New York-Presbyterian Conference on Innovations in Health Care Reform:Innovations in Health Care Reform:

Experience of Academic Medical CentersFriday, October 28, 2011Friday, October 28, 2011

Innovative Care Delivery Models PanelInnovative Care Delivery Models Panel

Michelle J. Lyn, Assistant Professor and Chief, Di ision of Comm nit HealthDivision of Community Health,

Department of Community and Family MedicineAssociate Director, Duke Center for Community Research

k l i l di i iDuke Translational Medicine Institute

AgendaAgenda

• Brief OverviewBrief Overview– Duke University Health System (DUHS)

Community Care of North Carolina (CCNC)– Community Care of North Carolina (CCNC)• Northern Piedmont Community Care (NPCC)

– Key Initiativesy– IT

• Inclusion of Health Professional Students and Residents

• Overall Successes and ChallengesOverall Successes and Challenges

•Components of Duke Medicine

DUKE MEDICINE – Who We Are Today

D k H C d H i•Duke University Health System

•Components of Duke Medicine

• Duke University Hospital• Durham Regional Hospital• Duke Raleigh Hospital

•Duke HomeCare and Hospice•Duke Primary Care•Patient Resource Management Org.

Durham Regional HospitalL d 1998

Duke University Hospital- 957 Beds (19 Psych)

Duke Raleigh HospitalP h d 1998- Leased 1998

- 369 Beds (23 Psych, 30 Rehab)-15,413 discharges in FY11

- 957 Beds (19 Psych)-Ranked #10 by USNWR-38,205discharges in FY11

- Purchased 1998-186 Beds-7,382discharges in FY11

Caring for Our DUHS Patients in FY10

DUKE MEDICINE – Who We Are Today

• 61,000 Discharges

Caring for Our DUHS Patients in FY10

, g• 1,927,635 Outpatient visits• 169 493 ED visits169,493 ED visits• 66,693 Surgical cases

All three hospitals have received Nursing Magnet status.

Durham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham Pediatrics

Hock Family PavilionDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro Road

Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*

Durham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham Pediatrics

Hock Family PavilionDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro RoadDuke Health Center at Roxboro Road

Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*Person Memorial Hospital*

GranvilleGranvilleGranvilleGranvilleGranvilleGranvilleGranvilleGranvilleGranville VanceVanceVanceVanceVanceVanceVanceVanceVanceDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of Durham

Durham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical Center

Maria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham Hospital

GranvilleGranvilleGranvilleGranvilleGranvilleGranvilleGranvilleGranvilleGranvillePersonPersonPersonPersonPersonPersonPersonPersonPerson

VanceVanceVanceVanceVanceVanceVanceVanceVanceDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleDuke Urgent Care HillandaleMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupMetropolitan Durham Medical GroupFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of DurhamFamily Medical Associates of Durham

Durham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical CenterDurham Medical Center

Henderson Family Medicine ClinicHenderson Family Medicine ClinicHenderson Family Medicine ClinicHenderson Family Medicine ClinicHenderson Family Medicine ClinicHenderson Family Medicine ClinicHenderson Family Medicine ClinicHenderson Family Medicine ClinicHenderson Family Medicine ClinicOxford Family PhysiciansOxford Family PhysiciansOxford Family PhysiciansOxford Family PhysiciansOxford Family PhysiciansOxford Family PhysiciansOxford Family PhysiciansOxford Family PhysiciansOxford Family Physicians

Maria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham HospitalMaria Parham Hospital

AlamanceAlamanceAlamanceAlamanceAlamanceAlamanceAlamanceAlamanceAlamance OrangeOrangeOrangeOrangeOrangeOrangeOrangeOrangeOrange DurhamDurhamDurhamDurhamDurhamDurhamDurhamDurhamDurhamDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care Mebane

Hillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family Practice

Davis Ambulatory Surgery Center

Hospice at the Meadowmonts

D k F il M di i t Pi kD k F il M di i t Pi kD k F il M di i t Pi kD k F il M di i t Pi kD k F il M di i t Pi kD k F il M di i t Pi k

Burlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical Practice

AlamanceAlamanceAlamanceAlamanceAlamanceAlamanceAlamanceAlamanceAlamance OrangeOrangeOrangeOrangeOrangeOrangeOrangeOrangeOrange DurhamDurhamDurhamDurhamDurhamDurhamDurhamDurhamDurham

FranklinFranklinFranklinFranklinFranklinFranklinFranklinFranklinFranklinDurhamRegional HospitalDurhamRegional HospitalDurhamRegional HospitalDurhamRegional HospitalDurhamRegional HospitalDurhamRegional HospitalDurhamRegional HospitalDurhamRegional HospitalDurhamRegional Hospital

Duke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care MebaneDuke Primary Care Mebane

Hillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeHillsborough Family PracticeButner-Creedmoor Family MedicineButner-Creedmoor Family MedicineButner-Creedmoor Family MedicineButner-Creedmoor Family MedicineButner-Creedmoor Family MedicineButner-Creedmoor Family MedicineButner-Creedmoor Family MedicineButner-Creedmoor Family MedicineButner-Creedmoor Family Medicine

Davis Ambulatory Surgery Center

Hospice at the Meadowmonts

D k F il M di i t Pi kD k F il M di i t Pi kD k F il M di i t Pi kD k F il M di i t Pi kD k F il M di i t Pi kD k F il M di i t Pi k

Burlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical PracticeBurlington Medical Practice

Duke University HospitalDuke University HospitalDuke University HospitalDuke University HospitalDuke University HospitalDuke University HospitalDuke University HospitalDuke University HospitalDuke University Hospital

Timberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal Medicine

Wake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family Physicians

Harps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care South

Triangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham Pediatrics

Duke Center for LivingDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at Pickens

Duke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett Road

DukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at Southpoint

FranklinFranklinFranklin

NashNashNashNashNashNashNashNashNashDuke University HospitalDuke University HospitalDuke University HospitalDuke University HospitalDuke University HospitalDuke University HospitalDuke University HospitalDuke University HospitalDuke University Hospital

Durham Regional HospitalDurham Regional HospitalDurham Regional HospitalDurham Regional HospitalDurham Regional HospitalDurham Regional HospitalDurham Regional HospitalDurham Regional HospitalDurham Regional Hospital

Duke Raleigh HospitalDuke Raleigh HospitalDuke Raleigh HospitalDuke Raleigh HospitalDuke Raleigh HospitalDuke Raleigh HospitalDuke Raleigh HospitalDuke Raleigh HospitalDuke Raleigh Hospital

Timberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterTimberlyne Family Medical CenterSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal MedicineSutton Station Internal Medicine

Wake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family PhysiciansWake Forest Family Physicians

Harps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineHarps Mill Internal MedicineDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Primary Care Creedmoor RdDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care SouthDuke Urgent Care South

Triangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeTriangle Family PracticeDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham PediatricsDurham Pediatrics

Duke Center for LivingDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at PickensDuke Family Medicine at Pickens

Duke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett RoadDuke Primary Care Pickett Road

DukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at SouthpointDukeHealthCenter at Southpoint

WakeWakeWakeWakeWakeWakeWakeWakeWakeDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care Knightdale

North Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at Southpoint

WakeWakeWakeWakeWakeWakeWakeWakeWakeChathamChathamChathamChathamChathamChathamChathamChathamChatham

g pg pg pg pg pg pg pg pg p

Duke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Primary Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care KnightdaleDuke Urgent Care Knightdale

North Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineNorth Hills Internal MedicineDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Primary Care of Galloway RidgeDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at SouthpointDuke Health Center at Southpoint

Duke Health Center of ClaytonDuke Health Center of ClaytonDuke Health Center of ClaytonDuke Health Center of ClaytonDuke Health Center of ClaytonDuke Health Center of ClaytonDuke Health Center of ClaytonDuke Health Center of ClaytonDuke Health Center of Clayton

• 3 Hospitals• 28 Primary Care Sites

– 22 Duke Primary Care

LeeLeeLeeLeeLeeLeeLeeLeeLeeDukePrimaryCareMorrisvilleD k P i C M i illD k P i C M i illDukePrimaryCareMorrisvilleD k P i C M i illDuke PrimaryCareMorrisvilleD k P i C M i illD k P i C M i illD k P i C M i ill

LeeLeeLeeLeeLeeLeeLeeLeeLee

JohnstonJohnstonJohnstonJohnstonJohnstonJohnstonJohnstonJohnstonJohnston

DukePrimaryCareMorrisvilleD k P i C M i illD k P i C M i illDukePrimaryCareMorrisvilleD k P i C M i illDuke PrimaryCareMorrisvilleD k P i C M i illD k P i C M i illD k P i C M i ill

Duke Health Center of SanfordDuke Health Center of SanfordDuke Health Center of SanfordDuke Health Center of SanfordDuke Health Center of SanfordDuke Health Center of SanfordDuke Health Center of SanfordDuke Health Center of SanfordDuke Health Center of Sanford

– 6 PDC/CPDC sites• 5 Urgent Care Sites• 2 Wellness/Lifestyle Programs

– Duke Diet & Fitness Center

Duke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier Creek

Duke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care Morrisville

Duke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Primary Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier CreekDuke Urgent Care Brier Creek

Duke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Primary Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care MorrisvilleDuke Urgent Care Morrisville– Duke Center for Living

• Davis Ambulatory Surgery Center• Hospice at Meadowlands and Hock Family Pavilion

Duke Medicine – Where We Are Going

• Develop true integrated care delivery from medical center to community

• “High Tech &  High Touch” Care delivered in State‐of‐the‐Art Facilities through Specialized Centers of Excellence

• Community Care with novel models of care provider team (physician assistants, nurse practitioners, registered nurses, laypersons)

• Use innovative IT for clinical information capture, connectivity, remote monitoring and decision support

Community Care of North C liCarolinaBrief Overview

Key Tenets ofCommunity CareCommunity Care

Public-private partnership“Managed not regulated”CCNC is a clinical partnership, not just a financing

h imechanismCommunity-based, physician-led medical homesC i il b li ffi iCut costs primarily by greater quality, efficiencyProviders who are expected to improve care must have ownership of the improvement processhave ownership of the improvement process

Community Care: “H i k ”“How it works”

Primary care medical home available to 1.1 million yindividuals in all 100 counties.Provides 4,500 local primary care physicians with

t b tt M di id l tiresources to better manage Medicaid populationLinks local community providers (health systems, hospitals health departments and other communityhospitals, health departments and other community providers) to primary care physicians Every network provides local care managers (600), y p g ( ),pharmacists (26), psychiatrists (14) and medical directors (20) to improve local health care delivery

Community Care: “H i k ”“How it works”

The state identifies priorities and provides financial support through an enhanced PMPM payment to community networksNetworks pilot potential solutions and monitorNetworks pilot potential solutions and monitor implementation (physician led)Networks voluntarily share best practice solutions

d b t ti d t th t kand best practices are spread to other networksThe state provides the networks access to dataCost savings/ effectiveness are evaluated by theCost savings/ effectiveness are evaluated by the state and third-party consultants (Mercer, Treo Solutions).

Community Care NetworksCommunity Care Networks

Key Initiativesy• Medical Home – providing resources and facilitating practices application

for national certification (e.g. e prescribing , multi-payer, tool box)C M t f M di l H t d di d t d• Care Management for Medical Homes – standardized assessments and care plans, Motivational Interviewing training, informatics and registries

• Population management Initiatives• Disease Management ( COPD, CHF, Diabetes, Asthma and Sickle Cell)• Palliative Care in outpatient setting• Behavioral Health Integration• Pharmacy (Formulary Management)• Pregnancy Medical Home and CC4C• Healthcheck/Healthchoice

• Transitions – focus on patient moving from inpatient setting to outpatient setting

– Collaborative with NCHA.– Home visit post discharge and Pharmacist – Medication Reconciliation– County wide opioid initiative with ED

Our NPCC Care Management TeamOur NPCC Care Management TeamFTE’s

Dietitians 3.0 Health Educators 1.5C it H lth W k 7 5Community Health Workers 7.5Nurses (mostly RNs) 6.0Social Workers 3 0Social Workers 3.0Pharmacist(2)/Pharm Tech(2) 2.2Occupational Therapist 0 3Occupational Therapist 0.3MD Champions(8) 1.0

NPCC COACH CDSSA i P id A i I f i J i TiAppropriate Provider, Appropriate Information, Just in Time

OutcomesOutcomesCommunity Care is in the top 10 percent in US in HEDIS for diabetes asthma heart disease compared tofor diabetes, asthma, heart disease compared to commercial managed care.More than $700 million in state Medicaid savings since 20062006.

Adjusting for severity, costs are 7% lower than expected. Costs for non-Community Care patients are higher than y p gexpected by 15 percent in 2008 and 16 percent in 2009.

For the first three months of FY 2011, per member per month costs are running 6 percent below FY 2009 figuresmonth costs are running 6 percent below FY 2009 figures.

For FY 2011, Medicaid expenditures are running below forecast and below prior year (over $500 million). p y ( )

Inclusion of Residents and Health Professional Students

L it di l C i l• Longitudinal Curriculum• Participation with Care Management Teams• Community Engaged Research• Community Engaged Research

One-year course covering:• the elements of community-engaged population health research,

l i h l h d d d i d• population health measures and study designs, and • the steps of community-engaged research based population-health

improvement. A mentored project in community health improvementA mentored project in community health improvement that builds off of and contributes to ongoing community health initiatives.Journal Club in which residents learn to criticallyJournal Club, in which residents learn to critically assess research.

Successes and ChallengesSuccesses and Challenges

• Home visits and Med ReconciliationHome visits and Med Reconciliation• IP admits for IOM chronic conditions • Participation of Specialists• Participation of Specialists• State Budget Crisis

P di ti th F t• Predicting the Future

ResourcesResources

• Community Care of North CarolinaCommunity Care of North Carolina– http://www.communitycarenc.org

• North Carolina Division of Medical Assistance• North Carolina Division of Medical Assistance– http://www.ncdhhs.gov/dma/