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What are the objectives of the program?
Reduced avoidable utilization, Reduced spending
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Please provide a brief description of the program:
*3. Please provide a brief description of the program: In March 2016, Redonda Miller, MD, MBA (current JHH President) and Renee Demski, MBA (VP of Quality) created the Johns Hopkins Health System High Value with 5 physician directors appointed from hospital medicine, radiology and lab/pathology. The committee includes physician representatives from all 6 of Johns Hopkins hospitals (JHH, Bayview, Sibley, Suburban, Howard County and All Children's) and the Johns Hopkins Community Practice, and teams from value analytics, informatics and finance. Numerous initiatives to reduce unnecessary tests and treatments have been implemented in FY 17 and FY 18. In March 2016, Redonda Miller, MD, MBA (current JHH President) and Renee Demski, MBA (VP of Quality) created the Johns Hopkins Health System High Value with 5 physician directors appointed from hospital medicine, radiology and lab/pathology. The committee includes physician representatives from all 6 of Johns Hopkins hospitals (JHH, Bayview, Sibley, Suburban, Howard County and All Children's) and the Johns Hopkins Community Practice, and teams from value analytics, informatics and finance. Numerous initiatives to reduce unnecessary tests and treatments have been implemented in FY 17 and FY 18.
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Is this program operated as part of HSCRC's Care Redesign Amendment?
No
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Which Center for Medicare and Medicaid Innovation (CMMI) category does (or would) the program fall under? Choose the best match.
Initiatives_to_Speed_the_Adoption_of_Best_Practices
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What are the major components of the program?
Care coordination/management
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What types of organizations participate in the program?
Physicians office (primary care), Hospital/health system
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Which population(s) does the program target?
Medicare/older adults, Medicaid, Dual eligibles (Medicare-Medicaid enrollees), Privately insured, Individuals with multiple chronic conditions, Frail/disabled, Younger adults, Children
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How many patients have participated in the program to date?
We cannot assess this statistic; all patients who have been served in our practices are included.
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In what Maryland jurisdictions do participating patients reside?
Allegany, Anne Arundel, Baltimore, Baltimore City, Calvert, Caroline, Carroll, Cecil, Charles, Dorchester, Frederick, Garrett, Harford, Howard, Kent, Montgomery, Prince Georges, Queen Annes, Saint Marys, Somerset, Talbot, Wicomico, Worcester, Participation also includes non-Maryland residents
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Briefly describe the staffing resources required to operate the program:
In addition to 5 physician leads, we have a project manager, team of financial data analysts, real-time dashboards to analyze ordering of labs, imaging and antibiotics system-wide, direct access to clinical decision support teams to implement interventions in the electronic medical record and marketing support for information dissemination.
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Briefly describe the key initial steps to implementation:
A System-wide committee (including all six JHHS hospitals and its physician practices) was established to review current practice, identify potential areas of opportunity (with quality and patient-centered care as guideposts) and -- in concert with colleagues from value analytics, informatics and finance -- develop initiatives to reduce unnecessary tests and treatments. Results are regularly evaluated and new opportunities are considered.
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Are incentive payments to health care providers part of the program?
False
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Which incentive type(s)?
Bonus payments, Shared resources (e.g., IT infrastructure)
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Does the innovation program qualify as a CMS Advanced Alternative Payment Model (APM)?
No
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What are/were the expected results in improved outcomes, population health, and cost savings?
JHHS HVCC aims to increase the quality and safety of care we deliver by reducing unnecessary unnecessary lab tests, radiology exams, consults, medications, and other treatments and improve efficiency of care while reducing a patients total cost of care.
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Have expected results for improving outcomes and population health been met?
Yes, expected results were achieved
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Please briefly explain your answer to Question 25, and describe any results for improved population health achieved to date:
We don't have population health data. Our work to reduce unnecessary lab tests, imaging tests and medications improves diagnostic efficiency. This work also protect patients from the risks associated with testing and treatments, including downstream risks promulgated by additional unnecessary testing to confirm absence of disease in the setting of false positive test results. , Yes, expected results were achieved
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Please briefly explain your answer to Question 27, and describe any cost savings results achieved to date:
In FY-17 these initiatives reduced charges by >$1.7 million and in FY-18, charge reductions have already exceeded $1.5 million.
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Please provide URLs to any published evidence (e.g., peer-reviewed literature, white papers, etc.)
Johnson PT, Alvin MD, Ziegelstein RC. Transitioning to a High Value Health Care Model: Academic Accountability. Acad Med. 2017 Nov 1. https://journals.lww.com/academicmedicine/Abstract/publishahead/Transitioning_to_a_High_Value_Health_Care_Model__.98063.aspx Johnson PT, Pahwa AK, Feldman LS, Ziegelstein RC, Hellmann DB. Advancing high-value health Care: A new AJM column dedicated to cost-conscious care quality improvement. Am J Med 2017; 130:619-621. [Invited] https://www.ncbi.nlm.nih.gov/pubmed/28093189 Trakhtenbroit M, Abdollahian D, Horton KM, Johnson PT. Choosing Wisely and Imaging 3.0 professional development: Radiology resident consultant service. J Am Coll Radiol. 2016; 13:730-732. http://www.jacr.org/article/S1546-1440(16)00170-8/abstract Iscoe M, Lord R, Schulz J, Lee D, Cayea D, Pahwa A. Teaching medical students about cost-effectiveness. Clin Teach. 2018 Feb;15(1):24-28 https://www.ncbi.nlm.nih.gov/pubmed/28322509 Ninan J, Feldman L. Ammonia Levels and Hepatic Encephalopathy in Patients with Known Chronic Liver Disease. J Hosp Med. 2017 Aug;12(8):659-661. https://www.ncbi.nlm.nih.gov/pubmed/28786433 Lusica M, Rondon-Berrios H, Feldman L. Urine Eosinophils for Acute Interstitial Nephritis. J Hosp Med. 2017 May;12(5):343-345 https://www.journalofhospitalmedicine.com/jhospmed/article/136492/hospital-medicine/urine-eosinophils-acute-interstitial-nephritis Patel SA, Alebich MM, Feldman LS. Routine replacement of peripheral intravenous catheters. J Hosp Med. 2017 Jan;12(1):42-45. Review. https://www.journalofhospitalmedicine.com/jhospmed/article/128828/hospital-medicine/routine-replacement-peripheral-intravenous-catheters Dittmar PC, Feldman LS. Carotid artery ultrasound for syncope. J Hosp Med. 2016 Feb;11(2):117-9. https://www.journalofhospitalmedicine.com/jhospmed/article/127627/carotid-artery-ultrasound-syncope Trost J, Feldman L. Creatine kinase-myocardial band for chest pain and suspected acute coronary syndrome. J Hosp Med. 2015 Dec;10(12):827-9. https://www.journalofhospitalmedicine.com/jhospmed/article/128302/ck-mb-chest-pain-and-suspected-acs Breu AC, Theisen-Toupal J, Feldman LS. Serum and red blood cell folate testing on hospitalized patients. J Hosp Med. 2015 Nov;10(11):753-5. https://www.journalofhospitalmedicine.com/jhospmed/article/126824/serum-and-red-blood-cell-folate-testing Feldman LS, Shihab HM, Thiemann D, Yeh HC, Ardolino M, Mandell S, Brotman DJ. Impact of providing fee data on laboratory test ordering: a controlled clinical trial. JAMA Intern Med. 2013 May 27;173(10):903-8 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1678807 Durand DJ, Feldman LS, Lewin JS, Brotman DJ. Provider cost transparency alone has no impact on inpatient imaging utilization. J Am Coll Radiol. 2013 Feb;10(2):108-13. http://www.jacr.org/article/S1546-1440(12)00347-X/fulltext Journal Editor Lenny Feldman, MD, Editor of J Hospital Medicine Column: Choosing Wisely( ): Things we do for no reason. https://www.journalofhospitalmedicine.com/jhospmed/choosing-wisely-things-we-do-no-reason National Medical Society Leadership: High Value Practice Academic Alliance. www.hvpaa.org In 2016, the Johns Hopkins high value leads created a national high value care organization joined by >80 academic institutions designed to advance high value practice through collaborative quality improvement, research and education. Programs include an annual national conference, multi-institutional practice improvement publications, multicenter quality improvement initiatives, a leadership program for house staff and monthly conference calls for educational presentations and information sharing. The organization's 1st 4 multicenter high value care guides have been published in JAMA Internal Medicine. 1. Evidence-based Guidelines to Eliminate Repetitive Laboratory Testing https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2657592?redirect=true 2. Eliminating Creatine Kinase'Myocardial Band Testing in Suspected Acute Coronary Syndrome https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2657592?redirect=true 3. Promoting High-Value Practice by Reducing Unnecessary Transfusions With an Evidence-based Blood Management Program https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2663855?redirect=true 4. Reducing Overtreatment of Asymptomatic Bacteriuria: An Implementation Guide https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2664517? redirect=true