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Pushing the Boundaries of Accountable Care
April 13, 2015 James Walton, MD, MBA, President and CEO, Genesis Accountable Physician Network
Sandra Selzer, MSHQ, Vice President Product Management, BluePrint Healthcare IT
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflict of Interest Sandra Selzer, MSHQ Has no real or apparent conflicts of interest to report.
© HIMSS 2015
Conflict of Interest James Walton, MD, MBA Consulting Fees (e.g., advisory boards): BluePrint Healthcare IT – Advisory Board Aetna – External Advisory Committee – Racial & Ethnic Disparities
© HIMSS 2015
Identify the specific challenges facing organizations in engaging, both, physicians and patients in the new accountable care world. Assess the unique needs organizations have when creating a care coordination model that addresses, both, the patient’s clinical, non-clinical and socio-economic barriers to care, as well as the physician’s need to deliver care successfully in a value- based care model. Delineate phased steps in the full deployment of the care navigation model and technologies, including mobile apps that engage clinicians, as well as patients and family caregivers. Extrapolate success criteria and barriers around deploying a care navigation model supported by care coordination technology across several care settings and with various types of care providers.
HIMSS STEPS™ Model SATISFACTION: Implementation of key technologies allows Genesis to display the entire care team, including patients and family members, as well as offer secure messaging, journaling and one-touch calling to streamline communications. TREATMENT/CLINICAL: This initiative increases the number of care team members who directly impact patient care and health outcomes. ELECTRONIC INFORMATION/DATA: This initiative increases the value of patient data by making it available, and actionable, to care coordinators supporting a team-based model of care. PREVENTION & PATIENT EDUCATION: As part of the technologies being utilized, care coordinators can now base their activities and workflows on outcomes to assessments as well as tailor automated education to close gaps in health knowledge. SAVINGS: By creating an ACO, and providing key care coordination and engagement tools, Genesis is able to support physicians and increase their ability to care for more patients. http://www.himss.org/ValueSuite
Sandi is a healthcare IT and quality improvement professional, who leads BluePrint’s software product strategy. Sandi previously served as the Director of the Camden Health Information Exchange and spent 15 years at the American Board of Internal Medicine in performance measurement and quality improvement.
Sandra Selzer, MSHQ Vice President Product Management BluePrint Healthcare IT
James Walton, DO, MBA President & CEO Genesis Accountable Physician Network
Dr. Walton is an internist and CEO of Genesis Physician Group and Genesis Accountable Care Network, a large IPA and ACO located in Dallas, Texas. Dr. Walton previously served as VP of Network Performance/Baylor Quality Alliance at Baylor Health Care System. Additionally, Dr. Walton was recently elected President of the Dallas County Medical Society.
Objective : Identify Challenges
Identify the specific challenges facing organizations in engaging, both, physicians and patients in the new accountable care world.
Genesis IPA & Historical Services
Supply Chain Purchasing
Office Operations Support
Genesis Physician Group is an association of independent physicians that credentials & contracts with payers, while also providing support and enabling services on behalf of its members.
No patient access
No direct patient care
No access to clinical data
No health information technology
Genesis: IPA by the Numbers
Square miles in North Texas
Genesis: Challenges for Change
Pressure from integrated delivery systems and payers
Threatened and disengaged physicians
Mediocre patient quality and cost management
Excessive IT expense and inefficiency
Genesis & Clinical Integration ACO Development - Addressing the Challenge
Direct Patient Contact
ACO Creation: Genesis Accountable Physician Network (GAPN)
Physicians in ACO 320
Contracts - 1.0 MSSP, 1.0 MA & 1.0 Commercial
Square miles in North Texas
Joint Venture Management Services Organization
Objective : Assess & Address
Assess the unique needs organizations have when creating a care coordination model that addresses, both, the patient’s clinical, non-clinical and socio- economic barriers to care, as well as the physician’s need to deliver care successfully in a value-based care model.
Genesis: C-MORE Strategy
Setting a Course for Success Executing C-MORE
What staffing model would support care coordination across a broad set of independent providers? Human
How do we connect physicians to the concept of accountable care?
What data does Genesis need to successfully identify, track and report on its ACO patient population?
GAPN’s Organizational Needs: Assessing Customer’s Needs
Limited EMR use & integration Limited MU & PQRS engagement Limited payer claims data sharing Limited organizational capacity for
data analytics, stratification and reporting
Payer attribution model limits control of “leakage”
Physician barriers limit engagement
GAPN’s Organizational Needs: Addressing Customer’s Needs
Quarterly financial rewards for EMR quality documentation
Organizational PQRS reporting Payer contracting linked to
claims sharing JV MSO for data management &
care coordination Software app. (i.e. Genesis
Ribbon) for physician engagement
Care Navigators (CHWs) & Care Coordinators (RNs) connect patients & physicians
Transitional care management for post-acute care
Software application for secure IM with patients & caregivers
Objective : Deploy Investments
Delineate phased steps in the full deployment of the care navigation model and technologies, including mobile apps that engage clinicians, as well as patients and family caregivers.
GAPN Investment: Human Resources
Goals • Increase physician &
patient engagement • Create “headroom” for
primary care physicians • Improve quality of
patient outcomes & reduce IP costs
Quality Improvement Committee Associate Medical Directors Care Navigators
(i.e. Community Health Workers) Case Managers
(i.e. Registered Nurses) Quality & Utilization Data Analysts
GAPN Investment: Health Technology
• ACO Contract Management • Physician Directory • Physician Credentialing
• Data Aggregation & Pop. Health • Disease Case Management • Performance Measurement
• Care Navigation • Patient Engagement • Physician Engagement
• Performance Measures • ACO Status Reporting
Data Aggregation Predictive Modeling Analytics & Pop. Health Mgmt. Care Gaps
GAPN Investment: Data
Quality & Utilization/Costs Performance Outcomes
ACO Statistics & Physician Incentives EMRs
Care Teams & Care Plans Social & Behavioral Assessments Patient Engagement & Education
Patient Data: Well-Being 5 Survey
Objective : Success & Barriers
Extrapolate success criteria and barriers around deploying a care navigation model supported by care coordination technology across several care settings and with various types of care providers.