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St. Vincent’s Health Partners, Inc. Dr. Michael G. Hunt CMO/CMIO Bridgeport, CT 06606 203-275-0201

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Presentation on theme: "St. Vincent’s Health Partners, Inc. Dr. Michael G. Hunt CMO/CMIO Bridgeport, CT 06606 203-275-0201"— Presentation transcript:

1 St. Vincent’s Health Partners, Inc. Dr. Michael G. Hunt CMO/CMIO Bridgeport, CT Clinical Integration, Network Development, Physician-Hospital Organization, ACO: Ask the Same Question… To HIE or not to HIE?

2  A PHO is a legal entity generally formed by physicians and one or more hospitals with the intention of negotiating contracts with payers and sharing in the financial rewards of controlling costs while delivering high-quality care. 2

3 “Physicians working together systematically, with or without other organizations or professionals, to improve their collective ability to deliver high quality, safe, and valued care to their patients and communities”. Alice Gosfield, J.D. 3

4  An active and ongoing program to evaluate and modify practice patterns by the network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.  This may include:  Establishing mechanisms to monitor and control utilization of health care services that are designed to control costs and assure quality of care  Selectively choosing network physicians who are likely to further these efficiency objectives  The significant investment of capital, both monetary and human, in the necessary infrastructure and capability to realize the claimed efficiencies SOURCE: FTC/DOJ - Statements of Antitrust Enforcement Policy

5 Harold Miller: How to Create Accountable Care Organizations

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9 SVHPSVHP Hospitals Skilled Nursing Facilities / Rehab / HHC PCPs Specialists Hospital Member(s) Physician Members 1 Flagship Hospital – St. Vincent’s Medical Center 370 Providers (Physicians, PAs, APRNs) 52 offices > 40 specialties 9

10  Service  Provision of medical care from a provider/facility directly to the patient  Managing all elements of individual patient care  Management  Population Health  Defining the operational roles of care coordination  Enterprise level  Defining the operational role of case management  Facility level 10

11  Participate in Care Coordination services across the clinically integrated network while utilizing existing case management services in the hospital, ambulatory, ED, urgent care centers and SNF’s by identifying the additional Care Coordination needs and develop processes across the continuum for a seamless transition of care.  SVHP Playbook  Identified more than 140 care transitions and established baseline requirements for data portability  Details quality metrics agnostic to Payer  Reference for Care Guidelines – Preventative and disease management  Organizational polices and plans 11

12  Goal:  Meet Patient Needs and Preferences in Delivery of High-Quality, High-Value Care  Bridging the gaps between:  Primary Care  Specialty Care  Inpatient  Mental Health Services  Long-Term Care  Medical History  Test Results  Home Care  Informal Caregivers  Patient/Family Education and Support  Medications/Pharmacy, and  Community Resources 12

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18  Legacy Data from disparate Practice Management Systems  Data  Hospital(s)  Laboratory  Local and national companies  Insurance  Patient specific (EMR)  Imaging  Pharmacy 18

19  Optimize preventive and chronic disease management  Primary and specialty care  Reduce variations of care  Care Coordination  Focus the right treatment at the right time for the patient  Identify and develop cost-effective management strategies  Support initiatives  Patient Centered Medical Homes  Participation with ACO  Maximize reimbursement  P4P, PQRS, etc.  Achieve clinical integration and physician adoption  Share Data  Between professionals and institutions  With the patient  Public transparency 19

20  Membership value to participate  Priorities of membership  Respect clinical workflow  Just another tool not well utilized  Cost and Budget  Limited financial resources  Quality and performance demonstration  Use of available data 20

21  Data types  Labs not based on LOINC  Need for mapping between organizations  Data receptivity  Format  HL7  CCD  Flat file  Patient transition and patient-specific information transfer  Intramember patient communication  Extrainstitution patient communication  Competing priorities between stakeholders  Technology  System oriented versus independent members 21

22  If you do not measure it, you cannot improve it.  IT is the backbone of the CI network's value proposition and is critical to improving coordination and connectivity between providers of care.  Today the industry is inundated with tools to assist with monitoring and reporting the care provided to a patient.  Two types of data sharing sources  Health records  patient registries  repository that holds clinical information specific to a disease, disease process, implant, drug, etc  Sources  physician office  Hospital  ancillary care facility  ambulatory care facility 22

23 ComponentDefinitionMethod of Measurement ProcessManner to ensure that care is given Clinical pathways Readmissions Rate of preventive testing InfrastructureFacilities, personnel and equipment used in the healing process Patient satisfaction survey OutcomeResults of patient careComplications Cost of care Length of hospital stay mortality Morbidity Disease-specific function tools 23

24  Inpatient  Readmission rates  Medication reconciliation  Care Coordination  Outpatient  Preventive Health  Wellness exams  Immunizations  Mammograms/pap smears  Chronic disease  Diabetes  CHF  Asthma/COPD  Acute and Chronic Care Management Measures  Appropriate testing for children with pharyngitis  Appropriate treatment for children with URI  Appropriate antibiotic treatment for acute bronchitis  New episode of depression: acute phase treatment  New episode of depression: continued treatment  AMI: persistence of beta-blocker treatment after a heart attack  CAD: ACE inhibitor/ARB therapy  Complete lipid profile for patients with CV conditions  Heart failure (HF) : beta-blocker therapy  PDC: for HTN (ACEI or ARB)  PDC: for cholesterol (Statins)  Diabetes: eye exam  Diabetes: hemoglobin A1c testing  Diabetes: lipid profile  Diabetes: urine protein screening  PDC: oral diabetes  Annual monitoring on persistent medications: ACE/ARB  Annual monitoring on persistent medications: anticonvulsants  Annual monitoring on persistent medications: digoxin  Annual monitoring on persistent medications: diuretics  Arthritis: disease modifying therapy in rheumatoid arthritis  Osteoporosis management in women who had a fracture  Use of appropriate medications for asthma   Preventive Care Measures  Breast cancer screening  Cervical cancer screening  Childhood immunization status: MMR  Childhood immunization status: VZV  Chlamydia screening in women  Glaucoma screening in older adults  Adolescent well visits: years  Well-child visits in the first 15 months of life  Well-child visits: 3-11 years 24

25  Inpatient  Length of Stay  Antibiotic usage  Blood products/transfusions  Readmission rate  Outpatient  Inappropriate ER use  Inappropriate advanced radiology  Costs pmpm for ED, Pharmacy, inpatient, outpatient, radiology  Ambulatory Sensitive Conditions  ER and Inpatient 25

26  McKesson Population Manager – Population Management  McKesson Risk Manager – Risk Management/Value Based Contracting  Clinical Informatics Systems – EHR/EMR/PMS/HIE/Pharmacy/Lab 26

27 Practice Management System Claims Data MSG - SVMC UCC – SVMC Goldfarb Ranno & Assoc. Allergy & Asthma Care, LLC Pulmonary & Internal Medicine Primary Care of Shelton Endocrine Associates, LLC Ehrlich Bariatrics Opthalmic Consultants of Connecticut Family Podiatry Center Dr. Reuvin Rudich Dr. R. Levin & Dr. L. Fliegelman McKesson Population Manager – SaaS/Cloud Secure File Transfer Protocol (SFTP) Claims Feed Quest Diagnostics HL7 Interface Results Feed Clinical Lab Partners.CSV Results File Upload Physician Quality Reporting Point of Care Technology (Future) Physician Offices Physician Hospital Organization (PHO) & PHO Hospital Partner Data Sources 27

28 28 Data TypeSource Primary Practice Mgmt / Billing System(s) At each practice and not centralized. Clinical EventsEMR systems. ProvidersMultiple sources. One provider could be in more than one source. TaxID & NPI’s are available for each provider (mid-levels too). LabHospital, Quest, Labcorp, CLP, POC labs RadiologyInpatient & Outpatient, may be different sources. POC radiology. PharmacyPossibly Surescripts. Processed ClaimsClaims from insurers. Other

29  Data sources include:  Demographic, ICD-9, CPT, CPT-2 from Practice Management Systems  Prescription history from Surescripts  HIEs  Lab results from hospital, local labs, LabCorp, Quest  EMRs  Hospital  State sources (Immunization Registry)  Survey Data  Payers  Data entered on-line 29

30  Every night, registry processing runs automatically:  PCP Assignment  Registry Assignment  Responsible Provider  Medical Exclusions  Registry Purge  Compliance Calculation McKesson Population Manager: Registry Processes 30

31 Providers Hierarchies Payer Medical & Rx Claims Membership Eligibility DataSentinelDataSentinel Rhapsody Data Mart Data Entered On line Lab Results EMR, HIE Data Patient & Population Risk Management: Predictive Models Risk Stratification Patient & Population Risk Management: Predictive Models Risk Stratification Pharmacy Mgt Workflow Engine Pharmacy Mgt Workflow Engine MD Attribution & Correction Workflows Episodes of Care Management Episodes of Care Management Capitation Management PMPM & Utilization Capitation Management PMPM & Utilization Benchmarks HEDIS & STAR Management HEDIS & STAR Management DCGs ETGs EBM Connect Quality Rules P4P Rules Formulary FDB MPI Attribution Organization Hierarchy 31

32 Across the continuum of care: inpatient, outpatient and pharmacy 32

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40  American Hospital Association’s Center for Healthcare Governance  Lakeshore Health Network Case Study,


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