munroe regional md education session 09 16-2011

© 2011 The Advisory Board Company • www.southwind.advisory.com© 2011 The Advisory Board Company • www.southwind.advisory.com

Munroe Regional Medical CenterMedical Staff Educati on Session

Prepared for:

Medical StaffMunroe Regional Medical CenterOcala, FLSeptember 15, 2011

© 2011 The Advisory Board Company • www.southwind.advisory.com

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Southwind Team

Ken KellerVice President

Chris RoweVice President


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Common Foundati on of Physician/Hospital Initi ati ves for Success

Requirements for Success Linked to Payment Endgame

Source: Health Care Advisory Board interviews and analysis; Southwind.

Degree of Management

Challenge

Provider Quality and Cost Accountability

Pay-for-Performance

• Track and analyze performance

• Standardize care processes

• Align physician incentives

• Engage full physician enterprise

Hospital-Physician Bundling

• Standardize devices• Reduce orders and

consults

Episodic Bundling

• Collaborate with post-acute providers

• Standardize care site transitions

Shared-Savings Model

• Collaborate with physicians

• Invest in chronic disease management

• Reduce utilization

Actions needed

under all payment reforms


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Foundati on for Aligning Independent Physicians

Benefits to Independent Physicians• Access to coordination

infrastructure• Access to technology• Data visibility across full

continuum of care

Clinically Integrated Organization

Core Components

Comprehensive Improvement InitiativesIdentified (and evolving) metrics and targets designed to meaningfully impact the clinical practice of all physicians in the network to improve value across the full continuum of care

Performance Improvement ArchitectureData-based mechanisms and processes to monitor and manage utilization of health care services, designed to control costs and ensure quality of care

Selective Physician PartnershipsNetwork of physicians opting to collaborate withthe hospital(s) in delivering evidence-based care andimproving quality, efficiency, and coordination of care

JointNegotiation

Base Rates andBonus Incentives

Payers

Employers

• Leadership opportunities• Enhanced community

impact• Potential for better

reimbursement

Participating Physicians

Munroe Regional


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Goals of Clinical Integration

Goals of Clinical Integrati on

• Create a platform for the physicians and Munroe Regional to:– Optimize clinical outcomes– Enhance patient experience– Create a culture of working together as a clinically integrated system

• Improve clinical outcomes through accelerating the adoption of evidence based protocols/medicine, clinical information technologies, and quality improvement techniques;

• Enable greater coordination of care among physicians and Munroe Regional across the continuum of care;

• Reduce unnecessary utilization, improve efficiency, and control the cost of care;• Enable joint contracting with FFS payers based upon demonstrated ability to

improve performance with financial incentives for continued improvement; and • Align incentives for all those involved in healthcare financing and delivery


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What does Clinical Integration Achieve?

Benefi ts of Clinical Integrati on

• Collaboration among physicians and hospital(s) in a way that increases the quality and efficiency of patient care;

• A powerful business, clinical, and legal strategy for physicians and hospital(s) to thrive within the advent of consumerism, pay-for-performance and mandated transparency;

• Comprehensive physician networks which are able to assert themselves forthrightly in legally compliant collective negotiations with fee for service health plans; and

• The foundation and infrastructure for succeeding in the upcoming era of “accountable care”


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Legal Compliance at Core of Success

“Clinical Integrati on” Coined by the FTC

“Clinical Integration is an active and ongoing program to evaluate and modify practice patterns by a network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.”

Recognizes joint contracting may be acceptable on the basis of value creation for patients and payersEstablishes a “Clinical Integration” concept as a defense against price-fixing challengesAllows for layering CI-related contracts on top of existing models of economic alignment Provides general concepts but limited detail on desired CI program structure


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CI Gaining Momentum Across Diverse Systems

Three Bright Lines for Program DesignProgram must be “real”

–Containing authentic initiatives, actually undertaken by the network

–Involves all physicians in the networkPromotes collaboration and

interdependence so physicians can achieve more than they likely could independently

Program initiative have the potential to achieve “likely improvements” in health care quality and efficiency

Joint contracting with fee-for-service health plans is “reasonably necessary” to achieve the efficiencies of the Clinical Integration program


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Step One – Strategy Formulati on

• Focus groups and interviews

• Review of key documents and strategic priorities

• Market conditions assessment

• Structure and staffing infrastructure

• Clinical protocols and performance targets

• Data monitoring and report processing

• Technology infrastructure

Forming the Clinically Integrated Organizati on

• Goal clarification and stakeholder identification

• Education and Q&A sessions with key executive and physician leaders

• Identify potential physician champions

Education/Identification

Stakeholder Analysis

Gap Analysis

Establish physician led CI

program

Develop initiatives matched to market

needs

Optimize performance management processes

Engage employers ; then

payers

Providing legal counsel and support

Enfranchising key stakeholders

Step Two– Strategy Implementati on

The Two Step Process at Munroe Regional Medical Center


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Key Functi ons of a Clinical Integrati on Program

Program Leadership• Provide guidance, oversight and final decision making on key issues during the CI

development process. Provide final approval of recommendations from other supportive functions led by physicians.

Program Development• Develop quality performance measures for services across the care continuum

including hospitals, physicians, ambulatory providers and ancillary care providers.

Operations Development• Develop the organizational structure, documents, contracts and related policies and

procedures for the CI program

Infrastructure Development and Support• Ensure technology infrastructure and processes for collecting, sharing, and

monitoring data and performance are optimized to support performance improvement and reporting


Discussion, Questi ons and Answers

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210 25th Avenue North, Suite 1200, Nashville, TN 37203www.southwind.advisory.com

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Our Commitment to You

Please do not hesitate to contact your team with any questions or comments.

[email protected]

Chris RoweVice President

[email protected]

Ken KellerVice President

mailto:[email protected]

mailto:[email protected]

munroe regional md education session 09 16-2011

Health & Medicine