyola Model Key Current Business Components State and Federal VA and Non-VA Healthcare Environment

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LOYOLA RECOVERY FOUNDATION, INC.

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  1. LOYOLA RECOVERY FOUNDATION, INC. Health System Innovation: Supporting Recovery in a post ACA Environment Long Island Recovery Conference November 15, 2013

  2. AGENDA • Brief Review of Loyola Model • Key Current Business Components • State and Federal VA and Non-VA Healthcare Environment • mPOWER—Protecting Veterans at Risk

  3. The Challenge • Can inpatient and outpatient medical/surgical, specialty, mental health, primary care and substance treatment service arrays be altered or augmented with evidence based tools embedded in technology? • Can those products be developed, tested and approved with consumer input or control? • Can behavioral health business models understand and generate products that consumers, health systems and public health systems will value? • Can those products be monetized in durable ways?

  4. What is The Local Imperative ? • Traditional BH Systems Largely Outside Robust Consumer Control (Peer Systems an Exception), Health Systems Planning and Significant Public Health Investment • Rapid Decline of State Discretionary Funding given Big State Employment Legacy, Health and Education Costs • 60 Months of Medicaid Rate Erosion and the Prolific 2014 Risk Bearing Care Management Proliferation • Metrics, Outcomes and Cost Models Not Widely Developed

  5. Imperative, cont. • Business Planning, Administration and Development Expertise Largely Drawn from Itinerant Board Members. • “Welcome to Parity and the ACA—The Doctor and Everyone else is Not In”; Staffing Problems • BH Passed By in initial pre-ACA Health Infomatics Investments • Anecdotal Observation: Most FQHC’s and Medical Homes are collaborating for Housing and building ACO or Medical Home BH services within.

  6. Imperative, cont. • The Emerging Complex Problems Opiate Dependent Surgical Patients Opiate Dependent Moms/Newborns College Binge Drinking Veterans—Suicide, IOM Findings Workplace Health (Including Health Systems) DWI—Traffic Fatalities

  7. Loyola Model Review • Provide an “Aspirin” for VA Healthcare “Headaches” for Veterans with Complex Care, Addiction, Housing, Employment and Behavioral Health Needs. • Loyola Rubric: Better Care as Evidenced by Clinical Outcomes and Patient Satisfaction; Lower Price; Expanded Service; Proof of Concept that Evidence Based Medicine, Innovation and Integration are possible.

  8. Loyola Model Review Continued • Maintain Rubric in Accordance with a Recovery Vision Veterans Support: Recovery = Health, Job, Home, Relationships (“A Life in the Community For Everyone”—Charles Curie) • Care Questions Normalized to the Voice of the Veteran with Veteran Governance. • Services Build “Mutual Reinforcement” by providing Veteran Employment.

  9. Loyola Model Service Components • 50 Crisis Detoxification Beds (Bath, Albany VAMC’s 25 Each). • Eaglestar Housing 15 Transitional Beds in East Pembroke, 15 in Spencerport and SPARC. • mPOWER Outpatient Model for At Risk Veterans. • “VITAL” Intervention Project with Rochester General Hospital. • Operation Economic Freedom Call Center

  10. Loyola Service Matrix

  11. VA and Non-VA Healthcare Environment • Affordable Care Act seeks to “bend the cost curve” through effective management of high risk/high need patients. • September, 2012 Presidential Executive Order directs VA to Contract with Community Healthcare Providers for Service needs not met by VA. • IOM Report (September 2012) indicating high opioid/alcohol prevalence among veterans and low infrastructure

  12. VA and Non-VA Healthcare Environment • Integrated Specialty Care Components based on evidence based models with “Pay for Performance” approaches Sought by Healthcare entities (“build or buy”) to capture savings or enhanced Medicaid. • Adoption of “Meaningful Use” EHR’s, Predictive Analytics and Mobile Technologies Essential (Loyola has all three). • Track Record, Accreditation, Quality Assurance.

  13. mPOWER • In 2010, Loyola identified 43 Veterans with 3 or more Detoxification Hospitalizations in 18 months or less. • Similar profiles of chronic alcohol dependence, trauma, mental health condition and physical illness • Every detox episode offered the “same thing” for a recovery support strategy • Health kept deteriorating and Risk Factors were rising

  14. mPOWER • Loyola designed a “bundled” evidence based care and integration strategy combining cutting edge technology in, smartphone recovery support (ACHESS), pharmacological recovery support (Vivitrol), trauma support (Najavits, et.al.) and peer support (White, et.al.). • Strategy defined as “mPOWER” Program (Mobile Patient Opportunities for Wellness, Empowerment and Recovery)

  15. mPOWER • SAMHSA funded project for 3 years (2011-2014) • Service Partners: University of Wisconsin ACHESS Project, Westat (Evaluation) and myStrength (online mental health support) • Key metric for the program is to reduce inpatient hospitalization rate to 1 or less every 18 months. • Data Collected: GPRA, SF-36, PHQ-6, Brief Alcoholism Monitor—BAM (weekly analytic)

  16. mPOWER • Project integration strategy is that mPOWER medical providers are credentialed by VA Health System and project works as “collaborative care” model with VA Mental Health and PACT primary care teams. • All services delivered at Bath VAMC and supported by Loyola Transportation Network • Loyola staff paid for by grant. Medication prescribed out of and procured by VA pharmacy and labs paid for by VA.

  17. mPOWER • Loyola staff enters notes in VA CPRS system capturing encounters for VA utilization data and Vivitrol ordered out of VA pharmacy • Loyola staff attends Behavioral Health and Primary Care team meetings. • Patients weekly survey mapping risk and protective factors are done on the smartphone (BAM) and staff responds to high risk situations • Smartphone ACHESS application utilization tracked by UW.

  18. mPOWER Key Results (Updated Sept. 1, 2013) • 44 Active Patients (0 to 18 Months, 26 for 12 Months or more) • Pre-Enrollment Total Hospitalizations in Patient Cadre = 153 • Post-Enrollment Total Hospitalizations in Patient Cadre = 56 • 63% Reduction in Hospitalizations. Multiple relapses localized to 6 patients

  19. mPOWER • Raises Questions about evolution of managing typical chronic co-morbidities and complex patient medical homes; use of “Big Data” • Program Admission Demand, driven by veteran patient “word of mouth” is double current capacity • VISN recognizing need for more capacity; ACHESS and Dashboard purchased for 1000 Veterans, contracting underway for service expansion • Rest of Care Continuum must be developed (Housing, Employment)

  20. Three Essential Ingredients of Change(CHESS Foundation) Coping Competence Quality of Life Social Relatedness • Autonomous • Motivation

  21. ACHESS

  22. ACHESS • Monitoring and alerts • Reminders • Autonomous motivation • Assertive outreach • Care coordination • Medication reminders • Peer & family support • Relaxation • Locations tracking • Contact with professionals • Information

  23. ACHESS has better 30 day abstinenceDifferences significant at p = .03 N = 349

  24. ACHESS had fewer heavy drinking days Differences significant at p = .003 N = 349

  25. Chronic Disease Costs

  26. Top Chronic Conditions

  27. Business Model Disconnect

  28. Creative Destruction of Medicine

  29. Technology Functions (M. Oss) • Diagnostics • Consumer Education/Decision Support • Clinical Treatment • Cognitive Function Restoration • Change In Disease State Detection • Relapse Prevention – • Remote Monitoring Of Consumer Health

  30. Technology Types (M. Oss) • Smarthome Technologies • Wearable Remote Vital Sign Sensors • Smartphone Applications • Text Messaging Alerts • Companion Robots (NZ-Rural Gerontological Medication Adherence) • Remote Therapy, Consultation and Recovery Support • Neurotechnology (Neuroplasticity, Neurofeedback) • Active vs. Passive (Monitoring v. Self Entry)

  31. Big Questions About Tech • Which of these perform a non-clinical service producing an outcome that equals or exceeds a clinical intervention? • Which of these can be characterized as non-clinical in nature and thus outside the social, legal, regulatory requirements of the clinical milieu? • Which of these best reflects the voice and preference of the end user or (even better) was developed by end users? • Which of these will be captured before commercialization?

  32. Key Questions About Patients • What Do Patients Need to Have the Highest Probability of Attaining a Positive Health Outcome • What Does the Public Health Case Mandate? • What Do You Know How To Do? • Can You Operationalize It and Prove It Over the Long Haul? • Are You the Least Expensive, Most Effective, Most Valuable Thing They Have Ever Seen? • What Will You Become When You Have Become #5?

  33. Thoughts, Next Steps, Discussion

  34. Contact Details • Christopher R. Wilkins, Sr., President Loyola Recovery Foundation, Inc. 1159 Pittsford Victor Road, Suite 240 Pittsford, New York 14534 PH: +1 585.203.1250 FAX: +1 585.203.1013 cwilkins@loyolarecovery.com

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