Clinical Integration: Managing Care Across the Continuum Michigan Critical Access Hospital Conference November 7, 2013
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1 Clinical Integration: Managing Care Across the Continuum Michigan Critical Access Hospital Conference November 7, 2013 Modified from: Munson Healthcare Board Meeting June 5, 2013
2 What is Clinical Integration? According to the Advisory Board: Clinical Integration is a network of physicians working (most often) in collaboration with a hospital(s). It includes a program of initiatives to improve the quality and efficiency of patient care, developed and managed by physicians and supported by a performance management infrastructure. 2
3 Clinical Integration (CI) is simply: Collaborating to improve Patient Care 3
4 Why do we need this? Current care approach fragmented and costly Lack information sharing across the continuum Many social issues interfere with care delivery Minimize duplication of services 4
5 The Clinical Integration Continuum: Connecting patients to healthcare resources for care management initiatives. Goal: reduce per capita costs, enhance patient experience, drive quality ENTRY LEVEL INTEGRATION HIGH INTEGRATION Patient Centered Medical Home Medical Neighborhood High Value Network Population Health Data Management ACO / PHO Leadership Payer Partnership Accountable Care Core Components 5
6 What does Clinical Integration try to achieve? Community Resources Education Transportation Community Health Senior Living Social Services Churches Insurers Clinical Resources Physicians Hospitals Home Care Nursing facilities Outpatient Surgery Laboratories Hospice 6
7 Hospice Care Patient Centered Medical Neighborhood: Building an Integrated Community Community Resources Education Skilled Nursing Facility Hospital Home Care Dental Care Patient Primary Care Physician Ambulatory Services Lab Pharmacy Specialist 7
8 CI from the Patient s View I have so many docs Why are you here? But I had an MRI Do I really need that.. I don t know who my doctor is Where are my test results? And then I went to UofM.. My Care Team Dr. S sent me a letter Looking at your MRI.. Our protocol says.. Dr. S is my medical home I know and I have your results 8
9 Care Management is the Key How do we manage our care managers? 9
10 & Populations Transitions of Care Complex Care Coordination Gaps in Care Care Coordination/Education Advanced Care Planning 10
11 The New Model starts with Primary Care Embracing Patient Centered Medical Home (PCMH) central to health reform Information Technology enabled: linking community and clinical resources Cooperative Specialists and Facilities to coordinate care New process, payments, delivery systems Engaged Patients 11
12 What do we end up with? Triple Aim: reduced per capita costs, enhanced patient experience, healthier population Healthier Populations Earlier interventions Shared information Less costly care Care delivered in the right place 12
13 Where are we now? Each of you are in different places The pressure to prove Value has never been greater We all need a crystal ball Weaknesses are in how much influence we do/don t have Size is an advantage and a disadvantage Expertise resides in our local organizations 13
14 Regional Response: We have to have the critical discussions to move forward and develop expertise in Population Health Management BCBS OSC work MiPCT Trinity CIN meetings IT strategy synergy 14
15 BCBS OSC Initiative Collaboration between Munson, NPO, PGIP and Wexford Crawford PHO S Creation of a shared patient database Early initiatives including Mental Health access BCBS spend data Cadillac $ = Munson $ for Wexford PHO 15
16 MiPCT Care Coordination for Lowering Costs Success Stories 16
17 Trinity CIN Project Creating a network to compete in the difficult GR Market Cadillac/Grayling invited Munson Shared expertise How could this look in the elsewhere? Future Marketing trends? 17
18 CIN Questions Who do we integrate with? Munson? Each other? All Critical Access Hospitals? EVERY physician or group in our area or only some? What is best for OUR patients!?! Primary Care will be the base unit 18
19 Going Forward Continue to refine IT infrastructure approach Data will drive our success Registry/HIE/Data warehouse Establish new physician hospital governance models Stay Flexible Covered Lives may be where our margin lies 19
20 Next Steps? 20
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