The Memphis Model - Methodist Healthcare

The Memphis Model:
Mapping and
Early Findings
Teresa Cutts, Ph.D. : Director of Research for Innovation
teresa.cutts@mlh.org; (901) 516-0593
August 18, 2011

Memphis: Land of Disparity
Egregious disparity exists: Income, Heart
Disease, Diabetes, Cancer,
Suicide/Homicide, Limb Amputation

Memphis: Assets are the Blues
and Lots of Church/Faith/”Soul”

• Anchors Memphis Model
• 7 Hospital system
• $1.5 Billion budget
• Provides high percentage of all indigent
care in Tennessee
• Owned by the UMC Arkansas, Memphis,
and Mississippi Conferences

Metropolitan Inter-Faith Association
(MIFA) formed in 1968: Safety Net

Church Health Center founded
1987: Safety Net

Christ Community Health Service
Neighborhood Clinic Opens 1995:
Safety Net

Mapping: Memphis Style
Our Ultimate Aim :
• Build a trusted care delivery system that
integrates traditional clinical care and
community-based caregiving
• Align and leverage religious and
community health assets to improve health
outcomes and access for all by 2020

An Integrated Health System
Employers
Education
CHN Partner
Church Health Center
Hospice
Govern
ment
Memphis
Health Ctr.
nvironment
Person
Family
Nutrition
Blue
Care,
United,
CHN Cigna Partner
Sports Clubs
MIFA
Social Net
Christ Community
Pharmacy Health Services
Community
Health Worker
Hospital
Health System

Mapping: Memphis Style
What do we mean by “mapping”: making
visible, aligning and leveraging assets
(“using what you got”….Memphis Style)
Mapping shaped primarily by the patient
journey (not hospital, healthcare or
provider-centric)
1. GIS mapping (congregational partners in
CHN, safety nets, schools, agencies, others)

CHN Congregations
30 Level 4
176 Level 3
42 Level 2
86 Level 1
496 trained liaisons
11,385 members registered
501 members from 128 congregations have been
through ‘Visitation Training’
212 persons have been in the ‘Care for the Dying’
training
78 persons were in the first Mental Health First Aid
training
106 persons have been in ‘Aftercare’ training

2. Participatory community
based mapping to align and
leverage both tangible (e.g.,
faith based clinic) and
intangible assets (e.g., trust)
outside hospital walls

PIRHANA morphs to CHAMP:
Community Engagement
• ARHAP PIRHANA tool used for 11 workshops
(5 most under-served neighborhoods)
• Adapt to US: renamed Community Health
Assets Mapping Partnership to highlight
ongoing collaboration
(www.memphischamp.org)
• Public “ownership” and transparent sharing of
data and models to nurture relationships
• CHAMP model: Specialty mapping done in 2
areas: eldercare, mental health; one case study

Mapping: Memphis Style
3. In-hospital aligning and leveraging of case
management, social work, quality, clinical
informatics, marketing, policy and all
divisions (e.g., CHF projects, meds) to
build seamless care pathways and
transitions in terms of continuity of
caregiving in community (liaisons and
navigators) with clinical in-house staff and
Big Table partners (e.g., TennCare)

Mapping: Strengthening Webs of Trust
• Leveraging CHN’s role as
a “trusted intermediary”
integrating with other
assets for 313 faith entities
(Cochrane, 2011)
• Share Abundantly and
Transparently
• Invitational, not
prescriptive…
• Emergent, leadership holds
open space for organic
growth; well adapted to
turbulence

Mapping Blended Intelligences through the
Center of Excellence in Faith and Health
• Traditional hospital
medical and spiritual
care structures
(>10,000 Associates)
• CHN Covenant with
400 congregations
• Honor and blend local
and global
intelligence: training,
webs of learning,
participatory analyses

Mapping Data Inside the Hospital
-Working with Case Management, Social
Work, Alliance Aftercare and Hospice to
integrate their work with our CHN navigators
to seamlessly build care pathways for
members/patients
CHN process measures through our Electronic
Medical Record (EMR)
-Preliminary CHN outcome and pre-post
data tracked through EMR

Navigator Consult Screen

Congregational Health Network:Outcome
Measures
• Impact measured in hospital from
Electronic Medical Record (compare
CHN vs. non-CHN patient on disease
care piece of “health journey”)
– Decreased length of stay?
– Decreased recidivism (return within 30 days)?
– Decreased total costs?
– Decreased mortality rate?

Member Registration: 11,385

CHN Early Outcome Data
Initial Data from first 25 months of
build-out and operation of CHN: Nov.
2007-Nov. 2009
Comparison of 473 CHN Members
who came into MLH to controls who
also were patients (matched on age,
gender, ethnicity) in this timeframe

CHN
CHN Outcome Data: 25 Months
Matched Controls*
N=473 473
Mean Age: 60 58
Gender:
Female 304 304
Male 169 169
Ethnicity:
African American 419 358
European American 54 115
*Matched on age, ethnicity and gender, DRG

CHN vs. Non-CHN: Admission
Flow Portals
250
200
150
100
50
CHN
Non-CHN
0
ED
Admits
MD
Refer
Other
Hos.
LTC

CHN vs. CHN Payor Mix
CHN
Non-CHN
Medicare A&B 62% 50%
Cigna FlexCare 9.1% 8.5%
United HC 6% 7.3%
TennCare 6% 6.1%
Uninsured 2.1% 9%

CHN: Top Diagnoses
Congestive Heart Failure: 23%
Fibroids (intramural, uterine): 21%
Uncontrolled Diabetes: 10%
Coronary Artherosclerosis: 8%
Schizoaffective Disorders NOS: 8%
Transient Cerebral Ischemia NOS: 6.5%
Other: UTI, Septicemia, Renal Failure

CHN vs. Non-CHN Length of
Stay and Re-admissions
50
40
30
20
10
0
LOS
total
Readmits
CHN
Non-CHN

CHN vs. Non-CHN: Mortality Rate
3.00%
2.50%
2.00%
1.50%
1.00%
0.50%
0.00%
Mortality
Rate
CHN
Non-CHN

CHN vs. Non-CHN CHF and
Septicemia Charges
$50,000
$40,000
$30,000
$20,000
CHN
Non-CHN
$10,000
$0
CHF
Septicemia

CHN vs. Non-CHN Stroke and
DM Charges
$120,000
$100,000
$80,000
$60,000
$40,000
CHN
Non-CHN
$20,000
$0
Stroke
DM

CHN vs. Non-CHN Renal Failure
and Other Cardiac Charges
$160,000
$140,000
$120,000
$100,000
$80,000
$60,000
$40,000
$20,000
$0
Renal
Failure
Other
Cardiac
CHN
Non-CHN

CHN vs. Non-CHN: Total
Charges
$8,200,000.00
$8,000,000.00
$7,800,000.00
$7,600,000.00
$7,400,000.00
$7,200,000.00
$7,000,000.00
$6,800,000.00
Sum of
Charges
CHN
Non-CHN

CHN vs. Non-CHN: System
Savings and Per Capita:
25 months, N=473
700000
600000
500000
400000
300000
200000
100000
0
Total System
Savings
Per Capita
Savings
CHN
Non-CHN
System Savings

Savings to Patients on
Readmits*: CHN vs. Non-CHN
*Based on Medicare Inpatient Deductible, net savings of
$110,000
$300,000
$250,000
$200,000
$150,000
$100,000
$50,000
$0
Readmit Cost to
Pt
Net Savings
CHN
Net Savings
Non-CHN

CHN vs. Non-CHN Discharge
140
120
100
80
60
40
20
0
Flow Pathways
Home
Hhealth
Rehab
SNF
Hospice
LTC
CHN
Non-CHN

CHN Pre-Post Data
• Compared Pre-Post Utilization Patterns in
subset of 50 (N=473) CHN patients 27
months before CHN started and first 27
months of CHN (within subject design)
• Excluded Trauma, Joint replacements and
expirations in either pre or post timeframe
• Excluded outliers 3 SD beyond mean for
LOS

CHN Pre-Post Data: Sample
Characteristics
• Mean Age=64.5; Median age=65
• 58% Female; 42% Male
• 86% African-American; 14% Euro Am.
• Major DRG: Circulatory System
Disorder
• Payor Mix:
68% Medicare; 12% Commercial;14%
TennCare/Medicaid; 6% Self-pay/uninsured

Hospital Metrics Pre-CHN Post-CHN
Total admissions 159 101
Admits/patient 3.2 2.0
Total readmits 37 17
Readmits/patient 0.74 0.34
Total patient days 1,268 772
Days/admit 8.0 7.6
Days/patient 25.4 15.4
Total charges $6,396,111 $3,740,973
Average charge/admit $40,277 $37,409
Average charge/patient $127,922 $74,819
ER admissions 84.9% 80.2%

Statistical Tests: T-Tests
Hospital Experiences Pre-FBN and Post-FB (N=50)
Characteristic Pre-FBN Post-FBN P
Admits/patient 3.2 2.0 .0180*
Readmits/patient 0.74 0.34 .0632
Days/patient 25.4 15.4 .01111*
Average charge/pt $127,922 $74,819 .0034*
Significant at the p

CHN Pre-Post Data
• Significant utilization differences existed
for patients served before and after the
CHN existed
– Fewer Admits, Hospital Days, Lower Average
Charge/Patient
– Readmits/Patient Approached Significance
– Charge data were not adjusted for inflation
over the full 54 month period
– Cohort aged over the timeframe

CHN Pre-Post Data
In this sample of CHN members:
• CHN implementation decreased overall
utilization of services, particularly
decreased average number of admissions
• Not due to inpatient clinical management
differences (no change in average
charge/admission)
• Which leads us outside of the hospital….

What’s moving the data?
• The hypothesis:
– Blended intelligence
• What the hospital knows about disease
• What the clergy and liaisons know about life
– Aligned assets leveraging Trust
• Faith-driven treatment system (reimbursed)
• Faith-driven healing system (non-reimbursed)
– Center of Excellence is the blender
• Constant data-driven innovation

CHN Outcome Data
Preliminary data is promising, but
needs more systematic review, more
rigorous scrutiny and deeper dive.
• Data sets archive at no cost
• Need funds/resources to analyze data
• Developing best practice models for
analyzing these data via
interdisciplinary models/lens

CHN Outcome Data
But, imagine what can happen when
we more strategically:
• Deeply analyze patterns of data to
drive program and education
• Connect the webs of trust
• Align and leverage all resources
• Grow to scale (400 churches)
• Flesh out patient care journeys
Build care-giving and other capacity!!!!

The Center of Excellence: Blending Faith &
Health
• Mature Faith should always mean
– “Compassionate”
– Merciful
– Just
• But also
– Smart
– Innovative
– Disruptively expansive

The Center of Excellence:
Blending Faith & Health
Relevant Science should:
– Be evidence based
– Result in improvement in
quality of life for all
– Eliminate disparity
But also be:
– Participatory and teachable by
blended intelligence
– Innovative
– or grounded in life;
– Disruptively useful for
promoting justice…UNTIL

We Grow into the Vision:
The Beloved Community