2013 mental health & addiction conferencephil atkins, licdc, ocps2

perating in the medical neighborhood:the future of prevention

• funded through a grant from ODMHAS• three components:

– education – media and development of public information– training and information dissemination

• Collaboration– Mental Health & Recovery Services Board of Allen,

Auglaize and Hardin Counties– ODMHAS – Dawn Thomas– MODO Media– Jim Ryan, Ryan Training

the spf-sig medical neighborhood project

• key components of health care reform• population health management• medical neighborhoods• measuring health outcomes• prevention of the future• getting ready for “prevention of

tomorrow!”

takeaways

heart disease and stroke: $312.6 billion

preventable health concerns: the big dollar items

diabetes: $245 billion

substance abuse: $600 billion

www.drugabuse.gov

how will these and other health care costs be managed while maintaining and improving the quality of care?

the triple aim:1. improving the health of populations2. improving the patient experience of care (quality +

satisfaction)3. reducing the per capita cost of health care

thinking about populations:health care of large groups

Accountable Care Organization

Patient Centered Medical Homes

Medical Neighborhood

our first stop…

Accountable Care Organization (ACO)

• Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their population of patients.

• The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

• When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the program.

Accountable Care Organizations

• address health needs at all points along the continuum of health and well being through: – coordinated participation in care – patient engagement– targeted interventions

• maintain and/or improve the physical and psychosocial well being of individuals through cost-effective and tailored health solutions focusing on:– central leadership role of the physician– importance of patient engagement, education, activation– capacity expansion of care coordination through non-physician

team members

essential elements of population health management

delivering population health management in any care setting

assess

stratify

implement

solutionsmeasur

e & report

population health management

• identify population• identify gaps in care• comprehensive health assessment• stratify risks

• integrated practice team

• evidence-based guidelines• development of performance

measures• selection of interventions• engage patients• evidence-based practices• care management• eliminating barriers

• outcome measurement• data analysis• report performance• customer satisfaction

• cost-effective• demonstrate quality• reimbursement diversification• ensure access• culturally and linguistically

appropriate• integration of community

resources

SPFASSESSMENT

CAPACITY

PLANNING

IMPLEMENTATION

EVALUATION

SUSTAINABILITY

CULTURAL COMPETENCE

prevention tools

risk levels:universal, selective, indicatedworkforce development

technology for planning and evaluation (POPS)

population health management functions

our next stop…

Patient Centered Medical Homes

Patient Centered Medical Homea practice in which an individual can receive quality, timely, efficient, and patient-centered comprehensive care and care coordination from a compassionate team of health-care professionals.

A PCMH is an approach to deliver comprehensive care, coordinated by a primary care physician-led extended care team.

personal relationship with a

PCP* and care team

proactive focus on health, care

intervention and chronic disease management

technology, services &

applications to support the new

collaborative model

+

*primary care physician

+

• …a model for re-designing primary care practices.• …intended to improve the quality and efficiency of care

delivery.• …based on the principles of:

– having a personal physician/provider– a physician directs the practice team– whole-person orientation– care coordination and integration– quality and safety– enhanced access– payment/reimbursement changes

a Patient Centered Medical Home is…

PCMH as the foundation for Accountable Care Organizations

our next stop…

Medical Neighborhood

a medical neighborhood can be conceptualized as a PCMH plus the constellation of other clinicians and specialists providing health care services to patients within it, along with community and social service organizations and state/local public health agencies.

a medical neighborhood

• emanates from PCMH• no one size/shape fits all communities• can include institutional providers.• not all neighbors are “equal” (“core” v. others)• compatible with a broad range of payment

structures• formal, mutual expectations for PCMH and

neighbors

a medical neighborhood

• communicates, coordinates and integrates bi-directionally with the PCMH as well as with patient.

• ensures appropriate & timely consultations and referrals.

• ensures effective flow of information.• addresses responsibility in co-management

situations.• supports patient centered care. • supports the PCMH practice as the “hub” of care

and as the provider of whole person primary care to the patient.

a medical neighbor…

a look into the future

improving our data through outcome measurement

health care organizations use HEDIS measures to track and report outcomes.H – healthcareE – effectivenessD – data andI – informationS – set• most widely used set of standardized performance

measures in the health care industry• system for establishing accountability in health care

measuring outcomes with HEDIS

health care organizations use HEDIS measures to track and report outcomes.H – healthcareE – effectivenessD – data andI – informationS – set• most widely used set of standardized performance

measures in the health care industry• system for establishing accountability in health care

what does HEDIS measure?HEDIS currently has 81 measures across 5 domains:• effectiveness of care – what is the quality of the care or

service that was received?• access and availability of care – can people get the care

and services they need?• experience of care – are people satisfied with things like

the communication skills of the provider or how easy it was to access services?

• utilization and relative resource use – how many and how often were services utilized and were costs competitive compared to other providers?

• health plan descriptive information – specific characteristics of the particular health plan such as certifications, diversity

HEDIS has both population-based measures (e.g. how many women in a particular population received

a breast cancer screening) andevent/diagnosis-based measures

(e.g. how many people were diagnosed with diabetes).

HEDIS has both population-based measures (e.g. how many women in a particular population received

a breast cancer screening) andevent/diagnosis-based measures

(e.g. how many people were diagnosed with diabetes).

why is this important to us?

1. knowing how health care is held accountable is essential to our understanding of their “world” and our cultural competence needed to develop relationships with primary health care.

2. creating prevention outcome measures that follow the format of HEDIS and other health care outcome systems helps us communicate in their language.

3. we can learn from physical health care how to demonstrate our effectiveness and value.

4. we need to learn to evaluate our efforts at both the population level (environmental strategies) and at the event level (individual strategies).

what does my community based agency need to do to become part of a medical neighborhood?

laying the foundation of our own house• Become prevention scientists - understand the

research behind what we do.• Know our new neighbors - develop competence in

this “new culture” of primary care.• Demonstrate value - show that what we are doing is

making a difference in people’s lives - with DATA!• Be proud of our product – we are prevention

specialists providing a specialty health care service.

putting it all together