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ACO, PCMH, PCSP The Ingredients for a Medical Neighborhood
Presented by: Cindy Friend, RN, BSN, MSN, MBA/HCA Executive Consultant November 8, 2013
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Agenda Healthcare Reform Future of Healthcare PCMH PCSP ACO
Payment Reform Healthcare Organization Fundamentals Organize, Prioritize & Strategize
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Healthcare Reform ACO PCMH ARRA/MU PQRS/eRx HIPAA
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Medical Neighborhoods
The Future of Healthcare Medical Neighborhoods ACO PCMH Meaningful Use HIPAA, PQRS & eRx
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The Medical Neighborhood
Hospital Home Health Payers LTC/Rehab Lab/Rad Pharmacy Physicians/Clinics Employers Government Patients
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The Name Means the Same ACO PHO CIN IDN ICO CCO
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Medical Neighborhood Foundation
PCMH – Patient Centered Medical Home PCSP – Patient Centered Specialty Practice ACO – Accountable Care Organization Medical Neighborhood ACO PCSP PCMH
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Today vs. Tomorrow Today vs. Tomorrow
My patients are those who make appointments to see me Our patients are everyone in our patient population A patient’s chief complaint or reason for the visit determines care We systematically assess all our patient’s health needs to plan care Care is determined by today’s problem and available time Care is determined by a proactive plan to meet patient needs Patients are responsible for coordinating their own care Care is standardized according to evidence-based guidelines I know I deliver high quality care because I am well trained A prepared team of professionals coordinates all of the patient’s care Acute care needs met through next available visit and walk-ins We continuously measure our quality and make rapid changes to improve our performance It’s up to the patient to tell us what happened to them We track test results and referrals, and follow-up, including ED visits and hospitalizations Operations center on meeting the doctor’s needs A multidisciplinary team works together and has defined roles and responsibilities Source: The University of Oklahoma-Tulsa (revised)
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PCMH Primary Care Providers Recognition programs NCQA 2011Standards
Includes Stage 1 Meaningful Use Requirements
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PCMH Numbers Started with 38 in 2008 Over 6,000 medical practices
Almost 30K clinicians 49 States ~15% of all primary care practices Source: The Commonwealth Fund Source: Market Watch, Business Wire, 2013
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PCMH Standards Source: NCQA
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PCSP Specialty practices NCQA recognition program
Launched end of 3/2013 Includes Stage 1 and Stage 2 Meaningful Use Requirements
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PCSP Standards Source: NCQA
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ACO Community collaborations
Almost 500 ACOs among private and public payers Accreditation available
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Number of ACOs Source: Levitt Partners, 2013
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Medicare Reimbursement
% 20% 18% 22% Source: Dartmouth Atlas, 2010
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Medicare ACOs Source: RUPRI Center for Rural Health Policy Analysis, 2013
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ACO by State Source: Levitt Partners, 2013
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ACO Standards Source: NCQA
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The Effort Continues Aetna and WellSpan form ACO (10/11/13)
River Health applies for MSSP (8/30/13) Memorial Hermann Physician Network and BCBS of Tx (9/18/13) Rutgers and Robert Wood Johnson Medical School form ACO (10/16/13) More than 300 Physicians Join Brown & Toland’s ACO with Cigna (10/15/13)
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Payment Reform Source: United Healthcare
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Healthcare Organization
Fundamental Components Healthcare Organization Business Technical Clinical
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Business Shared Governance Legal, Policy & Compliance Operations
Finance Population Management Risk Management Performance Reporting
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Technical IT Infrastructure Clinical Systems & Tools Regulations
Data Analytics Reporting Requirements ACO Connectivity Patient Connectivity Health Information Exchange
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Clinical Staff Assessment, Engagement & Education
Population Management Evidenced-Based Care Management Care Coordination Care Transitions Care Planning
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Clinical Clinical Workflow Patient Engagement Quality Measures
Performance Analysis Quality Improvement PCMH Practice/ Recognition
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Healthcare Organization
The Subcomponents Business Shared Governance Legal, Policy & Compliance Operations Finance Population Management Risk Management Performance Reporting Healthcare Organization Business Technical Clinical Clinical Staff Assessment, Engagement & Education Population Management Evidenced-Based Care Management Care Coordination Care Transitions Care Planning Clinical Workflow Patient Engagement Quality Measures Performance Analysis Quality Improvement PCMH Practice/ Recognition Technical IT Infrastructure Clinical Systems & Tools Regulations Data Analytics Reporting Requirements ACO Connectivity Patient Connectivity Health Information Exchange
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Organize, Prioritize & Strategize
Initiate stakeholder outreach and education Establish a separate entity with authority and accountability Conduct organizational assessments, improve deficiencies, and obtain recognition Improve medical management Identify technology requirements and implement systems Establish performance evaluation, reporting, and improvement process Develop a strategic plan and execute!
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For more information, please contact:
Cindy Friend, RN, BSN, MSN, MBA/HCA
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