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Welcome to the Webinar

Practice Transformation & Accountable Care Success:

Meryl Moss, MPA, EMHL Chief Operating Officer,

Coastal Medical

Coastal Medical: A Snapshot “Primary Care Driven” ACO 88 doctors, 35 NPs/PAs; 23 locations Predominantly primary care 120,000+ patients Physician owned and governed Successful CMS, Blue Cross, United and Tufts ACO

contracts Financially Quality Customer Service

ACO quality score in the top 1%

Results 2011-2014 Q2, Coastal’s inpatient admission rate fell by 29% and the ED visit rate fell by 17%

During the same period: • Inpatient hospital spending

dropped by 15% • Inpatient admissions via the

Emergency Department dropped by 31%

• Total membership (person years) rose by 12%

Patients Come First

“You are part of the care team.”

“Call us first. Call us anytime.”

“You will have more time.”

Volume and complexity has risen By 2014, many similar measures across the programs, all with slightly different specifications: • 11 BMI-related metrics • 7 HbA1C measures • 6 mammo measures • 5 BP control measures • 4 DM Nephropathy measures • 4 BP Control measures

Number Performance Based Clinical Quality 142 Measures in 2014

Misalignment Work flows in the offices were not designed to support

the patient centered medical home or population health strategy.

There is not one person in each office who is responsible for quality.

The work is nuanced, complicated and complex.

We are still learning

Requirements keep shifting.

What We Had… Vision and Strategy Strong Sense of Urgency Buy-In from All Levels of the Organization Staff and Physicians feeling that this work was real

and worthwhile. Highly positive feedback from patients

What We Needed to Do… Redesign quality improvement workflows

Audit performance in real time Increase centralized resources Standardize processes across all practices Stop the “fire drills”

Improve transparency and accountability Align incentives Get buy-in at every level

Three Important Changes to Drive Success

1. Problem solving through participation 2. Piloting programs 3. Creating teams and executing well

Brainstorming Open invitation to providers and staff to help solve

problem. Listened to everyone….all voices were heard. Created a vision for who we want to be and how we

want to work. Mirror Mirror….Reflected that the offices were not

performing at the expected level. Old tasks and antiquated processes were in the way. We asked what we could do to help.

How Could We Help? We expected to centralize operational functions Group recommended centralized clinical programs Designed pilot programs Required every practice to participate

Centralization of Services Centralized Clinical Services

Pre-Visit planning Prior Authorization Prescription Refills Diabetes Management Transitions of Care Team Specialty Program (CHF, COPD) Quality Team Lab/DI Tracking

Document Management Fax In Box Scanning

Pilot Well Designed pilot programs Required every practice to participate Formed teams for each pilot Continuously Improved Were highly flexible Built Trust

Execute With Discipline Moved from pilot to program expertly Audit, audit, audit Worried Refined and revised Clinical nature created additional pressure

Employees Are Happier!

Every Person Matters! For the 2nd year in a row, Coastal gave EVERY employee a shared savings check to recognize their contribution to our collective success.

Need Buy-In and Participation for Success Recent ACO Distribution Shared with Every Employee

Do Something! Engage everyone, full participation Reward work and extend appreciation Lean into Conflict (no avoiding) Be resilient Don’t forget the Mission and your Purpose!

Lessons Learned

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A copy of the slides from this presentation can be downloaded at: http://www.zurickdavis.com/ZurickDavis_industry_insights.php

OR http://tinyurl.com/moving-practice

We will be posting the recording at the same location on our

Website within the next day so you can access it.

Thank You!

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