Concurrent Session 2.3. Building an ACO Framework: Opportunities and Challenges for Providers and Hospitals. Dr. Edward G.

Size: px
Start display at page:

Download "Concurrent Session 2.3. Building an ACO Framework: Opportunities and Challenges for Providers and Hospitals. Dr. Edward G."

Transcription

1 Concurrent Session 2.3 Building an ACO Framework: Opportunities and Challenges for Providers and Hospitals Dr. Edward G. Murphy Chairman Amin Neghabat SVP, Business Development 1

2 Introduction Sound Physicians, Chairman o Hospitalist Organization focused on Performance Management Radius Ventures o Private Equity / Venture Capital 25 years health system CEO experience o 13 years at Carilion Clinic 8 hospitals, 700 provider group Professor, Department of Medicine o Virginia Tech, Carilion School of Medicine AMA: Advisory Committee on Professional Satisfaction o Care Delivery and Payment National Committee Quality Assurance (NCQA) o HEDIS o Medical Home 2

3 Accountable Care Organizations Two Questions: 1. Accountable to who? 2. Accountable for what? 3

4 Accountable Care Organizations 1. Accountable to who? Patients Community o Ultimately payors 4

5 Accountable Care Organizations 2. Accountable for what? Outcomes Services Costs o i.e. making them lower 5

6 Costs Cost reduction is the key driving force behind ACO advocacy. Total cost of care: The all in per capita cost of treating a population for a year. 6

7 Costs 7

8 ACO Value Thesis Redundancy Lowest Cost Setting Unnecessary tests and procedures Longitudinal management of patients with chronic diseases. Hospital Quality ED Care Surgical Outcomes Infection Rates Missed Diagnosis 8

9 Significant Business Model Conflict Health care is a volume driven, transaction oriented business. ACO s are a care management / efficiency value proposition. We re set up to deliver services not manage care. 9

10 Cost Savings Opportunities Pharmaceuticals Hospital admissions E.D. Usage Procedures Ancillary services, esp. high cost imaging (e.g., C.T.) 10

11 ACO Success Requires execution on a whole new body of work / new competencies Case management Largely the work of physicians and physician support personnel / services 11

12 ACO Hospital Care Home Care Physician Group Primary Care Foundation Medical Home Emergency Care Imaging Everyone is important but physician group is at the center. 12

13 National Health Expenditures by Type of Services, 2010 &

14 Hospitalists Will Play a Key Role 14

15 Hospitalist Penetration in the US More than 30,000 hospitalists Practicing in more than 3,300 hospitals 80% of hospitals >200 beds have a hospitalist program Average size of a hospitalist program >9.2 hospitalists 15

16 How Hospitalists Can Help Take a performance based approach Providers are taking on the risk now, so Must deliver care more efficiently Must improve outcomes to reduce overall costs Not just about revenue any longer 16

17 Our Vision: Accountable Acute Care Services PAT Hospitalist Decision Unit Concurrent Peer Review Re-Admission Prevention Core Hospitalist Service Post-Acute Service Acute Continuum ED Triage Admit Elective Transition Inpatient DC Post Acute Rehab PCP Value Proposition Appropriate care setting, avoid unnecessary admissions Evidence based, efficient inpatient care best outcomes Superior patient and physician experience Managed transitions, avoided re admissions 17

18 Focused Care Team Model 18

19 Preventing Avoidable Admissions No Does patient require treatment that can ONLY be provided in a hospital setting? Yes No Can patient be evaluated/treated within 24 hours and/or is rapid improvement of patient s condition anticipated within 24 hours? Yes Alternate level of care is appropriate, including Sound s post acute physician model and hospital at home Inpatient admission is appropriate Obs patients are automatically flagged in SoundConnect Observation is appropriate 19

20 Hospitalist RN Role Delivery of Clinical Models of Operation (85%) Practice Management (15%) High Impact Diagnoses Core Measures Patient Satisfaction Readmissions Management Transition of Care Custom initiatives Hospital committee participation Quality Throughput, utilization EHR implementation Nursing Forums Special projects 20

21 Reducing Costs and Bed Days High-Level Workflow: High-Impact Diagnoses Admission SoundConnect Interventions at the bedside Physician admits patient Patient is identified based on primary diagnosis Rounding list is generated HRN Workflow Applied Variances from best practice documented and addressed Rounding list is accessed Pharmacy intervention applied Discharge Facilitation intervention applied Intervention tracking in SoundConnect is updated 21

22 Reducing Pharmacy Costs Pharmacy communication tools designed to reduce costs and improve quality 22

23 Reducing Length of Stay Physicians or Hospitalist RN enter anticipated discharge date and document avoidable days Anticipated Discharge List Page 1 of 1 Room Patient Team Physician Comments IOF2 Patient A Blue Dr. A 10/07/ :58 Possible tx to university Patient B Green Dr. B 10/07/ :11 Hospice consult at 1200, possible dc home with hospice later 10/7 or 10/ Patient D Purple Dr. A 10/05/ :23 Possible dc 10/5 or 10/6 depending on sx control, fever, etc Patient E Purple Dr. B 10/07/ :15 Palliative care consult 10/7, possibly back to sunny acres 10/7 or 10/ Patient G Blue Dr. A 10/07/ :55 DC 10/7. Follow up to discharge ratio tracked by physician vs. team Patient I Red Dr. C 10/07/ : Patient J Purple Dr. A Anticipated Discharge Hope to List dc to SNF. distributed to Case Anticipated Discharge List distributed to Case Management, Nursing and others each morning 23

24 Prospectively Managing Quality SoundConnect Quality Measures Review Reduces fallouts and drives interventions, while the patient is still in the hospital 24

25 Reducing Readmissions Admission Inpatient Stay Discharge Post Discharge Autoflag High Readmission Risk Patients Diagnostic Chart Review if readmission within 90 days Teach Back Patient/Caregiver Education Enhanced Transition of Care Care Team Alert Discharge Readiness Assessment PCP Notification Schedule Follow up Appt within 7 Days Call Center Follow-Up within 72 hours Follow-Up Appointment Medications Discharge Instructions If Red Flag Apply Intervention(s) Additional Follow up within 48 Hours 25

26 Existing Payment System is a Major Impediment. 26

27 Two BIG Problems with Current Payment System 1. Patient management activities difficult to get into billing codes Case Management Health Educator Electronic Visits Risk of INCREASED COST and NO PAYMENT. 27

28 Two BIG Problems with Current Payment System 2. Success causes financial injury Services on the priority list for cost savings o Hospital Admissions o ED Usage o High End Imaging o Procedures 28

29 To make ACO s work we need: 1. A new payment system AND 2. A new relationship with payors 29

30 Carilion started six years ago 1. Clinic Conversion Organizational Structure Leadership Physician Compensation 2. IT Platform EPIC 3. Insurance Strategy M.A. Plan Aetna 30

31 Physician Compensation Link pay to what you value. Productivity is essential but.. Medicine is more than an endless stream of billable events. 31

32 Physician Compensation Link pay to what you value: Quality Service/Patient Satisfaction Citizenship Etc. 32

33 Why would any sane person do this voluntarily? (Better care aside.) 33

34 Must assess ACO s against your assessment of the Status Quo as a practical alternative. 34

35 Medicare (Federal Budget) SGR Hospital payment rates Readmissions Quality based purchasing Bundled payments Efficiency Measures Medicare spend per beneficiary 35

36 Medicaid (State Budgets) Commercial insurance Wellpoint contracts 36

37 How long have we got? 37

38 How long have we got? 38

39 Summary ACO s: Potential for high patient and societal value but A very complicated transition. 39

40 Summary Thank you! 40

Leadership Summit for Hospital and Post-Acute Long Term Care Providers May 12, 2015

Leadership Summit for Hospital and Post-Acute Long Term Care Providers May 12, 2015 Leveraging the Continuum to Avoid Unnecessary Utilization While Improving Quality Leadership Summit for Hospital and Post-Acute Long Term Care Providers May 12, 2015 Karim A. Habibi, FHFMA, MPH, MS Senior

More information

Population Health Management: Banner Health Network s Perspective. Neta Faynboym, Medical Director Banner Health Network

Population Health Management: Banner Health Network s Perspective. Neta Faynboym, Medical Director Banner Health Network Population Health Management: Banner Health Network s Perspective Neta Faynboym, Medical Director Banner Health Network 29 Acute Care Hospitals BANNER AT A GLANCE Banner Health Network with 400K lives

More information

Kaiser Permanente: Transition Care Performance and Strategies

Kaiser Permanente: Transition Care Performance and Strategies Kaiser Permanente: Transition Care Performance and Strategies Carol Ann Barnes, PT, DPT, GCS carbarne@gmail.com April 2009 Netta Conyers-Haynes, October, 2014 Principal Consultant, Communications Agenda

More information

INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS. Karen Unholz, RN, BSN

INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS. Karen Unholz, RN, BSN INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS Karen Unholz, RN, BSN Origins of the Accountable Care Organization ACOs originated from the Patient Protection and Affordable Care Act (Healthcare Reform)

More information

PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT. Norris Vivatrat, MD Associate Medical Director Monarch HealthCare

PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT. Norris Vivatrat, MD Associate Medical Director Monarch HealthCare PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT Norris Vivatrat, MD Associate Medical Director Monarch HealthCare 2 Agenda Pioneer ACO basics, performance and challenges Monarch HealthCare Post-acute network

More information

PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT

PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT PIONEER ACO A REVIEW OF THE GRAND EXPERIMENT Norris Vivatrat, MD Associate Medical Director Monarch HealthCare 2 Agenda Pioneer ACO basics, performance and challenges Monarch HealthCare Post-acute network

More information

Readmissions as an Enterprise Priority. Presenters 4/17/2014

Readmissions as an Enterprise Priority. Presenters 4/17/2014 Readmissions as an Enterprise Priority April 24, 2014 Presenters Vincent A. Maniscalco, MPA, LNHA Administrator Middletown Park Rehabilitation and Health Care Center Vmaniscalco@parkmanorrehab.com Eileen

More information

How To Manage Health Care Needs

How To Manage Health Care Needs HEALTH MANAGEMENT CUP recognizes the importance of promoting effective health management and preventive care for conditions that are relevant to our populations, thereby improving health care outcomes.

More information

PCMH and Care Management: Where do we start?

PCMH and Care Management: Where do we start? PCMH and Care Management: Where do we start? Patricia Bohs, RN, BSN Quality Assurance Manager Kelly McCloughan QA Data Manager Wayne Memorial Community Health Centers Honesdale, PA Wayne Memorial Community

More information

Care Transitions: Success Stories and Lessons Learned

Care Transitions: Success Stories and Lessons Learned Care Transitions: Success Stories and Lessons Learned Kim McCoy, Stratis Health Kris Garman, Redwood Area Hospital Joleen Johnson, Redwood Area Hospital June 29, 2015 Objectives Learn strategies for implementation

More information

Atrius Health Pioneer ACO: First Year Accomplishments, Results and Insights

Atrius Health Pioneer ACO: First Year Accomplishments, Results and Insights Atrius Health Pioneer ACO: First Year Accomplishments, Results and Insights Emily Brower Executive Director Accountable Care Programs Emily_Brower@AtriusHealth.org November 2013 1 Contents Overview of

More information

A Project to Reengineer Discharges Reduces 30-Day Hospital Readmission Rates. April 11, 2014

A Project to Reengineer Discharges Reduces 30-Day Hospital Readmission Rates. April 11, 2014 A Project to Reengineer Discharges Reduces 30-Day Hospital Readmission Rates April 11, 2014 About the QIO Program Leading rapid, large-scale change in health quality: Goals are bolder. The patient is at

More information

CARE MANAGEMENT SERIES Part 6 Developing a Staffing Model That Works

CARE MANAGEMENT SERIES Part 6 Developing a Staffing Model That Works CARE MANAGEMENT SERIES Part 6 Developing a Staffing Model That Works We will get to staffing but let s start by reviewing core functions. Care Management As we have discussed previously, Care Management

More information

Care Coordination at Frederick Regional Health System. Heather Kirby, MBA, LBSW, ACM Assistant Vice President of Integrated Care

Care Coordination at Frederick Regional Health System. Heather Kirby, MBA, LBSW, ACM Assistant Vice President of Integrated Care Care Coordination at Frederick Regional Health System Heather Kirby, MBA, LBSW, ACM Assistant Vice President of Integrated Care 1 About the Health System 258 Licensed acute beds Approximately 70,000 ED

More information

5/10/13 HEALTH CARE REFORM LONGITUDINAL CARE COORDINATION HEALTH CARE REFORM WHY = VALUE WHY WHAT HOW WHEN WHO WHY WHAT HOW WHEN WHO

5/10/13 HEALTH CARE REFORM LONGITUDINAL CARE COORDINATION HEALTH CARE REFORM WHY = VALUE WHY WHAT HOW WHEN WHO WHY WHAT HOW WHEN WHO TRANSITION CARE TRANSITION CARE WHY WHAT HOW WHEN WHO HEALTH CARE REFORM HEALTH CARE REFORM WHY = VALUE WHY WHAT HOW WHEN WHO Cost/Quality equation Higher cost care has not/does not equate with higher

More information

Riverside Physician Network Utilization Management

Riverside Physician Network Utilization Management Subject: Program Riverside Physician Network Author: Candis Kliewer, RN Department: Product: Commercial, Senior Revised by: Linda McKevitt, RN Approved by: Effective Date January 1997 Revision Date 1/21/15

More information

PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems

PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems By Kathleen M. Griffin, PhD. There are three key provisions of the law that will have direct impact on post-acute care needs

More information

Crowe Healthcare Webinar Series

Crowe Healthcare Webinar Series New Payment Models Crowe Healthcare Webinar Series Audit Tax Advisory Risk Performance 2014 Crowe Horwath LLP Agenda Bundled Care for Payment Improvements Payment Models Accountable Care Organizations

More information

Henry Ford Health System Care Coordination and Readmissions Update

Henry Ford Health System Care Coordination and Readmissions Update Henry Ford Health System Care Coordination and Readmissions Update September 2013 BACKGROUND Most hospital readmissions are viewed as avoidable, costly, and in some cases as a potential marker of poor

More information

ST JOHN S LUTHERAN MINISTRIES. Kent Burgess President & CEO

ST JOHN S LUTHERAN MINISTRIES. Kent Burgess President & CEO ST JOHN S LUTHERAN MINISTRIES Kent Burgess President & CEO WHAT S CHANGING MAYBE? -The way we get paid (Reduce Cost) -The way we get measured (Better Care) -What will be required of us (More) -Partnerships/Affiliations

More information

The Changing Face of Healthcare: Challenges & Solutions. Mark Stauder, President/COO

The Changing Face of Healthcare: Challenges & Solutions. Mark Stauder, President/COO The Changing Face of Healthcare: Challenges & Solutions Mark Stauder, President/COO Disclosure of Relevant Financial Relationship with Commercial Companies/Organizations Mark Stauder has disclosed financial

More information

Population Health Solutions for Employers MEDIA RESOURCES

Population Health Solutions for Employers MEDIA RESOURCES Population Health Solutions for Employers MEDIA RESOURCES ABOUT MISSIONPOINT MissionPoint s mission is to make healthcare more affordable, accessible and improve the quality of care for our members. MissionPoint

More information

How To Reduce Hospital Readmission

How To Reduce Hospital Readmission Reducing Hospital Readmissions & The Affordable Care Act The Game Has Changed Drastically Reducing MSPB Measures Chuck Bongiovanni, MSW, MBA, NCRP, CSA, CFE Chuck Bongiovanni, MSW, MBA, NCRP, CSA, CFE

More information

Home Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques

Home Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques Comprehensive EHR Infrastructure Across the Health Care System The goal of the Administration and the Department of Health and Human Services to achieve an infrastructure for interoperable electronic health

More information

Accountable Care Organizations: What Are They and Why Should I Care?

Accountable Care Organizations: What Are They and Why Should I Care? Accountable Care Organizations: What Are They and Why Should I Care? Adrienne Green, MD Associate Chief Medical Officer, UCSF Medical Center Ami Parekh, MD, JD Med. Director, Health System Innovation,

More information

High Desert Medical Group Connections for Life Program Description

High Desert Medical Group Connections for Life Program Description High Desert Medical Group Connections for Life Program Description POLICY: High Desert Medical Group ("HDMG") promotes patient health and wellbeing by actively coordinating services for members with multiple

More information

Optum s Role in Mycare Ohio

Optum s Role in Mycare Ohio Optum s Role in Mycare Ohio What is MyCare Ohio? New opportunities generated by the Affordable Care Act have allowed Ohio to implement the MyCare Ohio program. MyCare Ohio is a demonstration project that

More information

1900 K St. NW Washington, DC 20006 c/o McKenna Long

1900 K St. NW Washington, DC 20006 c/o McKenna Long 1900 K St. NW Washington, DC 20006 c/o McKenna Long Centers for Medicare & Medicaid Services U. S. Department of Health and Human Services Attention CMS 1345 P P.O. Box 8013, Baltimore, MD 21244 8013 Re:

More information

Implementing an Evidence Based Hospital Discharge Process

Implementing an Evidence Based Hospital Discharge Process Implementing an Evidence Based Hospital Discharge Process Learning from the experience of Project Re-Engineered Discharge (RED) Webinar January 14, 2013 Chris Manasseh, MD Director, Boston HealthNet Inpatient

More information

Presented by: Char Brar, ACNP, MS(Chem.), MSN, RN Cardiology Nurse Practitioner JBVAMC, Chicago

Presented by: Char Brar, ACNP, MS(Chem.), MSN, RN Cardiology Nurse Practitioner JBVAMC, Chicago Presented by: Char Brar, ACNP, MS(Chem.), MSN, RN Cardiology Nurse Practitioner JBVAMC, Chicago 200 bed acute care facility 4 Community Based Out-patient Clinics (CBOCs) 58,000 Veterans IN FY 2008 : 768

More information

Coordinating Transitions of Care: It Takes a Village

Coordinating Transitions of Care: It Takes a Village Coordinating Transitions of Care: It Takes a Village Ken Laube RN, BSN, MBA: Vice President Clinical Excellence Situation/Background Patients face significant challenges when moving from one health care

More information

Joan Carroll RN, CDMS, CCM Director of Care Transitions Lee Memorial Health System

Joan Carroll RN, CDMS, CCM Director of Care Transitions Lee Memorial Health System Joan Carroll RN, CDMS, CCM Director of Care Transitions Lee Memorial Health System 1 Explain how patients experience transitions of care Identify variables that affect transitions due to lack of patient

More information

4/27/2015. LeadingAge Michigan 2015 Annual Conference Dearborn, MI Monday May 18th, 2015. Jon Golm, President

4/27/2015. LeadingAge Michigan 2015 Annual Conference Dearborn, MI Monday May 18th, 2015. Jon Golm, President LeadingAge Michigan 2015 Annual Conference Dearborn, MI Monday May 18th, 2015 Jon Golm, President Aging Improving Enriched Post Discharge Services, LLC Outcomes Mike Logan, SVP/COO Wellspring Lutheran

More information

Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations

Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations Nuts and Bolts Accountable Care Organizations: A New Care Delivery Model for New Expectations Presented to The American College of Cardiology October 27, 2012 1 Franciscan Alliance Overview Franciscan

More information

Evaluating Your Hospitalist Program: Key Questions and Considerations

Evaluating Your Hospitalist Program: Key Questions and Considerations Evaluating Your Hospitalist Program: Key Questions and Considerations Evaluating Your Hospitalist Program: Key Questions and Considerations By Vinnie Sharma, MBA, MPH Manager, Physician Advisory Services

More information

Atrius Health ACO Initiative. Agenda

Atrius Health ACO Initiative. Agenda Atrius Health ACO Initiative November 9, 2012 Mark Yurkofsky MD Mark_yurkofsky@vmed.org 11/13/2012 1 Agenda Why the interest in the Pioneer ACO? What actually is Pioneer ACO anyway? What is Atrius Health?

More information

Be Careful What You Ask For A Predictive Model That Really Works

Be Careful What You Ask For A Predictive Model That Really Works Be Careful What You Ask For A Predictive Model That Really Works Rod Christensen, MD President, Allina Health Clinics Cheryl Hermann, RN, MBA Vice President, Clinic Operations & Patient Care Services Karen

More information

Kick off Meeting November 11 13, 2015. MERCY CLINIC EAST COMMUNITIES Management of Patients with Heart Failure (HF)

Kick off Meeting November 11 13, 2015. MERCY CLINIC EAST COMMUNITIES Management of Patients with Heart Failure (HF) Kick off Meeting November 11 13, 2015 MERCY CLINIC EAST COMMUNITIES Management of Patients with Heart Failure (HF) Team Composition Justin Huynh, MD Internal Medicine, Physician Champion Mary Laubinger,

More information

Nurse Transition Coach Model: Innovative, Evidence-based, and Cost Effective Solutions to Reduce Hospital Readmissions

Nurse Transition Coach Model: Innovative, Evidence-based, and Cost Effective Solutions to Reduce Hospital Readmissions Nurse Transition Coach Model: Innovative, Evidence-based, and Cost Effective Solutions to Reduce Hospital Readmissions Leslie Becker RN, BS Jennifer Smith RN, MSN, MBA Leslie Frain MSN, RN Jan Machanis

More information

Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment

Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment Donna Zazworsky, RN, MS, CCM, FAAN Vice President: Community Health and Continuum Care Carondelet Health

More information

Post-Acute Care Transitions: An Essential Component of Accountable Care

Post-Acute Care Transitions: An Essential Component of Accountable Care : An Essential Component of Accountable Care Bruce C. Smith, MD, FACP Associate Medical Director, Strategy Deployment Group Health Physicians, Seattle, WA Smith.bc@ghc.org AMGA 2012 Institute for Quality

More information

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for

More information

What is the prior authorization process for Skilled Nursing Facility Admission?

What is the prior authorization process for Skilled Nursing Facility Admission? MyCare Long Term Care (LTC) Nursing Facility FAQs The nursing facility network is an essential part of the health care delivery system and we value your partnership. We appreciate the compassion you offer

More information

5/13/2011. ACO Partnerships A Case Study. Contents: The Strategic Imperative for Accountable Care

5/13/2011. ACO Partnerships A Case Study. Contents: The Strategic Imperative for Accountable Care ACO Partnerships A Case Study Bob Edmondson, MPH Vice President, Innovation West Penn Allegheny Health System Pittsburgh, PA 1 Contents: 1. The Strategic Imperative for Accountable Care 2. Population Health

More information

Benchmarks and Best Practices in the Emergency Department. Jeanne McGrayne Premier Consulting Solutions

Benchmarks and Best Practices in the Emergency Department. Jeanne McGrayne Premier Consulting Solutions 1 Benchmarks and Best Practices in the Emergency Department Jeanne McGrayne Premier Consulting Solutions 2 Agenda How we use benchmarks to improve and sustain performance Introduction to tools available

More information

BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM?

BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? Uniform Data System for Medical Rehabilitation Annual Conference August 10, 2012 Presented by: Donna Cameron Rich Bajner

More information

RIH Transitions of Care Collaboration with Coastal Medical To Improve Transitions for Patients Discharged Hospital To Home

RIH Transitions of Care Collaboration with Coastal Medical To Improve Transitions for Patients Discharged Hospital To Home RIH Transitions of Care Collaboration with Coastal Medical To Improve Transitions for Patients Discharged Hospital To Home Sergio Petrillo, PharmD Clinical Pharmacist Specialist, Rhode Island Hospital

More information

CURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab

CURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab CURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab Robert S. Djergaian, M.D. Medical Director Banner Good Samaritan Rehabilitation Institute Stewardship Profitability

More information

Call-A-Nurse Location

Call-A-Nurse Location Call-A-Nurse A 24-hour medical call center, specializing in registered nurse telephone triage, answering service, physician and service referral, and class registration. Call-A-Nurse Location Call-A-Nurse

More information

Paying Through the Nose: New Payment Models for Physician Reimbursement March 16, 2015. AAO-HNS Leadership Forum Arlington, Virginia. www.ober.

Paying Through the Nose: New Payment Models for Physician Reimbursement March 16, 2015. AAO-HNS Leadership Forum Arlington, Virginia. www.ober. Paying Through the Nose: New Payment Models for Physician Reimbursement March 16, 2015 AAO-HNS Leadership Forum Arlington, Virginia Kristin Carter Principal Ober Kaler kccarter@ober.com Christopher Dean

More information

Banner Health Network Pioneer ACO - Physician Toolkit

Banner Health Network Pioneer ACO - Physician Toolkit & The Banner Health Network, an AIP and Banner Health partnership, present the Banner Health Network Pioneer ACO - Physician Toolkit This BHN Pioneer ACO Physician Toolkit has been developed to provide

More information

#Aim2Innovate. Share session insights and questions socially. UCLA Primary Care Innovation Model 6/13/2015. Mark S. Grossman, MD, MBA, FAAP, FACP

#Aim2Innovate. Share session insights and questions socially. UCLA Primary Care Innovation Model 6/13/2015. Mark S. Grossman, MD, MBA, FAAP, FACP UCLA Primary Care Innovation Model Mark S. Grossman, MD, MBA, FAAP, FACP Chief Medical Office, UCLA Community Physicians & Specialty Care Networks June 16, 2015 DISCLAIMER: The views and opinions expressed

More information

Reducing Readmissions with Predictive Analytics

Reducing Readmissions with Predictive Analytics Reducing Readmissions with Predictive Analytics Conway Regional Health System uses analytics and the LACE Index from Medisolv s RAPID business intelligence software to identify patients poised for early

More information

Developing Successful Hospital Partnerships

Developing Successful Hospital Partnerships Developing Successful Hospital Partnerships Michael Logan, MHA Director of Operations Services Publication Date: May 2013 2013 Sawgrass Partners, LLC DEVELOPING SUCCESSFUL HOSPITAL PARTNERSHIPS Those aging

More information

The RN Role in Healthcare Reform: How You Can Make a Difference

The RN Role in Healthcare Reform: How You Can Make a Difference The RN Role in Healthcare Reform: How You Can Make a Difference KT Waxman, DNP, MBA, RN, CNL, CENP Assistant Professor Director and Chair, DNP Program University of San Francisco Director, California Simulation

More information

Health care trend: Developing ACOs

Health care trend: Developing ACOs Health care trend: Health care trend: Accountable Care Organizations (ACOs) have been a significant topic within health care. While many organizations have embarked on a quest to embrace ACOs as quickly

More information

Realizing ACO Success with ICW Solutions

Realizing ACO Success with ICW Solutions Realizing ACO Success with ICW Solutions A Pathway to Collaborative Care Coordination and Care Management Decrease Healthcare Costs Improve Population Health Enhance Care for the Individual connect. manage.

More information

Sustainability: Achieving Clinical and Financial Benefits Through the Use of an EHR

Sustainability: Achieving Clinical and Financial Benefits Through the Use of an EHR Sustainability: Achieving Clinical and Financial Benefits Through the Use of an EHR Bert Reese SVP and CIO of Sentara Healthcare Sentara Healthcare October 6, 2014 1 Sentara Healthcare 126-year not-for-profit

More information

Get With The Guidelines - Stroke PMT Special Initiatives Tab for Ohio Coverdell Stroke Program CODING INSTRUCTIONS Effective 10-24-15

Get With The Guidelines - Stroke PMT Special Initiatives Tab for Ohio Coverdell Stroke Program CODING INSTRUCTIONS Effective 10-24-15 Get With The Guidelines - Stroke PMT Special Initiatives Tab for Ohio Coverdell Stroke Program CODING INSTRUCTIONS Effective 10-24-15 Date and time first seen by ED MD: The time entered should be the earliest

More information

Accountable Care Organizations

Accountable Care Organizations Accountable Care Organizations Myth, Reality, Facts Why =System Failure Low Quality - IOM report High Cost Quality Cost disconnect Low Value Problems Disconnect between Quality and Cost Care is fragmented

More information

1. Executive Summary Problem/Opportunity: Evidence: Baseline Data: Intervention: Results:

1. Executive Summary Problem/Opportunity: Evidence: Baseline Data: Intervention: Results: A Clinical Nurse Leader led multidisciplinary Heart Failure Program: Integrating best practice across the care continuum to reduce avoidable 30 day readmissions. 1. Executive Summary Problem/Opportunity:

More information

Building a Post Acute Network: Care Management and ACOs

Building a Post Acute Network: Care Management and ACOs Building a Post Acute Network: Care Management and ACOs A high level summary of proposed rules for ACOs and the shared savings program most relevant to post acute providers. Prepared By: Kathleen M. Griffin,

More information

Health Care Leader Action Guide to Reduce Avoidable Readmissions

Health Care Leader Action Guide to Reduce Avoidable Readmissions Health Care Leader Action Guide to Reduce Avoidable Readmissions January 2010 TRANSFORMING HEALTH CARE THROUGH RESEARCH AND EDUCATION Osei-Anto A, Joshi M, Audet AM, Berman A, Jencks S. Health Care Leader

More information

Making the Transition: Improving Coordination, Lowering Readmission, and Expanding the Care Team through Data-Driven Risk Stratification at Discharge

Making the Transition: Improving Coordination, Lowering Readmission, and Expanding the Care Team through Data-Driven Risk Stratification at Discharge Making the Transition: Improving Coordination, Lowering Readmission, and Expanding the Care Team through Data-Driven Risk Stratification at Discharge Jennifer McNay, MD Cindi Goddard, MPH, BSN, RN Mercy

More information

Medical Management Program

Medical Management Program Section 7. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.

More information

Clinically Integrated Networks and Accountable Care Organizations

Clinically Integrated Networks and Accountable Care Organizations Clinically Integrated Networks and Accountable Care Organizations 1 Do Nothing 2 Become Someone s Employee 3 Join a Network Provider The wake up call is for POPULATION health management managing clinical

More information

Transitions of Care Management Coding (TCM Code) Tutorial. 1. Introduction Meaning of moderately and high complexity 2

Transitions of Care Management Coding (TCM Code) Tutorial. 1. Introduction Meaning of moderately and high complexity 2 Transitions of Care Management Coding (TCM Code) Tutorial Index 1. Introduction Meaning of moderately and high complexity 2 2. SETMA s Tools for using TCM Code 3 Alert that patient is eligible for TCM

More information

ACO Operational Innovations Featuring the Winners of NAACOS Call for Innovation

ACO Operational Innovations Featuring the Winners of NAACOS Call for Innovation ACO Operational Innovations Featuring the Winners of NAACOS Call for Innovation January 14, 2014 Brian Silverstein, MD Managing Partner HC Wisdom briansilverstein@hcwisdom.com April 24,2014 AGENDA INNOVATION

More information

Using Root Cause Analysis to Determine Why Readmissions are High. Presentation Objectives. Background Information 11/30/2011

Using Root Cause Analysis to Determine Why Readmissions are High. Presentation Objectives. Background Information 11/30/2011 Using Root Cause Analysis to Determine Why Readmissions are High Nancy Seck RBN, BSN, MPH, CPHQ Director, Quality Management Glendale Memorial Hospital and Health Center Presentation Objectives Identify

More information

Managing Population Health: Equity through Person- Centered Care

Managing Population Health: Equity through Person- Centered Care Managing Population Health: Equity through Person- Centered Care Linda Alexander, RN, MBA, CCM Total Health Care Chief Clinical Officer Plante Moran Healthcare Consulting Detroit Medical Center - Clinical

More information

The importance of home and community-based settings in population health management

The importance of home and community-based settings in population health management The importance of home and community-based settings in population health management Nathan Cohen Dieter van de Craen Andrija Stamenovic Charles Lagor Philips Home Monitoring March 2013 Philips Healthcare

More information

Connect4 Patients CCCM Primary Care Community. Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM

Connect4 Patients CCCM Primary Care Community. Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM Connect4 Patients CCCM Primary Care Community Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM September 17, 2015 Objectives: Describe innovative care management

More information

Sentara Healthcare EMR: Our Journey. Bert Reese, CIO and Senior Vice President

Sentara Healthcare EMR: Our Journey. Bert Reese, CIO and Senior Vice President Sentara Healthcare EMR: Our Journey Bert Reese, CIO and Senior Vice President Sentara Healthcare 123-year not-for-profit mission 10 hospitals; 2,349 beds; 3,700 physicians on staff 10 long term care/assisted

More information

Cornerstone Health Care s ACO Playbook. Grace E. Terrell, MD January 17, 2012

Cornerstone Health Care s ACO Playbook. Grace E. Terrell, MD January 17, 2012 Cornerstone Health Care s ACO Playbook Grace E. Terrell, MD January 17, 2012 Mission: To be your medical home Vision: To be the model for physician-led health care in America Values: As a physician owned

More information

CHANGING YOUR CASE MANAGEMENT MODEL OF CARE. Jan Lear, RN, CMC Director of Case Management MedStar Franklin Square Medical Center

CHANGING YOUR CASE MANAGEMENT MODEL OF CARE. Jan Lear, RN, CMC Director of Case Management MedStar Franklin Square Medical Center CHANGING YOUR CASE MANAGEMENT MODEL OF CARE Jan Lear, RN, CMC Director of Case Management MedStar Franklin Square Medical Center 1 Program Objectives To be able to describe the compliance and regulatory

More information

High Rehospitalization Rates: Evaluation and Impact

High Rehospitalization Rates: Evaluation and Impact High Rehospitalization Rates: Evaluation and Impact May 29, 2009 Denise Remus, PhD, RN Chief Quality Officer, BayCare Health System BayCare Health System BayCare is the largest full-service, community-based

More information

Our Patient-Centered Medical Home a Process, not a Click

Our Patient-Centered Medical Home a Process, not a Click Our Patient-Centered Medical Home a Process, not a Click Richard Johnston, M.D. President, Medical Clinic of North Texas, P.A. Medical Clinic of North Texas, P.A. MCNT Physician Owned Primary Care Medical

More information

Empowering Value-Based Healthcare

Empowering Value-Based Healthcare Empowering Value-Based Healthcare Episode Connect, Remedy s proprietary suite of software applications, is a powerful platform for managing value based payment programs. Delivered via the web or mobile

More information

PHOTO HERE. Monarch Pioneer ACO: Designing and Implementing a Successful Shared Risk Model

PHOTO HERE. Monarch Pioneer ACO: Designing and Implementing a Successful Shared Risk Model PHOTO HERE Monarch Pioneer ACO: Designing and Implementing a Successful Shared Risk Model March 2014 Agenda About Monarch HealthCare Monarch s Pioneer ACO Experience Monarch s Evolving ACO Strategy Future

More information

Leveraging EHR to Improve Patient Safety: A Davies Story

Leveraging EHR to Improve Patient Safety: A Davies Story Leveraging EHR to Improve Patient Safety: A Davies Story Claudia Colgan, Vice President of Quality Initiatives Bruce Darrow, MD, PhD, Interim Chief Medical Information Officer Jill Kalman, MD, Director

More information

Inpatient Transfers, Discharges and Readmissions July 19, 2012

Inpatient Transfers, Discharges and Readmissions July 19, 2012 Inpatient Transfers, Discharges and Readmissions July 19, 2012 Discharge Status Codes Two-digit code Identifies where the patient is at conclusion of encounter Visit Inpatient stay End of billing cycle

More information

MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D.

MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D. MERCY-CR/UI HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Dan Fick, M.D. Timothy Quinn, M.D. November, 2012 Accountable Care Organization An ACO is a group of health care providers who agree to take on a shared

More information

CASE MANAGEMENT F R O M A C U T E C A R E T O T H E C O M M U N I T Y A C R O S S T H E C O N T I N U U M O F C A R E

CASE MANAGEMENT F R O M A C U T E C A R E T O T H E C O M M U N I T Y A C R O S S T H E C O N T I N U U M O F C A R E CASE MANAGEMENT F R O M A C U T E C A R E T O T H E C O M M U N I T Y A C R O S S T H E C O N T I N U U M O F C A R E CASE MANAGEMENT Case Management is a collaborative process of assessment, planning,

More information

New York Presbyterian Innovations in Health Care Reform at Academic Medical Centers

New York Presbyterian Innovations in Health Care Reform at Academic Medical Centers New York Presbyterian Innovations in Health Care Reform at Academic Medical Centers October 28, 2011 Timothy G Ferris, MD, MPH Mass General Physicians Organization, Medical Director Associate Professor,

More information

Financial Implications: The Push from Inpatient to Outpatient Care

Financial Implications: The Push from Inpatient to Outpatient Care Financial Implications: The Push from Inpatient to Outpatient Care Brian Baumgardner & Mitchell Mongell THE TRANSFORMATION TO CONSUMER-DRIVEN HEALTHCARE FINANCIAL IMPLICATIONS:THE PUSH FROM INPATIENT TO

More information

Transition of Care (TOC) Log Instructions (Effective: 4/15/14)

Transition of Care (TOC) Log Instructions (Effective: 4/15/14) Transition of Care (TOC) Log Instructions (Effective: 4/15/14) General Instructions: Please note that each transition requires a separate form. For example, an admission to the hospital should have one

More information

A Benefits Realization Management Strategy for EMR Implementation

A Benefits Realization Management Strategy for EMR Implementation A Benefits Realization Management Strategy for EMR Implementation E-Health Conference June 3, 2015 Toronto Convention Center Tammy DeGiovanni, Director Ambulatory Care Dr. Jim King, Physician and CMIO

More information

3/11/15. COPD Disease Management Tackling the Transition. Objectives. Describe the multidisciplinary approach to inpatient care for COPD patients

3/11/15. COPD Disease Management Tackling the Transition. Objectives. Describe the multidisciplinary approach to inpatient care for COPD patients Faculty Disclosures COPD Disease Management Tackling the Transition Dr. Cappelluti has no actual or potential conflicts of interest associated with this presentation. Jane Reardon has no actual or potential

More information

Quality Provisions Ordered by Implementation Date

Quality Provisions Ordered by Implementation Date 1 3006, 10301 2 1311 3 3006, 10301 by Secretary 10/1/2011 Ambulatory Surgery Centers 10/1/2011 Providers in HBE shall be accredited with respect to local performance on clinical quality measures (e.g.,

More information

Testimony of Dr. Randall Krakauer National Medical Director of Medicare. Aetna, Inc. Senate Committee on Aging

Testimony of Dr. Randall Krakauer National Medical Director of Medicare. Aetna, Inc. Senate Committee on Aging Testimony of Dr. Randall Krakauer National Medical Director of Medicare Aetna, Inc. Senate Committee on Aging Roundtable on Continuing the Conversation: The Role of Health Care Providers in Advance Care

More information

Maximizing Limited Care Management Resources to Improve Clinical Quality and Ensure Safe Transitions

Maximizing Limited Care Management Resources to Improve Clinical Quality and Ensure Safe Transitions Maximizing Limited Care Management Resources to Improve Clinical Quality and Ensure Safe Transitions Scott Flinn MD Deborah Schutz RN JD Fritz Steen RN Arch Health Partners A medical foundation formed

More information

The Social Context. If you are young and thin, you will be happy and live forever! (Assuming you have an iphone )

The Social Context. If you are young and thin, you will be happy and live forever! (Assuming you have an iphone ) Improving Care Transitions through Better Use of Palliative Care Resources Cooper Linton, MSHA, MBA VP Marketing and Business Development The Social Context Forget the 2.3 kids and the white, picket fence,

More information

Sanford Improvement Making Lean Work in Healthcare

Sanford Improvement Making Lean Work in Healthcare Sanford Improvement Making Lean Work in Healthcare David Peterson Enterprise Director of Continuous Improvement Outline/Agenda Office of Continuous Improvement Who are we and what do we do? History/Journey

More information

EMC: A Consultant s Perspective. MoHCA 2 nd National Summit on EMC March 26, 2003

EMC: A Consultant s Perspective. MoHCA 2 nd National Summit on EMC March 26, 2003 EMC: A Consultant s Perspective MoHCA 2 nd National Summit on EMC March 26, 2003 Conflicting and Competing Message VIEWPOINTS Electronic Magnetic Compatibility (Interference) Supporting Clinicians Through

More information

Accountable Care Organization Workgroup Glossary

Accountable Care Organization Workgroup Glossary Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.

More information

Population Health Management

Population Health Management Population Health Management 1 Population Health Management At a Glance The MedStar Medical Management Department is responsible for managing health care resources for MedStar Select Health Plan. Our goal

More information

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Medicare Quality Management Program Overview Quality Improvement (QI) Overview At Coventry, we

More information

Empowering Value-Based Healthcare

Empowering Value-Based Healthcare Empowering Value-Based Healthcare Episode Connect, Remedy s proprietary suite of software applications, is a powerful platform for managing value-based payment programs. Delivered via the web or mobile

More information

PREVENTING HEART FAILURE READMISSIONS

PREVENTING HEART FAILURE READMISSIONS PREVENTING HEART FAILURE READMISSIONS Tanya Sprinkle, BSN, RN, CCM Patient and Family Services Coordinator tanya.sprinkle@iredellmemorial.org 704-878-4534 Michelle Roseman, NHA, MBA Chief Operating Officer/Catawba

More information

Population Health Management Innovation Payer and Provider Collaboration. Population Health Management Innovation Payer and Provider Collaboration

Population Health Management Innovation Payer and Provider Collaboration. Population Health Management Innovation Payer and Provider Collaboration Population Health Management Innovation Payer and Provider Collaboration Population Health Management Innovation Payer and Provider Collaboration Agenda Strategic Context Population Health Journey Key

More information