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Value-Based Healthcare Through Care Coordination and Clinical Integration. Angelo Sinopoli, MD VP, Clinical Integration Chief Medical Officer. Strategic Positioning Multi-Year Goals. Beyond the Medical Home. Strategic Positioning Accountable Care Organization The Care Continuum.
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Value-Based Healthcare Through Care Coordination and Clinical Integration Angelo Sinopoli, MDVP, Clinical Integration Chief Medical Officer
Strategic Positioning Accountable Care Organization The Care Continuum Emergency Medical Services Collaboration Emergency Department Case Management Outpatient Care Management Department Clinical Advisory Teams Project RED CHF Observation Unit AccessHealth SC Nursing Home Relationships Palliative Care Employer On-site Pharmacy LTACH Medical Weight Management Program Sub-Acute Units Employer Health Risk Assessments Rehab Hospital Smoking Cessation CHF Clinic Graphic: Sg2 Employer On-site Nurse Practitioner Wellness Way Home Outreach and Case Management Pulmonary Rehab Diabetes Self Management Program Nurse Family Partnership Information Systems Care Coordination Competencies
Duke Innovation Grant Overview: • $2.7 million grant for delivery innovation Eligibility: • Initial pilot focused on Medicaid clinic population and subsequently the unfunded population • Developed a stratification process based on ER and hospital utilization
Duke Innovation Grant Results to-Date: • In year one, there was a 26% decrease in Emergency Department visits and a 55%decrease in inpatient days • For Diabetes, the number of patients with HgA1c High values (>9%) decreased 14% • LDL-C Abnormal values decreased 15% • For Hypertension, Non-Diabetic, the number of patients with readings within 140/80 parameters improved approximately 13% • For Asthmatics, the number of patients appropriately receiving corticosteroid/acceptable alternative therapy improved approximately 11%
ER Care Management • 130 Patients Enrolled • Active Case Management • Connecting to a Medical Home • Addressing Social Issues
GHS/EMS Partnership Awarded a $300,000 grant to reduce unnecessary ER and EMS utilization by: • Creating an innovative nurse triage call center that is currently being used in only two other locations in the US • Providing care coordination to ER and EMS high utilizers so they receive the right care at the right time and place • Developing patient-centered medical neighborhoods within the community
Community Care Outreach Collaboration between GHS, GCEMS, and Greenville City Fire Department to create patient-centered medical neighborhoods within the Greenville Community.
Medical Neighborhoods • Health System and Safety-net Collaboration • Providing Access to Care within Communities • Community Paramedic and Health Worker Models • Home Health • Care Management • Care Coordination
Accountable Communities • Community-led Innovation • Community Volunteer Programs • Community Paramedics • Community Resources (Faith-Based Organizations, Schools, EMS, Police and Fire Districts) • Patient Education and Social Determinants • Population Health Management • Social Service Providers
Business Health Services Wellness Programs Pharmaceutical Management On-site Clinics Care Coordination and Management GHS Community Offerings
Business Health Partners Pierburg US Southern Weaving City of Easley Drive Automotive
BlueChoice Medicaid • Partnership with BCBSSC • 14,000 covered lives in Greenville county • Joint Operating Committee • Care Management/Coordination by GHS/UMG • Shared-savings program
BlueChoice Medicaid • Inpatient utilization/1000 decreased by 11.2% • Professional utilization/1000 decreased by 4.5% • Script/member decreased by 12% • Percent generic utilization increased by 2% • Total cost PMPM decreased by 12.1% for CY 2013 compared to CY 2012 • Significant shared savings realized at year end
Present Model Healthcare Providers Healthcare Insurers Employers
Future Model Healthcare Insurers Healthcare Providers Employers
Hospital System vs. Healthcare Delivery System Full Service Health System Integrated Delivery System Payers Payers Medical Staff Clinically Integrated Employed Post Acute Services Faculty Diagnostic Center ASC Post Acute Services Employed Physicians and Outpatient Services
Medicare Shared Savings Program • Application was submitted on July 30. • If accepted, network providers will be asked to meet certain quality performance standards and reduce healthcare costs for 70,000 Medicare beneficiaries in 2015. • Providers who submitted their participation agreement after July 30 have until late August to be added to the MSSP application.
MSSP MinimumSavingsRates MinimumSavingsRates MinimumSavingsRates Number ofAssigned (lowend of assigned (highendof Beneficiaries beneficiaries) assignedbeneficiaries) 5,000–5,999 3.90% 3.60% 6,000–6,999 3.60% 3.40% 7,000–7,999 3.40% 3.20% 8,000–8,999 3.20% 3.10% 9,000–9,999 3.10% 3.00% 10,000– 14,999 3.00% 2.70% 15,000– 19,999 2.70% 2.50% 20,000– 49,999 2.50% 2.20% 50,000– 59,999 2.20% 2.00% 60,000+ 2.00% 2.00% Source:CentersforMedicare&MedicaidServices,MedicareSharedSavingsProgramFinalRule,CMS–1345–F
Clinical Integration Building Blocks Reduce Costs and Waste Improved Quality and Access Clinical Integration Finance/ Managed Care Value- based Payment Models Funds Flow Distribution Delivery Network Strengthen Partnerships Along Continuum Expand Primary Care Base Define Membership Criteria Care Model/ Information Technology Population Health Management Care Management Clinical Data Repository Data Analytics Organizational Structure Entity Formation Establish Governance Change Management Physician Leadership