one medicine: incorporating population health principles ... · population health framework •...
TRANSCRIPT
1
One Medicine: Incorporating Population Health Principles and Best Practices into Clinical WorkflowMarch 5, 2018
Jayne Bassler
President, Population Health Services Organization
Senior Vice President, Population Health Management
Adventist Health System
2
Jayne Bassler
Has no real or apparent conflicts of interest to report.
Conflict of Interest (30pt Verdana)
3
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.
4
5
Three Strategies
Individuals
Employers
6
Population Health Framework
• Payer & Government• Direct to Employer• Health Plan
• CIN• ACO• Preferred Providers
• Clinical Documentation Integrity - Ambulatory
• Care Gap Closures• Health Mgmt/Utilization• Network Integrity
• Quality• Experience• Total Cost
7
Network Design &Optimization
Provider EngagementCommunicationCredentialing
Network
Developmen
t &
OperationsNew Care ModelsLongitudinal Care MgmtContact/Memb Exp SvcsWellnessQuality Systems
Clinical
Performance
Financial ManagementIncentive/Dist ModelsActuary ServicesPayer/Employer
Contracting
Finance /
Contracting
Risk StratificationPredictive ModelsBenchmarksProvider Tools
Analytics
Direct to EmployerPartnerships
Business
Development
Information Systems & Interoperability
8
Health Plan
Network Mgmt
• Legacy Network
• CINs Medical Mgmt
Care Mgmt
Analytics
Population Health Services Organization
(PHSO)
Medical Mgmt
Care Mgmt
Analytics
Administrative Svcs
• Claims
• Authorization
• Sales
• Customer Service
• Regulatory
IDN #1
Health Plan
Provider Sponsored Health Plan
Risk-Bearing Entity
• Medicare Advantage
• Commercial
o Individual
o Large Group
o Small Group IDN #2
9
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
10
Physician Alignment Models
Independent Strategic Alignment Venture Alignment Clinical/Financial
Integration
HIGH
System
Resources
Required
LOW
Quality/Service
Line Chairs
Voluntary
Medical Staff
Orthopedic
Service Line
Agreement
Hospital-Based
Physician
Performance
Incentive
Medical Directorships
Academic
Affiliation
Agreement
Employed Medical
Group
Co-Management
Agreements
PHOs
PCMH
ACO
CIN
Degree of Alignment
11
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
12
Provider Services 1.0
Care Management
• Longitudinal Care Management
Assigned or Embedded
Provider Education
• EHR Program Subsidy & Support
• Optimize EHR Workflows
• Provider Management Tools
• Data Collection Templates
• Ease Practice Burden
• Vendor & Network Best Practice
Provider Reps/Population
Management Advisors
• Recruitment
• Contracting & Credentialing
• Initial Onboarding & Education
• Frequent Outreach Support
• High Level Practice Education
• Performance Scorecards
13
Transform the Network 2.0
Engage
Empower
Equip
14
Engage
Simplify messaging
1
Decrease number of channels &
increase frequency
2
Re-envision modality of
communication
3
Incentive
4
15
Empower
Education
1
Socialization
2
Involvement
3
16
Equip
Tools
1
Process
2
Platform
3
Information
4
17
Anatomy of a Pop Health Suite
18
Provider & Management Dashboards
Risk AdjustmentUtilization Scorecard
Provider Scorecard PHSO Cost Analysis
1919 19
RAF Summary KPIs
20
Practice & Physician Level KPIs
21
Care Gap Preferred Metric Scorecard
22
A better network - A new care delivery modelExclusive single signature network of expanded primary care with new service standard.
Aligned physicians but not exclusive
Broader network for adequacy and some specialty collaborations
23
“Never Discharge a Patient”
PHYSICIAN CARE
OUTPATIENT
• PCPs
• Specialists
• Virtual Care
• Retail Pharmacy
• Urgent Care
• ASCs
• Imaging Centers
• Outpatient Rehab
• DME
• Occ Med
• Retail Pharmacy
POST-ACUTE CARE
• Rehab Hospitals
• Home
Health/Hospice
• SNF
• LTAC
• Hospice
ACUTE CARE
• Inpatient
• Outpatient
• Cancer Centers
Physician Care
Network
Outpatient
Network
Post-Acute Care
Network
Acute Care Network
24
Care Navigation Model
25
Consumer Ecosystem
26
Questions
• Jayne Bassler
Senior Vice President, Population Health Management
Adventist Health System
President, Population Health Services Organization
• Reminder – Complete Online Session Evaluation
Please use blank slide if more space is required for charts, graphs, etc.
To remove background graphics, right click on selected slide,
choose “Format Background” and check “Hide background graphics”.