Roadmap to accountable care: The chicken or the egg technology investment or clinical process improvement?

Transcription

1 Roadmap to accountable care: The chicken or the egg technology investment or clinical process improvement? August 29, 2012

2 Meet the Presenters Michael Griffis CIO Innovative Practices Tucson, AZ Beth Hartquist, MD Vice President, Care Redesign, Accountable Care Solutions Optum

3 About Arizona Connected Care An ACO model emphasizing clinical integration between independent practices and facilities. Alignment with a large acute care hospital (Tucson Medical Center) and more than 200 clinicians (number is growing) 150+ primary care physicians 3 FQHCs Specialty physicians Strong partnership with Optum

4 About Tucson Medical Center (TMC) Began tradition of caring in Beds 21,000 Surgeries 88,000 ED Visits 6,000 Cath Lab and Specials Procedures 34,000 Admissions 6,000 Births 3,000 Employees 700 Physicians on Professional Staff Small Group of Employed Physicians

5 Primary Care Leadership Independent and Subsidiary Primary Care Anchors New Pueblo Medicine an Advanced PCMH and thought leader Saguaro Physicians, a TMC Subsidiary and PCMH FQHC Partners (including PCMH practices) El Rio Santa Cruz Neighborhood Center Marana Health Center Mariposa Community Health Center

6 History of ACO Development Results in a Unique ACO Model Primary care discussions with fiercely independent providers Expand on success of Patient Centered Medical Home Pilots United Healthcare Specialty physician involvement from the beginning Depends on exchange of data between independent but aligned parties Approval of many governing boards required Parties were strained to identify up start-up capital for infrastructure Acceptance as pilot by Brookings/Dartmouth Collaborative provided momentum and confirmation

7 Unique Attributes/Challenges Attributes An ACO respecting individual practitioners A belief that independent identity has value and should be encouraged Challenges Variable EMRs Variable infrastructure Variable process and procedure

8 Obligations of all participants Coordinate care across the continuum with other members, providers and suppliers Patient Make data available to enable care improvement and to reporting and performance measurement Primary Care Clinic Emergency Room Participate in data driven improvement activities Specialty Care Clinic Inpatient Hospital Home

9 Innovative Practices Technology and Service Support Organization Separate Ownership, a commercial business venture Arizona Connected Care a Pay when Paid customer Network Development Contracting Practice Transformation Care Coordination Technology and Connectivity Analytics and Reporting

10 Current State Contracts United Medicare Advantage 5,200 lives Medicare Shared Savings Program 7,200 lives In discussion with United (other products) Transformation underway Technology

11 What we need from technology Measure our performance Predict our trends Reduce variation Create actionable intelligence at point of care Coordinate processes Facilitate data transparency

12 Lessons Learned HIE necessary, but not sufficient for ACO data requirements Industry standards - control your destiny; can t wait Lead with a compelling business proposition, not an IT pitch Opportunistic EMR vendors ($$) Steep learning curve Lessons from acute care IT apply

13 Selected Current Challenges Last mile / integration with EMRs HL7v2 vs HL7v3 (query vs stream) Inter-HIE issues - NwHIN Immature tools HIE, Analytics

14 Care Transformation Beth Hartquist, MD

15 What are the Drivers of Successful Population Health Management? 1 Find Opportunities Patient ID and Risk Stratification Cost Analytics with Modeling, Variance and Benchmarking Identify and Prioritize Episodes and Risk Groups 2 Align Stakeholders Right-size clinician and resource network Guide patients to appropriate resource Network management 3 Care Architecture Design, Build, Operate Support internal capability to rapidly improve Establish EB practices, optimal patient and info. flow Methodology to measure, monitor & continuously improve 4 Manage Patient Cohorts Preventive and Chronic Disease High Risk Patients Outreach and Point of Care Solutions 5 Implement Coordinated Care Reduce excess ED, Admissions, Readmissions Transitions Management Match patient to the ideal resource 6 Maximize Margins Maximize revenue realized Achieve high productivity Manage costs 7 Implement Enabling Technologies Performance Management Platform Communication Platform Population Management Platform

16 Patient Navigation Current State PCP Office Surgeon Office Hospital OR Uni t ICU SNF $121, days COST TIME PT. EXP. Home Health Mary s Home

17 Care Transformation is a Team Sport!

18 Care Architecture Establish Infrastructure Form Steering Committee & Work Groups Identify leadership: Exec Sponsor & Program Manager Promote Strategy & Alignment Create vision Align roles & responsibilities Remove barriers Identify Current State Review quantitative & qualitative data Complete current state VSM Identify Opportunities & Set Goals Identify gaps & opportunities: use evidence, ID waste, and inefficient flow Establish high level goals Select & Prioritize Interventions Review current state, evidence & opportunities Select interventions with best practice, flow & care coordination Create Care Model Future State Establish best practices Build optimized workflows Design a care coordination system Improve the Care Model Set up care model infrastructure Begin PDCA cycles and implement locally Replicate & spread broadly when stable Measure, Monitor & Continuously Improve Select process & outcome measures Embed data collection into workflow Use data to continuously improve 1 2 3

19 Patient Navigation Future State PCP Office Surgeon Office Hospital OR Unit Owned SNF $15, days ICU COST TIME PT. EXP. Mary s Home Collab. Care Clinic EHR / HIE VSM VSM SNF Care Access Referral Mgmt Bundle Alert Educators / Rehab Readmit Prevention EHR / HIE Readmit Prevention

20 Principles for Sustained Care Transformation Burning Platform Leadership Evidence & Data Delivery Model Learning Organization Establish compelling reason to change: Triple Aim improve quality while reducing costs and improving patient satisfaction Align leadership from C-Suite to exam room Physicians must champion this effort Evidence-based medicine delivered in efficient processes Informationdriven Team based practice, planned care Establish team roles and responsibilities Reduce variation Address the full continuum of patient health Embed culture of learning and continuous improvement Establish organizational capabilities Integration of care management with care delivery Goal: Make it easy to do the right thing

21 So what comes first, the chicken or the egg? Technology investment or Clinical process improvement?

22 Questions? Thanks for joining us today. For more information about Optum, visit Look for our latest whitepaper, Lessons learned: insights from the trailblazers of accountable care