beacon health july 15, 2014 michael donahue, vp of network development & aco activities iyad...
TRANSCRIPT
Beacon HealthJuly 15, 2014
Michael Donahue, VP of Network Development & ACO Activities
Iyad Sabbagh, MD
Senior Medical Director, ACO Activities
Together We’re Stronger
Beacon Health by the Numbers• 22,000 Medicare Patients
• 12,000 EMHS employees and their families
• 13,000 Friends & neighbors
• 1,100 MaineCare Patients
• Negotiations underway to grow our population another 60,000
Together We’re Stronger
Why Pioneer?
Together We’re Stronger
Building a Statewide Network
Pioneer Commercial
Eastern Maine Medical Center, EMHS Eastern Maine Medical Center, EMHSInland Hospital, EMHS Inland Hospital, EMHSThe Aroostook Medical Center, EMHS The Aroostook Medical Center, EMHSThree Rivers Primary Care (Waterville) Three Rivers Primary Care (Waterville)
Blue Hill Memorial Hospital, EMHS Blue Hill Memorial Hospital, EMHSCharles Dean Hospital, EMHS Charles Dean Hospital, EMHSMount Desert Island Hospital Mount Desert Island HospitalSebasticook Valley Health, EMHS Sebasticook Valley Health, EMHSSebasticook Family Doctors Sebasticook Family DoctorsSt. Joseph Healthcare Central Maine Medical Center
Northern Maine Medical Center Health Access Network
Maine Coast Memorial Hospital Maine Coast Memorial HospitalMercy Hospital, EMHS Mercy Hospital, EMHS
2012
2013
2014
Together We’re Stronger
Population Health• Multidisciplinary team: Patient
representative, Physicians, Care Coordinators, Quality Nurses, Home Health, CCT, SNF, Pharmacy, hospital and practice administrators, IT, project management, wellness coordinators.
Together We’re Stronger
Sub teams and work groups
Pharmacy• Adherence• Brand/Generic• Injectable
Clinical Standards• Prevention Standards• Chronic Disease Standards• Specialty Standards
Together We’re Stronger
Post Acute Care• Quality and utilization dashboard• SNF 3-Night waiver (screening, monitoring and
transition management)• Home health and hospice management
Care Management• Complex care coordination• Disease management • Transition of care management.
Together We’re Stronger
Utilization Review• Lab Utilization Review
High frequency lab utilizationHigh cost lab utilizationCost of labClinical protocol
OutpatientInpatient
Quality Review Committee
Together We’re Stronger
How are we sharing best practices?
Together We’re Stronger 11
Community-Based Care Model
Together We’re Stronger
PCP Team Based Care• Practice redesign to
ensure team based care.• Goal to become provider
of health and wellness to the community
• Ensure ALL staff work toward new population health goals
Together We’re Stronger
Population Health is a mind set1. The more I do, the better I am.
2. One patient at a time, please.
3. I provide excellent care-how do I know? Because I think so!
4. When I see a patient, I’ll set the agenda.
5. Come back several times a year, whether you need it or not.
6. That is how I am going to do it because that’s how I was trained.
7. “I hate cookbook medicine”!!
8. Only primary care providers have to worry about ACO’s-they don’t really affect me.
1. I still may have to do a lot, but let it be based on value.
2. I have to think of my entire patient panel.
3. The care I give is measured and compared to the care provided by others.
4. Patients and consumers of health now set the agenda.
5. Please come back when either you or I realize a need.
6. I will do things based on best practices and protocols.
7. “I love protocols”-I don’t forget things or make errors as much as in the past.
8. We’re all in this together!
Together We’re Stronger
Population segmentation EMHS Pioneer
Together We’re Stronger
Traditional Fee for Service
Care Management
Patient Centered Medical Home
Medical Neighborhood ACO
Managed Care Organization
Integrated Delivery Network
RVU RVU & CM FeesRVU & Quality Incentive & CM
FeesShared Savings Risk Sharing Total
Cost of Care
The Journey…..
Together We’re Stronger
Beacon Health Care Coordination Program
Together We’re Stronger
Together We’re Stronger
The Care coordination journey
UR
Case management
Disease management
Chronic care management
Care coordination
1980 1990 2000 2010
Together We’re Stronger
Nurse Care Coordinators
• Chronic Disease • Complex Patients• Education• Embedded• Community Resources • Collaborative
Together We’re Stronger
Functions of Care Coordinator• Transitions of care• High-risk chronic disease management• Exacerbation management• Self management• Telephonic and/or device monitoring • Frequent follow up
Together We’re Stronger
Transitions of Care Coordinators – Coordinating at Points of Care
Together We’re Stronger
Pioneer Patients Feel the Difference • Hospital Readmissions
down 13%• Nurse care coordination
follow-up with 91% of patients
• Patient satisfaction with provider 93%
Together We’re Stronger
EMHS Employees Feel the Difference
Together We’re Stronger
Medical Surgical Admissions have decreased 40%Readmissions have decreased 57%
Together We’re Stronger
Together We’re Stronger
Lesson Learned
• Technology: EMR and Claims data.• Practice readiness: PCMH
involvement. • Care Coordination: Lack of
standardization.
Together We’re Stronger
Questions?