Clinical Integration as a Key to Value-based Care

Transcription

1 Clinical Integration as a Key to Value-based Care A Complimentary Webinar From healthsystemcio.com Sponsored by Perceptive Software Your Line Will Be Silent Until Our Event Begins at 12:00 ET Thank You!

2 Housekeeping Moderator Anthony Guerra, editor-in-chief, healthsystemcio.com Ask A Question We will be holding a Q&A session after the formal presentations. You may submit your questions at any time by clicking on the QA panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists. Download the Deck Go to Download today's deck at: Shortened URL at bottom of all slides View the Archive You will receive an when our archive recording is ready. Separate registration is required.

3 Agenda Approximately 45 Minutes 15 minutes: Dan Kinsella, EVP/CIO, Cadence Health System 15 minutes: Tom Moran, MD, CMIO, Cadence Health System 5 minutes: A Word From Our Sponsor: Thomas Pickard, Director, Healthcare Industry Marketing, Perceptive Software 10 minutes: Q&A w/dan Kinsella & Tom Moran

4 Examining Clinical Integration as a Key Ingredient of Value Based Care

5 Learning Objectives Define Clinical Integration in Context Introduce the Value Chain of Value Based Care Suggest Synergies Between Value and Volume Based Care Share Lessons Learned

6 Context for Healthcare Transformation HIPAA 5010 ICD-10 Meaningful Use of EHR Quality Reporting Regulation & Compliance Performance Improvement Cost reduction (14-20%) Shared Services Labor Supply Chain Clinical Resource Management Clinical Effectiveness Research ACOs, Population Health Physician Alignment New Medical Home Bundled Payments Health Exchanges Growth strategies M&A Health Reform Market Growth & Transformation Health Information Technology Clinical Integration HIE/REC HITECH Personal Health Records Image Sharing/VNA Analytics

7 Clinical Integration Defined On our journey toward Value Based Care, Clinical Integration (CI) is one of a hand full of high impact capabilities that will add value to the business as we get more advanced. So, what is Clinical Integration? At a very basic level, CI enables managed care group contracting among employed and affiliated providers without risk of anti-trust through the sharing of data to promote quality improvement. At full maturity, Clinical Integration is the secure sharing of selected portions of the medical record for a specific patient among authorized providers engaged in the coordinated delivery of healthcare services. Connected, secure sharing of specific patient information Authorized Providers engaged in coordinated delivery of services Resulting in effective care transitions to reduce readmissions

8 Triple Aim In the context of the Triple Aim, Clinical Integration provides the following benefits to our PHO members and the patients for which we care: Better Outcomes Extends our zone of influence to more closely match our zone of concern i.e., we are better able to ensure closed loops in referrals and filling of meds based on the information flow that is Clinical Integration Advanced capabilities such as registries enable focused program development around the greatest needs within the cohort of patient for which we are accountable Improved Patient Experience Improving the patient experience by confirming shared information vs. collecting it new at each visit across the continuum (Chronic Disease Management) Increased patient safety through sharing of CCD content around allergies, active medications and problem lists Lower Cost Through a better set of relevant information, target the most appropriate care for the individual patient at the right time, thereby reducing higher cost, in appropriate episodes down the road (Care Transitions, Care Advocacy) Avoid duplication of tests and procedures as recent and relevant information is shared in a secure environment among authorized providers

9 Illustration Enabling Clinical Integration with HIT Connectivity HIE Clinical Services Nurse Advice Line Interactive Web Presence Disease Registries Master Patient Index Independent Practice Expanded HIE Services CRM Contact Center Intelligence Quality/PQRS Enterprise Data Warehouse Consumer Engagement Patient Portal Telemedicine Meaningful Use Reporting Community Collaboration Population Management E-Visits Workflow Solutions Provider Portal Health Financial Services Referral Management Problem List Reconciliation Extended Enterprise Scheduling Health Risk Assessments Beneficiary Management Case Management Payer/Employer Portal Timing Now Next Later

10 Value Chain of Value Based Care Payer Contracts Provider Network Members, Patients Coordinate Care Manage Results Success Metrics # of lives under management Portfolio of profitable contracts Clinical Integration Geographic coverage Mix of PCP/Specialists Quality LTC, HH Performance standards Attribution of members Retention Satisfaction Engagement Retention of Referrals Readmissions Days without SSE Incentive Payments Patient Outcomes Quality Measures Distribution of Shared Savings Key Business Functions Benefit Design Risk Management Managed Care Contracting Contract Administration Recruiting Practice Transformation EMR implementation Data rendering Beneficiary Management Onboarding Customer Service Scheduling Nurse Line Care Transitions Chronic Disease Management Care Advocacy Population Health Medication Reconciliation Quality Improvement Monitor provider performance IT Enablers Managed Care Contracting Payer/Employer Portal Provider Portal Quality Reporting Analytics EMR HIE/Direct Clinical Messaging Patient/Member Portal CRM Call Center Enterprise Scheduling Registries Referral Management Case Management Care Plans Tele-presence Image Sharing Analytics Contract Management

11 P a t i e n t s Program Scale Considerations Duality Challenge reflects the need to provide consistent handling of patients in a setting... Don t have a gold, silver, bronze line... A = Cohort of program patients for our participating providers (e.g., PCP) B = Compliment of all other patients seen by this group of providers C = Additional providers contributing to the care of a specific cohort, e.g., Specialists, PAC D = Compliment of all other patients seen by that group of providers E = Universe of additional providers and patients in the market place E B E D E E Important to consider scale of the program required to accomplish the desired goals. A+B; C+D; consistent flow within a practice A+C; consistent patient experience (per cohort across sites) A C E P r o v i d e r s

12 Hedging your bet with IT good for Value and Volume Before Care During Care After Care Provider Contracting: Clinical Integration, Bundles, ACO Case/Care management Referral management, including ED Align care delivery partners evisits, encounter reporting ecommerce, DME, home care Engage consumers, patients, physicians, employers eprescribing, Medication Reconciliation Personal Health Record (CCR) Manage service lines and branding Meaningful Use of EMR $$ Quality Reporting/PQRI Manage wellness ICD-10 precision in clinical documentation HIM Coding/ ICD-10 Patient Liability Estimator Customer Relationship Management, Scheduling Community integration, HIE Payer relationship management (HIPAA 5010) Collaboration tools, infrastructure (Intranet) Enterprise shared service for (HR/Payroll, General Accounting, Supply Chain, IT, Facilities, Biomedical, PMO) Manage quality and provider effectiveness Revenue allocations to partners in care delivery Business Intelligence

13 Provider Network Drivers of the Provider Network include requirements of the payer to have adequate access across a geography. Cadence considering means by which to bolster its market presence without full asset mergers. Universe Other Hospitals Core PCP who drive attribution Secondary members of the PHO who share in distribution of shared savings, but don t drive attribution Tertiary participants in the extended provider network who benefit from referral volume in exchange for cost, quality and access but are not members of the PHO. Universe all other authorized providers who might contribute randomly to care of one of our patients. LTC Lab Specialists Community Participating Hospitals Primary Care Physicians Specialists Home Health Rehab Rx PCP

14 Customer Intimacy Care Coordination the secret sauce H Care Advocate (A only) Intimacy at Scale Care Transitions (A+C only) Chronic Disease Management (A+C only) L Nurse Line (A+B+C+D) L Cost/encounter H

15 Population Health enabled by Clinical Integration Collect Analyze Engage Data Rendering Sickest patients Care Advocates EMR connection costs Tiering (1,2,3) Nurse Line Temporal alignment Target disease conditions Chronic Disease Management Data quality, attribution Impact of interventions Care Transitions DURSA Provider performance EMR Patient consent Payer contract performance Patient Portal

16 Closing Clinical Integration is an enabler of Value and Volume Based Care. Balance your investment with the size and complexity of your payer contracts (KISS). The vendor market is frothy with must have solutions, caveat emptor.

17 Examining Clinical Integration as a Key Ingredient of Value-based Care Thomas Pickard, Director, Healthcare Industry Marketing Perceptive Software

18 Unprecedented demand for information

19 The road to clinical integration Enterprise Content Management (ECM) Perceptive Vendor Neutral Archive (VNA) Enterprise Image Connectivity (EIC) Document management External documentation Back office Intelligent capture Mobile capture Migration Storage consolidation Enterprise viewing Interoperability Image sharing Clinical documents and images Video capture DICOM CDs/DVDs EMR connectivity Image exchange

20 Healthcare Content Management

21 About Perceptive Software

22 Perceptive Bona Fides Top 3 Best in KLAS vendor for VNA and ECM in 2014 Market share leader in vendor neutral archive solutions (IHS) Positioned as a leader in Gartner s most recent Magic Quadrants for both enterprise content management and enterprise search Our enterprise image connectivity solutions have been adopted by over 50% of the U.S. hospital market One hundred percent of U.S.-based HIMSS Level 7 healthcare systems use Perceptive Software products and solutions

23 Customers across the continuum

24 Q&A Click on the Q&A panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists.

25 Thank You! Thanks to our featured speaker: Dan Kinsella & Dr. Tom Moran! Thanks to our sponsor: Tom Pickard & Perceptive Software You will receive an when our archive recording is ready. (Separate registration is required) CHIME CHCIO Credits Attending our Webinars = 1 CEU Questions/Comments Anthony Guerra aguerra@healthsystemcio.com Go to to view our upcoming schedule and see the last 12 months of archived events.