Triple aim of ACA. Shanty Creek, November Improved patient experience easier acess 2. Improved quality of healthcare 3.

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1 Theresa Anderson, West Shore Medical Center Tracey Chappel, West Shore Medical Center Ingemar Johansson, Centra Wellness Network Shanty Creek, November 2015 Triple aim of ACA 1. Improved patient experience easier acess 2. Improved quality of healthcare 3. Lower cost 1

2 VISION State of the Art regional integrated health care system Community members, with or without health insurance, of all social strata and walks of life will receive health care that is affordable easily accessible and friendly high quality holistic wellness oriented Northern Michigan Health Coalition VISION Care for the whole patient and manage multiple, interrelated and chronic health problems Collaborate to provide a range of health care services to people of all ages and Align our clinical and financial incentives to meet 1. improved quality 2. improved patient experience 3. reduced costs Northern Michigan Health Coalition Membership Crystal Lake Health Center Munson Medical Center District Health Dept #10 Catholic Human Services West Shore Medical Center Benzie Leelanau District Health Dept. Area Agency on Aging of Northwest Mich Centra Wellness Network Northwest Michigan Health Services Michigan Community Dental Clinics Michigan Health Council Northern Lakes Community Mental Health Traverse Health Clinic Child and Family Services 2

3 Committed to Collaborate Munson Healthcare Munson Healthcare Kalkaska Hospital Munson Healthcare Cadillac Hospital Paul Oliver Memorial Hospital Munson Healthcare Grayling Hospital Northern Physician Organization (NPO) Northern Michigan Health Network (ACO) Manistee Friendship Society Benzie Recovery Center Human Servicers Collaborative Manistee Human Services Collaborative Benzie Human Services Collaborative Grand Traverse Blue Cross Blue Shield of Michigan Foundation Traverse City Rotary Charities Oleson Foundation GT Regional Community Foundation Traverse Bay Area Tobacco Coalition Alliance for Economic Success Grand Traverse Pavillions/PACE Northwest Michigan Works Primary care is king Ingemar Johansson, MBCMH Integration 3

4 Crystal Lake Clinic primary care Centra Wellness Network behavioral health care Catholic Human Services substance use treatment West Shore Medical Center lab, imaging, PT Who Manistee will get voted Wellness off the Center island? Who Manistee will get voted Wellness off the Center island? Who Manistee will get voted Wellness off the Center island? 4

5 Care management Care coordination Health promotion Transitional care (inpatient out) Individual and family supports Referrals Tuesday morning huddle Psychiatrist Primary Care Provider RN Care Manager ER staff (hospital) Case managers Therapists Substance use counselor Peer Support Specialists Team facilitator Team leaders Clinical integration Integrated Electronic Health Record IT 5

6 Michigan Medicaid Health Home pilot to Certified Community Behavioral Health Clinic pilot Care management People with mild and moderate mental health issues Cost based service reimbursement West Shore Medical Center 45 Bed Hospital, County Owned Provider Based Clinics ACO Member 2015 is the 1 st year in MSSP 1 Rural Health Clinic since 2014 Patient Centered Medical Home since 2012 Patient Centered Medical Neighborhood Walk In Clinic/Occupational Medicine West Shore Medical Center 26 Office Based Providers Multispecialty Primary Care Internal Medicine OB/GYN Pediatrics Orthopedic Surgery, General Surgery, Neurology, Urology 6

7 Primary Care/Walk In Clinic Mental Health in Primary Care office Integrated EMR for scheduling, documentation, and billing 7

8 In the Primary Care Setting 8

9 Rural Health Clinic Provider Based Clinic Medicare Medicaid Commercial Payors Contracting vs direct employment Opportunities in RHC Reimbursement Credentialing Compliance no shows, scheduling 3 x week, 1 hour per patient FY15 (started 9/2014) 151 Patients 560 Encounters FY16 1 st QTR 80 Patients 220 Encounters Projected 320 Patients 880 Encounters Paradigm shifting Hospital perception of a social worker Mental Health in hospitals ED Inpatient Outpatient Ancillary Services 9

10 Resource vs Mental Health Discharge planning Connecting resources Crisis Interventions Emergency Department For Private Pay For initial screenings yes with Centra Wellness via contract Nursing does the rest No social worker in ED for resource management No social worker for placement/transport/etc done by nursing Emergency Department Access to care Frequent flyers Communication with Mental Health providers Integration with Primary Care Providers 10

11 Money for the Mission Type of Provider LMSW, Counselor, Psychologist, Psychiatrist Reimbursement RHC Billing Provider Based Clinic Inpatient/ED At this juncture we want Health information exchange Improved communication between providers ADT notifications for all Common schedulers Common health assessments Common care plans Common metrics Electronic health records meaningful use status 11