The Next Generation of Spine Care;

Place, Provider, Price

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Nikhil Thakur, MD, Orthopedic Spine Surgeon, Orthopedics Northeast Robin Hynds, MSN, RN, CPHM, Vice President, Care Continuum Dawn Bollhardt, BS, RN, MSN, CNL, Program Manager, Spine and Orthopedics Djamel Bayliche, Vice President, Corazon Patrick Vega, Vice President, Corazon

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Agenda

Introductions

Situation- Lawrence General Hospital

9 Essentials for Comprehensive Spine

Common Challenges in Spine

Core Elements of Comprehensive Spine

Assessment

Patient Navigation

Report & Recommendations

High Performance Profile

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Corazon – Industry Resource

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Robin Hynes, MSN, RN, CPHM Vice President, Care Continuum

Service line strategy & development in a community hospital

Implementing and leveraging a Co-Management Agreement with Orthopods

Population Health

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Primary Care & Community-

based Services

Psychiatry / Psychology

Worker’s Comp/

Occupational Medicine

Comprehensive

Spine

Intake, Triage, Navigation

Orthopedics Neurosurgery

Physiatry ED

Ancillaries -Rehabilitation; IP, OP

-Imaging

Pain Management -Acute and chronic

Alternative and Complimentary

Providers

Neurology Skilled

Nursing / Long-term Care

Comprehensive Spine

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Visiting Nurses / Home Care

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Dawn Bollhardt, BS, RN, MSN, CNL, Program Manager, Spine and Orthopedics

Creating a collaborative approach with surgeons

Patient education / “Spine Camp” that spans full episode of care; pre-habilitation through post-acute care

Navigation access and guidance to services; surgical and non-surgical

Ancillary services that impact compliance and outcomes; depression, nutrition…

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Build Comprehensive Spine: IP, OP, ASC

Design an integrated system

Navigate patients

Collect/benchmark/report metrics

Collaboration among spine specialists; employed and private

Engage Primary Care

Understand & manage the costs of care

Prepare for value-based care: data & episode cost, design / redesign care, physician engagement, patient engagement

Integrate Pain Management

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9 Essentials for Spine

in a Value-based Environment

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Common Challenges in Spine

-Poor Access

-Outmigration to Competing Hospitals, Physicians

-Exclusive surgical focus

-Lack of Service Line Vision

-History of failed initiatives, skepticism

-Low Surgical Volumes

-Ill-defined Programming

-Predictably Dissatisfying Patient Experience

-Distrust between Physicians & Executive Administration

-Orthopedic-Neurosurgical tension

-Migration of historically IP bound surgical cases to ambulatory

-Loss of Ancillary Revenues

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Poll Question 1

Does your organization have a patient navigation system that ensures access and guides patients through care?

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Core Elements of Spine Care

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Vision,

Strategy, Planning

Hospital-based

Services: -Pre & Perioperative

Services -Acute Care

-Rehabilitation

Primary Care

Relations

Patient Education

Physician Relations

Non-

Operative Spine:

Pain, Rehabilitation,

Imaging

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Elements- continued

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Outcomes Clinical, Functional, Operational, Financial

Collection, Measurement & Application

Financial Performance -including Medicare

analytics

Marketing Access

Intake, Triage & Navigation

Post-Acute Providers aligned across full Continuum -Rehabilitation, Home Health, Skilled Nursing, Long-Term Care

-a prerequisite for at-risk contracting

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Where to Start…?

Gap Assessment

Understanding key stakeholder visions

Market Opportunity

Data & performance metrics; operational, quality, finance

Patient- Self-referred

Navigation

Physician Specialist

PCP

EHR Fax

Phone

Neurosurgery Orthopedics

Neurosurgery Orthopedics

Physiatry-PMR/ Rehabilitation

PCP with support

Pain Management

Referring physician request Acuity Wait times Diagnostics/symptoms/history Geography Insurance

Intake/Triage/Navigation Process Referral Base

Triage disposition criteria

Chiropractic

Chiropractic

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Marketing Focus: Primary Care Education

Spine programs offers a clear brand for medical professionals and consumers, growing word-of-mouth referrals,

Physician-led education to Primary Care,

Primary near-term task is to build a credible comprehensive spine program, ensure access and communicate to key referral sources

Not principally an advertising activity in; rather - establishing / reestablishing trust and credibility with medical professionals and patients

Rapid growth, without structure will not suffice, new volume can compound disorganization and disappoint reinvigorated expectations.

Ensure access, without it- quality doesn't matter

billboards….

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Financial Analysis

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External Market Data (inpatient only) - this data is used to determine: Market share trending and out-migration Population projections Utilization rates Future volume potential

Internal Financial Data (inpatient and outpatient) - this data is used to determine: Volume trending Financial summary that includes:

Cases Average payments per case Average direct cost per case Average contribution margin per case Average contribution margin % per case

Payer mix Average length of stay compared to CMS benchmark

Projections of post-acute utilization and cost by provider and place of service

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Poll question #2

Does your organization have a written Strategic Plan for spine services?

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Report & Recommendations

Strategy, data and a defined leadership model drive all

other activities…

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Assessment Recommendations

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Strategy -Plan for Spine

-Plan for Musculoskeletal -Resource Focus

Shared Governance

-Service Line Leadership

-Medical Leadership -Structure

Marketing -Audience -Messages

-Tactics -Access

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In-migration

Episode costs known

Comprehensive spine

Access, triage, navigation

Clinical outcomes reliable

Post-acute care algorithms

Population health readiness

Direct-to-employer contracting

Place of service options: Inpatient, Outpatient, ASC

Bundled payment readiness; Medicare, Commercial

Standardization & Implementation of Best Practices

DESTINATION SPINE CENTER

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Thank You for attending!

Thank you- Robin Hynes, Dawn Bollhardt, Dr. Nikhil Thakur

and Lawrence General Hospital

Djamel Bayliche 412 364-8200 dbayliche@corazoninc.com

Patrick Vega 301 730-2595 pvega@corazoninc.com

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Corazon 2017 Fall Conference

Corazon’s World of Innovation: The Future of Healthcare

September 28-29

The Gaylord Palms Resort & Convention Center

Orlando, FL

Register at www.corazoninc.com.

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Wellbe is a Conference Sponsors-

Today’s webinar attendees can receive a special discount when registering.

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Addendum

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Additional resources

“The Five Keys for Orthopedics & Spine”

“Nurse Navigation for Spine”

“Marketing Spine to Primary Care”

“Helping Your Hospital Help Your Practice”

“4 Strategies to Prepare for Changes in Reimbursement”

© Corazon, Inc. All rights reserved.