Delivering High Value Care Through Clinical Integration
|
|
- Heather Simon
- 6 years ago
- Views:
Transcription
1 Delivering High Value Care Through Clinical Integration AMGA 2013 ACO Collaborative Meeting Bill Hensel, MD, Operating/Executive Committee Steve Neorr, Executive Director
2 Greetings from Cone Health Greetings from Cone Health 2
3 The Moses H. Cone Memorial Hospital A Brief History Moses H. Cone ( ) Bertha L. Cone ( ) Trust established by Bertha Cone in 1911 to build a hospital as a memorial to her late husband, Moses Cone Construction begins in 1949 on The Moses H. Cone Memorial Hospital Hospital's first patient admitted in 1953 Articles of Incorporation state: No patient shall be refused admittance because of an inability to pay. 3
4 Cone Health System Overview Facilities 5 Hospitals - 1,035 Acute Care Beds Awaiting final FTC approval to merge with Alamance Regional Medical Center (238 beds; 2,100 employees) 2 Ambulatory Surgery Centers 1 Nursing Home 92 Beds 2 Freestanding Ambulatory Care Campuses, Including a Freestanding ED 100+ Outpatient and MD Facilities, Including JVs in Imaging, Cardiovascular Services, and Oncology Services 4
5 Cone Health System Overview People Over 8,600 Employees 1,000+ Medical Staff Members; 320+ Employed Physicians in Cone Health Medical Group Patient Care (FY 2012) 49,345 Discharges; 229,834 Inpatient Days; ,619 Outpatient Visits; 197,050 ED Visits Finances Over $1 Billion Revenues; $1.9 Billion in Assets Financial Ratios At or Above AA Benchmarks $185 Million Charity/Uncompensated Care (at cost) 5
6 Cone Health System Market Area Service Area Population ,124 1,014,621 Inpatients Served = 50.4% Source: ThomsonReuters Market Expert 6
7 Our Mission We serve our communities by preventing illness, restoring health and providing comfort, through exceptional people delivering exceptional care. Our Vision Cone Health will be a national leader in delivering measurably superior healthcare. Cone Health System Strategic Overview 7 Strategic Target 7
8 Triad HealthCare Network History and Overview Began as a 20-member physician-led steering committee in fall 2010 Developed over eight months as collaboration between independent and employed community physicians and Cone Health Formed officially in 2011 as a Clinically Integrated Network serving the Piedmont Triad area Is an affiliate of the Cone Health System, but governance and operations is led by physicians Represents a new model of care clinical integration - designed to align physicians and hospitals to improve access, improve quality and lower costs. 8
9 Triad HealthCare Network Goals Allow physicians to have the opportunity to lead and have a voice in the necessary changes in healthcare versus simply being passive and have change dictated Engage physicians to develop new models of care and true transformation of the local healthcare delivery system Provide resources to physicians to meet the growing demands of accountability and transparency Create greater collaboration and trust among physicians, hospitals, patients and payers Be renowned as a national leader in delivering exceptional health care value in terms of cost, quality and service 9
10 Triad HealthCare Network Structure and Governance MANAGEMENT Executive Medical Director Thomas Wall, M.D. Executive Director Steve Neorr 21 members: 17 Physicians (9 Ind./8 Emp.) 3 Cone Representatives 1 Community Representative Board of Managers Operating Committee 8 members: 3 Physicians (2 Ind./1 Emp.) 2 Cone Representatives 3 Community Representatives Nominating Committee Oversees day-to-day operations Assist development of physician board memberships Credentialing Committee Quality Committee Contracting and Finance Committee Health Information Exchange ( HIE ) Council Initial and ongoing membership criteria Set clinical performance criteria and review member performance Look at 3 rd -party agreements and determine potential bonus distributions Management and oversight of the THN HIE 1 0
11 Triad HealthCare Network Quality Committee Structure Quality Committee Patrick Wright, M.D. Chairman Mary Jo Cagle, M.D. Vice Chairman 1 1 Medicine CPC Danielle Ray, MD John Bednar, MD Administrative Chair Gastroenterology Hem/Oncology Infectious Disease Nephrology Rheumatology Dermatology Emergency Medicine Endocrinology Hospital Medicine Pulmonology Hospice /Palliative Care Neurology Primary Care CPC Doug Shaw, MD Yvonne Lowne, DO Administrative Chair Family Medicine Internal Medicine Hospital Medicine Psychiatry Heart and Vascular CPC Ed Gerhardt, MD Tom Stuckey, MD Cardiology Cardiovascular Surg. Vascular Surgery Surgery CPC David Newman, MD John Hewitt, MD Anesthesia General Surgery Orthopedics Ophthalmology ENT Urology Neurosurgery Women s and Children s CPC Kelly Leggett, MD Ron Young, MD Ob/Gyn Neonatology Pediatrics Hospital Clinical Services CPC Josh Kish, MD Mark Shogry, MD Pathology Radiology Radiation Oncology Practice Management Todd Pittman Misti Sellers Administrative Chair Administrative Chair Administrative Chair Administrative Chair Administrative Chair Community Practice Administrators
12 Triad HealthCare Network Structure and Membership (as of March 2013) Physician-led governance and committees composed of 50/50 split between PCPs and Specialists and employed and independent physicians 776 Affiliated physicians; 324 employed by Cone 55 groups; separate tax IDs 231 Primary Care Physicians across the community 180 Adult Medicine 58 Unique clinic locations; 26 different EMR systems; 7 practices no EMR 51 Pediatricians 11 Unique clinic locations; 4 additional EMR systems 12
13 Triad HealthCare Network Driving Care Transformation Deployment of advanced IT resources to support population management Care Management team to support practices Assistance to achieve Patient-Centered Medical Home recognition and practice transformation Facilitate care process redesign 13
14 Triad HealthCare Network Key IT functions considered to transform delivery Aggregate clinical data from disparate sources EPIC, community EHRs, payer claims data, other hospitals, reference labs, radiology results, etc. Deliver actionable clinical data to physicians - at the point of care, disease registries, portals, faxes, etc. Proactively identify those at the highest risk ability to make proactive interventions in disease progression Routinely report physician performance and compliance to national metrics, benchmarks and standards Report and manage cost efficiency among providers 14
15 Information Technology/Analytics Systems Health Information Exchange ( HIE ) Interfaces with community providers and aggregates clinical data Hospitals Physicians Labs/Pharmacy/Radiology Master Patient Index ( MPI ) Provides portal view to all providers Clinical Performance Reporting System Reports performance to quality metrics Provides clinical protocol engine; Clinical recommendations Point-of-care reports Patient disease registries Claims data integration Case Management module care documentation, communication Population analytics, utilization, case management module Patient stratification; Predictive risk Utilization and cost efficiency analytics 15
16 Triad HealthCare Network The challenge of aggregating data in a community POC Report Pop mgmt Performance Primary care providers EMR CINA Edge Server at Practice DB Replication Aggregate Clinical CDR THN Server (CINA Datamart) Practice CDR THN Quality Clinicals / Procedures ODBC/SQL Direct Claims DB User Access Population Reports Payers (CMS to begin with) Claims System Claims Data CSV / SFTP Clinicals CSV/SFTP EMPI CSV/SFTP Payer Data (Future) CSV/SFTP (POC records PDF) Incremental Clinical Data Practice Care Mgr User Specialist Providers & Providers not in CINA HIE CDR EMR ADT & Clinicals HL7, CSV / MLLP, SFTP, WS Wellogic HIE (Amazon Cloud) (Care Plan PDF) EMPI Portal EMPI ADT, SIU, ORU, ORM HL7/MLLP Optum Care Suite (Hosted at Optum) IP CT II THN Care Mgr User Risk Stratification HL7/MLLP HL7/WS HL7 / MLLP Provider Portal EMR EMR Lite ADT (A01 - A08) HL7/MLLP HL7 / MLLP LabCorp Quest Solastas GSO radiology / Canopy Providers with no EMR Hospitals EPIC Clinicals: Encounter, Vitals problems, Meds, Allergies, immunization, Procedures, Social hist., Fam hist. 16
17 CINA Point of Care Report Improving Care Delivery to Patients Guides decision making at the Point of Care Drives consistent care delivery across providers / practices / THN Promotes team based care delivery Integrates data beyond the EMR claims, hospital, community Encouraging Patient Responsibility Provides easily accessible tool for Patient Engagement Encourages talking points between the patient and care team Benefiting Practice Management Enhances current / new revenue generation Highlights ACO required metrics for reporting 17
18 Sample Clinical Decision Support at the Point-of-Care Diagnoses and Meds are prioritized to highlight chronic conditions Practice Performance Feedback Action Items and Goals are highlighted for quick reference and visibility Labs, Calculations and Diagnostic Procedures pertinent to the Action Items are displayed for easy reference 18 Targeted reminders for nursing staff allow better leverage of provider time and more efficient workflow
19 Wellogic Health Information Exchange 19 Connects healthcare information systems and devices across the continuum of care: Primary care physician & specialist offices Hospitals Long term care facilities Laboratories Imaging Centers Pharmacies Payers Creates one patient one record across all venues of care Delivers tests, reports, alerts, and decision support recommendations wherever necessary
20 Wellogic Health Information Exchange Screen Shots Presents longitudinal view of patient in the community 20
21 Wellogic Health Information Exchange Screen Shots Click on Lab Value for Full Panel 21
22 Optum Population Management/Analytics Overall impact of Optum Risk stratification and interventions Who should THN Care Management help manage? Severity of illness determination Utilization, cost efficiency PCPs, SCPs, Episode Treatment Groups (ETGs) Effect on day to day PCP activities Communication with THN Care Management 22
23 23 SERVICES METHODS WHAT THIS MEANS RESULT Provider Collaboration Goal Collaboration Team Collaboration of Barriers High-Risk Community CM Relationship Building Health Belief Model Utilized Evidenced-Based Education Advanced Directive Planning Care Transition Disease Management Community Resource Referral Med Adherence Program THN Care Management Impacting Health and Wellness Outcomes for All Coordination of Serivces Assessment within hours Post-acute Health Promotion Model Utilized Evidenced-based Education Eligibility Determination Payer Collaboration Medication Box Fills Pharmaceutical Engagement Consistent Message to Patients Patients Assessed at Home Holistic Plans Implemented Patient and Family Engagement Standardized Assessment Call Early Identification of Barriers Plans to Remove Barriers Engage Members in Goal Setting Educate Toward Self-Management Members Connected With Services Reduces Barriers to Treatment Reduces Barriers to Quality of Life Reduced Confusion of Timing Meds Improved Adherence to Meds One Multifaceted Plan for Quality Outcomes Improved Self-Monitoring Reduced Emergency Room Visits Reduced 30-Day Readmissions Advanced Directive Goals Improved Quality of Life Reduced 30-Day Readmissions Improved Self-Management Treatment Goals Achieved Improved Outcomes Coordinated Services Improved Quality of Life Treatment Goals Achieved Consistent Med Optimization 24-hour Nurse Access Line Timely Access for Questions Reduced Anxiety about Unknown Reduced Emergency Room Visits
24 Triad HealthCare Network Care Management Team Supports Practices Rhonda Rumple, RN, MSN, CCM - Program Director RN Care Managers (16) Licensed Clinical Social Workers (3) RN Hospital Liaisons (2) Care Management Assistants (2) Geriatric Nurse Practitioner (1) Clinical Pharmacist Manager (1) Access Data Base Specialist (1) 24
25 Engaged TransforMED to lead PCMH initiative Train the trainer model Triad HealthCare Network PCMH Assistance Teamed with local Area Health Education Center (AHEC) to provide boots on the ground Funding one AHEC FTE dedicated to THN PCMH initiative Identified 24 initial practices expressing interest to go through process Wave 1: 5 practices; Late March 2013 Wave 2: 13 practices; June 2013 Wave 3: 4 practices; September 2013 Wave 4: 2 practices; January
26 Readmissions - System-wide breakthrough project CHF COPD Pneumonia High ED use/past Admissions Care Transitions Hand offs, access Chronic disease management CHF Diabetes Sanofi support Hypertension Triad HealthCare Network Facilitating Care Process Redesign 26
27 Triad HealthCare Network Contracting Approach Initial focus on quality, not joint FFS, contracting Practice maintains control of billing and collection Practice makes claims and EMR information available Goal to create community Clinical Data Repository (CDR) Focus on incentive-based contracts based on quality and cost control initiatives P4P, shared savings, gain sharing THN negotiates a Savings/Bonus Pool with the payers government, insurance companies and employers THN is responsible for managing / distributing bonus payments 27
28 Insurers and Employers Triad HealthCare Network Business Model P4P Shared Savings Gain Sharing Negotiated Incentive-Based Contracts Continue Current Fee-For-Service Claims & Payment Structure Quality Bonus Payout Based On THN Goals and Performance Measures POC, Registry, Performance Data 28 Physicians Claims and EMR Data
29 Triad HealthCare Network First Year Accomplishments Affiliated with over 750 community physicians over 50% independent Developed physician-led infrastructure Identified 129 quality metrics across all major specialties Approved to participate in Medicare Shared Savings Program as ACO Over 40,000 Medicare beneficiaries Identified and begun deployment of Clinical Performance Reporting System, Health Information Exchange ( HIE ), and population analytics, utilization, case management modules Identification and hiring of case management team 29
30 Triad HealthCare Network Lessons Learned Administrative Perspective PCP alignment/attribution is difficult Not prepared for initial MSSP list Underestimated time and effort to send letters to 40,000 patients Interfacing and connecting practices takes longer than anyone will tell you Vendors are all learning too EMR data is not structured and standardized and time consuming to validate Clinical data is difficult to aggregate and report must standardize 30
31 Triad HealthCare Network Lessons Learned - Administrative Perspective Need a plan to educate and train multiple clinics (physicians and staff) Should have required EMR use to participate Develop a model to distribute maybe money earlier versus later Plan well ahead for care management and analytics Have a plan to manage your population assuming you do not have much data initially Limit your initiatives and focus on key areas You can have a lot of ammunition and never get a shot off. 31
32 Triad HealthCare Network Lessons Learned Physician Perspective Take the time to develop understanding, unity and buy-in from your core physician leaders. Physician culture is one of skepticism. Don t expect full buy in from all physicians at first. Physicians witnessing the health system committing resources based on the potential is very influential. ACO leadership needs a balance of internal and external representation old and new. Physician engagement is key. Provide many opportunities for involvement. 32
33 Triad HealthCare Network Lessons Learned Physician Perspective Be cognizant of and transparent about hot button topics money, employed vs. independent, PCP vs specialists; MEC Focus on Primary Care. Need to expand physician definition of professionalism to include a vision of a team and bigger picture. Be aware and sensitive to change overload. Don t expect too much help from the government 33
34 Questions? For further information, please visit 34
ACOs: California Style
ACOs: California Style ACO Congress John E. Jenrette, M.D. Chief Executive Officer Sharp Community Medical Group November 2, 2011 California Style California Style A CO California Style California Style
More informationMedicare / Accountable Care Organization CHS Finance Division CPE Day November 2, 2015
Medicare / Accountable Care Organization CHS Finance Division CPE Day November 2, 2015 Steve Neorr Chief Administrative Officer, Triad HealthCare Network Jeff Jones Chief Financial Officer, Cone Health
More informationAMGA Webinar: MSSP Final Rule. Scott Hines, MD Chief Quality Officer Crystal Run Healthcare July 16, 2015
AMGA Webinar: MSSP Final Rule Scott Hines, MD Chief Quality Officer Crystal Run Healthcare July 16, 2015 Crystal Run Healthcare Physician owned MSG in NY State, founded 1996 >350 providers, >30 locations
More informationValue Based Care An ACO Perspective
Value Based Care An ACO Perspective NCIOM Task Force on Accountable Care Communities January 24, 2018 Steve Neorr Chief Administrative Officer 2 3 4 5 Source: Banthin, Jessica. Healthcare Spending Today
More informationRoll Out of the HIT Meaningful Use Standards and Certification Criteria
Roll Out of the HIT Meaningful Use Standards and Certification Criteria Chuck Ingoglia, Vice President, Public Policy National Council for Community Behavioral Healthcare February 19, 2010 Purpose of Today
More informationMedicare Shared Savings ACOs: One Organization s Lessons Learned. Gregory A. Spencer MD FACP Chief Medical Officer Crystal Run Healthcare LLP
Medicare Shared Savings ACOs: One Organization s Lessons Learned Gregory A. Spencer MD FACP Chief Medical Officer Crystal Run Healthcare LLP Learning Objectives Identify organizational strengths and weaknesses
More informationNew Strategies in Value Based Care
New Strategies in Value Based Care D. Keith Fernandez, M.D. Chief Clinical Officer, Privia Health CEO, Privia Medical Group Gulf Coast 713-545-1366 kfernandez@priviahealth.com none Disclosures Learning
More informationPhysician Engagement
Pathways for Successful Accountable Care Organizations: Physician Engagement Thomas Kloos, MD Jim Barr, MD Atlantic ACO & Optimus Healthcare Partners ACO Helping providers Care Better for their patients.
More informationJumpstarting population health management
Jumpstarting population health management Issue Brief April 2016 kpmg.com Table of contents Taking small, tangible steps towards PHM for scalable achievements 2 The power of PHM: Five steps 3 Case study
More informationUsing Data for Proactive Patient Population Management
Using Data for Proactive Patient Population Management Kate Lichtenberg, DO, MPH, FAAFP October 16, 2013 Topics Review population based care Understand the use of registries Harnessing the power of EHRs
More informationAdvocate Cerner Partnership Creates Big Data Analytics for Population Health
Advocate Cerner Partnership Creates Big Data Analytics for Population Health Tina Esposito, VP Center for Health Information Services Rishi Sikka, MD, Senior VP Clinical Operations Scottsdale Institute
More informationPopulation Health: Tamara Cull, MSW, LCSW, ACM National Director, Care Management, Value Based Programs and Operations November, 2014
In the Hospital and Health System ACO Tamara Cull, MSW, LCSW, ACM National Director, Care Management, Value Based Programs and Operations November, 2014 What We ll Be Discussing Who is CHI What are we
More informationSandra Robinson, RN, MSN, ACM, CEN
Developing and Measuring Care Coordination Outcome Goals and Objectives ACMA National Conference April 28, 2015 Cleveland Clinic Care Management Sandra Robinson, RN, MSN, ACM, CEN (robinss12@ccf.org) Joan
More informationRoadmap to accountable care: The chicken or the egg technology investment or clinical process improvement?
Roadmap to accountable care: The chicken or the egg technology investment or clinical process improvement? August 29, 2012 Meet the Presenters Michael Griffis CIO Innovative Practices Tucson, AZ Beth Hartquist,
More informationPhysician Liaison Program. Joan Brewer, RN Referral Relations Manager Billings Clinic Billings, MT
Physician Liaison Program Joan Brewer, RN Referral Relations Manager Billings Clinic Billings, MT Organizational Highlights Employ 3,750 employees Group practice with 280 Physicians, 90 PA/NPs Clinic &
More informationAccountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services
Accountable Care and the Laboratory Value Proposition Les Duncan Director of Operations Highmark Health - Home and Community Services Agenda The Goals and Status of Delivery System Reform and Alternative
More informationCare Management in the Patient Centered Medical Home. Self Study Module
Care Management in the Patient Centered Medical Home Self Study Module Objectives Describe the goals of care management Identify elements of successful care management Recognize the 5 step Care Management
More informationPOPULATION HEALTH PLAYBOOK. Mark Wendling, MD Executive Director LVPHO/Valley Preferred 1
POPULATION HEALTH PLAYBOOK Mark Wendling, MD Executive Director LVPHO/Valley Preferred www.populytics.com 1 Today s Agenda Outline LVHN, LVPHO and Populytics Overview Population Health Approach Population
More informationA Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation
A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation Daniel J. Marino, President/CEO, Health Directions Asad Zaman, MD June 19, 2013 Session Objectives Establish
More informationReducing Hospital Admissions Through the Use of IT. Steven Milligan MD Medical Director of ACO Management Colorado Health Neighborhoods
Reducing Hospital Admissions Through the Use of IT Steven Milligan MD Medical Director of ACO Management Colorado Health Neighborhoods Conflict of Interest Steven Milligan, MD Has no real or apparent conflicts
More informationCSO HIMSS Spring Conference 2013 Expanding Meaningful Use to the Point of Care
CSO HIMSS Spring Conference 2013 Expanding Meaningful Use to the Point of Care Glenn Loomis, MD President & CEO & M. Todd Philippe, MD Physician Superuser St. Elizabeth Physicians CSOHIMSS 2013 Slide 0
More informationDRAFT Complex and Chronic Care Improvement Program Template. (Not approved by CMS subject to continuing review process)
DRAFT Complex and Chronic Care Improvement Program Template Performance Year 2017 (Not approved by CMS subject to continuing review process) 1 Page A. Introduction The Complex and Chronic Care Improvement
More informationMission Health Care Network. April 2017
Mission Health Care Network April 2017 WHAT IS MISSION HEALTH CARE NETWORK? Mission Health Care Network is a Clinically Integrated Network including groups of doctors, the hospital and other health care
More informationPQP & Social Determinants of Health NC Medical Society Population Health Collaborative 9/14/2017 Amy Messier, MD, Medical Director Lydia Newman, MPP,
PQP & Social Determinants of Health NC Medical Society Population Health Collaborative 9/14/2017 Amy Messier, MD, Medical Director Lydia Newman, MPP, Executive Director physician Quality Partners Physician
More informationTechnology Fundamentals for Realizing ACO Success
Technology Fundamentals for Realizing ACO Success Introduction The accountable care organization (ACO) concept, an integral piece of the government s current health reform agenda, aims to create a health
More informationFrom Reactive to Proactive: Creating a Population Management Platform
Session D9 / E9 From Reactive to Proactive: Creating a Population Management Platform Richard Gitomer, MD Director, Brigham and Women s Primary Care Center of Excellence Vice Chair, Primary Care, Dept.
More informationHIE Data: Value Proposition for Payers and Providers
HIE Data: Value Proposition for Payers and Providers Session #21, March 6, 2018 Laura McCrary, Executive Director, KHIN Tara Orear, Senior Ambulatory Systems Analyst, Newman Regional Health Dirk Rittenhouse,
More informationConnected Care Partners
Connected Care Partners Our Discussion Today Introducing the Connected Care Partners CIN What is a Clinically Integrated Network (CIN) and why is the time right to join the Connected Care Partners CIN?
More informationCPC+ CHANGE PACKAGE January 2017
CPC+ CHANGE PACKAGE January 2017 Table of Contents CPC+ DRIVER DIAGRAM... 3 CPC+ CHANGE PACKAGE... 4 DRIVER 1: Five Comprehensive Primary Care Functions... 4 FUNCTION 1: Access and Continuity... 4 FUNCTION
More informationExamining the Differences Between Commercial and Medicare ACO Models
Examining the Differences Between Commercial and Medicare ACO Models Michelle Copenhaver December 10, 2015 Agenda 1 Understanding Accountable Care Organizations 2 Moving to Accountable Care: Enhancing
More informationAll ACO materials are available at What are my network and plan design options?
ACO Toolkit: A Roadmap for Employers What is an ACO? Is an ACO strategy right for my company? Which ACOs are ready? All ACO materials are available at www.businessgrouphealth.org What are my network and
More informationProgram Overview
2015-2016 Program Overview 04HQ1421 R03/16 Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service
More informationPCMH to ACO: Carilion Clinic s Journey
PCMH to ACO: Carilion Clinic s Journey Michael P. Jeremiah, MD, FAAFP Chair, Department of Family and Community Medicine Carilion Clinic and the Virginia Tech-Carilion School of Medicine Patient-Centered
More informationOMC Strategic Plan Final Draft. Dear Community, Working together to provide excellence in health care.
Dear Community, Working together to provide excellence in health care. This mission statement, established nearly two decades ago, continues to be fulfilled by our employees and medical staff. This mission
More informationAdopting Accountable Care An Implementation Guide for Physician Practices
Adopting Accountable Care An Implementation Guide for Physician Practices EXECUTIVE SUMMARY November 2014 A resource developed by the ACO Learning Network www.acolearningnetwork.org Executive Summary Our
More informationL8: Care Management for Complex Patients: Strategies, Tools and Outcomes
The Triple Aim 16 th Annual Summit: Institutes for Healthcare Improvement - Improving Patient Care in the Office Practice and the Community March 16, 2015 Dallas, Texas L8: Care Management for Complex
More informationMAKING PROGRESS, SEEING RESULTS
MAKING PROGRESS, SEEING RESULTS VALUE-BASED CARE REPORT HUMANA.COM/VALUEBASEDCARE Y0040_GCHK4DYEN 1117 Accepted 2 Americans are sick and getting sicker, with millions of us living with chronic conditions
More informationESRD Network 14. Supporting Quality Care
1 ESRD Network 14 Supporting Quality Care 2 What is an HIE HIE Type National State Region Community HIE Goal Share health information Better patient outcomes Lower costs 3 How do HIEs support Patient Care
More informationKatherine Schneider, MD, MPhil Senior Vice President, Health Engagement July 29, 2011
Accountable Care: Health System View CHC Best Practices Forum Katherine Schneider, MD, MPhil Senior Vice President, Health Engagement July 29, 2011 Who we are Southeastern New Jersey s largest health system
More informationPopulation Health. Collaborative Care. One interoperable platform. NextGen Care
Population Health. Collaborative Care. One interoperable platform. NextGen Care We ve become very proactive in identifying at-risk patients and getting them in our door before they get sick. Our physicians
More information2015 Physician Licensure Survey
2015 Physician Licensure Survey 1. What is your racial background? Please select all that apply. White American Indian or Alaska Native Native Hawaiian/Pacific Islander Black or African American Asian
More informationCreating a Data-Driven Culture to Right-Size Capacity and Enhance Quality and Safety
Creating a Data-Driven Culture to Right-Size Capacity and Enhance Quality and Safety MaryPat Sullivan, CNO and Chief Experience Officer, Overlook Medical Center, Atlantic Health System, Summit, NJ Jacalyn
More informationYOUR HEALTH INFORMATION EXCHANGE
YOUR HEALTH INFORMATION EXCHANGE Introduction to Health Information Exchange Healthcare organizations are experiencing substantial pressures from initiatives and reforms such as new payment models, care
More informationFrom Volume to Value: Toward the Second Curve AHA Sections for Metropolitan and Small or Rural Hospitals
From Volume to Value: Toward the Second Curve AHA Sections for Metropolitan and Small or Rural Hospitals A Network Affiliation the Preserves Hospital Independence Nebraska Regional Provider Network Kimberly
More informationOne Medicine: Incorporating Population Health Principles and Best Practices into Clinical Workflow
One Medicine: Incorporating Population Health Principles and Best Practices into Clinical Workflow March 5, 2018 Jayne Bassler President, Population Health Services Organization Senior Vice President,
More informationEMPI Patient Matching Solution Product Use Cases: Epic Electronic Health Record Integration
EMPI Patient Matching Solution Product Use Cases: Epic Electronic Health Record Integration Enterprise Master Patient Index (EMPI) Product Overview NextGate can break down the patient identification barriers
More informationPhysician Compensation Directions and Health Reform. July 2017
Physician Compensation Directions and Health Reform July 2017 Speaker Introduction Wayne Hartley Vice President, AMGA Consulting Over 20 Years of Medical Group & Consulting Experience Allina Health, Minneapolis,
More informationBuilding the Universal Roadmap to Population Health Management
Building the Universal Roadmap to Population Health Management Executive Webinar January 21, 2016 Karen Handmaker, MPP, PCMH CCE IBM Watson Health House Keeping 1. Using the control panel Use the control
More informationTransitions of Care: Primary Care Perspective. Patrick Noonan, DO
Transitions of Care: Primary Care Perspective Patrick Noonan, DO Disclosures None Bio Outpatient primary care internist at New Pueblo Medicine Completed residency at the University of Iowa Graduated from
More informationImproving Care Coordination to Manage an ACO Population. Greater Baltimore Medical Center
Improving Care Coordination to Manage an ACO Population Greater Baltimore Medical Center Presenter: Julie Silver September 27, 2012 Background Greater Baltimore Medical Center (GBMC) 281 Licensed Beds
More informationOrange County s Health Care Coverage Initiative Network Structure: Interim Findings
Orange County s Health Care Coverage Initiative Network Structure: Interim Findings Introduction The HCCI Demonstration Program in Orange County provides health care to low-income uninsured adults and
More information1998 AAPA Census Report
Section I. General Information about Respondents Table 1. Distribution of Respondents by Sex Respondents... 15716 100.0% Male... 7413 47.2% Female... 8303 52.8% Table 2. Distribution of Respondents by
More informationExhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013)
Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) 24 percent (52 ACOs) earned shared savings bonus 27 percent (60 ACOs) reduced spending,
More informationValue-Based Models: Two Successful Payer-Provider Approaches March 1, 2016
Value-Based Models: Two Successful Payer-Provider Approaches March 1, 2016 Clifford T. Fullerton, MD, MSc President, Baylor Scott & White Quality Alliance Chief Population Health Officer, Baylor Scott
More informationThe Physician s Perspective
The Physician s Perspective How the Changing Role of the PCP is Leading Healthcare Reform May 22, 2015 Carman A. Ciervo, DO Chief Physician Executive Our Vision To transform the healthcare To transform
More informationArkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual
Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2016 This document is a guide to the 2016 Arkansas Blue Cross and Blue Shield Patient-Centered Medical Home program (Arkansas
More informationMEDICARE CCLF ANALYTICS: MEDICARE ANALYTICS DATA ENGINE (MADE)
MEDICARE CCLF ANALYTICS: MEDICARE ANALYTICS DATA ENGINE (MADE) Frequently Asked Questions 1.2 November 13, 2017 hmetrix hmetrix This document contains frequently asked questions regarding the utility,
More informationUsing Data to Yield High Impact Business Intelligence Wednesday, July 25, 2012
Using Data to Yield High Impact Business Intelligence Wednesday, July 25, 2012 Brent J. Estes President and CEO, Rush Health About Rush Rush University Medical Center 673 Beds 36,000 admissions 391,700
More informationCommunications Strategies for Effectively Marketing an ACO. Pam Zippi, Director of Marketing Jean Sullivan, Marketing Manager
Communications Strategies for Effectively Marketing an ACO Pam Zippi, Director of Marketing Jean Sullivan, Marketing Manager Laying the Foundation Established in 1994 80 physicians in 14 locations (Acquired)
More informationPopulation Health or Single-payer The future is in our hands. Robert J. Margolis, MD
Population Health or Single-payer The future is in our hands Robert J. Margolis, MD Today s problems Interim steps Population health Alternatives Conclusions Outline $3,000,000,000,000 $1,000,000,000,000
More informationHealthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks
Healthcare Financial Management Association October 13 th, 2016 Introduction to Accountable Care Organizations and Clinically Integrated Networks Agenda Define ACO, CIN, and Coordinated Care Review ACO/CIN
More informationProposed Meaningful Use Incentives, Criteria and Quality Measures Affecting Critical Access Hospitals
Proposed Meaningful Use Incentives, Criteria and Quality Measures Affecting Critical Access Hospitals Paul Kleeberg, MD, FAAFP, FHIMSS Clinical Director Regional Extension Assistance Center for HIT (REACH)
More informationCPAs & ADVISORS PHYSICIAN POPULATION RATIOS: THE KEY TO EVALUATING PHYSICIAN NEED, AND CREATING EFFECTIVE RECRUITING, RETENTION PLANS
CPAs & ADVISORS experience ideas // PHYSICIAN POPULATION RATIOS: THE KEY TO EVALUATING PHYSICIAN NEED, AND CREATING EFFECTIVE RECRUITING, RETENTION PLANS Presented by Scott Bezjak, Partner, BKD, LLP and
More informationCoastal Medical, Inc.
A Culture of Collaboration The Organization Physician-owned group Currently 19 offices across the state of Rhode Island and growing 85 physicians, 101 care providers The Challenge Implement a single, unified
More informationBuilding a Multi-System Clinically Integrated Network
Building a Multi-System Clinically Integrated Network 22 nd Annual AHA Leadership Summit July 2014 Valence Health Has Been Helping Provider Organizations Progress Toward Value-Based Care Since 1996 Technology-enabled
More informationAmerican Recovery & Reinvestment Act
American Recovery & Reinvestment Act Meaningful Use Dawn Ross, Clinical Informatics Director Linda Wilson, Meaningful Use Coordinator 10/26/2015 Overview American Recovery and Reinvestment Act of 2009
More informationAdvancing Primary Care Delivery
Advancing Primary Care Delivery Tenth National Pay for Performance Summit March 3, 2015 Simeon Schwartz, MD CEO, WESTMED Medical Group, P.C. WESTMED Medical Group Established 1996 by 16 physicians 300
More informationCONTENTS. Introduction...3. Current State of Regulatory Burden...4. Burden Level by Regulatory Issue...5. The Move Toward Value...
R E G U L ATO RY B U R D E N S U RV E Y OCTOBER 2018 1 CONTENTS Introduction...3 Current State of Regulatory Burden...4 Burden Level by Regulatory Issue...5 The Move Toward Value...6 The Medicare Quality
More informationFrequently Asked Questions (FAQ) The Harvard Pilgrim Independence Plan SM
Frequently Asked Questions (FAQ) The Harvard Pilgrim Independence Plan SM Plan Year: July 2010 June 2011 Background The Harvard Pilgrim Independence Plan was developed in 2006 for the Commonwealth of Massachusetts
More informationMaryland s Integrated Care Network. Heading into Year Three
Maryland s Integrated Care Network Heading into Year Three Facilitator David Finney Chief of Staff, CRISP Partner, Leap Orbit Learning Objectives At the end of this session, you will be able to Explain
More informationInsights as a Service. Balaji R. Krishnapuram Distinguished Engineer, Director of Analytics, IBM Watson Health
Insights as a Service Balaji R. Krishnapuram Distinguished Engineer, Director of Analytics, IBM Watson Health Data & Knowledge Explosion: New data about individuals, used in new ways helps determines health
More informationTopics for Today s Discussion
MICAH Quality Network Population Insights Reporting and 2017 2018 PG5 P4P Program Year Updates Blue Cross Blue Shield of Michigan Hospital Incentive Programs August 18 th, 2017 Topics for Today s Discussion
More informationDeriving Value from a Health Information Exchange. HIMSS17 DA-CH Community Conference Healthix I New York I February 20, 2017
Deriving Value from a Health Information Exchange HIMSS17 DA-CH Community Conference Healthix I New York I February 20, 2017 About Healthix About Healthix Hundreds of healthcare organizations at more than
More informationThe Accountable Care Organization Specific Objectives
Accountable Care Organizations and You E. Christopher h Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State
More information2017 BENEFIT ENROLLMENT
2017 BENEFIT ENROLLMENT 2017 Medical Plans. All medical plans will be on the Wichita Preferred Quality Point of service (QPOS) plans in the Wesley preferred narrow network. Employees will be required to
More informationMedical Home as a Platform for Population Health
Medical Home as a Platform for Population Health Population Health Colloquium March 8, 2016 Emily Brower Vice President, Population Health Atrius Health Emily_Brower@atriushealth.org 2016 Atrius Health,
More informationHEALTH CARE REFORM IN THE U.S.
HEALTH CARE REFORM IN THE U.S. A LOOK AT THE PAST, PRESENT AND FUTURE Carolyn Belk January 11, 2016 0 HEALTH CARE REFORM BIRTH OF THE AFFORDABLE CARE ACT Health care reform in the U.S. has been an ongoing
More informationDeveloping and Implementing Alternative Payment Models. Presented by AllCare Health APM Team
Developing and Implementing Alternative Payment Models Presented by AllCare Health APM Team AllCare Service Area and Membership County Members Jackson 28,449 Josephine 19,016 Curry/Douglas 2,871 Total
More informationThought Leadership Series White Paper The Journey to Population Health and Risk
AMGA Consulting Thought Leadership Series White Paper The Journey to Population Health and Risk The Journey to Population Health and Risk Howard B. Graman, M.D., FACP White Paper, January 2016 While the
More informationABOUT THE CONE HEALTH NETWORK OF SERVICES
THE MOSES H. CONE MEMORIAL HOSPITAL (536 beds) Critical Care Services All system ICU patients are monitored with the help an electronic ICU monitoring system (VISICU ). Emergency Services Medical Intensive
More informationLeveraging HIE to Bolster Accountable Care Organizations. Healthcare Unbound / July 12, 2013
Leveraging HIE to Bolster Accountable Care Organizations Healthcare Unbound / July 12, 2013 Types of Health Info. Exchange Direct (Point-to-Point) Query-Based 2013 Colorado Regional Health Information
More informationBCBSM Physician Group Incentive Program
BCBSM Physician Group Incentive Program Organized Systems of Care Initiatives Interpretive Guidelines 2012-2013 V. 4.0 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee
More informationPrimary Care Transformation in the Era of Value
Primary Care Transformation in the Era of Value CMS Innovation Center & Primary Care Bruce Finke, MD Janel Jin, MSPH Gabrielle Schechter, MPH Center for Medicare & Medicaid Innovation Centers for Medicare
More informationTransforming Health Care with Health IT
Transforming Health Care with Health IT Meaningful Use Stage 2 and Beyond Mat Kendall, Director of the Office of Provider Adoption Support (OPAS) March 19 th 2014 The Big Picture Better Healthcare Better
More informationMitzi Cardenas Sr. VP/Strategy, Business Development and Technology Truman Medical Centers
Mitzi Cardenas Sr. VP/Strategy, Business Development and Technology Truman Medical Centers HIMSS Stage 7: What it Means Heart of America HIMSS and the Missouri Health Information Management Association
More informationAchieving HIMSS Level 7 Implications for HIM. Children s Health System of Texas
Achieving HIMSS Level 7 Implications for HIM Children s Health System of Texas Katherine Lusk, MHSM, RHIA Chief Health Information Management & Exchange Officer Children s Health SM Four Campuses, 562
More information2018 Hospital Pay For Performance (P4P) Program Guide. Contact:
2018 Hospital Pay For Performance (P4P) Program Guide Contact: QualityPrograms@iehp.org Published: December 1, 2017 Program Overview Inland Empire Health Plan (IEHP) is pleased to announce its Hospital
More informationIMPROVING TRANSITIONS OF CARE IN POPULATION HEALTH
IMPROVING TRANSITIONS OF CARE IN POPULATION HEALTH TABLE OF CONTENTS 1. The Transitions Challenge 2. Impact of Care Transitions 3. Patient Insights from Project Boost 4. Identifying Patients 5. Improving
More informationDisclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws.
Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that
More informationThe Drive Towards Value Based Care
The Drive Towards Value Based Care Thursday, March 3, 2016 Michael Aratow, MD, FACEP Chief Medical Information Officer, San Mateo Medical Center Gaurav Nagrath, MBA, Sr. Strategist, Population Health Research
More information2013 Physician Inpatient/ Outpatient Revenue Survey
Physician Inpatient/ Outpatient Revenue Survey A survey showing net annual inpatient and outpatient revenue generated by physicians in various specialties on behalf of their affiliated hospitals Merritt
More informationPacificSource Community Solutions Referral Frequently Asked Questions
PacificSource Community Solutions Referral Frequently Asked Questions **For Provider Use Only** 1. What is the difference between a referral and a preapproval? A referral is the process by which the member
More informationDisclosures. Learning Objectives 4/26/2017. Impact of a Pilot Ambulatory Care Pharmacist in a Family Practice Clinic
Impact of a Pilot Ambulatory Care Pharmacist in a Family Practice Clinic Taylor Sandvick, PharmD, PGY1 Pharmacy Resident St. Peter s Hospital, Helena, MT April 29, 2017 Disclosures 2 Financial: Nothing
More informationDenver Health Medical Plan, Inc Access Plan for Large Group and Exchange Plans
Denver Health Medical Plan, Inc. 2016 Access Plan for Large Group and Exchange Plans Table of Contents Page INTRODUCTION 3 I. DHMP NETWORKS OF PRIMARY CARE, SPECIALISTS, BEHAVIORAL HEALTH, HOSPITALS AND
More informationA Care Coordination Model for Value-Based Performance Programs
A Care Coordination Model for Value-Based Performance Programs Richard S. Chung, MD Chief Clinical Officer APS Healthcare 8th National Pay for Performance (P4P) Summit February 20, 2013 Hyatt Regency Hotel,
More informationEmbedded Case Manager
Embedded Case Manager Joann Sciandra, RN, BSN, CCM Medical Home Summit ProvenHealth Navigator Geisinger Health System An Integrated Health Service Organization Provider Facilities Managed Care Companies
More informationThe content and/or presentation of the information will promote quality or improvements in healthcare and will not promote commercial interests
Disclosure Statement: The content and/or presentation of the information will promote quality or improvements in healthcare and will not promote commercial interests UTILIZING POPULATION HEALTH DATA John
More informationManaging Populations to Achieve Triple Aim Outcomes
Managing Populations to Achieve Triple Aim Outcomes Pete Knox, Executive Vice-President and Chief Learning & Innovation Officer March 2014 Agenda 2 1. Overview of Bellin 2. Strategically Aligning the Work
More informationRe: Non-participation in the new Horizon Medicare Blue Patient-Centered w/rx (HMO) product
Three Penn Plaza East Newark, NJ 07105-2200 HorizonBlue.com October 2014 Re: Non-participation in the new Horizon Medicare Blue Patient-Centered w/rx (HMO) product
More informationCare Management at Mercy ACO
JANUARY 18 Care Management at Mercy ACO Case Study About Mercy Mercy ACO Care Management 01 Who they are Mercy ACO, one of the largest Accountable Care Organizations in the Midwest U.S. with 400+ service
More information