![Page 1: Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014](https://reader036.vdocuments.mx/reader036/viewer/2022062620/551a09a85503464c588b4edf/html5/thumbnails/1.jpg)
Building an Integrated System for Personalizing Care
Tim Johnson, MDSpring, 2014
![Page 2: Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014](https://reader036.vdocuments.mx/reader036/viewer/2022062620/551a09a85503464c588b4edf/html5/thumbnails/2.jpg)
Intermountain Medical Group• 1,056 physicians
• 342 primary care• 491 secondary care• 86 hospitalists• 17 radiologists• 120 urgent care
• 265 advanced practice clinicians• 81 primary care clinics
![Page 3: Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014](https://reader036.vdocuments.mx/reader036/viewer/2022062620/551a09a85503464c588b4edf/html5/thumbnails/3.jpg)
Dual Model for the Medical Home
Distributed Model Intensive Model
![Page 4: Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014](https://reader036.vdocuments.mx/reader036/viewer/2022062620/551a09a85503464c588b4edf/html5/thumbnails/4.jpg)
Distributed Model: Personalized Primary CareIntermountain Medical Group and SelectHealth Modeled on 2011 PCMH NCQA StandardsTeam members
• Primary Care Clinician• RN Care Manager• MA Health Advocate(s)• Advanced Practice Clinicians• Doctor of Pharmacy• Mental Health Integration
![Page 5: Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014](https://reader036.vdocuments.mx/reader036/viewer/2022062620/551a09a85503464c588b4edf/html5/thumbnails/5.jpg)
Personalized Primary CareImplementation 2010 - 2014
• 64 adult primary care clinics• 17 pediatric clinics• 345 physicians and advance
practice clinicians• ~100 care managers and health
advocatesHybrid model: central and region leadershipLevel 2 and level 3 within 2-3 years
![Page 6: Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014](https://reader036.vdocuments.mx/reader036/viewer/2022062620/551a09a85503464c588b4edf/html5/thumbnails/6.jpg)
Personalized Primary Care: Results
20%
35%Intermountain diabetes bundle: HgbA1c < 8% LDL < 100 BP < 140/90 Annual nephropathy screen Eye exam every 2 years
48%
50%
52%
54%
56%
58%
60%
62%
64%2013 Stretch Goal
1 2 3
PPCsAll
Clinical Quality
Patient Satisfaction
Years after Implementation
Allowed Per Member Per Month
Total Cost Trend*
*Preliminary results, risk-adjusted and normalized for contractual payment differences
![Page 7: Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014](https://reader036.vdocuments.mx/reader036/viewer/2022062620/551a09a85503464c588b4edf/html5/thumbnails/7.jpg)
Intensive Model: Personalized Care Clinic
• An outpatient clinic that provides intensive medical, behavioral, and social management for Intermountain’s high-risk patients
• Patients in the top 5-10% of costs for 2 of the last 3 years
![Page 8: Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014](https://reader036.vdocuments.mx/reader036/viewer/2022062620/551a09a85503464c588b4edf/html5/thumbnails/8.jpg)
Personalized Care Clinic: The Team
• Internal Medicine Physician• Palliative Care Physician (0.2)• RN Care Manager• Psychiatry APRN• LCSW• Pharmacist
• 2 Medical Assistants• PSR• Clinic Manager• Assistant Region Operations
Officer• Region Medical Director
![Page 9: Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014](https://reader036.vdocuments.mx/reader036/viewer/2022062620/551a09a85503464c588b4edf/html5/thumbnails/9.jpg)
Personalized Care Clinic: Process of care
• Acts like a primary care office with more resources to coordinate care, address mental health conditions, and manage complex medication issues
• Ensure patients receive care in appropriate setting – focus on acute care utilization
• Coordinate and collaborate with all of the patient’s specialists
• Committed to eliminating all avoidable health care emergencies
![Page 10: Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014](https://reader036.vdocuments.mx/reader036/viewer/2022062620/551a09a85503464c588b4edf/html5/thumbnails/10.jpg)
Your comments and questions…