1. Delivering Value-Based Care: Creating the Medical Home IHS Leadership Symposium April 19, 2011 Brad Archer, MD – Medical Director of Advanced Care Innovation Dennis Bussey, DO – Grimes Family Physicians Heather Roberts, DO – Lakeview Internal Medicine Kyla Routson, Senior Operations Manager - IHP Kate LaFollette, Quality Director - PIH

2. Objectives Recognize how creating the Medical Home through Care Model Redesign supports the IHS strategic vision Identify the guiding principles for the team-based care model Understand the components of the care model and implementation strategies Describe how care packages based on evidence- based medicine improve the quality of patient care 2

3. CURRENT: Volume Individual services Sickness Errors Insulated consumer Tort-defensive Price discount negotiations VALUE-BASED: Outcomes Integrated services Prevention Performance Cost-sensitive consumer Personalized evidence- based Value-based purchasing 3 Incentive Drivers

4. Physician Alignment Delivering Value Demonstrating Value Value-Based Contracting 4 Value-Based Strategy

5. Screening/Prevention Primary Care/Specialists Integrated Care Management Advanced Medical Team Disease Management System Risk Stratification Tool Quality Indicators and Metrics Home Health Hospice/Palliative Care 5 Delivering Value Disease Management Continuum

6. Care Model Redesign & Care Packaging Goal Redesign care to create the ideal Iowa Health System experience that focuses on the “Best Outcome for Every Patient Every Time” Fairview Health System Prototype Clinics Grimes Family Physicians Dr. Dennis Bussey, Janell Schlosser Lakeview Internal Medicine Dr. Heather Roberts, Heath Hill 6

7. Care Model Redesign & Care Packaging Goals Redesign care and align incentives to produce quality care with a reduction in total cost of care based on defined metrics Improve clinical quality outcomes aligned with evidence based guidelines Improve employee, physician, and patient and family satisfaction with care provided through the new model. Implement a team based care model Identify, prioritize and sequence five (5) Care Packages that provide enhanced quality with effective cost efficiencies at the identified prototype clinics. 7

8. Team Based Care Models The fundamental structure or the “track” in which quality care will run Care Packages Quality Care will be designed through the use of Care Packages or “cars” that will run on the track Care Model Redesign & Care Packaging 8

9. It is when care is redesigned and incentives are aligned to produce quality care with a reduction in total cost of care Care Model Redesign & Care Packaging 9

10. Team Based Care Model Guiding Principles 10

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12. Care Model Implementation 12

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18. Care Model Implementation 18 Patient calls for a physical Pre-Visit Task created My Nurse calls patient for Pre-Visit Call Information is available in EHR when patient arrives in clinic Patient calls to cancel or change physical Pre-Visit Task is updated Day of Visit workflow conducted

19. Care Model Implementation 19 –The person I talked to was VERY nice and she made the conversation fun! –Saved time day of visit. –Factual, to the point. Got me mentally prepared for the visit to the office. –Thorough check of my family and medical history. –Shortened my visit by asking fewer questions. –I felt my nurse cared and wanted to know about my health. –Thought that it was an excellent use of time. –It was nice to have those questions asked/answered before the appointment. –I would have liked notice when I scheduled my visit that the nurse was planning to call. –Some of it was repetitive with the info the nurse asked during my visit.

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21. Care Package Implementation 21

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26. Questions? Contact Information Kate LaFollette, RN, Quality Director, PIH 515-205-2970 lafollcs@ihs.org Mark Mitchell, RN, Senior Manager for Care Redesign, IHP 515-471-9368 mitchemj@ihs.org 26