ThedaCare, Inc. - Touchpoint Health Plan

Last year, ThedaCare™ and Touchpoint’s diabetes management program prevented nearly 40 major complications among 3,400 diabetes patients for a savings of more than $4 million.

Situation

Nearly half of the U.S. population, more than 125 million Americans, suffers from some sort of chronic medical condition. Care of these chronic conditions accounts for 60% of healthcare spending, which topped $1.4 trillion in 2001 and is estimated to grow to $3.1 trillion by 2012. Unfortunately, in spite of overwhelming evidence that standardization of care for these conditions reduces complications, decreases costs, and improves quality of life, there remains wide variation in the care these patients receive.

This variation is exacerbated by backlogs in patient appointments within most physician practices, poor tracking of chronic disease populations, and inefficient or fragmented systems to prompt the delivery of preventive care.

Solution

ThedaCare™ is a community-owned health system of three acute-care hospitals, more than 100 primary care physicians practicing at 22 sites, and multiple other healthcare related businesses and services including Touchpoint™ Health Plan, which is owned in partnership with area physicians and Bellin Health of Green Bay.

Understanding that the care of chronic disease is the greatest medical and economic challenge facing healthcare, in 1998, ThedaCare and Touchpoint embarked on a four-pronged strategy to better manage chronic disease with the goal of improving clinical quality, reducing costs, and improving patient satisfaction.

1. Development of a common information technology platform encompassing all aspects of our health system—hospitals, physician practices, and the health plan—including an electronic medical record and computers in the exam room.
   
2. Development of a system-wide "data warehouse" to track and prompt the treatment of patients with diabetes, coronary artery disease and other chronic diseases in real time.
   
3. Adoption of physician-driven, evidence-based standards for preventive care as well as management of chronic disease.
   
4. Conversion to an "Open-Access" model of clinical office practice with the goal of seeing all patients who want to be seen the same day and delivering all needed services during that one episode of care (max care), in contrast to the "old world" system of packed schedules and significant delays for appointments for all but the most acute patients. 

Each of these strategies has been a key component to successfully managing chronic disease. Without the common electronic platform among all parts of the system, it would be impossible for the data warehouse to collect information about patients with chronic disease or report these results to treating physicians. Without physician driven standards of care, including education of all providers about those standards and training of office staffs, the data warehouse would be useless. Conversion to "Open Access" means more patients are being seen when they want to be seen and are receiving more needed preventive and chronic care each time they are seen.

Here is an example of how this works. Mrs. Smith has diabetes and also has coronary artery disease. One day, Mrs. Smith awakens with a severe sore throat, logs on to her computer at home, and makes an appointment for that afternoon with her physician who is on an "open access" schedule. While on-line, Mrs. Smith uses the secure web portal to detail all of her current symptoms. After arriving for her appointment, the nurse checks Mrs. Smith's electronic record, which queries the data warehouse and informs the nurse that Mrs. Smith is due for blood tests to check her blood sugar and her cholesterol for both her diabetes and her heart disease. She also determines Mrs. Smith is overdue for her screening mammogram. Mrs. Smith agrees to the blood tests and also allows the nurse to schedule a mammogram. Mrs. Smith is shown to an exam room where her physician, who orders a throat culture, examines her. The physician tells her she may have strep throat, and assures her that he will review all of her tests and call her if there are any problems. Otherwise, he tells her she can review the tests on-line later that evening after he reviews the results, and invites her to call or e-mail with any questions. He orders bed rest and Tylenol as needed.

By the end of 2003, this "ideal" world will be the "real world" in every ThedaCare practice. The best care is predicated on readily accessible, realtime information about a patient's most current health status. Understanding that each individual is ultimately responsible for their individual health, patient access to their personal medical information via secure connection through the Internet is critical. By the end of this year (2003), all of our primary care patients will be able to review their information, schedule their own appointments, refill their prescriptions, e-mail their physician, and research and track their own chronic conditions using a Web portal from their home computer.

Better Health & Lower Costs

Last year, ThedaCare and Touchpoint's diabetes management program prevented nearly 40 major complications among 3,400 diabetes patients for a savings of more than $4 million. Based on the latest HEDIS® data, The National Committee for Quality Assurance says ThedaCare and Touchpoint are the best in the nation for effectiveness of care, setting four national benchmarks and ranking in the top 5% in the nation in seventeen of the effectiveness of care measures including:

• Breast Cancer Screening: #1
  
• Diabetic Retinal Exam: #1
  
• Cholesterol Control for Diabetes: #1
  
• Beta Blocker after Heart Attack: #1
  

But that's not all! ThedaCare's hospitals have consistently been rated among the "100 Top Hospitals" in the nation. Theda Clark Medical Center in Neenah, WI, has earned the distinction four times and is the only Wisconsin hospital to make the "100 Top Hospitals" in 2003-2003. Both of ThedaCare's other hospitals, Appleton Medical Center and New London Family Medical Center, each have been "100 Top Hospitals" three times. ThedaCare is the only health system in Wisconsin to be included on the American Hospital Association's "100 Most-Wired" list for their use of information technology.

ThedaCare's commitment to quality has resulted in lower costs. ThedaCare's urban hospitals, Appleton Medical Center and Theda Clark Medical Center, are the lowest cost hospitals in Wisconsin for both inpatient and outpatient care. In fact, since 1992, price increases at ThedaCare's hospitals have averaged just over 5% per year over the last twelve years.