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TRANSCRIPT
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1.800.4BEACON │ BeaconPartners.com
BOSTON · CLEVELAND · SAN FRANCISCO · TORONTO
Thank You
Presented by:
Wendy Vincent, National Practice Director, Strategic Advisory Services
HFMA Dixie Institute
February 19, 2015
Population Health Management:
What it Means For You and Your
Organization
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Heading – Ariel 40
Define Population Health Management
Identify targeted populations
Create effective governance structure
Use technology to accomplish goals
Establish realistic benchmarks
Integrate care approach through
community partnerships
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Objectives
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State of Healthcare
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Storm Factors
Affordable Care Act: As of April 2014 – 8 Million Americans have signed up for healthcare, shocking the system as they present to PCP’s1
Rapid Baby Boomers, everyday 10,000 people turn 65
Reduction in Primary Care Physicians
Increase in prescription drugs, contributing to higher costs and more advanced treatments resulting in longer life expectancy
1) Familiar Physician, Dr. Peter Jackson
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Heading – Ariel 40Top Concerns of Health Care Systems
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1. What is the business model for population health?
2. Have I assembled the right network components?
3. Do we understand our patients as consumers?
4. What investments can we can make to help us with both fee-for-service and value-based incentives?
http://www.advisory.com/Research/Health-Care-Advisory-Board/Blogs/At-the-Helm/2014/05/Four-challenges-every-leadership-team-is-talking-about?WT.mc_id=Email|Daily+Briefing|Blog|HCAB|Jul-14-2014|||||
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Why Is It So Important Now?
Healthcare Payment Reform
• End of fee for service
• Value-based purchasing
• ACOs and PCMHs
Reporting On Clinical Quality Is Retrospective
Care Coordination – what do we need to do right now to produce the best outcome for a single, particular patient
Population Health – focuses on the future, what can we and should we do in the future to produce better outcomes, higher quality and lower costs
Technology
• Broad EHR adoption
• mHealth
• Analytical tools
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Population Health Management (PHM) Defined
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Heading – Ariel 40Population Health
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“The use of a variety of
individual, organizational and cultural interventions to help improve the illness and injury burden and the health care use
behavior of defined populations.”Dr. Michael Hillman,
Marshfield Clinic
“The health outcomes of a group
of individuals, including the distribution of such outcomes
within the group”
American Journal of Public Health
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Heading – Ariel 40PHM Defined
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Population Health describes the health outcomes of a group of
individuals, including the distribution of such outcomes within the
group. Population health outcomes are the product of multiple
determinants of health, including medical care, public health,
genetics, behaviors, social factors, and environmental factors.
Goal: Keep patient population as healthy as possible and reduce the
need for costly interventions such as ED visits, hospitalizations,
imagine tests, and procedures.
To support PCMH & ACOs, many organizations will need to start
implementing PHM to keep patient population healthier and reduce
costs.
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Heading – Ariel 40PHM Framework
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Heading – Ariel 40Patient Centered Medical Home
Engaged leadership
Quality improvement strategy
Empanelment
Patient-centered interactions
Organized, evidence-based
care
Care coordination
Enhanced access
Continuous, team-based
health relationships
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ACOs
• Healthcare organizations are formulating
Clinically Integrated Networks (CINs)
• Network of Providers belong to ACO
• Physician metrics/scorecards are established
• Targets/Projections/Actuals – Shared Savings
• Population Health Management Systems are on
the rise for real time data
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ACOs
Complete & timely information about their patients and the
services they are receiving
Technology and skills for population management and
coordination of care
Adequate resources for patient education and self
management
A culture of teamwork
Coordinated relationships with specialists and other providers
Ability to measure and report on the quality of care
Infrastructure skills for the management of financial risk
Commitment by leadership to improving value as a top priority
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ACO Growth
14http://healthaffairs.org/blog/2014/01/29/accountable-care-growth-in-2014-a-look-ahead/
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Heading – Ariel 40CMS State Innovation Programs
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Challenges to Overcome
Technology Alignment with Business:
• Are we collecting the right data?
• Once we get it, what does it mean?
• How can we effectively use data?
Organizational Strategy:
• My organization doesn’t have a clear strategy
• Our areas are like silos with their own information
Process Changes:
• Each department has their own plan; roles and process
changes are needed towards a new optimal state but where do
we start?
Lower costs:
• How can overall costs for defined Populations be reduced?
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Identifying Targeted Populations
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Heading – Ariel 40Identifying Targeted Populations
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What’s the best way to use our resources?
• Identify high risk
Readmissions
Repeat ED visits
LOS
• Specific diagnoses
Diabetes
Congestive heart failure
High blood pressure
Asthma
• Geographic/population areas
• Community Health Needs Assessment
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Heading – Ariel 40Identification Mechanisms
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Predict resource usage
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Heading – Ariel 40Conditions Analysis
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Screenshot from Caradigm Risk Management tool
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Heading – Ariel 40Risk Assessment
21 Screenshot from Caradigm Risk Assessment Tool
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Heading – Ariel 40Organizational Considerations
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What are your resources across the continuum of care?
• Case managers
• Transition of care program
• DSRIP efforts
• PCMH development
• Care coordination
• Community resources
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Governance
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Heading – Ariel 40Governance Key to Success
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Leadership endorsement of new staffing models and roles
Define specific roles and responsibilities
How will you
communicate
efforts?
How will you
ensure care and
resources are
centered around
the patient?
How will you
involve the
community?
How will you
integrate efforts
into the continuum
of care?
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Heading – Ariel 40Key Considerations
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Who will review and analyze data?
Avoid redundancy and overlapping efforts
Avoid silos
What committees do you already
have in place?
• Quality committee
• Ambulatory care committees
• Policy and procedure committees
• Credentialing committees
What has or hasn’t worked well in the past?
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Technology
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Heading – Ariel 40Effectively Using Technology
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Automate workflows for appropriate utilization of
resources
Connect care team in coordinating patient care
HIE
Communicate via a portal
• Patients
• Physicians
• Affiliates and community resources
Track and report data in timely manner
Use appropriate metrics to evaluate the program
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Heading – Ariel 40Example: Patient Portal
28Screenshot from Allscripts FollowMyHealth™ patient portal
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Heading – Ariel 40Primary Care
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Registry member
Portal for EMR management
Push alerts for recalls and
immunizations or upcoming
needs for blood testing
Self-scheduling online
Diabetes management
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Heading – Ariel 40Care Management/Coordination
30 Screenshot from Caradigm Care Management Tool
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Heading – Ariel 40Care Gaps
31Screenshot from Caradigm Care Management Module
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Evaluation Criteria
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Heading – Ariel 40Establishing Benchmarks
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Gather data
• EMR
• Claims data
Input critical
• Staff
• Patients
• Providers
Evaluation techniques
• Timely data
• LACE index
• PHM tool
Set realistic targets
Where are you NOW
compared to your
benchmarks?
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Integrated Care Approach
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Heading – Ariel 40Connect with Your Community
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Heading – Ariel 40Outreach Strategy
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Risk assessment
Define population
Define new roles and workflows
Define issues to address
Develop plan to target needs
• Education
• Counseling
• Preventative clinics/care
Communication strategies to target underserved
populations
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Heading – Ariel 40Integrated Care Example
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Heading – Ariel 40Key Takeaways
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Develop PHM strategy and program
Use data to define your populations (internal and external)
Ensure your strategy aligns with organizational goals
Create a governance structure to drive change and
accountability (new roles)
Engage in Risk Model Programs (ACOs and MSSPs)
Develop care coordination programs through new optimal
workflows (Re-admission programs, PCMHs)
Use technology to automate processes
Create an outreach approach to integrate care throughout
the community
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Change is Hard
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Heading – Ariel 40Questions?
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Wendy Vincent, RN, is an accomplished healthcare executive with 30 years of
professional experience across all areas of healthcare. She has served in both
executive and senior leadership positions with academic medical centers and large
Integrated Delivery Networks. Wendy understands the unique opportunities and
challenges associated with optimizing people, process, and technology. She has
been successful with helping organizations identify areas to improve care quality,
increase operational efficiencies, and optimize revenue. Wendy is a strategic thinker
and planner with strong problem-solving and organizational skills. She is accustomed
to building relationships at all levels of leadership and staff. She holds a Bachelor of
Science in Nursing with graduate work in Nursing Education. She is actively involved in nursing, clinical, and IT professional societies.
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1.800.4BEACON │ BeaconPartners.com
BOSTON · CLEVELAND · SAN FRANCISCO · TORONTO
Thank YouFor more information
please contact
Thank You
Wendy Vincent