Integrating our community partners for a more accountable

organization

Presented By:Jon Holmes, Christopher Kelly & Himabindu Moram

Accountable Care Organization

• VisionWe will be a clinically integrated health care delivery system that is the health provider of choice in Phoenix and recognized nationally for quality, service and community programs.

Our Accountable Care Organization

The 203-bed hospital with all private rooms excels in emergency heart care, pediatric emergency and inpatient care, orthopedics, and many other specialties.

48,125 inpatient days and outpatient days.

25,946 patient visits to the 24/7 Children’s Emergency Center

48,950 patient visits to the Emergency Department.

John C Lincoln Deer Valley Hospital

The 266-bed hospital

71,917 inpatient days and outpatient days.

50,393 patient visits to the Emergency Department.

3,098 individual patients who needed Level 1 Trauma care.

John C Lincoln North Mountain Hospital

ACO ParticipantsJohn C. Lincoln, LLCJohn C. Lincoln Comprehensive Women's Center, LLCJCL Gastroenterology, LLCNorth Valley Internal Medicine, LLCJCL Neurology, LLCJCL Urgent Care, LLCBreast Imaging Specialists of Arizona, LLC

John C. Lincoln Physician Network

2011 AT A GLANCE

600,000 patient visits to our hospitals, physician and specialty practices.

36,391 emergency food boxes for the community.

9,749 visits to Adult Day Health Care.

3,849 employees in the Network.

3,100 children served at the Children’s Dental Clinic.

1,902 volunteers with 194,491 hours of service.

1,111 physicians on our combined medical staffs.

69 new homeowners created through Neighborhood Renewal.

Accountable Care Organization

You are only as strong as your weakest link…

Moving Patient Care and Assuring Quality Patient Outcomes

A Path to Connectivity…

• We have not identified as one organization yet.

• Difficult Information Sharing

• Variation of technology among service providers

• Security• Providers seeing this as a

priority

Key Challenges we face as an ACO

John C. Lincoln Physician Network

John C Lincoln North Mountain Hospital

John C. Lincoln Deer Valley

Hospital

John C Lincoln ACO

• Three institutions:• Separate

administrations• Separate IT

infrastructures• Must collaborate!!!• Quality metrics• Coordination of Care

• Sharing of data facilitates collaboration

John C. Lincoln Physician Network

eClincalWorks

John C Lincoln North Mountain Hospital

EPIC

John C. Lincoln Deer Valley

HospitalCerner

JCLMyChart Personal Electronic Health Record

For patients of John C. Lincoln Physician Network Practices

JCL’s initial response to connecting partners…

JCL Deer Valley

JCL Physician Network

JCL North Mountain Hospital

Cerner Report

EPIC Report

eClincialWorksReport

Reporting Today

John C Lincoln ACO

• One ACO– Not three institutions

• Achieve collaboration through an EDW– Centralized

repository of clinical data

John C. Lincoln

ACO

JCL Deer Valley

JCL Physician Network

JCL North Mountain Hospital

JCL EDW

Enterprise Data Warehouse (EDW)

JCL EDW

Reporting with EDW

JCL Report

• Ability to create performance dashboards

• Physician dashboards that summarizes patient condition across all JCL institutions.

• Patient portals to their own information

Benefits of an EDW

Quality Dashboard Example

Benefits of an EDW

• Ability to create performance dashboards

• Physician dashboards that summarizes patient condition across all JCL institutions.

• Patient portals to their own information

Physician Dashboard Example of Patient Medications

• Ability to create performance dashboards

• Physician dashboards

that summarizes patient condition across all JCL institutions.

• Patient portals to their own information

Benefits of an EDW

Patient Dashboard Example

• Three year pilot of the EDW. • Budgeted for implementation for FY14• Unanimous agreement across each institution• Financial support for a three year pilot of the EDW. – Hardware– Personnel

Request to JCL

Appendix 1

Year 1 Year 2 Year 3 Total

Hardware $500k 0 0 $500k

Maintenance $54k $54k $54k $162k

Personnel $600k $600k $600k $1,800k

Total $1,154 $654 $654 $2,462k

Financial Commitment Over Three Year Pilot

Three Year Total

Institution $821 K

Three Year Commitment for Each Institution

Information is power… Sun Tzu

Next steps in connecting the network

ESTABLISH– Steering Committee– Guidelines– Workflows– Policy and Procedures– Rules and Regulations

Process Change– Imbed meaningful use

into culture today– Align with ACO measures– Lean Six Sigma– Leverage best practices– Use of specialized

consulting firms– Potential for revenue

generation with successful changes

Operational Transition

Communications

• E-mail distribution groups• On-line Survey• Web-based questionnaires• Alternative electronic multi-media • blogs, website, etc

• Formal presentations • “Lunch and learn” education

sessions (offer CMEs)• Attend BoD meetings

Stakeholder Analysis• Essential stakeholders must be

identified and engaged

• Physician’s and nurses input should be proactively sought early in the decision making process

• Active involvement of stakeholders will facilitate end user to accept new system

• Engaging provider participation may be challenging

• Hospital will need to put in place special initiatives in order to engage partners early

Quality - Becoming an organization that emphasizes and adopts cooperation, savings, quality, more use of evidence-based medicine, more use of data and information technology (Harolds, 2010)

Improved

cooperation

EHR,

Screenings, EBM

Web based information

made available

Group educational sessions on diagnosis

Decision-aided support

in orderingexams

UtilizingNurse

Practitioners&

PhysicianAssistants

“e-visits”

Quality Care

• Beacon Award for Excellence in Critical Care

• Magnet Nursing Hospital• Chest Pain Center Accreditation• Heart Failure Center Accreditation• Primary Stroke Center Accreditation• Breast Imaging Center of Excellence• Blue Distinction Center for Knee and Hip

Replacement• Best Workplaces for Women Awards• Best Places to Work - Valley of the Sun• Business Woman of the Year• Arizona Pioneer Award for Quality

• U.S. News and World Report's Best Hospitals• Premier QUEST Award for High-Value

Healthcare• Premier QUEST Award for Top Performing

Hospitals• Outstanding Trauma Center and Outstanding

Trauma Surgeon Awards• Gold Medal of Honor for Organ Donations• Volunteer Heart of Business Award• Health Leadership Award• Lifetime Achievement Award Finalists• JCL.com: One of the World's Top 25

Healthcare Provider Websites

Awards & Honors: 2008 - 2011

Conclusion