Value Based P4P High Performers

Transcription

1 Value Based P4P High Performers Marnie Baker, MD, MemorialCare Medical Foundation George Christides, MD, AppleCare Medical Management Melissa Gerdes, MD, John Muir Health Moderated by: Diane Stewart, Pacific Business Group on Health Dolores Yanagihara, Integrated Healthcare Association

2 Marnie Baker, MD Medical Director of Performance Improvement, MemorialCare Medical Foundation George Christides, MD Chief Medical Officer, AppleCare Medical Management Melissa Gerdes, MD Medical Director for Clinical Effectiveness, John Muir Health Moderators: Today s Speakers Diane Stewart, Pacific Business Group on Health Dolores Yanagihara, Integrated Healthcare Association 2017 Integrated Healthcare Association. All rights reserved. 2

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4 MemorialCare Medical Foundation MemorialCare Medical Foundation (MCMF) MemorialCare Imaging Centers Medical Group Division IPA Division MemorialCare Medical Group (MCMG) UC Irvine Health Physicians Greater Newport Physicians (GNP) Primary Care Specialty Care Urgent Care Hoag Pod Orange Coast Pod 360 PCPs, 2,200 Specialists 800,000 lives (260K at risk) >50 PCP Health Centers 12 Urgent Care Centers MemorialCare Surgical Centers Nautilus HealthCare Management Long Beach Pod Saddleback Pod UC Irvine Health Physicians Pod 10 Imaging Centers 9 Surgery Centers 13 Dialysis Centers 2017 Integrated Healthcare Association. All rights reserved. 4

5 MemorialCare Medical Foundation Value Based P4P Successes: Organizational commitment to population health Culture of quality Leveraging LEAN Challenges/Lessons Learned: Getting data at the point of care Aligned incentives 2017 Integrated Healthcare Association. All rights reserved. 5

6 AppleCare Medical Group Medical Group and IPA servicing Los Angeles and North Orange County 100,000 members Senior, Dual, Commercial, Medi-Cal Cal-Medi Connect Commercial HMO ACO Dual and shared risk arrangements 900 Primary Care Physicians and Specialists Clinical infrastructure Hospitalist Program Pharmacists, Social Workers and Nurse Case Managers Disease Management and Preventative Care Programs High Risk and Post-Discharge Clinic 2017 Integrated Healthcare Association. All rights reserved. 6

7 AppleCare Medical Group George Christides, MD Chief Medical Officer La Palma, CA What worked: All roads lead to: reducing inappropriate utilization and improving quality Integrated cross-departmental teams Innovative around addressing patient barriers: Welcome Wagon Pill Pack Amwell Telehealth Remote Monitoring Challenges: Training and retraining of clinical services staff Data Data Data There is no perfect model Measuring success is critical Prioritizing initiatives Building a strong foundation 2017 Integrated Healthcare Association. All rights reserved. 7

8 Three Hospitals Concord, Walnut Creek, San Ramon (49% interest) Regional trauma center in WC Behavioral Health Center John Muir Physician Network Over 1,000 primary care and specialty physicians John Muir Medical Group, Muir Medical Group, IPA Five major outpatient centers, including our newest in Pleasanton Physician offices throughout Contra Costa, southern Solano and eastern Alameda counties 3 Medicare Advantage and 6 Commercial HMO contracts managing 73,000 lives Full-range of medical services John Muir Health Community-Based, Not-For Profit Partnerships Primary care, specialty care, inpatient, outpatient and imaging services Canopy Health 2017 Integrated Healthcare Association. All rights reserved. 8

9 John Muir Health Locations 2017 Integrated Healthcare Association. All rights reserved. 9

10 Success Factors Cross-walking quality metrics across programs, IHA, CMS, CIN, where able Selecting specific focus metrics per year Risk stratifying the attributed population and matching care management and behavioral health resources 2017 Integrated Healthcare Association. All rights reserved. 10

11 Challenges/Lessons Learned Individual physician dashboard production with real-time, accurate, transparent, actionable quality data is a challenge Full engagement of other members in the health system, i.e. ED, in-patient teams is key to driving performance in resource use performance 2017 Integrated Healthcare Association. All rights reserved. 11

12 Discussion

13 Audience Q&A