11.5 1545 bocht maddenm concurrent 3.5 acc rev 1presentation agenda ... s p e c i a l i s t r ef r a...
TRANSCRIPT
Don’t Boil the Ocean!
Gain Immediate Value Practicing Responsible Population Health
Management
Terry Boch, Sr. VP, WellcentiveMichael Madden, CEO, The Physician
Alliance
Presentation Agenda
Purpose: Learn how to manage complex population health initiatives
Objective 1: Understand the realities behind population health management and how to best achieve focus.
Objective 2: Identify the key components of the population health management lifecycle.
Objective 3: Share the successes of a large Physician Organization’s PHM Activities.
Population Health Management Reality
PhysiciansPatients
IT Systems
Workflows
Data Domains
Payers
Employers
Population Health Management Reality
ALIGNMENT REQUIRES GOALS
GOALS NEED TO BE MEASURED
MEASUREMENT REQUIRES FOCUS
"Obstacles are those frightful things you see whenyou take your eyes off your goal.”
Henry Ford
Network Maturity Model
Quality Programs Become Your Anchor Point
Provide a finite set of data requirements
Become a lens for data quality
Provide measurable goals
Enable organizational focus
Reduce clinical and financial risk
Focus on delivering value
Achieve Critical Reimbursement Mass
Connecting Quality Programs
PHM Workflow
Data Quality
The Physician Alliance (TPA)
For All You “Ocean Boilers”
PIN
DIRECTIONS
TPA Basics
Foundational PrinciplesDoing the Right ThingExceeding Customer ExpectationsServicing Patients and PhysiciansBeing Good Partners
TPA Basics
Partnership of 5 POs 2,185 Physicians1500 square miles (five counties)Founded in February 2011Generated $3.86 million in P4P revenue in 2012 2013 projected P4P revenue of $8.0 million+Projected to generate $5.5 million in direct P4P reimbursement to PCPs in 2013Projected to distribute an additional $5.4 million in performance incentives to Physicians in 2013
BCBSM’s PGIP
Physician Group Incentive Program
Focused on rewarding POs and their Physicians for implementing PCMH‐N processes, improving quality and reducing cost
Infrastructure Investment ModelMonies are provided up front to develop PHM infrastructure
Infrastructure drives process and performance improvements
Improvements drive improved quality and decreased costs
POs and their Physicians are rewarded for process improvements, quality improvement and decreased cost
TPA Basics
TPA PGIP Group is one of the largest in Michigan
Perceived by BCBSM to be one of the most innovative POs in Michigan
316 Patient Centered Medical Home PCPs
Designated by BCBSM as an “Organized System of Care Low Cost Benchmark Performer” in July 2012 and 2013
Developed a Patient Centered Specialist Practice Designation program for specialists – considered a best practice by BCBSM –117 specialists designated to date
140 of our specialists are receiving 20‐25% E&M uplifts from BCBSM based on performance
TPA Basics
TPA has partnered with St. John Providence Health System to integrate and coordinate health care services in order to deliver clinical excellence and value across the continuum of care.
The partnership is called Partners in Care
Formed a Medicare Shared Savings Accountable Care Organization (ACO) with St. John Providence Health System
An Innovative Partnership Model
Continuum Improvement Management
Population Health Management Activities
Monitoring of Practice PCMH‐N Processes
SRD – Self Reporting DatabaseAllows TPA to monitor practice performance across the entire PO
SRD – Self Reporting Database
Domains of Function
Patient Provider Agreement
Patient Registry
Performance Reporting
Individual Care Management
Test Tracking
Self Management
Linkage to the Community
Coordination of Care
Specialist Referral Process
Patient Portal
Capabilities: 126 per PCP practice, 96 per Specialist practice 57,000 total, 22,000+ FIP
Domains of Function
I----Practice Names----------I1---------------------------------126
SRD – Next Steps
Development beyond the PCMH
PCPs PCMH
SpecialistsPCSP
Emergency Department
Hospitalists Hospitals Post Acute
Point of Service Disease Registry with TPA Level Reporting
Top 15%ile
PO LEVEL REGISTRY REPORTING
STATE‐WIDE PO PERFORMANCE COMPARSION
Diabetes Management
Practice 1
Practice 2
Practice 3
Practice 4
Practice 5Practice 204
1. Practice enters data into EMR or
Wellcentive directly2. Data then passed into
Wellcentive for aggregation and
analysis
3. Practice produces Gaps in Care Reports and contacts patients4. Practice monitors physician performance
5. TPA monitors practice and physician performance6. TPA sends Clinical Quality Liaisons to practices to assist with performance improvement
7. Overall TPA physician performance improves
Top 15%ile
PO LEVEL REGISTRY REPORTING(stimulates TPA leaders to leverage performance
improvements at the practice level)
STATE‐WIDE PO PERFORMANCE COMPARSION
(High performing registry systems result inmoving TPA to the highest performance levels)
PRACTICE LEVEL REGISTRY PERFORMANCE REPORTING
(stimulates practice/physicians to improve performance)
TPA MEAN
PRACTICE 1 HgA1c REGISTRY PERFORMANCE REPORT
Mary AppleDOB: 11/29/1953
HgA1c: 9.7 12/13/11Annual Foot Exam: 12/13/11DMII GFR: 7.5 12/13/11HTN on ACE/ARB: Not in PlaceMammography: Normal 12/15/11Cervical Screening: Normal 12/15/11Colonoscopy: Normal 12/16/11Lipid Screening: Normal 12/13/11
PRACTICE LEVEL POINT OF SERVICE (POS) PATIENT REGISTRY(prompts action at the Point of Service)
HOW POS DISEASE REGISTRIES IMPROVE PATIENT CARE AND TPA PERFORMANCE METRICS
Diabetes ManagementPRACTICE LEVEL REGISTRY with GAPS IN CARE REPORT
(stimulates patient contact and action)
Clinical Quality Liaisons
Visit practices regularly to help practices:Implement PCMH CapabilitiesMonitor physician performance Develop PI plansCapture P4P dollars
Regional Physician Performance Improvement Teams
Data Review and
Physician Engagement Strategies
TPA Medical Director
Regional Medical Directors
Clinical Quality Liaisons
Director of Strategy and
Performance Design
“You Can’t Boil the Ocean but PHM, ACOs, OSCs, PCMH‐Ns lead us to try and warm it up a bit”
Focused Goal Setting Allows for Good Balance Management
Rapid Focused Improvement Results
Innovation Development
ETHICA IT SOLUTIONS – EMR Rescue & Optimization ETHICA CONSULTING ‐ Innovative PHM StrategiesETHICA VENTURES – PHM New Business OpportunitiesETHICA MANAGEMENT SERVICES – Physician Services
SummaryClose monitoring of 2,185 Physicians PCMH‐N Performance
Designated Low Cost Benchmark OSC
Successful integration of multiple EMR PHM data into an integrated common disease registry that can be monitored remotely
Unique innovative approaches to Partnering with a Health System
Highly functioning P4P performance models
Innovative approaches to monitoring PHM activities
All successes related to “Doing the Right Thing” and “Exceeding Customer Expectations”
“No Opportunity” PGIP Opportunity Report – Key Measurement of TPA’s PHM Success
Over $15 million earned for PHM Activities
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