Affinity s Medical Home Journey Operational, Clinical and Financial Perspectives
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1 Affinity s Medical Home Journey Operational, Clinical and Financial Perspectives Dr. Christine Griger - President Timothy Loch - COO Jane Curran-Meuli Regional Director
2 Affinity Health System Top 100 Integrated Healthcare Networks in the Nation Three (3) Hospitals St. Elizabeth Hospital, Appleton Mercy Medical Center, Oshkosh Calumet Medical Center, Chilton Network Health Plan 135,000 Members Affinity Medical Group 264 provider multi-specialty group located in the Fox Valley area of Wisconsin 878 non provider employees 13 Level 3 NCQA Accredited sites, 9 submitted for Accreditation and 1 to submit prior to October 31 Sponsored by Ministry Health Care & Wheaton Franciscan Healthcare
3 Agenda Establishment of Vision and Champion Hoshin process: Core/Coordination Team Team Roles Health plan partnership Physician Compensation Team
4 Establishment of Vision and Champion
5 The Wonder Years Vision: Medical Home is the way to improve quality and delivery of care in a PC shortage and for the future. Physician leader with the vision convinced senior leadership to be supportive of this vision. It was critical to have top Executive level support Pilot at two primary care departments: Kaukauna FM and Koeller IM.
6 The Wonder Years Network Health Plan partnered from the start as this would improve access, costs and quality The Medical Home strategy aligns the system brand promise of personalized care with the care delivery model. Medical Home differentiates Affinity Medical Group from other strong healthcare systems in our region by being first to market.
7 The Challenges Cultural paradigm shift Alignment of 100 PCP for support of this vision and a compensation structure that will continue to drive the outcomes. Geographic and Silo Issues: Implement 23 Medical Homes in a 50 mile radius. Affinity Medical Group Leadership transition left us without a champion
8 Hoshin Process (must do, can t fail)
9 Hoshin Process Hoshin Process within Affinity: aligns leadership support and resources from the system LEAN methodology improve processes, eliminate waste Pilots demonstrated success. Then through Hoshin process developed several 3-month plans to guide our implementation across the system No project manager utilized ownership of process at each department, yet system standardization Core Team development and directional
10 Structure and Function Leader Champion President AMG Core Team: President, COO, Director of Medical Operations (DMO), Marketing, Physicians, Network Health Plan (NHP), Director of Clinical Operations (DCO) Coordination Team: DCO, President, LEAN Coach team that makes the work happen Site based MH Teams: Physician/Advanced Practice Provider (APP) Leadership, RN Specialists, Healthcare Associate (HCA), Patient Service Representative (PSR), Behavioral Health Coordinator, Mgmt LEAN methodology to address flows
11 Team Roles
12 Physician & APP Physician: Provides overall leadership to the team Retains PCP role--in collaboration with other team members Overall accountability for performance of practice relative to attributes of Medical Home, related measures of success Advanced Practice Providers APP (APNP/PA): Leadership role in patient education Retains PCP Role in collaboration with other team members Shares team accountability for Wellness/ Disease/ Population Mgt.
13 RN Specialists RN Specialist: Leadership Role in Wellness & Disease Management, Population Management, Health Coaching Chronic disease management Coordinates implementation of disease management registries and other population management tools Participates in direct patient care Collaborative visits for Wellness & Disease Management Acute care visits (protocol directed and/or collaborative) Chronic disease follow-up (blood pressure checks, ADHD) Phone follow-ups
14 Behavioral Health Coordinator Behavioral Health Care Coordinator: Leadership role in psychosocial support of patients & team Position(s) selected by team based on practice needs Care Coordinator (LCSW)/Behavior Health Coordinator (MSW)/Behavioral Health Specialist (PhD) Range of services: Care management Psycho-social assessments, counseling & group work Patient advocacy, liaison to community resources Provision of social support to team
15 Health Care Associate Health Care Associate (HCA): (LPN/MA) Leadership role in workflow management Rooms patients but role in initiating care is expanded via medication reconciliation, paperwork control, clinical protocols, and advanced intake tools Key support role in access management Team Nursing
16 Patient Service Representative Patient Service Representative (PSR): Leadership role in Service Excellence & relationship management Access management and coordination Visit preparation
17 Network Health Plan Partnership
18 Insurance Plan Pilot support: $8PMPM Second year: Must implement and move to NCQA accredited Advantage of being able to get cost data on the care we provide to patients
19 AMH Outcomes: Cost 40.00% Overall Cost Comparison Review Compares 12 month period ending 4/09 to 12 month period ending 4/ % 0.00% % NHP Overall Medical Home Overall PCP Care Only 18.66% 33.50% Specialist Care Only 8.51% % Overall Cost Review 9.74% 0.62%
20 AMH Outcomes: Cost 20.00% Overall Cost Comparison Review Compares 12 month period ending 4/09 to 12 month period ending 4/ % % % % NHP Overall Medical Home Overall Outpatient Cost 9.74% 0.62% Inpatient Costs -6.38% % Overall Cost Review 6.06% %
21 Full Implementation Health plan agreed to extend the $8PMPM to all practices. Move to a shared risk reimbursement model. Integration of health plan data (claims) into the ambulatory electronic record
22 Physician Compensation
23 Compensation Provider compensation first year guarantee to facilitate meeting attendance and movement to team based care model. Physician involvement to develop compensation plan going forward Implementation October 1, 2011 Rewards: Quality, access, panel size, patient satisfaction, medical coordination, management of cost as well as production
24 Next Steps, Lessons Learned and Future Development
25 Lessons Learned Change management Start from scratch? RN Specialists: Thought they would be more case management Weekly group meetings Provider engagement Champion, Compensation, team development, interviewing, leadership training, collaborative across sites. Team Development Behavioral based interviewing Huddles Role of Behavioral Health Coordinator
26 Future Development Medical Neighborhood Integrative Medicine Diabetic Education Lipids COPD Vascular Screening Physical Therapy Primary Care Innovation to continue redesign work Evaluate impact of compensation model
27 Next Steps Imbed Case Manager from Health Plan Implement on-going audits to assure maintenance of processes and NCQA standards Implement new compensation plan (Oct 1) Implement shared risk model of reimbursement (Jan 1)
28 Questions? Affinity Medical Home
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