Pushing the Boundaries of Accountable · PDF file 2015-06-02 · Pushing the...

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Transcript of Pushing the Boundaries of Accountable · PDF file 2015-06-02 · Pushing the...

  • 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

  • Learning Objectives

    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.

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  • 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

  • Presenters

    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.

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  • Genesis IPA & Historical Services

     Contract Management

     Physician Credentialing

     Supply Chain Purchasing

     Office Operations Support

     Pay-for-Performance 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

    Physicians 1,400

    500

    900

    700

    400

    PCPs

    SCPs

    Practices

    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

     Consolidating markets

  • Genesis & Clinical Integration ACO Development - Addressing the Challenge

     Direct Patient Contact

     Data-Driven Improvement

     Population Health

     Performance Measurement

     Physician Collaboration

     Care Coordination

  • ACO Creation: Genesis Accountable Physician Network (GAPN)

    Physicians in ACO 320

    20,000

    3

    120

    400

    Patient Lives

    Contracts - 1.0 MSSP, 1.0 MA & 1.0 Commercial

    PCPs

    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.

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  • Genesis: C-MORE Strategy

    Coordinate Care

    Manage Utilization

    Optimize Physician

    Culture

    Engage Patients

    Engage Families

    Report Improved

    Performance

  • Setting a Course for Success Executing C-MORE

     What staffing model would support care coordination across a broad set of independent providers? Human

    Resources

    Technology

    Data

     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

    Physicians Patients

     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

    Physicians Patients

     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.

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  • 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

     Care Navigators

  • 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

    HIE Claims

     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.

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  • Succ