Upload
yasmine-greer
View
214
Download
0
Tags:
Embed Size (px)
Citation preview
ACO, PCMH, PCSP The Ingredients for a Medical Neighborhood
Presented by:
Cindy Friend, RN, BSN, MSN, MBA/HCA
Executive Consultant
November 8, 2013
2
Heading – Ariel 40
• Healthcare Reform
• Future of Healthcare
• PCMH
• PCSP
• ACO
• Payment Reform
• Healthcare Organization Fundamentals
• Organize, Prioritize & Strategize
Agenda
4
Heading – Ariel 40
HIPAA, PQRS &
eRx
Meaningful Use
PCMH
ACO
Medical Neighborhoods
The Future of Healthcare
5
Heading – Ariel 40The Medical Neighborhood
Hospital
Home Health
PayersLTC/
Rehab
Lab/Rad
Pharmacy
Physicians/Clinics
Employers
Government
Patients
7
Heading – Ariel 40
• PCMH – Patient Centered Medical Home
• PCSP – Patient Centered Specialty Practice
• ACO – Accountable Care Organization
Medical Neighborhood Foundation
Medical Neighborhood
ACO
PCSPPCMH
8
Heading – Ariel 40Today vs. TomorrowToday 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)
9
Heading – Ariel 40
• Primary Care Providers
• Recognition programs
• NCQA 2011Standards
• Includes Stage 1 Meaningful Use Requirements
PCMH
10
Heading – Ariel 40
• Started with 38 in 2008
• Over 6,000 medical practices
• Almost 30K clinicians
• 49 States
• ~15% of all primary care practices
PCMH Numbers
Source: Market Watch, Business Wire, 2013
Source: The Commonwealth Fund
11
Heading – Ariel 40PCMH Standards
Source: NCQA
12
Heading – Ariel 40
• Specialty practices
• NCQA recognition program
• Launched end of 3/2013
• Includes Stage 1 and Stage 2 Meaningful Use Requirements
PCSP
14
Heading – Ariel 40
• Community collaborations
• Almost 500 ACOs among private and public payers
• Accreditation available
ACO
15
Heading – Ariel 40
Q4 2010
Q1 2011
Q2 2011
Q3 2011
Q4 2011
Q1 2012
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013
0
100
200
300
400
500
600
4267 84 100
144 154
215
341 363
464 484 493
Number of ACOs
Source: Levitt Partners, 2013
20
Heading – Ariel 40
• 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)
The Effort Continues
23
Heading – Ariel 40
• Shared Governance
• Legal, Policy & Compliance
• Operations
• Finance
• Population Management
• Risk Management
• Performance Reporting
Business
24
Heading – Ariel 40
• IT Infrastructure
• Clinical Systems & Tools
• Regulations
• Data Analytics
• Reporting Requirements
• ACO Connectivity
• Patient Connectivity
• Health Information Exchange
Technical
25
Heading – Ariel 40
• Staff Assessment, Engagement & Education
• Population Management• Evidenced-Based Care Management• Care Coordination• Care Transitions• Care Planning
Clinical
26
Heading – Ariel 40
• Clinical Workflow• Patient Engagement• Quality Measures• Performance Analysis• Quality Improvement• PCMH Practice/ Recognition
Clinical
27
Heading – Ariel 40The Subcomponents
Healthcare Organization
Business
Shared Governa
nce
Legal, Policy & Complia
nce
Operations
Finance
Population
Management
Risk Manage
ment
Performance
Reporting
Technical
IT Infrastru
cture
Clinical Systems & Tools
Regulations
Data Analytics
Reporting
Requirements
ACO Connecti
vity
Patient Connecti
vity
Health Informati
on ExchangeCl
inical
Staff Assessme
nt, Engageme
nt & Education Populatio
n Managem
ent
Evidenced-Based
Care Managem
ent
Care Coordinati
on
Care Transition
sCare
PlanningClinical
Workflow
Patient Engageme
nt
Quality Measures
Performance
Analysis
Quality Improvem
ent
PCMH Practice/
Recognition
Heading – Ariel 40
• 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!
28
Organize, Prioritize & Strategize
1.800.4BEACON │ BeaconPartners.com
BOSTON · CLEVELAND · SAN FRANCISCO · TORONTO
Thank You
29
For more information, please contact:
Cindy Friend, RN, BSN, MSN, MBA/HCA
443.413.6901