A Clinically Integrated Network

Who is SignalHealth? Unique corporate identity Parent organization is Virginia Mason Memorial Formed in 2011 Participation allows us to contract for and on behalf of our members Tuesday, December 04, 2018 SignalHealth

Who are we? Diverse membership 87 unique practices 315 unique physicians 104 unique midlevels 6 skilled nursing facilities Tuesday, December 04, 2018 SignalHealth

Tuesday, December 04, 2018 SignalHealth

What is clinically integrated? American Hospital Association: “Clinical integration is needed to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, and patient-focused. To achieve clinical integration we need to promote changes in provider culture, redesign payment methods and incentives, and modernize federal laws.” Tuesday, December 04, 2018 SignalHealth

What is clinically integrated? Advisory Board It’s a specific type of legal arrangement that allows hospitals and physicians to collaborate on improving quality and efficiency, while remaining independent entities. In a clinical integration organization, physicians collectively invest in IT infrastructure, such as disease registries and clinical performance management systems, as well as funding staff dedicated to performance improvement.  Tuesday, December 04, 2018 SignalHealth

What is clinically integrated? 1996: FTC and DOJ Clinical Integration (CI) is an active and ongoing program to evaluate and modify practice patterns by the CI network's physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality Tuesday, December 04, 2018 SignalHealth

DOJ and FTC Expectations for CIN’s Establishes mechanisms to monitor and control utilization of healthcare services that are designed to control costs and ensure quality of care. Selectively chooses CI network physicians who are likely to further these efficiency objectives. Utilizes investment of significant capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies. Tuesday, December 04, 2018 SignalHealth

Why all the fuss? Collective bargaining by physicians that compete with each other is considered anticompetitive and is prohibited except when physician networks are: financially or clinically integrated. Tuesday, December 04, 2018 SignalHealth

What are the minimum requirements? Collect, analyze, and understand performance data on quality and cost, for episodes of care, and for total cost of care for populations Manage clinical quality and cost performance across diverse settings for episodes of care, and/or for populations Govern the whole operation Tuesday, December 04, 2018 SignalHealth

Tuesday, December 04, 2018 SignalHealth

Physician Autonomy “ At Virginia Mason… we understand that healthcare is impeded not facilitated by the notion of physician autonomy.” ~Dr. Gary Kaplan, MD CEO Virginia Mason January 11, 2014 Modern Healthcare Tuesday, December 04, 2018 SignalHealth

Yakima County Tuesday, December 04, 2018 SignalHealth

2016 Community Needs Health Assessment Yakima County is composed of primarily rural communities (14 cities and towns) in Central Washington Spanning 4,296 square miles 65% Medicare/Medicaid payer mix Total current population for Yakima County as of July 1, 2015 is 248,830 Tuesday, December 04, 2018 SignalHealth

2016 Community Needs Health Assessment Tuesday, December 04, 2018 SignalHealth

2017 County Health Rankings Tuesday, December 04, 2018 SignalHealth

Tuesday, December 04, 2018 SignalHealth

Reality… Tuesday, December 04, 2018 SignalHealth

Tuesday, December 04, 2018 SignalHealth

This should be easy, right? Presumptions: Patients and their families are invested in their own health. Patients tell their story fully to their providers. Patients do what they say they’re going to do. Palliative and hospice care are appropriate interventions/options for specific populations. Patient actively participate in their medical decision making. Tuesday, December 04, 2018 SignalHealth

Tuesday, December 04, 2018 SignalHealth

What are the operational priorities? Quality Care coordination Nurses Social workers Community care connector (ALTC) Utilization management Medical management Pharmacy management Tuesday, December 04, 2018 SignalHealth

2016 Lessons Learned Small changes and actions make a big difference Patients are first Quality matters We are a learning organization, building on our internal strengths and differences Teamwork "the perfect is the enemy of the good“ …Keep moving. Tuesday, December 04, 2018 SignalHealth

Tuesday, December 04, 2018 SignalHealth

2017 Contracts Medicare Advantage Virginia Mason Memorial High Value Plan (HMO) Puget Sound High Value Network Health Alliance Northwest Employees Molina Medicaid More than 10,000 lives under contract Tuesday, December 04, 2018 SignalHealth

Tuesday, December 04, 2018 SignalHealth

Case studies Diabetic with prescription she couldn’t afford Hoarder with congestive heart failure Housing over provider visits Tuesday, December 04, 2018 SignalHealth

Tuesday, December 04, 2018 SignalHealth

Question and Answer Tuesday, December 04, 2018 SignalHealth

Thank you!