A Blueprint for Building a Medical Group s Internal Quality and Cost Efficiency Infrastructure

Transcription

1 + A Blueprint for Building a Medical Group s Internal Quality and Cost Efficiency Infrastructure

2 + Disclosures: Timothy Harlan: I have no actual or potential conflict of interest in relation to this presentation. Eric Gallagher: I have no actual or potential conflict of interest in relation to this presentation. Nicholas Bernard: I have no actual or potential conflict of interest in relation to this presentation.

3 + Objectives: Upon completion of this activity, participants should be able to develop a roadmap for initiating population health/quality improvement initiatives and successfully engaging physicians in those efforts.

4 + Tulane University School of Medicine: Background Size Faculty Katrina context HCA partnership Regional competitive, M&A landscape EMR Decision HITECH

5 + Roadmap: Introduction Planning Execution Assessment PDSA Cycle

6 + Introduction: Healthcare landscape in NOLA? Our eclinicalworks relationship Meaningful Use team MU practice transformation as a model for quality improvement. GPRO reporting

7 + Introduction: GSQN March 2013 July The Imperative : 2012 QRUR Need for data aggregation Acquisition of data analytics tool

8 + Planning: Strategy Alignment with Medical Group Strategy External vs. Internal Outpatient vs. Inpatient Quality vs. Cost Public Providers vs. Private Insurers Achievability Resources Data Access Scalability Core Competencies

9 + Planning: Prioritization PQRS/HEDIS/AH RQ Specialty Groups Financial Driver Strength/Weakness Metric Private Payers Industry Quality Sources Prioritize Analyze

10 + Planning: Approach

11 + Execution Data Strategy: Analytics Needs Real-time Platform Agnostic Payer Agnostic Point of Care Integration eclincalworks CCMR product selected

12 + Execution Data Connectivity: Data Sources Outpatient EMR 1 and EMR 2 Practice Management System CMS Claims Data Payer Claims Data Inpatient EMR Data Other systems Data 80% of ambulatory quality data 80% of financial drivers

13 + Execution - Team: Program Manager Act as primary liaison for managing multiple programs MSSP ACO, Quality/CI network, Private Payer programs Act as project manager for organizational quality ops - Physician Engagement, Care Coordination Ops, Process Improvement Ops Quality Analyst Performance Improvement Specialist Clinical Training, Education, Workflow, Data Capture

14 + Execution: Care Coordination Outreach Follow-up Engagement Communication Navigation Medicine Evidence-Based Treatment Protocols Process Improvement Workflow Data Capture Team Engagement Training Education

15 + Execution: Care Coordination Medicine Evidence- Based Process Improvement Treatment Protocols

16 + Execution: Care Coordination Medicine Evidence-Based Treatment Protocols Process Improvement Workflow Data Capture Team Engagement Training Education

17 + Execution - Team: Nurse Navigator Patient Care Coordinator Scribes ( Quality Extenders ) Quality Analyst Physician Committees

18 + Care Coordination: Outreach Strategy: Address Tulane s patient care opportunities Patient Care Coordinator Pay for Performance Shared Savings Index Score

19 + Care Coordination: Patient Engagement Strategy: Ensure that patients have all resources to manage their health Nurse Navigator Target Population Means of Communication Daily Census and Rounding

20 + Care Coordination: Patient Engagement Strategy: Ensure that patients have all resources to manage their health Nurse Navigator Target Population Means of Communication Daily Census and Rounding

21 + Care Coordination: Follow Up Strategy: Build programs to reduce Tulane s overall readmission rate Quality Analyst Hypertension Pilot Other Chronics

22 + Care Coordination: Communication/Navigation Strategy: Implement technology to track a patient throughout the continuum of care Nurse Navigator and Quality Extenders Addressing Care Gaps Care Coordination Medical Record Payer Agnostic

23 + Care Coordination: Training/Education Strategy: Engage office staff to improve outcomes Quality Analyst Blood Pressure Technique Excel Structured Fields Group Physician Reporting Option

24 + Execution Physician Engagement Strategy: Construct governing bodies to direct quality and cost initiatives Board of Managers Quality Committee Medical Subspecialties Committee Surgical Subspecialties Committee Payer Committee

25 + Assessment: Outcomes data Incentives paid Penalties avoided Cultural shift

26 + Plan, Do, Study, Act: Next Steps Cost analyses Expansion of payer program management Resource allocation Depth vs. Breadth Physician compensation

27 + Plan, Do, Study, Act: Key Information AMGA FPSC AAMC

28 + Plan, Do, Study, Act: Strategic Partnerships Vision 2020? LPHI HIE LSU / ILH PTN Network

29 + A Blueprint for Building a Medical Group s Internal Quality and Cost Efficiency Infrastructure