“
Clinical Integration as a Key to
Value-based Care
”
A Complimentary Webinar From healthsystemCIO.com
Sponsored by Perceptive Software
Your Line Will Be Silent Until Our Event Begins at 12:00 ET
Housekeeping
• Moderator – Anthony Guerra, editor-in-chief, healthsystemCIO.com
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http://healthsystemcio.com/presentation/clinicalintegration-webinar.pdf
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Agenda — Approximately 45 Minutes
• 15 minutes: Dan Kinsella, EVP/CIO, Cadence Health System
• 15 minutes: Tom Moran, MD, CMIO, Cadence Health System
• 5 minutes: A Word From Our Sponsor: Thomas Pickard, Director,
Healthcare Industry Marketing, Perceptive Software
Learning Objectives
• Define Clinical Integration in Context
• Introduce the Value Chain of Value Based Care
Context for Healthcare Transformation
2015 2020
• HIPAA 5010
• ICD-10
• Meaningful Use of EHR
• Quality Reporting
• Cost reduction (14-20%)
• Shared Services
• Labor
• Supply Chain
• Clinical Resource Management
• Clinical Effectiveness Research
•ACOs, Population Health
•Physician Alignment
•New Medical Home
•Bundled Payments •Health Exchanges •Growth strategies •M&A •Clinical Integration •HIE/REC •HITECH
•Personal Health Records
•Image Sharing/VNA •Analytics Performance Improvement Regulation & Compliance Health Information Technology Health Reform
Clinical Integration Defined
• On our journey toward Value Based Care, Clinical Integration (CI) is one of a hand full of high impact capabilities that will add value
to the business as we get more advanced. So, what is Clinical Integration?
• At a very basic level, CI enables managed care group contracting among employed and affiliated providers without risk of anti-trust
through the sharing of data to promote quality improvement.
• At full maturity, Clinical Integration is the secure sharing of selected portions of the medical record for a specific patient among
authorized providers engaged in the coordinated delivery of healthcare services.
Resulting in effective care transitions to
reduce readmissions
Connected, secure sharing of specific
patient information
Triple Aim
• Extends our zone of influence to more closely match our zone of concern – i.e., we are better able to ensure closed loops in referrals and filling of meds based on the information flow that is Clinical Integration
• Advanced capabilities such as registries enable focused program development around the greatest needs within the cohort of patient for which we are accountable
Better Outcomes
• Improving the patient experience by confirming shared information vs. collecting it new at each visit across the continuum (Chronic Disease Management)
• Increased patient safety through sharing of CCD content around allergies, active medications and problem lists
Improved Patient Experience
• Through a better set of relevant information, target the most appropriate care for the individual patient at the right time, thereby reducing higher cost, in appropriate episodes down the road (Care Transitions, Care Advocacy)
• Avoid duplication of tests and procedures as recent and relevant information is shared in a secure environment among authorized providers
Lower Cost
Enabling Clinical Integration with HIT
Connectivity Intelligence Workflow Solutions Consumer EngagementHealth Financial Services Clinical Services
HIE
Quality/PQRS Interactive Web Presence
Patient Portal
Provider Portal
Disease Registries
Telemedicine Independent Practice
Extended Enterprise Scheduling Problem List Reconciliation
Meaningful Use Reporting Population Management
Health Risk Assessments Beneficiary Management Referral Management
CRM Contact Center
Now Next Later
Community Collaboration Master Patient Index
Enterprise Data Warehouse
Nurse Advice Line
Expanded HIE Services
E-Visits
Case Management
Timing
Illustration
Success
Metrics
• # of lives under management • Portfolio of profitable contracts • Clinical Integration • Geographic coverage • Mix of PCP/Specialists • Quality LTC, HH • Performance standards • Attribution of members • Retention • Satisfaction • Engagement • Retention of Referrals • Readmissions• Days without SSE
• Incentive Payments • Patient Outcomes • Quality Measures • Distribution of Shared Savings
Key
Business
Functions
• Benefit Design • Risk Management • Managed Care Contracting • Contract Administration • Recruiting • Practice Transformation • EMR implementation • Data rendering • Beneficiary Management • Onboarding • Customer Service • Scheduling • Nurse Line • Care Transitions • Chronic Disease Management • Care Advocacy • Population Health • Medication Reconciliation • Quality Improvement • Monitor provider performanceIT
Enablers
• Managed Care Contracting • Payer/Employer Portal • Provider Portal • Quality Reporting • Analytics • EMR • HIE/Direct • Clinical Messaging • Patient/Member Portal • CRM • Call Center • Enterprise Scheduling • Registries • Referral Management • Case Management • Care Plans • Tele-presence • Image Sharing • Analytics • Contract ManagementValue Chain of Value Based Care
Program Scale Considerations
B
A
P
a
t
i
e
n
t
s
P r o v i d e r s
“Duality Challenge” reflects the need to provideconsistent handling of patients in a setting... Don’t have a gold, silver, bronze line...
• A = Cohort of program patients for our participating providers (e.g., PCP)
• B = Compliment of all other patients seen by this group of providers
• C = Additional providers contributing to the care of a specific cohort, e.g., Specialists, PAC
• D = Compliment of all other patients seen by that group of providers
• E = Universe of additional providers and patients in the market place
Important to consider scale of the program required to accomplish the desired goals.
• A+B; C+D; consistent flow within a practice
Hedging your bet with IT… good for Value and Volume
Before Care
During Care
After Care
Provider Contracting: Clinical Integration, Bundles, ACO
Case/Care management Referral management, including ED
Align care delivery partners eVisits, encounter reporting eCommerce, DME, home care
Engage consumers, patients, physicians, employers
ePrescribing, Medication Reconciliation Personal Health Record (CCR)
Manage service lines and branding Meaningful Use of EMR $$ Quality Reporting/PQRI
Manage wellness ICD-10 precision in clinical documentation HIM Coding/ ICD-10
Patient Liability Estimator Collaboration tools, infrastructure (Intranet)
Manage quality and provider effectiveness
Customer Relationship Management, Scheduling
Enterprise shared service for
(HR/Payroll, General Accounting, Supply Chain, IT, Facilities, Biomedical, PMO)
Revenue allocations to partners in care delivery
Community integration, HIE
Payer relationship management (HIPAA 5010)
Provider Network
Primary Care Physicians Specialists Participating Hospitals Home Health LTC Rehab Other Hospitals• Core – PCP who drive attribution
• Secondary – members of the PHO who share in distribution of shared savings, but don’t drive attribution
• Tertiary – participants in the extended provider network who benefit from referral volume in exchange for cost, quality and access but are not members of the PHO. • Universe – all other authorized providers
who might contribute randomly to care of
one of our patients. Lab
Community
Drivers of the Provider Network include requirements of the payer to have adequate access across a geography.
Cadence considering means by which to bolster its market presence without full asset mergers.
PCP Specialists
Universe
