delivering high value care through clinical integration
Post on 18-Dec-2015
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Triad HealthCare NetworkOverview
• Triad HealthCare Network is a new Clinically Integrated Network that has formed in the Piedmont Triad area.
• THN is a new model of care designed to bring employed physicians, independent physicians, and Cone Health into a more clinically and financially aligned business partnership to improve access, improve quality and lower costs.
• THN seeks to better prepare its members for the inevitable changes to the nation’s health care system driven by either or both government and market-based reform.
www.TriadHealthCareNetwork.com
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Triad HealthCare NetworkStructure and Governance
Board of Managers
Operating Committee
Nominating Committee
Contracting and Finance
CommitteeQualityCredentialing
Committee
Initial and ongoing membership criteria
Set clinical performance criteria and review member
performance
Look at 3rd-party agreements and determine potential
bonus distributions
Assist development of physician board
memberships
Oversees day-to-day operations
www.TriadHealthCareNetwork.com
8 members:3 Physicians (2 Ind./1 Emp.)
2 Cone Representatives3 Community Representatives
21 members:17 Physicians (9 Ind./8 Emp.)
3 Cone Representatives1 Community Representative
MANAGEMENTExecutive Medical Director
Thomas Wall, M.D.
Executive DirectorSteve Neorr
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Triad HealthCare NetworkProposed Quality Committee Structure
www.TriadHealthCareNetwork.com
Family Medicine
Quality Committee
Patrick Wright, M.D. – Chairman
Mary Jo Cagle, M.D. – Vice Chairman
Medicine
CPC
Carl Gessner, MD
John Bednar, MD
Primary Care
CPC
Doug Shaw, MD
Yvonne Lowne, DO
Heart and
Vascular CPC
Ed Gerhardt, MD
Tom Stuckey, MD
Surgery
CPC
David Newman, MD
John Hewitt, MD
Women’s and
Children’s CPC
Kelly Leggett, MD
Ron Young, MD
Hospital Clinical
Services CPC
Josh Kish, MD
Mark Shogry, MD
Internal Medicine
Hospital Medicine
Gastroenterology
Hem/Oncology
Infectious Disease
Nephrology
Rheumatology
Dermatology
Emergency Medicine
Endocrinology
Hospital Medicine
Pulmonology
Neurology
Neurosurgery
Cardiology
Cardiovascular Surg.
Vascular Surgery
Anesthesia
General Surgery
Orthopedics
Ophthalmology
ENT
Urology
Ob/Gyn
Neonatology
Pediatrics
Pathology
Radiology
Radiation
Oncology
Practice
Management
John Nosek
TBD
Community
Practice
Administrators
Administrative Chair
ADMINISTRATIVE CHAIRSwould be composed of Cone Health System employees or non-physician health leaders – Hospital presidents, vice presidents, directors of nursing,
practice administrators, etc. Hospice /Palliative Care
Administrative Chair Administrative Chair Administrative Chair Administrative Chair Administrative ChairAdministrative Chair
Psychiatry
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www.TriadHealthCareNetwork.com
Value for Physicians
• THN to provide value-added services and resources to assist practices– Deployment of Clinical Performance Reporting System to:
• Capture and analyze clinical data• Implement in-office Point-of-Care decision support• Generate patient disease registries
– Case Management– Assistance to achieve Meaningful Use and Patient-Centered Medical
Home recognition– Submission of quality measures for the Physician Quality Reporting
System (PQRS)– Joint contracting for quality/cost savings incentive plans with payers
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Triad HealthCare NetworkBusiness Strategy
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Continue CurrentFee-For-Service
Claims & PaymentStructure
QualityBonus Payout
Based On THN Goals and
PerformanceMeasures
Insurers and Employers
Negotiated Incentive-Based
Contracts
Clinical Performance Reporting System
PhysiciansClaims and EMR Data
POC, Registry, Performance Data
P4PShared Savings
Gain Sharing
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www.TriadHealthCareNetwork.com
Clinical Performance Reporting System is Critical
Data from Practice Management
Systems
Data from EMRs
Data from Hospitals
Lab data from Reference Labs
Pharmacy data
Electronic claims data from payers
Data is extracted, aggregated,
standardized and stored by a third-party intermediary vendor
Clinical Data
Repository (“CDR”)
Clinical ProtocolEngine
Data is processed through protocols and algorithms to support clinical metrics
and benchmarks established by Physicians
• “Real “ time• Patient Summary• Preventive Care &
CDM Reminders
Point-of-CareDecision Support
PatientDisease
Registries
Practice Performance
Feedback
• Community• NCQA, BTE• PQRS• Payers
External Reporting
Web Portal Access and Reporting
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Sample Clinical Decision Supportat the Point-of-Care
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Practice Performance Feedback
Diagnoses and Meds are prioritized to highlight chronic conditions
Goals Not Met are highlighted for quick reference and visibility
Targeted reminders for nursing staff allow better leverage of provider time and more efficient workflow
Labs, Calculations and Diagnostic Procedures pertinent to the Action Items are displayed for easy reference
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Information Technology/Analytics Systems
PCPs with EMRs
Specialists w/ EMRs using POC
Data from Hospitals
Lab data from Reference Labs
Pharmacy data
Clinical Data
Repository Claims Data from Payers
• Expertise in clinical data extraction• Provides clinical protocol engine• Point-of-care reports• Patient disease registries
• “Manual” population analytics• Claims data integration• Reports compliance with metrics• Submits PQRS/ACO data to CMS
CommunityData
Repository
All Other PCPs and Specialists
Radiology
• Expertise in community data aggregation• Provides longitudinal view of patient across
community – all pertinent activity over time• Interfaces with EHRs
• Master Patient Index (“MPI”)• Provides portal view to all providers• Ability to enter data for non-EMR physicians
• “Automatic” population analytics - patient stratification • Prospective identification of patient risk – case mgmt targets
• Retrospective analytics – utilization and cost efficiency• Admits/1000, hi-tech imaging, ETGs - Episode Treatment Groups
• Identify opportunity for savings and improvement• Case Management module – care documentation, communication• Patient portal – patient engagement
Clinical Performance Reporting System
HIE
Health Information Exchange (“HIE”)
CPRS
Population analytics, utilization, case management module
Triad HealthCare NetworkMembership Requirements
www.TriadHealthCareNetwork.com
– North Carolina Licensure
– Board Certification
– DEA License
– Liability Insurance
– Credentialing Requirements
– Participation Agreement– Clinical Integration Program
– Education– Compliance – Quality Assurance
– Provide Claims/Clinical Information
– All-Contracts Participation– High-speed internet– Actively Used E-mail– Attend Orientation
Physician Eligibility Requirements
Physician Participation Requirements
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www.TriadHealthCareNetwork.com
Opportunities
• Medicare Shared Savings Program– Submitted application to participate as an “ACO” with Medicare
effective July 1, 2012– Submitted 170 adult Primary Care Physician network with
application – 5 counties – will include over 34,000 beneficiaries– Will seek conversion from opt-in to executed participation
agreements for specialists by June 30, 2012– Must report and meet 33 “quality” metrics to access savings
• All major payers interested in discussing arrangement• Cone Health Employee population (12,000+)
– Development of THN-based “narrow” network
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Triad HealthCare Network Value
www.TriadHealthCareNetwork.com
Practice Performance Feedback
Physicians PatientsPayersCone Health
Physicians PatientsPayersCone Health
GIVE
GET
FinancialSupport,
Resources
Commitment,Participation,Leadership
PerformanceIncentivePayments
Trust,Proactive
Involvement
Efficiency,Partnership,
Mission
IncreasedEfficiency,
Coordination
Transparency,Efficiency,
Quality
BetterHealthCare
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Questions?
For further information, please visit www.TriadHealthCareNetwork.com or
call (855) 4 THN NOW (484-6669)
www.TriadHealthCareNetwork.com
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