Second Forum on Health Care Management & Policy November 28 30, Discussion Report. Care Management

Size: px
Start display at page:

Download "Second Forum on Health Care Management & Policy November 28 30, 2012. Discussion Report. Care Management"

Transcription

1 Second Forum on Health Care Management & Policy November 28 30, 2012 Discussion Report Care Management Thomas G. Rundall Henry J. Kaiser Emeritus Professor of Organized Health Systems School of Public Health, University of California, Berkeley, CA, USA Federico Lega Professor Bocconi University, Milan, Italy Walter C. Kopp President Medical Management Services San Anselmo, CA, USA 1

2 The following report summarizes the round table discussion about care management at the Second International Forum on Health Care Management & Policy in Hamburg, Germany November 28 29, What is care management? Care management is an evolving concept that refers to a set of evidence-based, integrated clinical care activities that are tailored to the individual patient and ensure each patient has his or her own coordinated plan of care. Care management is closely related to the concepts of care coordination and case management, but it typically involves a broader array of activites than is usually seen with efforts to coordinate care or implement case management. Care management not only seeks to manage care intelligently when patents show up for treatment, it seeks to identify patients who need care and bring them into the system before their illness becomes serious and their care becomes expensive. Care management programs also attempt to educate patients about how they can best manage their own health and engages them with data about their health. Effective care management requires that physician practices, hospitals and other care providers implement technologies and develop capabilities to enable them to manage patient care. These typically include: Work process redesign to implement new activities and workflows that increase patient engagement, improve staff productivity, and optimize efficiency Population management, including the ability to identify patients with common clinical conditions on which to focus secondary prevention and early treatment efforts Health information technologies including electronic health records (EHR), disease registries and reporting systems to facilitate data capture, patient tracking and outcomes review Clinical decision support within a comprehensive EHR to effectively make use of best practices and evidence to help guide care efficiently and effectively Coordination tools including an interoperable EHR connecting primary, specialist and hospital-based physicians and patient portals that enable patients to access informaton and communicate with physicians offices 2

3 In addition to these practice-based capabilities, effective care management is enabled by a number of activities specific to an individual patient. Patient engagement including relationship building, exploring patient s needs and values, education, collaborative goal setting and care planning to engage patients and their families in their own care and to support self-management Assessment of the patient initially, periodically and at points in time when the course of the patient s disease changes; assessment should include the patient s clinical condition, feasibility of completing various interventions, preferences and readiness to engage in self-management and treatment Planning an individualized care plan that balances best practices for managing the targeted condition(s) with feasibility and patient preferences in a way that optimizes outcome; the plan should be periodically reviewed and adjusted as necessary. Provision of services required to implement the care plan, including arranging referrals and follow-up Coordination of services provide by using the practice-based tools and capabilities described above to communicate and coordinate with the patient and other caregivers to ensure that the care plan is implemented safely and efficiently The potential benefits of care management are improvement in population health, improvement in patient s experience with their care (including the quality of care), and reductions in medical costs associated with avoidable use of hospitals and emergency rooms, use of ineffective care practices, and patient non-compliance with care plans. What are common barriers to effective care management? There are several interrelated barriers to effective care management, including: Physician and patient behavior patterns that perpetuate fragmented care Payment incentives that reward primary care providers (PCPs) for only treating patients who present with an illness and fail to reward PCPs for managing the population of patients they serve Fee-for-service payment systems that reward providers for duplicative, unnecessary and avoidable services Primary care practice models that make inefficient use of PCP s time and make little use of nurse practitioners, patient coaches, navigators and case managers and other physician extenders Lack of coordination between PCPs, specialists, the hospital and follow-up care providers after hospitalizaton For most care management initiatives, the principal challenge is finding effective ways to change physician and patient behavior. In most developed countries the institutionalized form of medical practice is characterized by a high degree of physician autonomy, weak communication among health care providers, and a reactive approach to patient care. Similarly, the institutionaized patient role is one of passive acceptance of medical 3

4 prescriptions and advice and heavy reliance on technologically-based treatment for medical conditions. The care management approach seeks to transform medical practice structures and work patterns and more fully engage patients in maintaining their health and ameliorating health problems. The existing patient care structures and behaviors are difficult to change. A related barrier in most health systems is the physician and hospital payment system, which typically rewards episodic, fragmented care through fee-forservice or other productivity-based payment methods. Many of the care management activites identified above are not reimburseable under most pubic and private health insurance plans. However, there is a growing effort in the United States and some European countries to implement bundled payment, capitation, value-based purchasing, specific payments for care management activities and other payment reforms that will support care management. Why is pressure increasing on clinicians and managers in health systems to improve care management? Health care systems in most developed countries are struggling to control health expenditures. The OECD countries spend on average 9.5% of GDP on health care. The Unites States spends more on health care than any other nation: $8,322 per person per year, or about 17% of GDP. But health expenditures in other countries are increasing as a percentage of GDP and are straining public budgets. The Netherlands, France, Germany, Canada, Switzerland, Denmark and Austria currently spend 11-12% of GDP on health care. Research over the past two decades has documented that a substantial portion of health expenditures is due to medical errors, avoidable hospital admissions and emergency room visits, duplicative or unnecessary medical tests and patient noncompliance with drug prescriptions and behavioral recommendations to reduce risk factors such as obesity. Increasingly public and private payers of health care services employers, public and private health insurance plans and individual patients are demanding delivery and payment reforms to reduce the cost of care, especially those expenditures that are avoidable through managing care and more fully engaging patients in maintaining their health. Another source of pressure on the clinicians and managers in health systems to improve care management is the growing awareness that the quality of care in most health systems is not as good as would be expected given the amount of money spent in the health care sector. The frequency with which clinicians commit medical errors in hospitals, fail to provide recommended care to patients in amubulatory settings and allow patients to fall through the cracks during care transitions are just some of the systemic quality problems that have been identified. Effective care coordination can help to integrate care and prevent poor outcomes that give rise to avoidable hospital admissions and readmissions. For example, in the United States 20% of hospitalized Medicare beneficiaries are readmitted within 30 days; more than 33% are readmitted within 90 days. Research suggests that a substantial proportion of readmissions can be prevented with evidence-based care in the hospital combine with comprehensive dischanrge planning, supportive transitions in care, and timely primary 4

5 care. With reduce readmissions, it is estimated that that the nation can save $12 billion annually in the Medicare program alone. What are promising examples of effective care management practices? Care management programs have been in existence in some health systems for a long time. But, as the pressure to manage care has increased. More heath systems are implementing either comprehensive care management programs or programs to management care for specific diseases that pose particular challenges. The Kaiser Permanente Care Management Institute has been in existence since 1997 and partners with physicians, other clinicians, organizational leaders and patients to design and implement new approaches to patient care management that are consistent with six guiding principles: 1. Keeping members at the center 2. Harnessing technology 3. Care coordination 4. Applying evidence-based care 5. Measuring results 6. Spreading successful practices The Commonwealth Fund recently published three case studies of care management programs to reduce hospital admissions and readmissions among chronically ill and vulnerable patients: the Cinncinnati Children s Hospital Medical Center s Asthma Improvement Collaborative; the UCSF Medical Center s Heart Failure Care Management Program; and the Visiting Nurse Service of New York s Choice Health Plans. Another example is John Muir Health in the Northern California region of the U.S., which implemented a comprehansive care manaement program duirng The overarching goals of the program are to (1) create an organizational structure that effectively facilitates an integrated care management process; (2) initiate a Patient Centric model of care; and (3) create care processes by disease condition that will be followed across the continuum of care. The operational objectives of John Muir Health s Care Management Program include: Reducing emergency department visits Redirecting patients to the optimal site of care Providing palliative care as necessary Establishing routine medication reconciliation Improving discharge planning at admission, including identifying patients with a high rsk of readmission Improving care management of high-risk individuals Establishing a transition-of-care process Reducing avoidable hospital readmissions Improving communication among PCPs, specialists and patients 5

6 What organizational structures are recommended to support care management? The organizational capabilities and tools identified above (work process redesign, population management, health information technologies, clinical decision support, and communication tools) are crucial to establishing an effective care management program. Each of them will require some type of supportive organizational structure with clinical and non-clinical staff dedicated to the development and maintenance of each respective capability. In most cases, health care organizations that implement a care management program will also implement changes in their organizational design and reporting relationships in order to provide adequate organizational oversight and support for the new program. Of course, the needs of each health care organization and the population it serves must be assessed to determine the package of organizational structures that will be needed to support care management. In the case of John Muir Health, durng the roll-out of its care management program several organizational changes were implemented that support the new program: All care management functions were reorganized to report to a new Senior Vice President of Care Coordination and Integration A comprehensive patient risk stratification process was adopted to identify the proper resources for individualized patient care Alternative care settings were created, including an ambulatory care center Care planning across the continuum was coordinated, in large part through the implementation of a new electronic medical record Other organizations may need to develop even more supportive structures to sustain their care management efforts over time. Conclusion Improving health system performance in developed countries requires pursuing what Dr. Don Berwick and others have referred to as the triple aim: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Patient care management provides health systems with an effective approach to achieveing these aims. 6

WHITE PAPER. How a multi-tiered strategy can reduce readmission rates and significantly enhance patient experience

WHITE PAPER. How a multi-tiered strategy can reduce readmission rates and significantly enhance patient experience WHITE PAPER How a multi-tiered strategy can reduce readmission rates and significantly enhance patient experience Vocera Communications, Inc. June, 2014 SUMMARY Hospitals that reduce readmission rates

More information

ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT

ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT Accountable Care Analytics: Developing a Trusted 360 Degree View of the Patient Introduction Recent federal regulations have

More information

Population health management:

Population health management: GE Healthcare Population health management: Navigating successfully from volume to value In the new world of value-based care and risk-sharing compensation, success will depend on how well provider organizations

More information

CCNC Care Management

CCNC Care Management CCNC Care Management Community Care of North Carolina (CCNC) is a statewide population management and care coordination infrastructure founded on the primary care medical home model. CCNC incorporates

More information

Population Health Management Primer

Population Health Management Primer Population Health Management Primer A White Paper October 2014 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800- 680-7570 Impact- Advisors.com Table of Contents What Is Population

More information

Analytic-Driven Quality Keys Success in Risk-Based Contracts. Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst

Analytic-Driven Quality Keys Success in Risk-Based Contracts. Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Analytic-Driven Quality Keys Success in Risk-Based Contracts March 2 nd, 2016 Ross Gustafson, Vice President Allina Performance Resources, Health Catalyst Brian Rice, Vice President Network/ACO Integration,

More information

E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences

E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences Accountable Care Organizations and You E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State University

More information

Designing the Role of the Embedded Care Manager

Designing the Role of the Embedded Care Manager Designing the Role of the Embedded By Patricia Hines, Ph.D., RN and Marge Mercury, RN, MS, CMCE The Embedded The use of an Embedded ( ECM ) to coordinate within the complex delivery system is sharply increasing.

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

Medweb Telemedicine 667 Folsom Street, San Francisco, CA 94107 Phone: 415.541.9980 Fax: 415.541.9984 www.medweb.com

Medweb Telemedicine 667 Folsom Street, San Francisco, CA 94107 Phone: 415.541.9980 Fax: 415.541.9984 www.medweb.com Medweb Telemedicine 667 Folsom Street, San Francisco, CA 94107 Phone: 415.541.9980 Fax: 415.541.9984 www.medweb.com Meaningful Use On July 16 2009, the ONC Policy Committee unanimously approved a revised

More information

Nancy L. Wilson Department of Medicine-Geriatrics Houston Center for Quality of Care& Utilization Studies Texas Consortium of Geriatric Education

Nancy L. Wilson Department of Medicine-Geriatrics Houston Center for Quality of Care& Utilization Studies Texas Consortium of Geriatric Education 1 Nancy L. Wilson Department of Medicine-Geriatrics Houston Center for Quality of Care& Utilization Studies Texas Consortium of Geriatric Education Centers Care for Elders Governing Council Acknowledge

More information

The Evolving Nature of Accountable Care. Results from the 2015 ACO Survey

The Evolving Nature of Accountable Care. Results from the 2015 ACO Survey The Evolving Nature of Accountable Care Results from the 2015 ACO Survey BACKGROUND Accountable care organizations (ACOs) are voluntary networks of healthcare providers that have agreed to work together

More information

How Health Reform Will Affect Health Care Quality and the Delivery of Services

How Health Reform Will Affect Health Care Quality and the Delivery of Services Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care

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

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

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY Table of Contents I. Introduction... 2 II. Background... 2 III. Patient Safety... 3 IV. A Comprehensive Approach to Reducing

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

The Potential Savings from Enhanced Chronic Care Management Policies

The Potential Savings from Enhanced Chronic Care Management Policies The Potential Savings from Enhanced Chronic Care Management Policies November 2011 John Holahan, Cathy Schoen, and Stacey McMorrow Introduction Focusing on improving the quality of care for adults and

More information

Nuts and Bolts of. Frank G. Opelka, MD FACS American College of Surgeons. Vice Chancellor for Clinical Affairs Professor of Surgery LSU New Orleans

Nuts and Bolts of. Frank G. Opelka, MD FACS American College of Surgeons. Vice Chancellor for Clinical Affairs Professor of Surgery LSU New Orleans Nuts and Bolts of Accountable Care Organizations Frank G. Opelka, MD FACS American College of Surgeons ACS Advocacy & Health Policy, Vice Chancellor for Clinical Affairs Professor of Surgery LSU New Orleans

More information

THE NATIONAL QUALITY FORUM

THE NATIONAL QUALITY FORUM THE NATIONAL QUALITY FORUM NQF-ENDORSED TM DEFINITION AND FRAMEWORK FOR MEASURING CARE COORDINATION 1 Sufficiently developed, existing measures of coordination of care could not be identified for endorsement.

More information

How MissionPoint Health is Using Population Health Insights to Achieve ACO Success

How MissionPoint Health is Using Population Health Insights to Achieve ACO Success How MissionPoint Health is Using Population Health Insights to Achieve ACO Success Background The United States spends more per capita on healthcare than other country, yet is ranked last among industrialized

More information

Patient Centered Medical Home: An Approach for the Health Plan

Patient Centered Medical Home: An Approach for the Health Plan : An Approach for the Health Plan By Marissa A. Harper and JoAnn E. Balara Excellence in healthcare consulting The Medical Home Concept Works Recent Medicare demonstration projects on Patient Centered

More information

Customized Care Coordination Strategies that Fill Workforce Gaps and put a Human Face on Health Systems. Page 1

Customized Care Coordination Strategies that Fill Workforce Gaps and put a Human Face on Health Systems. Page 1 Customized Care Coordination Strategies that Fill Workforce Gaps and put a Human Face on Health Systems Page 1 Customized care coordination strategies that fill workforce gaps and put a human face on health

More information

The ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health

The ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health The ABCs of Population Health Management Jennifer Houlihan, MSP Director of CIN Strategy, Integration and Population Health A view from the marketplace Employers seek Other health Systems for Clinically

More information

I n t e r S y S t e m S W h I t e P a P e r F O R H E A L T H C A R E IT E X E C U T I V E S. In accountable care

I n t e r S y S t e m S W h I t e P a P e r F O R H E A L T H C A R E IT E X E C U T I V E S. In accountable care I n t e r S y S t e m S W h I t e P a P e r F O R H E A L T H C A R E IT E X E C U T I V E S The Role of healthcare InfoRmaTIcs In accountable care I n t e r S y S t e m S W h I t e P a P e r F OR H E

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

Population Health Management & the Medical Neighborhood. Patient Centered Primary Care Collaborative Monthly National Briefing September 26, 2013

Population Health Management & the Medical Neighborhood. Patient Centered Primary Care Collaborative Monthly National Briefing September 26, 2013 Population Health Management & the Medical Neighborhood Patient Centered Primary Care Collaborative Monthly National Briefing September 26, 2013 Outline What is Population Health Management? Registries

More information

CPCA California Primary Care Association

CPCA California Primary Care Association CPCA California Primary Care Association Accountable Care Organizations: Next Generation Systems for Community Health Centers? CPCA Annual Conference Sacramento, California October 10, 2014 Larry Garcia,

More information

OBJECTIVES AGING POPULATION AGING POPULATION AGING IMPACT ON MEDICARE AGING POPULATION

OBJECTIVES AGING POPULATION AGING POPULATION AGING IMPACT ON MEDICARE AGING POPULATION OBJECTIVES Kimberly S. Hodge, PhDc, MSN, RN, ACNS-BC, CCRN- K Director, ACO Care Management & Clinical Nurse Specialist Franciscan ACO, Inc. Central Indiana Region Indianapolis, IN By the end of this session

More information

Proven Innovations in Primary Care Practice

Proven Innovations in Primary Care Practice Proven Innovations in Primary Care Practice October 14, 2014 The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA. 2014 Society for Healthcare

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

New Business and Investment Opportunities Emerging from Population Health Management (PHM)

New Business and Investment Opportunities Emerging from Population Health Management (PHM) Stax s Perspective on Changes Driven by PHM New Business and Investment Opportunities Emerging from Population Health Management (PHM) By Natalie De Fazio, Director, Stax Inc. November 2014 New Business

More information

Breathe Easier: Using Clinical Education and Redesign Techniques to Improve Pediatric Asthma Care

Breathe Easier: Using Clinical Education and Redesign Techniques to Improve Pediatric Asthma Care Breathe Easier: Using Clinical Education and Redesign Techniques to Improve Pediatric Asthma Care Lalit Bajaj,, MD, MPH The Children s s Hospital, Denver Hoke Stapp,, MD, FAAP Colorado Pediatric Partners,

More information

Community Paramedicine

Community Paramedicine Community Paramedicine A New Approach to Integrated Healthcare Prepared by a committee of: 600 Wilson Lane Suite 101 Mechanicsburg, PA 17055 (717) 795-0740 800-243-2EMS (in PA) www.pehsc.org 1 P age Community

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

Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases

Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Epidemiology Over 145 million people ( nearly half the population) - suffer from asthma, depression and other chronic

More information

Structuring Your ACO Business Model To Achieve Success in a Post Acute Continuum. 2011 Annual Summit of the Executive Operators Forum

Structuring Your ACO Business Model To Achieve Success in a Post Acute Continuum. 2011 Annual Summit of the Executive Operators Forum Structuring Your ACO Business Model To Achieve Success in a Post Acute Continuum 2011 Annual Summit of the Executive Operators Forum Healthcare Reform and What it Means to You Loren Claypool CIO, Extendicare

More information

ACOs: Impacting the Past, Present and Future State of Healthcare

ACOs: Impacting the Past, Present and Future State of Healthcare ACOs: Impacting the Past, Present and Future State of Healthcare Article By Alan Cudney, RN, CPHQ, PMP, FACHE, Executive Consultant October 2012 What are Accountable Care Organizations? Can they help us

More information

Primary Care, ACOs, and Payment Reform

Primary Care, ACOs, and Payment Reform Primary Care, ACOs, and Payment Reform Mark McClellan, MD, PhD Director, Initiatives on Value and Innovation in Health Care Engelberg Center for Healthcare Reform Senior Fellow, Economic Studies The Brookings

More information

Analytics for ACOs Integrated patient views

Analytics for ACOs Integrated patient views Analytics for ACOs Integrated patient views What s at stake? Level-setting Overview The healthcare environment is changing and healthcare organizations have challenging decisions to make. With the dramatic

More information

Value Based Care and Healthcare Reform

Value Based Care and Healthcare Reform Value Based Care and Healthcare Reform Dimensions in Cardiac Care November, 2014 Jacqueline Matthews, RN, MS Senior Director, Quality Reporting & Reform Quality and Patient Safety Institute Cleveland Clinic

More information

Pennsylvania s Chronic Care/ Medical Home Initiative: Transforming Primary Care

Pennsylvania s Chronic Care/ Medical Home Initiative: Transforming Primary Care Pennsylvania s Chronic Care/ Medical Home Initiative: Transforming Primary Care Ann S. Torregrossa, Esq. Director Governor s Office of Health Care Reform Commonwealth of Pennsylvania WORKING TO ACHIEVE

More information

Physicians ACO. Don McCormick President. Company Logo

Physicians ACO. Don McCormick President. Company Logo Physicians ACO Don McCormick President Company Logo Why Congress and CMS want ACOs Cost of health care is too high Quality of health care is too low Evidence for both conditions is undeniable Congress

More information

Making ACOs Work for You. By Gregory A Culley, MD

Making ACOs Work for You. By Gregory A Culley, MD Making ACOs Work for You By Gregory A Culley, MD The continuing increase in medical costs has created a renewed interest in changing the payment method for healthcare providers. In some ways, everything

More information

New Dental Care Delivery Systems: Implications for People with Disabilities

New Dental Care Delivery Systems: Implications for People with Disabilities New Dental Care Delivery Systems: Implications for People with Disabilities Paul Glassman DDS, MA, MBA Professor of Dental Practice, Director of Community Oral Heath University of the Pacific School of

More information

MODULE 11: Developing Care Management Support

MODULE 11: Developing Care Management Support MODULE 11: Developing Care Management Support In this module, we will describe the essential role local care managers play in health care delivery improvement programs and review some of the tools and

More information

6/12/2015. Dignity Health Population Health Management and Compliance Programs. Moving Towards Accountable Care. Dignity Health Poised for Innovation

6/12/2015. Dignity Health Population Health Management and Compliance Programs. Moving Towards Accountable Care. Dignity Health Poised for Innovation Dignity Health Population Health Management and Compliance Programs Julie Bietsch, VP Population Health Management Dawnese Kindelt, Senior Compliance Director, Clinical Integration June 8, 2015 Moving

More information

T h e M A RY L A ND HEALTH CARE COMMISSION

T h e M A RY L A ND HEALTH CARE COMMISSION T h e MARYLAND HEALTH CARE COMMISSION Discussion Topics Overview Learning Objectives Electronic Health Records Health Information Exchange Telehealth 2 Overview - Maryland Health Care Commission Advancing

More information

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions...

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions... TABLE OF CONTENTS SECTION PAGE NUMBER Background... 2 Policy... 2 535.1 Member Eligibility and Enrollment... 2 535.2 Health Home Required Functions... 3 535.3 Health Home Coordination Role... 4 535.4 Health

More information

Meaningful Measures of Care Coordination

Meaningful Measures of Care Coordination Meaningful Measures of Care Coordination Sarah Hudson Scholle Assistant Vice President, Research National Committee on Vital and Health Statistics October 13, 2009 Key Points Care coordination measures

More information

Avoiding Rehospitalizations in LTC Chris Osterberg, RN BSN Pathway Health Services

Avoiding Rehospitalizations in LTC Chris Osterberg, RN BSN Pathway Health Services Avoiding Rehospitalizations in LTC Chris Osterberg, RN BSN Pathway Health Services Objectives Understand the new consequences to hospitals for discharged clients being re-admitted within selected time

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

ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION)

ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION) ESSENTIA HEALTH AS AN ACO (ACCOUNTABLE CARE ORGANIZATION) Hello and welcome. Thank you for taking part in this presentation entitled "Essentia Health as an ACO or Accountable Care Organization -- What

More information

On the Front Line: Primary Care Doctors Experiences in Eleven Countries

On the Front Line: Primary Care Doctors Experiences in Eleven Countries On the Front Line: Primary Care Doctors Experiences in Eleven Countries Findings from the Commonwealth Fund 12 International Health Policy Survey of Primary Care Physicians and Health Affairs article,

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

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

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs Idaho Health Home State Plan Amendment Matrix: Summary Overview This matrix outlines key program design features from health home State Plan Amendments (SPAs) approved by the Centers for Medicare & Medicaid

More information

Measuring and Assigning Accountability for Healthcare Spending

Measuring and Assigning Accountability for Healthcare Spending Measuring and Assigning Accountability for Healthcare Spending Fair and Effective Ways to Analyze the Drivers of Healthcare Costs and Transition to Value-Based Payment Harold D. Miller CONTENTS EXECUTIVE

More information

Strengthening Medicare: Better Health, Better Care, Lower Costs Efforts Will Save Nearly $120 Billion for Medicare Over Five Years.

Strengthening Medicare: Better Health, Better Care, Lower Costs Efforts Will Save Nearly $120 Billion for Medicare Over Five Years. Strengthening Medicare: Better Health, Better Care, Lower Costs Efforts Will Save Nearly $120 Billion for Medicare Over Five Years Introduction The Centers for Medicare and Medicaid Services (CMS) and

More information

Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014

Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014 Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014 Introduction The Office of Mental Health (OMH) licensed and regulated Assertive Community

More information

Partnerships in Primary and Behavioral Health Care ACO Survival Integrated Care

Partnerships in Primary and Behavioral Health Care ACO Survival Integrated Care Partnerships in Primary and Behavioral Health Care ACO Survival Integrated Care Ensuring Success for ACOs September 22 23 Joyce Wale LCSW Vice President, Institute for Behavioral Healthcare Improvement

More information

DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I

DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I A firm understanding of the key components and drivers of healthcare reform is increasingly important within the pharmaceutical,

More information

Continuity of Care Guide for Ambulatory Medical Practices

Continuity of Care Guide for Ambulatory Medical Practices Continuity of Care Guide for Ambulatory Medical Practices www.himss.org t ra n sf o r m i ng he a lth c a re th rou g h IT TM Table of Contents Introduction 3 Roles and Responsibilities 4 List of work/responsibilities

More information

Building an Accountable Care Organization. Jean Malouin, MD MPH University of Michigan Health System September 21, 2012

Building an Accountable Care Organization. Jean Malouin, MD MPH University of Michigan Health System September 21, 2012 Building an Accountable Care Organization Jean Malouin, MD MPH University of Michigan Health System September 21, 2012 Agenda UMHS overview PGP demo ACO precursor Current efforts underway Role of primary

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

Prescription For Pennsylvania

Prescription For Pennsylvania Prescription for Pennsylvania A set of integrated practical strategies for Improving the health care of all Pennsylvanians, Making the health care system more efficient, and Containing costs. PA Family

More information

Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013

Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013 Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013 Introduction The OMH licensed and regulated Assertive Community Treatment Program (ACT) will

More information

STATEMENT OF ACHIEVING THE PROMISE OF HEALTH INFORMATION TECHNOLOGY BEFORE THE UNITED STATES SENATE COMMITTEE ON HEALTH, EDUCATION, LABOR & PENSIONS

STATEMENT OF ACHIEVING THE PROMISE OF HEALTH INFORMATION TECHNOLOGY BEFORE THE UNITED STATES SENATE COMMITTEE ON HEALTH, EDUCATION, LABOR & PENSIONS STATEMENT OF PATRICK CONWAY, MD, MSc ACTING PRINCIPAL DEPUTY ADMINISTRATOR, DEPUTY ADMINISTRATOR FOR INNOVATION AND QUALITY, AND CHIEF MEDICAL OFFICER, CENTERS FOR MEDICARE & MEDICAID SERVICES ON ACHIEVING

More information

POPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk

POPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk POPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk Julia Andrieni, MD, FACP Vice President, Population Health and Primary

More information

Note: This is an authorized excerpt from 57 Population Health Management Metrics. To download the entire report, go to

Note: This is an authorized excerpt from 57 Population Health Management Metrics. To download the entire report, go to Note: This is an authorized excerpt from 57 Population Health Management Metrics. To download the entire report, go to http://store.hin.com/product.asp?itemid=4817 or call 888-446-3530. 57 Population Health

More information

Integrated Leadership for Hospitals and Health Systems: Principles for Success

Integrated Leadership for Hospitals and Health Systems: Principles for Success Integrated Leadership for Hospitals and Health Systems: Principles for Success In the current healthcare environment, there are many forces, both internal and external, that require some physicians and

More information

THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD?

THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD? UNDER THE MICROSCOPE NOVEMBER 5, 2013 THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD? ISSUE. A 2006 Institute of Medicine report ( Performance measurement: Accelerating

More information

Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS

Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Mind the Gap: Improving Quality Measures in Accountable Care Systems October

More information

Accountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014

Accountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Accountable Care Communities 101 Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Premier is the largest healthcare alliance in the U.S. Our Mission:

More information

GBMC HealthCare is Building a Better System of Care for Our Community. John B. Chessare MD, MPH President and CEO GBMC HealthCare System

GBMC HealthCare is Building a Better System of Care for Our Community. John B. Chessare MD, MPH President and CEO GBMC HealthCare System GBMC HealthCare is Building a Better System of Care for Our Community John B. Chessare MD, MPH President and CEO GBMC HealthCare System Agenda The Challenges in our National and Local Healthcare Systems

More information

Game Changer at the Primary Care Practice Embedded Care Management. Ruth Clark, RN, BSN, MPA Integrated Health Partners October 30, 2012

Game Changer at the Primary Care Practice Embedded Care Management. Ruth Clark, RN, BSN, MPA Integrated Health Partners October 30, 2012 Game Changer at the Primary Care Practice Embedded Care Management Ruth Clark, RN, BSN, MPA Integrated Health Partners October 30, 2012 Objectives To describe the recent evolution of care management at

More information

Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency

Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency Julie Lewis Director of Health Policy Dartmouth Institute for Health Policy and Clinical Practice

More information

Washington State Medicaid: Implementation and Impact of ER is for Emergencies Program May 4, 2015 l The Brookings Institution

Washington State Medicaid: Implementation and Impact of ER is for Emergencies Program May 4, 2015 l The Brookings Institution THE RICHARD MERKIN INITIATIVE ON PAYMENT REFORM AND CLINICAL LEADERSHIP Washington State Medicaid: Implementation and Impact of ER is for Emergencies Program May 4, 2015 l The Brookings Institution Executive

More information

The Accountable Care Organization: An Introduction

The Accountable Care Organization: An Introduction January 2011 The Accountable Care Organization: An Introduction The healthcare reform discussion introduced new terms and ideas and reintroduced many concepts explored in the past: value-based healthcare,

More information

Key Strategic and Tactical Steps to Excel as Community Hospital May 2011

Key Strategic and Tactical Steps to Excel as Community Hospital May 2011 Key Strategic and Tactical Steps to Excel as Community Hospital May 2011 1 2 3 Pillars of Excellence 4 Transformation from Hospital-Centric to Community-Centric with Triple Aim as Framework 5 Objectives

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

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed?

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Accountable Care Organizations: Implications for Consumers October 14, 2010 Washington, DC Sam Nussbaum, M.D. Executive Vice

More information

2014 Model of Care Training SHP_2014838A

2014 Model of Care Training SHP_2014838A 2014 Model of Care Training SHP_2014838A 1 Model of Care Training This course is offered to meet the CMS regulatory requirements for Model of Care Training for our Special Needs Plans. It also ensures

More information

Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA

Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA pglassman@pacific.edu Disclosures Direct a research center at

More information

Delivery System Innovation

Delivery System Innovation Healthcare Transformation Concepts and Definitions Our healthcare transformation process is invigorated by many stakeholders with differing backgrounds. To help them with new terms and all of us to use

More information

Managing Patients with Multiple Chronic Conditions

Managing Patients with Multiple Chronic Conditions Best Practices Managing Patients with Multiple Chronic Conditions Advocate Medical Group Case Study Organization Profile Advocate Medical Group is part of Advocate Health Care, a large, integrated, not-for-profit

More information

Preparing for Online Communication with Your Patients

Preparing for Online Communication with Your Patients Preparing for Online Communication with Your Patients A Guide for Providers This easy-to-use, time-saving guide is designed to help medical practices and community clinics prepare for communicating with

More information

caresy caresync Chronic Care Management

caresy caresync Chronic Care Management caresy Chronic Care Management THE PROBLEM Chronic diseases and conditions, including heart disease, diabetes, COPD and obesity, are among the most common, expensive, and preventable health problems in

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

Population Health Management: Advancing Your Position in the Journey to Value-Based Care

Population Health Management: Advancing Your Position in the Journey to Value-Based Care Population Health Management: Advancing Your Position in the Journey to Value-Based Care Webcast Session One: An Integrated Approach to Population Health Management 11 August 2015 Welcome & Introductions

More information

Dual RFI Response Summary

Dual RFI Response Summary Dual RFI Response Summary Improving Care through Integrated Medicare and Medi- Cal Delivery Models Stuart Levine, MD., MHA. Keith Wilson, MD Robert Margolis, MD. Stakeholder Meeting August 30, 2011 1 Organization

More information

Accountable Care Organizations: An old idea with new potential. Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010

Accountable Care Organizations: An old idea with new potential. Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010 Accountable Care Organizations: An old idea with new potential Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010 Impetus for ACO Formation Increased health care cost From

More information

5 pillars of clinical integration

5 pillars of clinical integration REPRINT AUGUST 2012 Daniel M. Grauman Carole J. Graham Molly Martha Johnson healthcare financial management association hfma.org 5 pillars of clinical integration A healthcare organization s ability to

More information

Anatomy of an ACO. Through the Eyes of a Physician-owned IPA. Genesis Accountable Care Organization

Anatomy of an ACO. Through the Eyes of a Physician-owned IPA. Genesis Accountable Care Organization Anatomy of an ACO Through the Eyes of a Physician-owned IPA Genesis: IPA by the Numbers 1,400 Physicians PCPs 500 900 SCPs 700 Practices 400 Square miles in North Texas Genesis: Challenges for Change Pressure

More information

Accountable Care Organizations: How Does the DME Join the Party?

Accountable Care Organizations: How Does the DME Join the Party? Accountable Care Organizations: How Does the DME Join the Party? Presented by: Jeffrey S. Baird, Esq. Chairman, Health Care Group, Brown & Fortunato, P.C. 2015 Brown & Fortunato, P.C. BACKGROUND Accountable

More information

CMS-1600-P 201. As we discussed in the CY 2013 PFS final rule with comment period, we are

CMS-1600-P 201. As we discussed in the CY 2013 PFS final rule with comment period, we are CMS-1600-P 201 I. Complex Chronic Care Management Services As we discussed in the CY 2013 PFS final rule with comment period, we are committed to primary care and we have increasingly recognized care management

More information

The Progressive Journey Toward Population Health Management

The Progressive Journey Toward Population Health Management The Progressive Journey Toward Population Health Management Lee B. Sacks, MD CEO Advocate Physician Partners, Executive Vice President and Chief Medical Officer, Advocate Health Care Michael Udwin, MD

More information

THE NEW FACE OF CHRONIC CARE MANAGEMENT

THE NEW FACE OF CHRONIC CARE MANAGEMENT THE NEW FACE OF CHRONIC CARE MANAGEMENT By Joseph Berardo Jr., President and Chief Executive Officer, MagnaCare Introduction Over 75 percent of total health care spending in the U.S. will focus on chronic

More information

Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices

Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices Accountable Care Organizations & Other Reimbursement Reforms: The Impact on Physician Practices Martin Bienstock, Esq. Wilson Elser Martin.Bienstock@WilsonElser.com The New York Times Take... For the first

More information