Population Health and Ambulatory Services

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1 Population Health and Ambulatory Services

2 Population Health and Ambulatory Services Division President, Kelly Macken-Marble Clinical Integration Population Health Primary Care Home & Community Health Urgency Centers Specialty Care Minnetonka Medical Center Ambulance & AirCare Services

3 The Triple Aim NMHC has adopted the Institute for Healthcare Improvement s definition of improving healthcare value through the Triple Aim by: Delivering the best patient experience (highest quality with impeccable customer service) At the most affordable cost To improve the overall health of the population of patients we serve North Memorial is using Clinical Integration as the path to pursuing and achieving the Triple Aim. Clinical Integration allows us to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, and patient-focused. Achieving this for every patient, every time will allow us to more successfully manage the risk (clinical and financial) within the population of patients we collectively care for.

4 Clinical Integration Model Clinical Integration is the platform to align physicians and the health system to develop innovative ways to keep our communities healthy. This requires new approaches to engaging patients in their health, developing cost-effective care models, and ensuring highly coordinated care between providers and locations. Clinical Integration describes the integration of clinical information and healthcare delivery services from distinct entities across a continuum of services, including: Preventive Outpatient Inpatient acute hospital care Post-acute including skilled nursing Rehabilitation, home health services Palliative care to improve the value of the care provided

5 North Collaborate Care Network President, Craig Matticks Established: 2012 North Collaborative Care Network is an Accountable Care Organization (ACO) with hospital leadership and representation from multiple primary and specialty care clinic network. North Collaborative Care Network is a physician-led organization designed to leverage and build upon existing relationships to partner with North Memorial Medical Center, Maple Grove Hospital, and other select provider partners in the delivery of coordinated, high-quality, low-cost care. Click on the Photos to Learn More About Dr. Matticks and North Collaborative Care Network

6 Population Health Management Population Health Management uses predictive modeling and integrated care to improve the health care use and behavior of defined populations. PHM applies across the Care Continuum from managing patients with chronic conditions to prevention efforts with low health risk individuals Graphic from 2014 HFMA Conference

7 Population Health Care Models As an Accountable Care Organization (ACO), NMHC must have 3 complementary care models for 3 discrete populations of patients. Through the Complex Care Management program, high-risk patients have a dedicated care manager. North Memorial Clinics are certified by the Minnesota Department of Health as Health Care Homes designed to manage moderaterisk/rising-risk patients in the patient centered medical home. The Patient Access Center (i.e. Call Center), North e-care, and Urgency Centers ensure ease of access for low-risk, healthy patients

8 Primary Care Outpatient Services Primary Care Clinic Locations: Arbor Lakes Blaine Brooklyn Center Brooklyn Park Camden Elk River Golden Valley Maple Grove-Internal Medicine Minnetonka Medical Center Northeast Minneapolis Plymouth City Center Ridgedale Rockford Road St. Anthony Approximately 400,000 annual outpatient visits Click on the Photo to Learn More About North Memorial Primary Care Clinics

9 Primary Care Outpatient Services

10 Primary Care Outpatient Services Specialties within Primary Care: Urgent Care Maple Grove and Roseville 28 Providers Occupational Medicine Program Camden, Elk River, Golden Valley, Ridgedale, and Roseville Sports Medicine Sport, Spine, & Joint Clinic International Health Executive Health & Concierge Services Click on the Photos to Learn More About Each North Memorial Specialty

11 Home & Community Outpatient Services Services Home Health Care 45,810 patient home visits expected in 2014, with an average daily census of 400 patients April 2014: joint venture partnership with Fairview Home Infusion began Hospice Hospice care emphasizes relieving pain and uncomfortable symptoms of persons with terminal illness 8 bed hospice residence located on the north shore of Upper Twin Lake in Brooklyn Center Expecting to provide care to 762 patients in 2014, which accounts for 51,824 billed patient days Palliative Care Palliative care enhances comfort and improves the quality of life during the disease course, and continues until cure, remission, or death occurs. In 2014, 2,516 consults/visit expected in inpatient units, as well as the Humphrey Cancer Center Total Care for Seniors A key component to a longitudinal care continuum and outcomes and value based purchasing and risk sharing Partners with key long term care facilities in providing follow up medical care in both Transitional Care Units for active rehab as well as Long Term Care, Assisted Living and Independent Living for routine and chronic conditions Click on the Photo to Learn More About North Memorial Home and Community

12 Urgency Centers Outpatient Services Urgency Center Model More Urgent than Urgent Care Staffed by North Memorial Emergency Medicine Physicians Provides treatment for wide range of illnesses including chest pain, dehydration, fractures & dislocations, head injuries, etc. Lower cost to patients than an ER visit Shorter wait times Urgency Center Locations Blaine Partnership between North Memorial and Multicare Associates Minnetonka Medical Center Click on the Photo to Learn for More About North Memorial Urgency Centers

13 Specialty Care Outpatient Services Heart & Vascular Institute (HVI) Cardiology Cardiovascular Surgery Humphrey Cancer Center (HCC) Oncology Genetic Counseling Complementary Care Oral Maxillofacial Surgery (OMFS) Gastroenterology Podiatry Rheumatology Psychiatry CACE Collaborative Acute Care for the Elderly Click on the Photos for More Information About Each North Memorial Specialty

14 Specialty Care Outpatient Services Specialty Programs with Affiliate Physician Partners Metabolic and Bariatric Surgery Infectious Disease Balance Center Maternal Fetal Medicine Hope Chest Breast Cancer Center Dermatology Interventional Pain (pending) Sleep Center Click on the Photos for More Information About Each North Memorial Specialty

15 Specialty Care Outpatient Services Heart & Vascular Institute Recognition 2013: Best in the Region for Cardiac Care by HealthGrades Awarded Blue Distinction+ from Blue Cross and Blue Shield of MN Services Advanced Cardiac Diagnostics Electrophysiology Heart Catheterization Open Heart Surgery Endovascular Surgery Endovenous Laser Therapy Heart Team STAT Program Chest Pain Program Cardiac Rehab Click on the Photo for More Information About North Memorial Heart and Vascular Institute Care Team Locations Hospitals North Memorial Medical Center Maple Grove Hospital Clinics Robbinsdale Maple Grove Buffalo Monticello Minnetonka

16 Specialty Care Outpatient Services Cancer Care Humphrey Cancer Center Locations Robbinsdale (North Memorial Outpatient Center) Maple Grove Monticello Cancer Center (joint venture) Services Medical Oncology Hematology Radiation Oncology Oncology Pharmacy PET/CT Prevention and Early Detection Specialized Lung Cancer Program Genetics Program Acupuncture Hospice & Palliative Care Nutrition and Rehab Services Click on the Photo for More Information About North Memorial Humphrey Cancer Care Center Care Team

17 Minnetonka Medical Center The Minnetonka Medical Center is a convenient, one-stop resource for primary, specialty, emergency and diagnostic care for the entire family. Services: North Memorial Primary Care Clinic North Memorial Urgency Center Specialty Care Clinic Comprehensive Laboratory & Imaging Services Ambulatory Surgery Center 50/50 Joint Venture with North Memorial and Affiliated Surgeons Click on the Photo for More Information About North Memorial Minnetonka Medical Center Managed by Surgical Management Professionals (managers of Maple Grove ASC)

18 Ambulance & AirCare Outpatient Services 7 Helicopters and 125 Ambulances in 27 communities throughout Minnesota and western Wisconsin Ground Transports: 72,000/year Air Transports: 2,700/year Over 750 Employees The only MN-based ambulance service accredited by the Commission on Accreditation of Ambulance Services Click on the Photos for More Information About North Memorial Ambulance and Air Care Services

19 Ambulance & AirCare Outpatient Services Park Rapids Alexandria Minneota Marshall Bemidji 2007 Pine River Crosslake Brainerd 2000 Walker Redwood Falls 2000 Aitkin Milaca Princeton 2005 Zimmerman Brooklyn Ctr New Prague Longville Faribault Waseca Burnett Cty Frederic Forest Lake Lakeville 2006 Spooner Ground and AirCare covers a service area larger than the state of Massachusetts Helicopter Ambulance

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