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ACO, PCMH, PCSP The Ingredients for a Medical Neighborhood Presented by: Cindy Friend, RN, BSN, MSN, MBA/HCA Executive Consultant November 8, 2013.

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Presentation on theme: "ACO, PCMH, PCSP The Ingredients for a Medical Neighborhood Presented by: Cindy Friend, RN, BSN, MSN, MBA/HCA Executive Consultant November 8, 2013."— Presentation transcript:

1 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 2 Agenda

3 Heading – Ariel 40 3 Healthcare Reform ACO PCMH ARRA/MU PQRS/eRx HIPAA

4 Heading – Ariel 40 HIPAA, PQRS & eRx Meaningful Use PCMH ACO Medical Neighborhoods 4 The Future of Healthcare

5 Heading – Ariel 40 5 The Medical Neighborhood Hospital Home Health Payer s LTC/R ehab Lab/ Rad Pharm acy Physicians/ Clinics Employer s Governm ent Patients

6 Heading – Ariel 40 6 The Name Means the Same ACO PHO CIN IDN ICO CCO

7 Heading – Ariel 40 PCMH – Patient Centered Medical Home PCSP – Patient Centered Specialty Practice ACO – Accountable Care Organization 7 Medical Neighborhood Foundation Medical Neighborhood ACO PCSPPCMH

8 Heading – Ariel 40 8 Today vs. Tomorrow Todayvs.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 9 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 10 PCMH Numbers Source: Market Watch, Business Wire, 2013 Source: The Commonwealth Fund

11 Heading – Ariel PCMH 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 12 PCSP

13 Heading – Ariel PCSP Standards Source: NCQA

14 Heading – Ariel 40 Community collaborations Almost 500 ACOs among private and public payers Accreditation available 14 ACO

15 Heading – Ariel Number of ACOs Source: Levitt Partners, 2013

16 Heading – Ariel Medicare Reimbursement Source: Dartmouth Atlas, 2010 % 20% 18% 20% 22%

17 Heading – Ariel Medicare ACOs Source: RUPRI Center for Rural Health Policy Analysis, 2013

18 Heading – Ariel ACO by State Source: Levitt Partners, 2013

19 Heading – Ariel ACO Standards Source: NCQA

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) 20 The Effort Continues

21 Heading – Ariel Payment Reform Source: United Healthcare

22 Heading Ariel Fundamental Components Healthcare Organization Business TechnicalClinical

23 Heading – Ariel 40 Shared Governance Legal, Policy & Compliance Operations Finance Population Management Risk Management Performance Reporting 23 Business

24 Heading – Ariel 40 IT Infrastructure Clinical Systems & Tools Regulations Data Analytics Reporting Requirements ACO Connectivity Patient Connectivity Health Information Exchange 24 Technical

25 Heading – Ariel 40 Staff Assessment, Engagement & Education Population Management Evidenced-Based Care Management Care Coordination Care Transitions Care Planning 25 Clinical

26 Heading – Ariel 40 Clinical Workflow Patient Engagement Quality Measures Performance Analysis Quality Improvement PCMH Practice/ Recognition 26 Clinical

27 Heading – Ariel The Subcomponents Healthcare Organization Business TechnicalClinical Business Shared Governance Legal, Policy & Compliance Operations Finance Population Management Risk Management Performance Reporting Technical IT Infrastructure Clinical Systems & Tools Regulations Data Analytics Reporting Requirements ACO Connectivity Patient Connectivity Health Information Exchange Clinical Staff Assessment, Engagement & Education Population Management Evidenced- Based Care Management Care Coordination Care Transitions Care Planning Clinical Workflow Patient Engagement Quality Measures Performance Analysis Quality Improvement PCMH Practice/ Recognition

28 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

29 BEACON │ BeaconPartners.com BOSTON · CLEVELAND · SAN FRANCISCO · TORONTO Thank You 29 For more information, please contact: Cindy Friend, RN, BSN, MSN, MBA/HCA


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