april 15, 2015 webinar slides
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Regional Learning WebinarApril 15, 2015
www.hcgc.org
… catalyzing the spread of healthcare best practices
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Regional Learning WebinarApril 15, 2015
www.hcgc.org
Webinar Notes
• We are recording the webinar - will be available via our website later today
• If using computer and phone to access the webinarplease turn on your computer speakers in order to hear video
• If using phone only, you will not be able to hear the video portion of today’s webinar
• We welcome your reflections and questions via Webinar chat feature or Text to 614-906-2440
© 2015 A. Milstein/Stanford Univ
Providing More with Less:
Primary Care Bright Spots
Arnold Milstein, MD MPH
Melora Simon MPH
Stanford Clinical Excellence
Research Center
Healthcare Collaborative
of Greater Columbus
April 15, 2015
America’s Most Valuable Primary Care
Video: From the patient’s
perspective
• Attribution and risk adjustment
• Members attributed to group having maximum number of claims
• Member-level risk-adjustment using 3M’s Clinical Risk Group software (CRG)
• Cost basis
• Allowed amounts
• Standardized costs using a fee schedule
• Composite of > 40 HEDIS, NQF endorsed, or Medicare Star measures
• Balanced across process of care, prevention/wellness, and medication
management domains and specific conditions
• Weighted to reflect a hybrid of clinical and empirical importance
• Clinical - medication management, prevention-wellness, and diseases such as diabetes, asthma, CVD, etc.
• Empirical - Determines measures, weighting to maximize discrimination between providers, identifies measures to remove as same in discriminating providers
Total cost of care
Identifying Bright Spots:
Assessing Performance
Quality
Approach informed by consultation with diverse panel of
experts in clinical performance assessment.
© 2015 A. Milstein/Stanford Univ
Rare But Powerful
<5%
10,000 scorable sites
In top quartile on both quality and cost
• Risk-adjusted per capita total cost of care > 20% lower than average
• >10% higher on quality composite
© 2015 A. Milstein/Stanford Univ
Bright Spots in high and low
cost labor markets
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© 2015 A. Milstein/Stanford Univ
Bright Spot Sites are Diverse
Fee-for-service (FFS)
reimbursement
• Greater Minneapolis,
MN
• Greater Rochester, NY
Capitated
• Greater Orlando, FL
Capitated
• Greater Tampa, FL
Fee-for-service
• Phoenix, AZ
• Memphis, TN
• Greater Dayton, OH
• Greater Cincinnati, OH
Capitated
• Orange County, CA
Independent,
primary care only
Independent,
multispecialty
Part of ahealth system
Other • Workplace clinic: San Antonio, TX
• Federally Qualified Health Center: Greater Boston, MA
Shared Features of Idol Sites
Deeper
patient
relationships
Wider
scope of
responsibility
Team-based
practice
organization
Deeper Patient
Relationships
• Always on
• Conscientiousness and
conservation
Adherence to guidelines
Moderately adjustable care intensity
Informal shared decision-making, advanced care planning, & other forms of choosing wisely
• Complaints are gold
Wider scope of
responsibility
• Responsible in-sourcing
• Staying close
• Closing the loop
Team-Based
Practice Organization
• Upshifted staff roles
• “Hived” workstations or rules-based
decision making/standard work
• Balanced compensation
• Investments in people, not space &
equipment
Next steps
• Spread and scale – collaboration with the
Peterson Center on Healthcare
• Applying approach to other areas of health
care delivery:
• Community Hospitals
• 8 Specialties – Longitudinal Management and Episodic care
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Regional Learning WebinarApril 15, 2015
www.hcgc.org
Learning from your reflections and questions via…
Webinar chat feature
Or
Text to 614-906-2440
Thank you!
www.hcgc.org
We thank….
• Dr. Arnold Milstein & Melora Simon
• Our public-private funding partners
• Each of you for participating
We will send you a follow-up email asking for your feedback on the value of today’s webinar.
Reminder: Recording of today’s webinar will be available via our website later this afternoon – please share with your colleagues!
Next Regional Learning Session…
www.hcgc.org
Regional In-Person Learning SessionMay 15, 20158:30-11:30a EST Nationwide & Ohio Farm Bureau 4-H Center2201 Fred Taylor Dr.Columbus, 43210
Register via our website www.hcgc.org
Learning Topic: Improving quality transparency in Greater Columbus
Objectives:
• Explore lessons learned and best practices from recent national summit on healthcare price, cost, and quality transparency.
• Collaborate with colleagues and competitors to help shape the design for a new regional quality transparency website – a good place to start in Greater Columbus.