Building an Integrated System for Personalizing Care Tim Johnson, MD Spring, 2014

Intermountain Medical Group 1,056 physicians 342 primary care 491 secondary care 86 hospitalists 17 radiologists 120 urgent care 265 advanced practice clinicians 81 primary care clinics

Dual Model for the Medical Home Distributed ModelIntensive Model

Distributed Model: Personalized Primary Care Intermountain Medical Group and SelectHealth Modeled on 2011 PCMH NCQA Standards Team members Primary Care Clinician RN Care Manager MA Health Advocate(s) Advanced Practice Clinicians Doctor of Pharmacy Mental Health Integration

Personalized Primary Care Implementation adult primary care clinics 17 pediatric clinics 345 physicians and advance practice clinicians ~100 care managers and health advocates Hybrid model: central and region leadership Level 2 and level 3 within 2-3 years

Personalized Primary Care: Results 20% 35% Intermountain diabetes bundle: HgbA1c < 8% LDL < 100 BP < 140/90 Annual nephropathy screen Eye exam every 2 years Clinical Quality Patient Satisfaction Years after Implementation Allowed Per Member Per Month Total Cost Trend* * Preliminary results, risk-adjusted and normalized for contractual payment differences

Intensive Model: Personalized Care Clinic An outpatient clinic that provides intensive medical, behavioral, and social management for Intermountains high-risk patients Patients in the top 5-10% of costs for 2 of the last 3 years

Personalized Care Clinic: The Team Internal Medicine Physician Palliative Care Physician (0.2) RN Care Manager Psychiatry APRN LCSW Pharmacist 2 Medical Assistants PSR Clinic Manager Assistant Region Operations Officer Region Medical Director

Personalized Care Clinic: Process of care Acts like a primary care office with more resources to coordinate care, address mental health conditions, and manage complex medication issues Ensure patients receive care in appropriate setting – focus on acute care utilization Coordinate and collaborate with all of the patients specialists Committed to eliminating all avoidable health care emergencies

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