MaineGeneral HealthAging Advocacy Summit

November 14th, 2012

Why do we need change?

• Costs are increasing• Overall health is deteriorating• The patient experience is often poorly

coordinated• Provider workforce is dissatisfied

What are our goals?

• MaineGeneral’s fundamental objectives align with the Institute for Healthcare Improvement’s (IHI) Triple Aim:– Better health– Better care– Lower cost

• And, we need to add a fourth:– Recruit and retain an experienced, quality

workforce

Advancing Accountability in Healthcare

• Principles of accountable care:– Founded on primary care and the principles of the

patient-centered medical home (PCMH)– Based on the community and populations served

by the organization– Integrating the system of care, across the

continuum, outpatient to inpatient to home– Incentivized based on positive health outcomes

and efficient care

Implementing ACO Framework

Healthy Chronic AcutePost-

Acute and LTC

End of Life

Primary Care - Outpatient

Outpatient Diagnostics &

Surgery

Specialty Care - Outpatient

Acute Care - ED and Inpatient

Home Health and Hospice

Reimbursement Methodology:

Incentivize Efficiency and Reward Quality

MedicareSelf-Insured Commercial MedicaidFully Insured

CommercialSelf-Pay

At the Primary Care Practice Level

Expand Shared Decision-Making

Reduce Practice Pattern

Variation

Coordinate Care Transitions

Enhance Care Management

Manage Utilization

Implementation of patient advisory councils

Practices receiving quality and utilization performance measurement reports

Increased communication between hospitalists and primary care practices

On-site licensed clinical social workers and/or registered nurses

Practices receiving and monitoring daily ED and inpatient discharge reports

Framework for Population Health ManagementData driven risk stratification to support intervention strategy

Our Service

Area

KRHA 25

Practices

110,289

Patients

Priorities A, B, C

Primary Care

KVCCT

LOW Diseas

e Burde

n

LOW Cost

HIGH Care Gaps

HIGH Cost

Internal and external

data sourc

es

Winthrop Family

Medicine7,185

Patients

Winthrop Family

Medicine7,185

Patients

HIGH Disea

se Burde

n

Care Managemen

t

Disease Managemen

t and monitoring

Wellness programs

• Manage high costs

• Help members navigate system

• Close gaps in care

• Monitor compliance rates

• Manage risk factors

GOAL INTERVENTION

HIGH

CostA

LOW Cost

HIGH Disea

se Burden

LOW Disea

se Burden C

B

HIGH

Care Gap

s

LOW

Care Gap

s

What it will take?

better healthbetter carelower costs

• A fundamental re-thinking of healthcare• A movement from volume to value• An engagement of patients and families• A change from silos to integration