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, Population Health Management Adventist Health System 1
Conflict of Interest (30pt Verdana) Jayne Bassler Has no real or apparent conflicts of interest to report. 2
Learning Objectives Define Clinical integration and discuss the process and challenges in implementation across diverse partnerships Outline leading trends in care team strategy, transitional care, and care coordination across the healthcare continuum Summarize techniques to achieve better outcomes and close care gaps using clinical systems and steps to mitigate current system limitations Identify early warning signs of physician burnout and discuss strategies providers can take to circumvent Recognize best practices for long-term consumer engagement and person-centered care delivery. 3
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Three Strategies Individuals Employers 5
Population Health Framework Quality Experience Total Cost Payer & Government Direct to Employer Health Plan Clinical Documentation Integrity - Ambulatory Care Gap Closures Health Mgmt/Utilization Network Integrity CIN ACO Preferred Providers 6
Clinical Performance New Care Models Longitudinal Care Mgmt Contact/Memb Exp Svcs Wellness Quality Systems Network Developmen t & Operations Network Design & Optimization Provider Engagement Communication Credentialing Analytics Risk Stratification Predictive Models Benchmarks Provider Tools Finance / Contracting Financial Management Incentive/Dist Models Actuary Services Payer/Employer Contracting Business Development Direct to Employer Partnerships Information Systems & Interoperability 7
Health Plan Provider Sponsored Health Plan Risk- Bearing Entity IDN #1 Population Health Services Organization (PHSO) Medicare Advantage Commercial o Individual o Large Group o Small Group IDN #2 Health Plan Network Mgmt Care Mgmt Legacy Network CINs Medical Mgmt Analytics Care Mgmt Medical Mgmt Analytics Administrative Svcs Claims Authorization Sales Customer Service Regulatory 8
Networks Florida 1 Statewide ACO & 3 CINs West Florida CIN Central Florida CIN East Florida CIN Kansas 1 Super CIN with 3 Partners North Carolina - 1 ACO with Partner 9
Physician Alignment Models HIGH System Resources Required Quality/Service Line Chairs Orthopedic Service Line Agreement Hospital-Based Physician Performance Incentive Academic Affiliation Agreement Employed Medical Group Co-Management Agreements PHOs CIN ACO Medical Directorships PCMH LOW Voluntary Medical Staff Independent Strategic Alignment Venture Alignment Clinical/Financial Integration Degree of Alignment 10
Physician Burnout Causes of Burnout Loss of Control Over Work Increased Performance Measurement Inefficiencies in Practice Environment Signs of Burnout Reduce Time Devoted to Clinical Work Unnecessary Testing & Referrals Poor Quality/Medication Errors Leave Profession/Retire Early Physician Burnout Is A Public Health Crisis: A Message To Our Fellow Health Care CEOs, " Health Affairs Blog, March 28, 2017. DOI: 10.1377/hblog20170328.059397 11
Provider Services 1.0 Care Management Longitudinal Care Management Assigned or Embedded Provider Reps/Population Management Advisors Recruitment Contracting & Credentialing Initial Onboarding & Education Frequent Outreach Support High Level Practice Education Performance Scorecards Provider Education EHR Program Subsidy & Support Optimize EHR Workflows Provider Management Tools Data Collection Templates Ease Practice Burden Vendor & Network Best Practice 12
Transform the Network 2.0 Engage Empower Equip 13
Engage 1 2 3 4 Simplify messaging Decrease number of channels & increase frequency Re-envision modality of communication Incentive 14
Empower 1 2 3 Education Socialization Involvement 15
Equip 1 2 3 4 Tools Process Platform Information 16
Anatomy of a Pop Health Suite 17
Provider & Management Dashboards Provider Scorecard PHSO Cost Analysis Utilization Scorecard Risk Adjustment 18
RAF Summary KPIs 19 19 19
Practice & Physician Level KPIs 20
Care Gap Preferred Metric Scorecard 21
A better network - A new care delivery model Exclusive single signature network of expanded primary care with new service standard. Aligned physicians but not exclusive Broader network for adequacy and some specialty collaborations 22
PHYSICIAN CARE ACUTE CARE PCPs Specialists Virtual Care Retail Pharmacy Urgent Care Outpatient Network Acute Care Network Inpatient Outpatient Cancer Centers ASCs Imaging Centers Outpatient Rehab DME Occ Med Retail Pharmacy Physician Care Network Post-Acute Care Network Rehab Hospitals Home Health/Hospice SNF LTAC Hospice OUTPATIENT Never Discharge a Patient 23 POST-ACUTE CARE
Care Navigation Model 24
Consumer Ecosystem 25
Questions Jayne Bassler Senior Vice President, Population Health Management Adventist Health System President, Population Health Services Organization Jayne.Bassler@ahss.org Reminder Complete Online Session Evaluation 26
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