emerging care models transformative results
TRANSCRIPT
David W. Moen, MD
Principal Consultant
Emerging Care Models
Transformative Results
Emerging Care Delivery Models
2 sessions; each followed by table discussion
and feedback
1. Community-Based Primary Care Teams
holistic models for high risk populations
2. Chronic Disease Management
efficient distribution; proven behavior change
Rose’s story
Alternative Delivery Systems
Community-based primary care
What are the barriers to building these models
in your system?
Session 1
“Underserved and Over-serviced”
16% of Medicare Population spending >70%
People who lack access to reliable and
proactive holistic care interventions:
-Frail elders experiencing unneeded utilization
-People with disabilities
-un or under-insured
Virtual Teams; Vertically Integrated Primary Care and Care Management
VA Home Based Primary Care
*VA Home Base Primary Care Program (HBPC)
Impact of at home services
*VA Home Base Primary Care Program (HBPC)
Health Quality Partners
Health Quality Partners
Change in Visit Types
This is what makes it work!
High touch, team-based, relationship oriented
Proactive engagement (new predictive models)
Care provided in community settings
Care planning engages social network
24/7 team responsiveness
Social technologies that facilitate communication
FFS/At risk/Care Management Revenue Streams
(private pay and insurance)
New Contracts are Key to success
FFS with case management PMPM
FFS with gain share contracts
Capitated payments
Private pay customers
These models work.
Why aren’t they implemented at scale in your system?
Name 2 barriers and 2 potential solutions
Table discussion and Report out
10 minutes
Disease Management
Multi-billion dollar industry (employer purchased)
Trend: Shifting to providers
How do we build capability at scale?
Session 2
Chronic disease accounts
for
$3 out of every $4 spent on healthcare
The economics of chronic disease
1 in 3 children will develop diabetes in their lifetime.
Healthcare costs for a person with one or
more chronic conditions are
five times higherCompared to those without
• Chronic disease MUST be managed for value-based care to succeed economically
• Managing chronic disease REQUIRES patient behavioral change
• Physicians do not have the TIME or EXPERTISE to manage behavioral change
• Distribution via group visits and digital tools are NECESSARY to reach population health scale
What we’ve learned
What influences our
beliefs?
• personal
experiences
• family experiences
• social network
• culture
• religion
trusted advisors
What motivates
learning?
• intrinsic motivation
• self-determination
• context
• joy
What promotes
actions?
• clear intention
(goal)
• social influence
• measurement
• shared
accountability
References include:
Design Thinking, Tim Brown
Drive: The Surprising Truth about What Motivates us, Daniel Pink
Theory of Reasoned Action, Icek Ajzen
Behavior Change
LOW
ENGAGEMENT
NOT
INTEGRATED
PERSONAL TOUCH
DOESN’T SCALE
LOW
REIMBURSEMENT
Why “disease management” doesn’t work:
Have tools that are
accessible, reliable and
relatable.
Adult learning principles
Facilitate group learning
Scalable solutions must:
Digital coaching platform
maintains ongoing behavior change
GOAL
SETTINGTRACKING COACHING
CURATED
CONTENT
What challenges do your providers face
in your system?
Identify potential solutions.
Managing Chronic Disease in the
ambulatory setting
Social Entrepreneurs
Innovating at Extremes
(Values-driven)
Early business
model
innovation
-efficiency
-quality
-technical
requirements
established
Current State
