BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE FULL-BOARD MEETING

Transcription

1 BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE FULL-BOARD MEETING WEDNESDAY, MAY 27, :30 p.m. Buffet for board members & invited guests PALOMAR HEALTH DOWNTOWN CAMPUS 6:00 p.m. Meeting GRAYBILL AUDITORIUM 555 E. VALLEY PARKWAY, ESCONDIDO, CA Form A Time Page Target CALL TO ORDER 6:00 Public Comments :15 Information Item(s) 1. * Approval: Strategic & Facilities Planning Committee Meeting Minutes April 22, 2015 (ADD A-Pp-8-11) :18 2. * Approval: Revised Strategic & Facilities Planning Committee Bylaws (ADD B-Pp13-15) :21 3. * Review/Approval: Committee Meeting Frequency :31 4. * Review/Approval: Committee Standing Agenda Items :41 5. Review: Corporate Health s Business to Business Strategy (ADD C-Pp17-32) :11 6. Review: Population Health (ADD D-Pp34-81) :41 Public Comments :56 ADJOURNMENT 7:58 Board Strategic & Facilities Planning Committee Members Ray McCune, RN, Chair Linda Greer, RN, CCP Dara Czerwonka, MSW Robert Hemker, President & CEO 1 st Alternate: Dr. Aeron Wickes Della Shaw, EVP Strategy Diane Hansen, EVP Finance Jodi Mansfield, IEVP Operations Jean Larsen, Philanthropy Officer Lorie Shoemaker, VP PMC David Tam, VP PHDC / POM Maria Sudak, CNO PMC Dan Farrow, AVP Hospitality / Facilities Chiefs / Chiefs-elect PMC / POM Janine Sarti, General Counsel Brenda Turner, EVP Human Resources NOTE: If you have a disability, please notify us by calling hours prior to the event so that we may provide reasonable accommodations Asterisks indicate anticipated action. Action is not limited to those designated items. 1 5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in meeting room. The Board Strategic & Facilities Planning committee meeting is being agendized as a full board meeting due to the possibility of a quorum being present. Only committee business will be discussed at this meeting, however all board members may attend to participate in the discussion. Only those board members who sit on the Board Strategic & Facilities Planning committee are permitted to make a motion or vote on these matters.

2 B O A R D S T R A T E G I C & F A C I L I T I E S P L A N N I N G C O M M I T T E E M E E T I N G A T T E N D A N C E R O S T E R - C A L E N D A R Y E A R MEETING DATES: 1/26/15 2/25/15 3/25/15 4/22/15 5/27/15 MEMBERS DIRECTOR LINDA GREER COMMITTEE CHAIR X X X X DIRECTOR RAY MCCUNE X X X X DIRECTOR DARA CZERWONKA X X X X DIRECTOR AERON WICKES, M.D. ALTERNATE DIRECTOR HANS C.M. SISON GUEST X X X DIRECTOR JEFF GRIFFITH GUEST DIRECTOR JERRY KAUFMAN GUEST ROBERT HEMKER X X X STAFF ATTENDEES DELLA SHAW X X X X DIANE HANSEN X X JODI MANSFIELD, FACHE X X X X JANINE SARTI X JEAN LARSEN, CFRE X X PH FOUNDATION BOARD MEMBER LORIE SHOEMAKER, RN, DHA, MSN, NEA-BC X X X DAVID TAM, MD, MBA, FACHE X X MARIA SUDAK, RN, MSN, CCRN, NEA-BC X X DAN FARROW X X JEFF ROSENBURG, MD X X X X FRANKLIN MARTIN, MD X X X X PAUL NEUSTEIN, MD X X CHARLES CALLERY, MD X X X X DEBBIE HOLLICK SECRETARY X X X X INVITED GUESTS SEE TEXT OF MINUTES FOR NAMES OF GUEST PRESENTERS X

3 Minutes Board Strategic & Facilities Planning Committee Wednesday, April 22, 2015 TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Debbie Hollick, Committee Secretary Background: The minutes of the Board Strategic & Facilities Planning Committee meeting held on Wednesday, April 22, 2015 are respectfully submitted for approval (Addendum A). Budget Impact: N/A Staff Recommendation: Staff recommends approval of the Wednesday, April 22, 2015 Board Strategic & Facilities Planning Committee meeting minutes as presented. Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time: 1

4 Bylaws Board Strategic & Facilities Planning Committee TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Della Shaw, Executive Vice President Strategy Background: Section of the Board Strategic & Facilities Planning Committee Bylaws was revised to reflect the changes in organizational structure. Budget Impact: None Staff Recommendation: It is recommended that of the Board Strategic & Facilities Planning Committee Bylaws be amended per the redline excerpt attached for the Committee s review. Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time: 2

5 Meeting Frequency Board Strategic & Facilities Planning Committee TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Della Shaw, Executive Vice President Strategy Background: Per request of the Board of Directors, board committees are to review their committee meeting frequency. Budget Impact: None Staff Recommendation: It is recommended that the Board Strategic & Facilities Planning Committee set the meeting frequency based on the pertinent issues within its scope. Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time: 3

6 Standing Agenda Items Board Strategic & Facilities Planning Committee TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Della Shaw, Executive Vice President Strategy Background: Per request of the Board of Directors, board committees are to review their yearly standing agenda items. Budget Impact: None Staff Recommendation: It is recommended that a yearly Environment of Care update report be added to the Board Strategic & Facilities Planning Committee Standing Agenda Items. Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time: 4

7 Corporate Health s Business to Business Strategy TO: Board Strategic & Facilities Planning Committee MEETING DATE: May 27, 2015 FROM: Russell Riehl, Director Employee, Corporate & Retail Health Duane Johnson, Business Development Background: The informational program presented to the Board Strategic & Facilities Planning Committee provides a high level overview of Corporate Health s Occupational Medicine program, which has been actively deploying a business to business strategy. It further outlines the program s successes and future strategies for growth. Budget Impact: N/A Staff Recommendation: N/A Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: X Required Time: Form A Board Strategic - Corp Hlth & B2B.doc 5

8 Population Health TO: Board Strategic & Facilities Planning Committee MEETING DATE: May 27, 2015 FROM: Alan Conrad, M.D. - Medical Director Clinical Outreach Services, Palomar Home Health, Diabetes Services, expresscare Background: Organizations are examining their role in Population Health in order to comply with the concepts of the Triple Aim. Palomar Health is evaluating its approach to Population Health. Budget Impact: N/A Staff Recommendation: N/A Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time: Form A Population Health.doc 6

9 ADDENDUM A 7

10 STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES WEDNESDAY, APRIL 22, 2015 AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / RESPONSIBLE PARTY DISCUSSION I. CALL TO ORDER The meeting held in the Graybill Auditorium at Palomar Health Downtown Campus, 555 E. Valley Parkway, Escondido, CA was called to order at 6:18 p.m. by Board Chair Linda Greer, who then turned the meeting over to Board Strategic & Facilities Planning Committee Chair Ray McCune II. ESTABLISHMENT OF QUORUM Quorum comprised of Directors Greer, McCune, Czerwonka, Sison Excused Absences: Directors Kaufman, Griffith, Wickes III. NOTICE OF MEETING Notice of Meeting was posted at PH s Administrative Office; also posted with Full Agenda Packet on the PH web site on Wednesday, April 15, 2015, which is consistent with legal requirements. Notice of that posting was made via to the Board and staff members IV. PUBLIC COMMENTS There were no public comments IV. INFORMATION ITEMS There were no information items 1. APPROVAL OF MEETING MINUTES BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE MEETING MARCH 25, 2015 No discussion MOTION: By Director Czerwonka, 2 nd by Director McCune and carried to approve the March 25, 2015 Board Strategic & Facilities Planning Committee meeting minutes as submitted. All in favor. None opposed 2. Q3 FY2015 STRATEGIC & OPERATIONAL INITIATIVES REVIEW DRAFT Board Strat & Facil Planning Cmtee Mtg Min.doc 1 8

11 STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES WEDNESDAY, APRIL 22, 2015 AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / RESPONSIBLE PARTY DISCUSSION Utilizing the presentation distributed in the meeting packet, the committee reviewed the second quarter updates to the FY15 strategic and operational initiatives Executive Vice President Strategy Della Shaw reported that the committee would be reviewing a fairly high level update to the six initiatives as well as a deeper dive for Operational Initiative 2 given by Vice President Palomar Medical Center Lorie Shoemaker Noted that Cardiovascular Center of Excellence (COE) Program Development Manager Serrina Bergstraesser would provide an update on strategic initiative 1 at this meeting; a deeper dive will be presented at the next meeting FY2015 Strategic Initiative 1: Achieve and maintain Center of Excellence status in orthopedics/spine and rehabilitative care, cardiovascular care, neuroscience and women's services Ms. Shaw and Ms. Bergstraesser provided the update: Have already met outcome maximum for Milestone 2 New OR heart team video review process illustrates potential opportunities for improvement o Dr. Rosenburg noted that great progress has been made re: efficiency, patient-first atmosphere and communication along the whole hospitalization process. Surgeries now start at 7:30 a.m. Latest outcomes data reflects a 0% mortality rate FY2015 Strategic Initiative 2: Become the dominant provider of primary care in support of the total patient health experience provided, including the expansion and growth of Arch Health Partners, effective affiliations with local providers and development of a strong regional primary care network in the secondary markets Ms. Shaw reported that the initiative is on target o Completed Milestone 1 o o o Milestone 2 on track for completion by the end of fourth quarter Milestone 3 anticipate surpassing 4% target for increasing baseline FY14 PCP alignment with targeted Area of Focus (AOF) Service line Specialists Still actively seeking involvement with Graybill FY2015 Strategic Initiative 3: Develop a delivery model that supports care coordination and transitions across the continuum, with emphasis on chronic disease management, illness prevention, and patient involvement Ms. Shaw reported that Milestones 1-7 have been completed by their target dates; expectation for Milestones 8 and 9 to meet their respective target dates as well Working on an interoperability platform to connect inpatient I.T. with outpatient I.T. and physician offices, skilled nursing facilities et al to fully exchange information for the care of the patient Vice President Information Systems Prudence August reported that last two vendors are in the review process with discussion re: negotiation and implementation timelines. Currently evaluating the primary needs the organization has outlined. Next steps develop communication plan FY2015 Operational Initiative 1: Build and operate a decision analytics structure that supports the real time availability and standardized use of information and expertise for knowledge management and measurement of value based metrics of care Ms. August provided the following update: Milestones for this initiative are not in sequential order for target attainment Milestone 1 completed elements 1 and 3; 2 will be completed in May Milestone 2 creating implementation plan DRAFT Board Strat & Facil Planning Cmtee Mtg Min.doc 2 9

12 STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES WEDNESDAY, APRIL 22, 2015 AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / DISCUSSION Milestone 3 - testing prototype Milestone 4 on target to identify 2 areas RESPONSIBLE PARTY Milestone 5 have met and exceeded target of implementing five reports from the EDW and VHA/Truven for ongoing decision-making for clinical and operational improvement Milestone 6 education plans to be rolled out once corresponding tools are in place will meet June target FY2015 Operational Initiative 2: Create a positive experience for all key stakeholders by improving clinical and business throughput and efficiency through all transitions of care Vice President Palomar Medical Center Lorie Shoemaker provided the following update: On target to meet all milestones by fiscal year end Milestone 3 almost at target turnaround times for troponin and basic metabolic panel steadily improving. o Current focus is on staffing model HCAHPS scores for PMC and POM steadily rising Expense reduction over $600,000 thus far Utilizing the presentation distributed in the meeting packet, Ms. Shoemaker shared an update on the Patient Flow initiative, noting that progress is being made to the reduce the time patients wait to be admitted or discharged from the hospital. Concentration on key focus areas drives successes achieved thus far FY2015 Operational Initiative 3: Develop and implement a strong physician integration and alignment model that allows for effective communication, partnership and accountability in the management and care of patient Palomar Medical Center Chief of Staff Dr. Jeffrey Rosenburg provided the following update: Overall the initiative is on track for completion by target date o o o ADJOURNMENT Milestone 1- completed six of the eight elements for phase1. Currently focusing on identifying physician mentors, creating design for the orientation program and physician culture vision compact Modules 7 and 8 have been implemented Physician engagement survey currently under way;target is 55% participation; currently at 54.8%. Potential to extend survey to May 4 th to allow even greater participation MOTION: By Director Czerwonka, 2 nd by Director Greer and carried to adjourn the meeting. All in favor. None opposed Committee Chair McCune adjourned the meeting at 7:09 p.m. SIGNATURES: COMMITTEE CHAIR RAY MCCUNE, R.N DRAFT Board Strat & Facil Planning Cmtee Mtg Min.doc 3 10

13 STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES WEDNESDAY, APRIL 22, 2015 AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / RESPONSIBLE PARTY DISCUSSION BOARD ASSISTANT DEBBIE HOLLICK DRAFT Board Strat & Facil Planning Cmtee Mtg Min.doc 4 11

14 ADDENDUM B 12

15 STRATEGIC & FACILITIES PLANNING COMMITTEE AMENDED AND RESTATED BYLAWS 13 REVISED February 18, 2014 January 26, 2015 May 27, 2015

16 6.1.1 Strategic and Facilities Committee. (a) (b) (c) Voting Membership. The Committee shall consist of six voting members, including three members of the Board and one alternate who shall attend Committee meetings and enjoy voting rights on the Committee only when serving as an alternate for a voting Committee member, the President and Chief Executive Officer and the Chiefs of Staff of the Hospitals or the designees of the Chiefs of staff as approved by the Committee Chairperson. Non-Voting Membership. The Executive Vice President Strategy, Executive Vice President Finance, Executive Vice President Human Resources, Executive Vice President Operations, General Counsel,,, Vice Presidents of Palomar Medical Center, Palomar Health Downtown Campus and Pomerado Hospital, a nurse representative from Palomar Medical Center or Pomerado Hospital, Assistant Vice President Hospitality & FacilitiesDirector of Facilities Planning and Development, Chief Foundation Philanthropy Officer, a board member of the Palomar Health Foundation recommended by the Foundation and approved by the Committee Chairperson and an additional physician from each hospital as recommended by each hospital s Chief of Staff and as approved by the Committee Chairperson. As needed, other appropriate relevant staff in engineering, architectural, planning and compliance, and a Physician Advisory Committee member may be requested to attend along with Palomar Health staff to facilitate the work of the Committee. Duties. The duties of the Committee shall include but are not limited to: Regarding the Strategic Function: (i) Review and make recommendations to the Board regarding the District s short and long range strategic plans, master and facility plans, physician development plans and strategic collaborative relationships; and REVISED February 18, 2014 January 26, 2015 May 27,

17 Review annually those policies within the Committee s purview and report the results of such review to the Governance, Audit and Compliance Committee. Such reports shall include recommendations regarding the modification of existing, or creation of new policies; and (ii) (iii) (iv) Undertake planning regarding physician recruitment and retention and program development of new and enhanced services and Facilities; and Monitor new initiatives and programs; and Perform such other duties as may be assigned by the Board. Regarding the Facilities Function: (i) (ii) (iii) (iv) (v) (vi) (vii) Review construction estimates and expenses for accuracy and architectural plans for completeness and effectiveness; Approve construction project change orders in accordance with applicable district law and Palomar Health policies; Receive reports from the Construction Manager and the Director of Facilities Planning and Development; recommend action to the Board regarding facilities design and maintenance; Review regulations and reports regarding facilities and grounds from external agencies, accrediting bodies and insurance carriers; make recommendations for appropriate action regarding the same to the Board; Approve the annual Facilities Development Plan and regularly review updates on implementation of plan; Receive a biannual Environment of Care report; Perform such other duties as may be assigned by the Board REVISED February 18, 2014 January 26, 2015 May 27,

18 ADDENDUM C 16

19 Corporate Health Services Business to Business Strategy through Occupational Medicine 17

20 Philosophy Mission Heal, comfort, and promote health throughout the business community. Vision Provide peace of mind for work related risks and injuries, allowing organizations to focus on the total health of their business. 18

21 Background Opened Poway Clinic Onsite Wellness & Vaccination Services Interim Director Focus on growth Opened San Marcos Clinic Expand Onsite Services - Surveillance First Responder Surveillance Program 19

22 Our Services PREVENTION New Hires Physicals Drug Test HRA Biometrics Medical Surveillance CONTAINMENT Injury Mgmt Return to Work Case Mgmt Claims Review EDUCATION Ergonomics Presentations Consulting Medical Oversight 20

23 Touch Points Patient Encounters G O O D 16,000 Outpatient Clinic Visits 14,000 12,000 10,000 8,000 6,000 4,000 2,000 9,805 10,654 12,185 13,718 - FY2012 FY2013 FY2014 FY15 Proj 21

24 Referral Benefit FY14 $00,000 $00,000 $000,000 FY15 $00,000 $00,000 $000, Direct Care Referrals FY2012 FY2013 FY2014 FY15 Proj Specialist Rehab Total 22

25 Breadth of Connection Employer Clients G O O D Employers Serviced FY2012 FY2013 FY2014 FYTD 15 23

26 Bridging the Gap 50,000 45,000 Connected Employer Lives G O O D C Connected 40,000 35,000 40,456 37,752 41,234 43,036 H Healthcare 30,000 S Solution 25,000 FY2012 FY2013 FY2014 FYTD 15 24

27 The Power of Relationships Newsletters Annual Conference Quarterly Roundtable 25 Personal Connections

28 Newsletter Issues 96 Consecutive Issues Total Opens 14,167 Subscribers Open Rate 700+ Employers Newsletters 33% (National Average 24.87%) Click Through 25% (National Average 7.24%) Opt Out.01% (National Average 1.05%) 26

29 Annual Conference Newsletters attendees 56 attendees 69 attendees 11 vendors 81 attendees 16 vendors 97 attendees 17 vendors 100+ Estimated 21 vendors 27

30 Employer Roundtables Healthcare Reform Burnham Benefits Ergonomics Palomar Health Rehabilitation Aging Workforce ALPHA Fund Insurance Newsletters Affordable Care Act Impacts CA Work Comp Update Burnham Benefits Barney & Barney 28

31 Personal Connections Clinic Tours Employers who take time to tour take relationship seriously 90% close rate when we get employer to walk through our doors Workplace Tours Strengthens relationship when doctor takes time to tour workplace Clearer understanding of environment when writing work restrictions Employer Health Fairs TPA/Insurance Presentation Great opportunity to gain INTEL and build relationship with HR reps No charge for to participate Influencers of occupational health care Build trust and recognition through education presentation to this group Professional Associations Business park associations, HR associations, Insurance, etc. Network, Network, Network!!! 29

32 Traditional Occupational Medicine Medical Groups Employer Corporate Health Palomar Health Services Brokers Insurance 30

33 Corporate Health Model C Connected Insurance S H Healthcare Solution Corporate Health 31

34 Questions 32

35 ADDENDUM D 33

36 CONTINUUM OF CARE POPULATION HEALTH ALAN, J. CONRAD, MD, MMM, CPE, FACHE 34

37 TRIPLE AIM INSTITUTE FOR HEALTHCARE IMPROVEMENT Improving the patient experience of care Improving the health of populations Reducing the per capita cost of care 35

38 JOURNEY TO THE SECOND CURVE VOLUME TO VALUE Fee-for-Service reimbursement VALUE VALUE-BASED SECOND CURVE High quality not rewarded Value No shared financial risk Acute inpatient hospital focus IT investment incentives not seen by hospital Stand-alone care Systems can thrive Regulatory actions impede hospitalphysician collaboration Value VOLUME-BASED FIRST CURVE LIVING IN THE GAP VOLUME 36 Payment rewards population value - quality and efficient Quality impacts reimbursement Partnerships with shared risk Increased patient severity IT utilization essential for population health management Scale increases in importance Realigned incentives, encouraged coordination

39 POPULATION HEALTH Working Definition: Applying systematic quality and process improvement approaches in order to achieve the IHI Triple Aim An active, management approach An organization works to manage a populations health 37

40 POPULATION HEALTH: Macro levers Populations served by each payer: Quality expectations Cost targets Effects of benefit design Delivery of care: Care pathways, quality, access, site of service, efficiency Benefit & Product Design Patient Level Care Activities Community and External Environment Care Delivery Network Population Health Management Community: Needs and resources Network Construction: full spectrum of care across geography, contracted discounts 38 System level medical management: Clinical models, decreased variation, connect to the community

41 POPULATION HEALTH Actionable information to address the new needs Population sub-segmentation is the key tactic to: Drive a clinical model Address special-cause variation among teams and clinical group practices Address common-caused variation by improving the system 39

42 POPULATION HEALTH Transform Care delivery Create population health teams to do the work Physicians Nursing: Advanced Practice, RN, Diabetes Educators, LVN Health Coaches, Medical Assistants, Care Coordinators, Behavioral Health and Social Workers 40 Standardization enables delegating to a team Maximally use each team member s skills Physicians manage exceptions

43 POPULATION HEALTH 4 Areas for Success Actionable Information Registries, ADT summaries, EHR reminders Variation data from support teams Clinical operations per clinical model Primary Care Practice Population Health teams including physicians, RNs, MAs, Care Coordinators Success Communications and Processes Leadership and communication from top to bottom of the organization Processes that fit practice work flow Practice level activities that roll up to the goals of the organization Aligned Funding Payment models that allow us to pay for population health management activities Incentives aligned to goals at all levels of the organization 41

44 JOURNEY TO THE SECOND CURVE ALIGNING HOSPITALS, PHYSICIANS AND OTHER PROVIDERS ACROSS THE CONTINUUM OF CARE Evaluation Metrics A. Percentage of aligned and engaged physicians B. Percentage of physician and other clinical provider contracts with performance and efficiency incentives aligned with ACO-type incentives C. Availability of non-acute services D. Distribution of shared savings/performance bonuses/gains to aligned physicians and clinicians E. Number of covered lives accountable for population health F. Percentage of physicians in leadership Metrics for the Second Curve of Health Care 42

45 POPULATION HEALTH MANAGEMENT OPTIMIZING HIGH-RISK CARE MANAGEMENT The most costly 1% of patients account for one-fifth of national healthcare expenditures Complex co-occurring conditions High risk care management programs Clinicians and health care organizations are increasingly adopting programs of their own JAMA January 22,

46 POPULATION HEALTH MANAGEMENT OPTIMIZING HIGH-RISK CARE MANAGEMENT Anchored in the practice where patients receive their care There is no substitute for person-to-person contact Traditional fee-for-service reimbursement actively hinders experimentation with care management New payment models JAMA January 22,

47 POPULATION HEALTH MANAGEMENT OPTIMIZING HIGH-RISK CARE MANAGEMENT Purchasers have a fundamental role Employers and other purchasers of health care are the ultimate beneficiaries For most employers, it will entail working with payers and clinicians and health systems JAMA January 22,

48 POPULATION HEALTH MANAGEMENT FINDING THE ROLE OF HEALTH CARE IN POPULATION HEALTH Compared with social, environmental, and behavioral factors, medical care has only a relatively small influence on health for populations To meet this responsibility, health systems will need to (1) take additional responsibility, (2) create and expand partnerships, and (3) respond to societal demands for equity and value JAMA January 23,

49 POPULATION HEALTH MANAGEMENT POPULATIONS Advances in health information technology make it easier to: identify populations of patients; measure and track risk factors, quality of care, and outcomes; and facilitate teambased care. Must address non-medical drivers of health such as housing, education, or remediation of environmental threats. 47 JAMA January 23, 2014

50 POPULATION HEALTH MANAGEMENT PARTNERSHIPS Health systems or payers must believe that their contributions will produce value for their own patients or members A health system s influence on health will be greatest for those under direct care, but it also recognizes that the system can contribute to partnerships Innovative partnerships between health care system stake holders and other sectors Financial models that overtly foster partnership 48 JAMA January 23, 2014

51 POPULATION HEALTH MANAGEMENT EQUITY Must overcome the challenge of inequity of both access to and quality of medical care The first responsibility of any health care organization is to address disparities Health systems must be confident that a group-level focus will decrease disparities and that key stakeholders are engaged JAMA January 23,

52 POPULATION HEALTH MANAGEMENT HOSPITAL COMMUNITY BENEFIT PROGRAMS The geographic communities in which people live and work have a profound effect on their health and the health cate they receive CMMI has state grants to implement and test state innovations model plans Community benefits has been an obligation of tax-exempt hospitals JAMA February 2,

53 POPULATION HEALTH MANAGEMENT HOSPITAL COMMUNITY BENEFIT PROGRAMS Four principles could help guide the development of a strategy for leveraging community benefit programs: 1. defining mutually agreed-on regional geographic boundaries 2. ensuring that community benefit activities use evidence to prioritize interventions 3. increasing the scale and effectiveness of community benefit investments by pooling some resources 4. establishing shared measurement and accountability for regional health improvement 51 JAMA February 2, 2105

54 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL Health outcomes are produced by multiple factors, or health determinants The contribution of health care to health is modest-only 20 percent No single entity can be held accountable Collective effort is needed Frontiers of Health Services Management Summer

55 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL Contributions must come from those that have secondary influence on health outcomes Must form partnerships Michael Porter states solution lies in the principle of shared value, which involves creating economic value in a way that also creates value for society by addressing its needs and challenges Frontiers of Health Services Management Summer

56 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL Some elements of the community health business model would be: All stakeholders must be engaged Transparency Common purpose Resources need to be identified Interventions to improve community health Economic incentives Each community needs to be assessed and monitored Continuous redesign Frontiers of Health Services Management Summer

57 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL One sector may take lead responsibility for population health improvement, using informal or formal authority This lead entity serves as the integrator to align activities across multiple sectors Frontiers of Health Services Management Summer

58 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL Resources can be identified Capture funding Better return on investment from policies and programs outside of healthcare Strengthen governmental funding Focus on philanthropy Engage corporate business leaders Frontiers of Health Services Management Summer

59 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL Sector s primary control; multi-sectoral partnerships Business case for population health improvement and determine the resources and policies each community actor requires Foundations and government should collaborate Frontiers of Health Services Management Summer

60 STATE INNOVATION MODEL INITIATIVE CMS will award $665 million to support states in transformation. Key strategies are incorporating: Integration of Community-Based Services Population Health Focus 58

61 STATE INNOVATION MODEL INITIATIVE Enabling Strategies to Support System Transformation Quality Measurement Alignment Strategy 59

62 STATE INNOVATION MODEL INITIATIVE Programs will examine multiple delivery models: Patient Centered Medical Homes Health Homes Accountable Care Organizations Bundled Payments Episode-Based Payments Accountable Care Communities 60

63 Palomar Health Physicians Community Government 61

64 Addenda 62

65 JOURNEY TO THE SECOND CURVE ALIGNING HOSPITALS, PHYSICIANS AND OTHER PROVIDERS ACROSS THE CONTINUUM OF CARE Evaluation Metrics A. Percentage of aligned and engaged physicians B. Percentage of physician and other clinical provider contracts with performance and efficiency incentives aligned with ACO-type incentives C. Availability of non-acute services D. Distribution of shared savings/performance bonuses/gains to aligned physicians and clinicians E. Number of covered lives accountable for population health F. Percentage of physicians in leadership Metrics for the Second Curve of Health Care 63

66 POPULATION HEALTH MANAGEMENT OPTIMIZING HIGH-RISK CARE MANAGEMENT The most costly 1% of patients account for one-fifth of national healthcare expenditures Complex co-occurring conditions for which high-risk patients often receive poorly coordinated care, driving unnecessary utilization and poor outcomes High risk care management programs have the potential to improve care and reduce costs for this population Clinicians and health care organizations are increasingly adopting programs of their own JAMA January 22,

67 POPULATION HEALTH MANAGEMENT OPTIMIZING HIGH-RISK CARE MANAGEMENT High risk care management programs are most effective when they are anchored in the practice where patients receive their care There is no substitute for person-to-person contact Traditional fee-for-service reimbursement actively hinders experimentation with care management Shared savings arrangements, capitated payments and permember per-month payments for long term care management all afford care delivery organizations with the flexibility to reengineer care and create an environment where success improves financial performance JAMA January 22,

68 POPULATION HEALTH MANAGEMENT OPTIMIZING HIGH-RISK CARE MANAGEMENT Purchasers have a fundamental role in promoting effective high-risk care management for their covered populations Employers and other purchasers of health care are the ultimate beneficiaries of any savings borne by successful care management For most employers, it will entail working with payers to (1) promote a shift away from payer and third party led systems and (2) drive employees to clinicians and health systems that can offer these services more effectively. JAMA January 22,

69 POPULATION HEALTH MANAGEMENT FINDING THE ROLE OF HEALTH CARE IN POPULATION HEALTH Compared with social, environmental, and behavioral factors, medical care has only a relatively small influence on health for populations whether defined by health system or geographic boundaries. To meet this responsibility, health systems will need to (1)take additional responsibility for the health of the patient populations under their care, (2) create and expand partnerships with other entities with the potential to influence health, and (3) respond to societal demands for equity and value. JAMA January 23,

70 POPULATION HEALTH MANAGEMENT POPULATIONS Advances in health information technology make it easier to identify populations of patients; measure and track risk factors, quality of care, and outcomes; and facilitate team-based care. There is also increased potential for the identification and management of at-risk individuals within a practice or delivery system who may benefit from community resources to address non-medical drivers of health such as housing, education (e.g., early intervention for children), or remediation of environmental threats. 68 JAMA January 23, 2014

71 POPULATION HEALTH MANAGEMENT PARTNERSHIPS For meaningful contributions to population health initiatives to occur, health systems or payers must believe that such contributions will produce value for their own patients or members A health system s influence on health will be greatest for those under direct care, but it also recognizes that the system can contribute to partnerships that are important to achieving desired population outcomes when health systems alone have less capacity and control Innovative partnerships between health care system stake holders and other sectors with influence on health (public health, education, transportation, employers and others) are increasing Financial models that overtly foster partnership may hold promise for improving population health 69 JAMA January 23, 2014

72 POPULATION HEALTH MANAGEMENT EQUITY Any effort by health care systems to improve the health of either the patients they serve directly or the broader population must overcome the challenge of inequity of both access to and quality of medical care The first responsibility of any health care organization is to address disparities in the provision and outcomes of clinical care within its system Health systems must be confident that a group-level focus will decrease disparities and that key stakeholders (group members and leaders) are engaged fully in setting priorities and implementing solutions JAMA January 23,

73 POPULATION HEALTH MANAGEMENT HOSPITAL COMMUNITY BENEFIT PROGRAMS The geographic communities in which people live and work have a profound effect on their health and the health cate they receive CMMI has state grants to implement and test state innovations model plans with regional collaborative structures, sometimes called accountable health communities The provision of community benefits has been an obligation of tax-exempt hospitals for many decades JAMA February 2,

74 POPULATION HEALTH MANAGEMENT HOSPITAL COMMUNITY BENEFIT PROGRAMS Four principles could help guide the development of a strategy for leveraging community benefit programs to increase their influence: defining mutually agreed-on regional geographic boundaries to align both community benefit and accountable health communities initiatives ensuring that community benefit activities use evidence to prioritize interventions increasing the scale and effectiveness of community benefit investments by pooling some resources establishing shared measurement and accountability for regional health improvement JAMA February 2,

75 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL Health outcomes are produced by multiple factors, or health determinants-including medical care, health behaviors and the social and physical environments The contribution of health care to health is modest-only 20 percent No single entity can be held accountable for achieving the goals of improved population health Collective effort is needed by sectors not accustomed to working together and by stakeholders who may not be aware of how their actions affect population health Frontiers of Health Services Management Summer

76 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL Contributions must come from those that have secondary influence on health outcomes, such as business, education, state and local government, community development and philanthropy. Must form partnerships drawn from all sectors and the partnerships must be integrated using a community health business model Michael Porter states solution lies in the principle of shared value, which involves creating economic value in a way that also creates value for society by addressing its needs and challenges Frontiers of Health Services Management Summer

77 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL Some elements of the community health business model would be: All stakeholders must be engaged in the process Transparency with engagement and reporting to the public Common purpose needs to be established Resources need to be identified Interventions are directed at the overall purpose of improving community health Economic incentives need to be identified The state of health in each community needs to be assessed and monitored Continuous redesign Frontiers of Health Services Management Summer

78 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL One sector may take lead responsibility for population health improvement, using informal or formal authority This lead entity serves as the integrator to align activities across multiple sectors Frontiers of Health Services Management Summer

79 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL Resources can be identified Capture funding from reduction of ineffective healthcare spending Better return on investment from policies and programs outside of healthcare Strengthen governmental funding for population health improvements at all levels Focus on philanthropy Engage corporate business leaders Frontiers of Health Services Management Summer

80 POPULATION HEALTH IMPROVEMENT A COMMUNITY HEALTH BUSINESS MODEL Care should be taken to identify those improvements and opportunities that fall within the sector s primary control; those not under primary control should move to multi-sectoral partnerships Policymakers should make the business case for population health improvement and determine the resources and policies each community actor requires Foundations and government should collaborate to develop a group of cost-effective health policies in sectors beyond health, which could be reinforced by financial or regulatory incentives Frontiers of Health Services Management Summer

81 STATE INNOVATION MODEL INITIATIVE CMS will award $665 million to support states in transformation: Key strategies are incorporating: Integration of Community-Based Services Integration of public health, community-based and behavioral health services across the entire care continuum Population Health Focus Target the preventable drivers of poor health 79

82 STATE INNOVATION MODEL INITIATIVE Enabling Strategies to Support System Transformation Workforce development plans, HIT improvements and data analytics to enhance health care delivery Quality Measurement Alignment Strategy Outline a statewide plan for aligning quality measures by convening private and public payers to accelerate quality improvement and ease the administrative burden for all clinicians 80

83 STATE INNOVATION MODEL INITIATIVE Programs will examine multiple delivery models: Patient Centered Medical Homes Health Homes Accountable Care Organizations Bundled Payments Episode-Based Payments Accountable Care Communities 81