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TRANSCRIPT
2017
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Value-based Care: Anchor of the New Health Care Landscape
Essentials in Population Health April 11, 2017
Veronica Gunn, MD, MPH, FAAP Vice President Population Health Management and Payment Innovation Children’s Hospital of Wisconsin
Welcome
Children’s Hospitals: Creating Health
• Commodity-driven health care system is not generating the optimum health for children.
• Much of health care is not curing factors that decrease life quality/expectancy. Majority of spend treats symptoms.
• Need to understand populations, subpops and what drives cost and health 5
The Role(s) of a Children’s Hospital
Children’s hospitals will determine if they are leaders, conveners or agents in a wide community-based partnership for population health.
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UPCOMING 2017 WEBINARS Engaging Communities to Optimize Outcomes and Care Coordination May 9 | 2:00 pm ET Rosemary Frasso, PhD, MSc, CPH | Program Director, Public Health Program Jillian L. Baker, DrPH | Assistant Professor, Jefferson College of Population Health
Integrating Mental Health and Behavioral Health June 21 | 2:00pm ET Rahil D. Briggs, PsyD | Director, Pediatric Behavioral Health Services Montefiore Medical Group
From Pilot to Practice: Implementing and Disseminating Innovations July 25 | 2:00pm ET Linda Fleisher, PhD, MPH | Lecturer, Jefferson College of Population Health Alexander Fiks, MD, MCSE | Associate Professor of Pediatrics , Children’s Hospital of Philadelphia
2017
Today’s Presenter
David B. Nash, MD, MBA Dean, Jefferson College of Population Health Thomas Jefferson University
2017 Children’s Hospital Association Essentials in Population Health Webinar Series
Value-Based Care: Anchor of the New Healthcare Landscape
April 11, 2017
David B. Nash, MD, MBA Dean
Jefferson College of Population Health 901 Walnut Street – 10th Floor
Philadelphia, PA 19107 215-955-6969 (Office) 215-570-2107 (Cell)
)
[email protected] jefferson.edu/populationhealth blogs.jefferson.edu/nashhealthpolicy.com
www.facebook.com/jeffersonjcph twitter.com/JeffersonJCPH
… all hospitals are accountable to the public for their degree of success…
If the initiative is not taken by the medical profession, it
will be taken by the lay public.
1918 Am Coll Surg
Shortell Stages of Integration
• Functional • bring partners together
• Physician - System Integration • bring together doctor groups
• Clinical integration
What will clinical integration require?
• Centralization of process
• Evidence based medical practice
• Commitment to self evaluation
Cultural Barriers to Integration (and Industrialization)
• Autonomous decision making
• Socialization
• Uneven evidence about outcomes
• Fear of performance assessment
Connection & Organization • Enable episodic care • Develop support services • Manage payer contracting
Coordination & Analysis • Aggregate & normalize • Analyze data & report outcomes • Identify opportunities • Engage providers
Collaboration & Improvement • Engage patients • Close care gaps • Identify high-risk patients • Implement care management programs
Consolidation & Optimization • Utilize predictive modeling • Assess organization’s risk • Manage utilization • Optimize efficiency & costs • Improve patient experience • Market organization
Maturity Model: This is a complex journey for providers
Affiliated Engaged Coordinated High-performing Qua
lity
Fee-for-Service Pay-for-Performance Shared Savings/Risk & Bundled Payments
MACRA APMs & Capitation
Aggregation & Measurement
Performance & Improvement
Risk
Is Population Health the Answer?
1. What’s the question?
2. Where are we now?
3. Where are we going in the future?
Population Health: Conceptual Framework
Health outcomes and their distribution within a population Health determinants that influence distribution Policies and interventions that impact these determinants
Morbidity Mortality Quality of Life Medical care Socioeconomic status Genetics Social Environmental Individual
Source: Bipartisan Policy Center, “F” as in Fat: How Obesity Threatens America’s Future (TFAH/RWJF, Aug. 2013)
The Four Underlying Concepts of Cost Containment Through Payment Reform…
Range of Models in Existence or Development
What Does This All Mean?
Major Themes Moving Forward
1. Transparency 2. Accountability 3. No outcome, No income
How Might We Get There?
Change the Culture
1. Practice based on evidence 2. Reduce unexplained clinical variation 3. Reduce slavish adherence to professional autonomy 4. Continuously measure and close feedback loop 5. Engage with patients across the continuum of care
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• Health becomes a collective matter, not an individual one Communities increasingly band together public / private partnerships and collaborate to solve for health challenges at the city, local and state levels.
• Non-traditional players take interest in health As connections between the health and the local economy become clearer, untraditional parties, such as large employers, have more to gain from supporting health at the community level.
• Prevention goes beyond just diet and exercise Cross-sector partners tackle the upstream root causes of health problems, even facilitating environmental and infrastructural interventions to make spaces more conducive to healthy living.
• Advanced analytics help shape the public health agenda Smart use of technology and analytics make it possible to identify “hot spots” of concern and target interventions more effectively.
EMERGING EVIDENCE
$20m The amount of money H-E-B is investing to lower the price of fresh produce through coupons and other incentives (San Antonio Express News)
4k The number of hospital visits attributed to 900 people in just 2 buildings over a 6-year period, identified through detailed analysis of health utilization patterns in Camden, NJ (The New Yorker)
In the future, Healthy Communities will mean…
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• Consumers become the CEOs of their own health In the future, consumers become increasingly responsible for not only financing their care, but also administering their care.
• Technology advancements democratize health Medical expertise and tools become more widely and immediately accessible to consumers; smart phones are the primary vehicle through which consumers diagnose and manage basic and chronic conditions, as well as stay focused on their general wellness.
• Consumers lean on non-traditional authorities for advice and information Consumer centers of trust increasingly shift from health care experts to family members, friends, neighbors, and even virtual acquaintances, as consumers seek out advice from people who know me or people who are just like me.
• Caregivers become a formalized part of the care team Friends and family caregivers not only take a more active role in care delivery but also play a crucial role on the formal care team; while clinicians contribute formalized medical knowledge, caregivers offer their deep expertise of the patient.
EMERGING EVIDENCE
19% The proportion of smartphone owners who have downloaded an app specifically to track or manage health
26% The proportion of internet users who have read or watched someone else’s experience about health or medical issues in the last 12 months (Pew Internet Research)
In the future, Next Gen Self-Care will mean…
Medical Staff Structure • Anachronism
• Slavish adherence to consensus
• Incentives under prospective payment
Discussion
Pose questions to “All Participants” using the chat box on the right side of your screen, or simply use the Q/A pod.
7/6/16 childrenshospitals.org/populationhealth
Essentials in Population Health Webinar and Whitepaper Series Creating Health newsletter Web content
Virtual learning opportunities on topics such as: • social determinants of
health • community partnerships • clinical management and
payment models
Community Health Strategy Peer Network CHA conferences Web-based communities
2015 Population Health Benchmarking Survey and findings
Receive pediatric content on community and population health to master key concepts and terms
Learn about trends among children’s hospitals, allied organizations and the industry
Find out how others implement community health needs assessments and link to hospital strategy
Use benchmarking tools to understand what peers are doing and support your transition to value-based care
Helping Children’s Hospitals Navigate Population Health
Knowledge Building Sharing Practices Peer Networking Benchmarking
Value Based Care: Lurie Children's Hospital and Seattle Children's Join us on April 27 at 2:00 p.m. ET. This member highlight webinar will feature: Pursuing Risk Based Models Scott Wilkerson, Executive Director | Lurie Children's Health Partners Creating and Operating a Clinically Integrated Network Michael Murphy, Vice President of Accountable Care | Seattle Children's Registration link: https://childrenshospitals.webex.com/childrenshospitals/onstage/g.php?MTID=e2da342e077a879097a4c7097105d1917
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Washington, DC Office: 600 13th Street NW Suite 500 Washington, DC 20005 Phone: 202-753-5500
Contact: Karen Seaver Hill Director, Community & Child Health [email protected]
Photo by Tine Hoffman Cincinnati Children’s Hospital Kansas City Office:
16011 College Blvd Suite 250 Lenexa, KS 66219 Phone: 913-262-1436