“Tim’s experience and insights capture the fundamental realities of caring for complex patients and the impact that can have on our delivery system. Those providers that heed his advice will survive in the emerging managed care market environment and have the satisfaction of doing the right thing for their patients and families.”

Brad Archer, MD, FACP
Chief Clinical Officer, University of Iowa Health Alliance ACO
Director of Population Health, University of Iowa Health System

BR3A0329-X2If you are responsible for managing the health of a population or the risk associated with one, there are better ways to address the challenges you face. I integrate a visionary approach to care delivery through a unique philosophical perspective modeled into methodology which can be strategically implemented into any healthcare system to meet the needs of patients, systems and payers.

My unique philosophical approach of care delivery differs from the historical linear algorithmic healthcare model. Ihrig MD & Associates focuses on discovering real problems, identifying the most probable or highest impact failures that could occur and finding elegant solutions for caring for the most vulnerable, sickest, highest utilizers and generally most unsatisfied patients. This philosophy moved the perceived spectrum of palliative care upstream beyond a service line for hospice and into a role and the DNA backbone for population health.

A paradigm unlike traditional healthcare models and unlike all other palliative programs, we support individuals from diagnosis across the care continuum. Transitioning toward embracing the ambiguity of living with serious illness and away from the linear care delivery process focused on repetitive activities that fail to achieve high quality is our key to successful system transformation.

Successes:

  • Near 94% zero hospital admissions for live outpatient palliative care patients
  • 40% reduction in 30-day readmissions
  • 70% per-capita reduction in expenditures estimated on pre- and post- palliative care involvement over comparative 12 month periods
  • Consistently rated at the top of “patient satisfaction” and “likely to recommend to others” via Press Ganey with overall patient satisfaction mean scores of 95.
  • Decreased symptom burden, per patient subjective response
  • Ubiquitous discussion and near similar attainment of advanced care planning and/or completion of advanced directives and Physician Orders for Life Sustaining Treatment [POLST]
  • An inpatient Palliative Care consultation rate of nearly 30%, greater than three times the national average
  • Decrease in acute hospitalization days from above 4 to 1.79 with Palliative Care involvement; and persistent coordination of care through our Cancer Center, Emergency Department and EMS services.

Historically, concurrent focus has included: Curriculum development – providing palliative care education in over twenty nursing facilities in the region and moving toward creating a certified graduate nursing program in palliative care, lecturing and mentoring through regional educational institutional’s Allied Health Professional and Business departments recognizing the need to integrate clinical and business /economic awareness of healthcare; Tele-health – working to expand tele-medicine program to clinical partners including critical access hospitals, primary care clinics and other clinical leaders within the region and; Healthcare Provider Advocacy – continue to promote and endorse the use of ARNPs and RNs in the field of palliative care across the continuum and through the ACO network.

In addition, we can assist in the development of system-wide Palliative Care Affinity Groups whose purpose is to promote palliative care best practice and the standardization of metrics and analytics to measure program effectiveness in meeting strategic initiatives.
Ihrig MD & Associates expertise, experience and success is the apparatus for population health management within any organization. Pre- and post-acute care services are operationalized to support the delivery of true strategic medicine. We work closely with all involved with patient care to optimize the patient experience, define and manage population health, maximize economic opportunities – revenue streams and cost avoidance, while supporting seamless patient transitions throughout their lives to levels of care appropriate with their goals of care.

Challenges met to date demonstrate the Ihrig MD & Associates philosophy is successfully responsive and reproducible in meeting the needs of the highest risk individuals and organizations goals.

Previously I was medical director for palliative medicine at the Trinity Regional Medical Center (TRMC) within the Unity Point Health System.  I also served on the Board of Mangers for ACO Development for the past 4 years. Unity Point Health, with a total operating budget just under $4 billion, offers care in eight large regions across Illinois, Iowa and Wisconsin. The health system includes 15 owned and 14 affiliated hospitals, 280 physician clinics and home care and hospice locations. The Trinity Regional Medical Center was a Pioneer ACO organization through the Centers for Medicaid and Medicare Innovation. Located in North Central Iowa it serves a rural, eight county area with a combined population of approximately 120,000 and approximately 35.2% between the ages of 75-84. The area is disproportionally elderly and ill when compared nationally and has a palliative appropriate population exceeding 42,000 lives. All counties in the service are medically underserved areas.

As medical director my role was the conceptualization, design, integration, implementation and expansion of palliative medicine within the Pioneer ACO. Through a true dyad partnership with administration a program was established which broke down the vertical silos and service lines of care delivery.  I built upon existing relationships within and outside of Unity Point Health System and established new ones to develop “palliative partners.” Patients were seen across all sites of care: acute care inpatient consultation service; palliative medicine ambulatory clinics adjacent to TRMC, as well as, clinics established and embedded in local long term care facilities and care facilities in adjacent counties and rural primary clinics; patient homes; long term care facilities without embedded palliative clinics including skilled care, intermediate care, memory units, semi- and independent residential facilities. Additional palliative partners include the Cancer Center, Pain Center, Emergency Department and EMS. On-call coverage was also provided 24 hours / day by palliative physicians.