Don t Boil the Ocean! Gain Immediate Value Practicing Responsible Population Health Management Terry Boch, Sr. VP, Wellcentive Michael Madden, CEO, The Physician Alliance Presentation Agenda Purpose: Learn how to manage complex population health initiatives Objective 1: Understand the realities behind population health management and how to best achieve focus. Objective 2: Identify the key components of the population health management lifecycle. Objective 3: Share the successes of a large Physician Organization s PHM Activities.
Population Health Management Reality Payers IT Systems Physicians Patients Data Employers Domains Workflows Population Health Management Reality ALIGNMENT REQUIRES GOALS GOALS NEED TO BE MEASURED MEASUREMENT REQUIRES FOCUS "Obstacles are those frightful things you see when you take your eyes off your goal. Henry Ford
Network Maturity Model Quality Programs Become Your Anchor Point Provide a finite set of data requirements Become a lens for data quality Provide measurable goals Enable organizational focus Reduce clinical and financial risk Focus on delivering value Achieve Critical Reimbursement Mass
Connecting Quality Programs PHM Workflow Data Quality
The Physician Alliance (TPA) For All You Ocean Boilers PIN DIRECTIONS
TPA Basics Foundational Principles Doing the Right Thing Exceeding Customer Expectations Servicing Patients and Physicians Being Good Partners TPA Basics Partnership of 5 POs 2,185 Physicians 1500 square miles (five counties) Founded in February 2011 Generated $3.86 million in P4P revenue in 2012 2013 projected P4P revenue of $8.0 million+ Projected to generate $5.5 million in direct P4P reimbursement to PCPs in 2013 Projected to distribute an additional $5.4 million in performance incentives to Physicians in 2013
BCBSM s PGIP Physician Group Incentive Program Focused on rewarding POs and their Physicians for implementing PCMH N processes, improving quality and reducing cost Infrastructure Investment Model Monies are provided up front to develop PHM infrastructure Infrastructure drives process and performance improvements Improvements drive improved quality and decreased costs POs and their Physicians are rewarded for process improvements, quality improvement and decreased cost TPA Basics TPA PGIP Group is one of the largest in Michigan Perceived by BCBSM to be one of the most innovative POs in Michigan 316 Patient Centered Medical Home PCPs Designated by BCBSM as an Organized System of Care Low Cost Benchmark Performer in July 2012 and 2013 Developed a Patient Centered Specialist Practice Designation program for specialists considered a best practice by BCBSM 117 specialists designated to date 140 of our specialists are receiving 20 25% E&M uplifts from BCBSM based on performance
TPA Basics TPA has partnered with St. John Providence Health System to integrate and coordinate health care services in order to deliver clinical excellence and value across the continuum of care. The partnership is called Partners in Care Formed a Medicare Shared Savings Accountable Care Organization (ACO) with St. John Providence Health System An Innovative Partnership Model
Continuum Improvement Management Population Health Management Activities
Monitoring of Practice PCMH N Processes SRD Self Reporting Database Allows TPA to monitor practice performance across the entire PO
SRD Self Reporting Database Domains of Function Patient Provider Agreement Patient Registry Performance Reporting Individual Care Management Test Tracking Self Management Linkage to the Community Coordination of Care Specialist Referral Process Patient Portal Capabilities: 126 per PCP practice, 96 per Specialist practice 57,000 total, 22,000+ FIP Domains of Function I----Practice Names----------I 1---------------------------------126
SRD Next Steps Development beyond the PCMH PCPs PCMH Specialists PCSP Emergency Department Hospitalists Hospitals Post Acute Point of Service Disease Registry with TPA Level Reporting
1. Practice enters data into EMR or Wellcentive directly 2. Data then passed into Wellcentive for aggregation and analysis PO LEVEL REGISTRY REPORTING STATE WIDE PO PERFORMANCE COMPARSION Top 15%ile Practice 1 Practice 2 Practice 3 Practice 4 Practice 5 Practice 204 Diabetes Management 3. Practice produces Gaps in Care Reports and contacts patients 4. Practice monitors physician performance 5. TPA monitors practice and physician performance 6. TPA sends Clinical Quality Liaisons to practices to assist with performance improvement 7. Overall TPA physician performance improves HOW POS DISEASE REGISTRIES IMPROVE PATIENT CARE AND TPA PERFORMANCE METRICS PRACTICE LEVEL REGISTRY PERFORMANCE REPORTING (stimulates practice/physicians to improve performance) PO LEVEL REGISTRY REPORTING (stimulates TPA leaders to leverage performance improvements at the practice level) STATE WIDE PO PERFORMANCE COMPARSION (High performing registry systems result in moving TPA to the highest performance levels) Top 15%ile TPA MEAN PRACTICE 1 HgA1c REGISTRY PERFORMANCE REPORT PRACTICE LEVEL REGISTRY with GAPS IN CARE REPORT (stimulates patient contact and action) PRACTICE LEVEL POINT OF SERVICE (POS) PATIENT REGISTRY (prompts action at the Point of Service) Mary Apple DOB: 11/29/1953 Diabetes Management HgA1c: 9.7 12/13/11 Annual Foot Exam: 12/13/11 DMII GFR: 7.5 12/13/11 HTN on ACE/ARB: Not in Place Mammography: Normal 12/15/11 Cervical Screening: Normal 12/15/11 Colonoscopy: Normal 12/16/11 Lipid Screening: Normal 12/13/11
Clinical Quality Liaisons Visit practices regularly to help practices: Implement PCMH Capabilities Monitor physician performance Develop PI plans Capture P4P dollars Regional Physician Performance Improvement Teams Data Review and Physician Engagement Strategies TPA Medical Director Regional Medical Directors Clinical Quality Liaisons Director of Strategy and Performance Design
You Can t Boil the Ocean but PHM, ACOs, OSCs, PCMH Ns lead us to try and warm it up a bit Focused Goal Setting Allows for Good Balance Management
Rapid Focused Improvement Results Innovation Development ETHICA IT SOLUTIONS EMR Rescue & Optimization ETHICA CONSULTING Innovative PHM Strategies ETHICA VENTURES PHM New Business Opportunities ETHICA MANAGEMENT SERVICES Physician Services
Summary Close monitoring of 2,185 Physicians PCMH N Performance Designated Low Cost Benchmark OSC Successful integration of multiple EMR PHM data into an integrated common disease registry that can be monitored remotely Unique innovative approaches to Partnering with a Health System Highly functioning P4P performance models Innovative approaches to monitoring PHM activities All successes related to Doing the Right Thing and Exceeding Customer Expectations No Opportunity PGIP Opportunity Report Key Measurement of TPA s PHM Success Over $15 million earned for PHM Activities Contact Us info@wellcentive.com thephysicianalliance@thephysicianalliance.org info@ethicaholdings.com
Thank you! Contact us with any questions: terry.boch@wellcentive.com michael.madden@thephysicianalliance.org