“Population Health Management In A Standards-Strained ...physicians, 52 mid-level practitioners...
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Transcript of “Population Health Management In A Standards-Strained ...physicians, 52 mid-level practitioners...
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Event # 666 191 661
“Population Health Management In A Standards-Strained Environment”
A Complimentary Webinar From healthsystemCIO.com,
Sponsored By NetApp
Your Line Will Be Silent Until Our Event Begins
Thank You!
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Event # 666 191 661
Housekeeping
• Moderator – Anthony Guerra, editor-in-chief, healthsystemCIO.com
• Ask A Question• We will be holding a Q&A session after the formal presentations. • You may submit your questions at any time by clicking on the QA panel located in the
lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as “All Panelists.”
• Download the Deck • Go to: http://healthsystemcio.com/presentation/population-health-webinar.pdf• Shortened link below appears on all slides.
• View the Archive• You will receive an email when our archive recording is ready. • Separate registration is required.
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Agenda
• (15 min) Marc Probst, CIO, Intermountain Healthcare
• (15 min) Bill Spooner, SVP/CIO, Sharp HealthCare
• (5 min) A Word from our Sponsor: Dave Nesvisky, Executive Director of Healthcare, NetApp North America
• (20+ min) Q&A with CIO Panelists
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Population Health Management In A Standards-Strained
EnvironmentMarc Probst
CIO
Intermountain Healthcare
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Intermountain Healthcare1975
SelectHealth1983
Medical Group1994
Intermountain Healthcare: An Integrated Health System
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7.714.3
37.9
Social Security
Current Debt and Unfunded Federal Obligations by Category ($ Trillions)
Total National
Debt
Medicare
Source: Office of Management and Budget, May, 2011
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Commercial Health Insurance Premiums
$15,073
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Three Point Delivery Strategy
• Redesign the care process and create a more robust mechanism to deliver appropriate, evidence-based care.
• Align financial incentives
• Engage patients in their care and the cost of their care
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1. Development of Intermountain Healthcare Clinical Best Practice
2. Integrated Care Management
3. Utilization Review and Management
4. Personalized Primary Care- PCMH
5. Clinical Decision Support
6. Medical Technology, Pharmacy, and Therapeutics Evaluation
8. Telehealth
9. Health Literacy
10. Shared Decision Making
11. Health Promotion and Wellness
12. Consumer/Provider Price Transparency
13. Benefit Design
Redesigning Care and Engaging Patients
• Our clinical agenda for success in a prepaid environment
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Broader IS Trends in Shared Accountability
Making the right way the easy way- CPOE/CDS.
Using technology to increase the convenience, quality and efficiency of care delivery – Telehealth
360 View of Patients
• All claims data• All EMR data
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Physician Payment Model Performance Measurement
• Performance to benchmarks and peers• Tool for improvement• Support referral management• Understanding cost, quality, service variability quickly
Analytics Organizational Design
• Balance between being close to the process and economies of scale• Connecting Claims Data, Clinical Data, and Delivery System Financial Data• Process management vs. process improvement• Support Analytics in the context of Process Improvement
Broader IS Trends in Shared Accountability
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Data Standards
Dependency for Shared Accountability
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Rail Gauge in Australia
Variations in gauge standards have been
a problem for over a hundred years
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Healthcare’s Standardization Problem
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Leading in a New Paradigm
Intermountain Healthcare
Health Data Dictionary
Clinical Element Models
Decision Support
…and many more
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Population Health Management In A Standards-Strained
EnvironmentBill Spooner
SVP/CIO
Sharp HealthCare
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Sharp HealthCare
• Grew from one hospital in 1955 to an integrated health care delivery system
• Approx. 2,000 beds on 4 campus locations• Aligned physician partners• Over 25 years experience in managing care under
population-based payment structures• Sharp Health Plan, a 65,000 member, Knox Keene
licensed commercial health plan• 15,000 + employees, 2,500 affiliated MD’s• Integrated I.T. systems and infrastructure• Centralized system support services
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Physician Practice Models
Sharp Rees-Stealy Medical Centers
• San Diego’s oldest multi-specialty medical group
• In 1985, Sharp acquired the assets of Rees-Stealy Medical Group, originally formed in 1923
• 21 clinic facilities and 5 urgent care centers owned or leased by Sharp
• Medical group composed of 124 primary care physicians, 52 mid-level practitioners and 205 specialists
• Physicians and nurse practitioners are employees of the medical group, a professional corporation
• Average capitated enrollment of 143,000 and 1.2 million physician visits in fiscal 2012
Sharp Community Medical Group
• San Diego’s largest Independent Physicians Association
• Formed in 1989 as a professional corporation
• Primary care and specialty physicians practicing in their own offices
• Medical group composed of 209 primary care physicians and 527 specialists
• Sharp provides MSO services
• Contracting, marketing, claims processing, utilization management, care management, credentialing, human resources, payroll and information technology
• Average capitated enrollment of 138,000
Independent Physicians AssociationMulti-Specialty Foundation
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Sharp’s Population Health Strategy
Care coordination and population health management are not new concepts at Sharp
35
,00
0 Senior Enrollees
24
6,0
00 Commercial
Enrollees
20
,00
0 Commercial ACO Members
32
,00
0 Pioneer ACO Beneficiaries (Medicare)
Capitated PaymentNarrow NetworkPatient Enrollment (voluntary)
Fee-for-service, with incentivesOpen NetworkPatient Assignment (attribution)
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Identify, develop, and implement data solutions to support effective care management from an operational perspective
and with a patient-care focus.
Care-Management Focused Data Solutions
Wellness Illness
Preventionand
WellnessOutpatient Acute
Rehab/Post Acute
Home CareDisease
ManagementHospice/ Palliative
Care
Information Technology• Master Patient Index (MPI) • Hospital EMR
• Medical Group EHR• Health Information
Exchange• MEDai• Data Warehouse • my Sharp
Evidence-Based Care
Operational Excellence
Quality Reporting
External Care Coordination
• Government Quality Programs• Pay for Performance
• Meaningful Use
• Providers• Patients
• Financial and Practice Management• MedVentive
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Priority I.T. Requirements for ACO’s
• Master Person Index - Registry• Methodology for effective patient identification
• Link to enterprise systems.
• Population Health/ Analytics• Evaluate all aspects of quality, access and cost of care
• Case/Care Management
• E.H.R..
• Patient Portal• Advance patient engagement, “stickiness”
• Health Information Exchange• View the complete record across all providers
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Data Warehouse
Diverse Uses: Disease ManagementPopulation ManagementQuality Reporting – P4PHEDIS Physician Assessment RecordsHealth Plan Actuarial Rpts Patient SatisfactionAdvertising CampaignFinancial ReportingContracting Accounts Receivable
Diverse Users: Report Authors: > 60Adhoc Reporting: > 100Consumers: > 250
Self-developed BI Platform
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External Assessment (late 2011)
Purpose: Optimize BI effectiveness
• Design and tools are good, need to grow the platform
• More training in data modeling advised
• Additions to BI team recommended
• Effective data governance important
• Uniform data model essential
• End user data stewards indispensable
We need to standardize internally!!
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Population Health – lots of Vision!
It’s a Fine Line Between a Vision and an Hallucination !!
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What about Standards?
Today – Improvisation
• Patient Identity: 9-step matching algorithm
• Many crosswalk tables• Example: Laboratory transition to LOINC• NCQA, Pioneer ACO, HEDIS request LOINC• However, Meaningful Use wants SNOMED
• External references: National Provider Database, CMS Death Master File, others
Near term – Semantic interoperability tools?
Future – True standards, national and local ?• Electronic capture of clinical indicators
• Embed capture into workflow
• Harmonize federal programs
NetApp Healthcare Solutions Overview
Name Dave Nesvisky
Title Executive Director, NetApp Healthcare
July 2013
NetApp
NetApp is a $6.3B
Fortune 500® company
that creates innovative
storage and data
management solutions
A Recognized Leader
Committed to improving healthcare
delivery and quality through technology
Trusted by over 3,000 health
organizations around the world
Certified with leading technology and
clinical application providers Ranked # 32 in the
Healthcare Informatics 100
Healthcare Informatics
magazine
June 2013
Innovative Storage Solutions for Healthcare
Partnerships for IT Agility
Applications/
Databases
Virtualization
Operating
Systems
Clinical ISV
Network
Services
Data
Management
Over 3,000 Healthcare Clients Worldwide
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Q&AClick on the Q&A panel located in the lower right corner of your screen,
type in your questions in the text field and hit send. Please keep the send to default as “All Panelists.”
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Event # 666 191 661
Thank You!• You will receive an email when our archive recording is ready.
(Separate registration is required)
• Questions/Comments – Anthony Guerra [email protected]
• Thanks to our sponsor: NetApp
Go to www.healthsystemCIO.com/webinars to view our upcoming schedule and see all archived events.
