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

Transcription

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

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4 Pillars of Excellence 4

5 Transformation from Hospital-Centric to Community-Centric with Triple Aim as Framework 5

6 Objectives Understand the Why CaroMont Health began the journey to partner with the community on wellness Develop Tactical Steps (The How ) 1. Becoming an accountable healthcare system 2. Create partnerships with our payers 3. Focusing on wellness for our employees 4. Community Wellness Summit 6

7 The Why Care not always patient-centric, not always coordinated Current fee-for-service system undermines real clinical transformation and encourages volume of services Chronic disease and obesity dominate the American public Impact of health care reform legislation 2014 Separation between provider, payer and employer 7

8 Chronic Diseases Account for 75% of direct medical core costs (1.9T of 2.5T) 70% of chronic disease is preventable by lifestyle choices (1.3T of 2.5T) Top five: Diabetes, Congestive Heart Failure, Coronary Artery Diseases, Asthma and Depression Key to controlling overall long-term health care cost in our community Good health doesn t just happen; we create it. 8

9 Obesity United States is the most obese nation among 22 developed countries Two-thirds of Americans are overweight Obesity is a precursor for many chronic diseases Obesity starts with children Children are never good at listening to their elders but they never fail to imitate them James Baldwin 9

10 North Carolina 10

11 North Carolina 11

12 North Carolina 12

13 North Carolina 13

14 Obesity Trends* Among U.S. Adults BRFSS, 2009 North Carolina 14

15 The How 15

16 CaroMont Health: Building Blocks Beginning September 2009 Created new mission statement with a focus on community health Reorganized the CaroMont leadership structure to include: -EVP of Clinical Integration - EVP of Operational Integration - VP of Wellness - VP of Chronic Disease Analyzed data on community health to determine opportunities for improvement and cost reductions (see Appendices 1 and 2) Utilized CHRA Prescription from UMR and claims data to identify greatest opportunities Developed six physician-led councils to redesign delivery system which included community representatives 16

17 Performance Excellence 17

18 Safety: Community Focus 18

19 Becoming Accountable for the Care in Our Community Listen to the voice of the customer Evidence Based Medicine Care Coordination Primary Care Medical Home (PCMH) through NCQA Designation Create Triple AIM Metric Reporting Align the continuum with EMR/HIE Positioning our Health Care System for coming ACO 19

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21 National Multi-Payer Bundled Knee Program Entities Involved CaroMont Health Blue Cross Blue Shield of NC Blue Cross Blue Shield Association rolling out all independent licensed Blue Cross plans 21

22 National Multi-Payer Bundled Knee Program Description Bundled payment program for total knee replacement that extends 180 days past admission Contracted with GE Healthcare and Sg2 to observe care provided and determine how to best redesign care Redesigning care through GE Healthcare s simulation modeling and examining ultimate functional outcomes 22

23 National Multi-Payer Bundled Knee Program 23

24 Becoming Accountable for the Care in our Community Listen to the voice of the customer Evidence Based Medicine Care Coordination Primary Care Medical Home (PCMH) through NCQA Create Triple AIM Metric Reporting Align the Continuum with EMR/HIE Positioning Our Health Care system for becoming ACO 24

25 Triple AIM at CaroMont Health Description Knowledge of the population Focus on a culture of wellness Right care, at the right time, at the right place Incentives designed into the health plan 25

26 Becoming Accountable for Our Employees January 1, 2011 Redesigned benefit plan for 3,800 CaroMont employees Lower premiums and lower out of pocket expenses for staying in CaroMont Health network of providers Disease management programs available and incentives offered for participation Electronic Medical Records prevent duplication of tests or procedures Health Care navigators Wellness Coaches Nurse practitioner on-site Geographic footprint and continuum of care; offer the care patients need where they need it, when they need it. 26

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28 The goal is not to claim that stakeholders are acting irrationally but rather to change what is rational for them to do. Dr. Don Berwick 28

29 Population Health Initiative: Community Triple Aim Project Description A group of community leaders focused on Educating the community on health status issues Identifying barriers to health Creating sustainable solutions for individuals, employers and community groups The Triple Aim framework will be presented to the greater community local governments, large employers, churches and education systems Present potential solutions Encourage and solicit commitments from leaders and influential stakeholders to engage in and promote activities that increase the health status of our communities The Voice of the Community strategies have been developed. 29

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31 The country needs and, unless I mistake its tempter, the country demands bold, persistent experimentation. It is common sense to take a method and try it: If it fails, admit it frankly and try another. But above all, try something. Franklin Roosevelt 31