Presentation on theme: "2013 mental health & addiction conference phil atkins, licdc, ocps2"— Presentation transcript:
1 2013 mental health & addiction conference phil atkins, licdc, ocps2 perating in the medical neighborhood:the future of prevention2013 mental health &addiction conferencephil atkins, licdc, ocps2
2 the spf-sig medical neighborhood project funded through a grant from ODMHASthree components:educationmedia and development of public informationtraining and information disseminationCollaborationMental Health & Recovery Services Board of Allen, Auglaize and Hardin CountiesODMHAS – Dawn ThomasMODO MediaJim Ryan, Ryan Training
3 takeaways key components of health care reform population health managementmedical neighborhoodsmeasuring health outcomesprevention of the futuregetting ready for “prevention of tomorrow!”
4 preventable health concerns: the big dollar items heart disease and stroke: $312.6 billiondiabetes: $245 billionsubstance abuse: $600 billion
5 how will these and other health care costs be managed while maintaining and improving the quality of care?the triple aim:improving the health of populationsimproving the patient experience of care (quality + satisfaction)reducing the per capita cost of health care
6 thinking about populations: health care of large groups Accountable Care OrganizationPatient Centered Medical HomesMedical Neighborhood
7 our first stop…Accountable Care Organization (ACO)
8 Accountable Care Organizations Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their population of patients.The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the program.
9 essential elements of population health management address health needs at all points along the continuum of health and well being through:coordinated participation in carepatient engagementtargeted interventionsmaintain and/or improve the physical and psychosocial well being of individuals through cost-effective and tailored health solutions focusing on:central leadership role of the physicianimportance of patient engagement, education, activationcapacity expansion of care coordination through non-physician team members
10 delivering population health management in any care setting assessstratifyimplementsolutionsmeasure & report
11 population health management functions identify populationidentify gaps in carecomprehensive health assessmentstratify risksintegrated practice teamevidence-based guidelinesdevelopment of performance measuresselection of interventionsengage patientsevidence-based practicescare managementeliminating barriersoutcome measurementdata analysisreport performancecustomer satisfactioncost-effectivedemonstrate qualityreimbursement diversificationensure accessculturally and linguistically appropriateintegration of community resourcesSPFASSESSMENTCAPACITYPLANNINGIMPLEMENTATIONEVALUATIONSUSTAINABILITYCULTURAL COMPETENCEprevention toolsrisk levels:universal, selective, indicatedworkforce developmenttechnology for planning and evaluation (POPS)
13 Patient Centered Medical Home a practice in which an individual can receive quality, timely, efficient, and patient-centered comprehensive care and care coordination from a compassionate team of health-care professionals.
14 personal relationship with a PCP* and care team A PCMH is an approach to deliver comprehensive care, coordinated by a primary care physician-led extended care team.personal relationship with a PCP* and care team+proactive focus on health, care intervention and chronic disease management+technology, services & applications to support the new collaborative model*primary care physician
15 a Patient Centered Medical Home is… …a model for re-designing primary care practices.…intended to improve the quality and efficiency of care delivery.…based on the principles of:having a personal physician/providera physician directs the practice teamwhole-person orientationcare coordination and integrationquality and safetyenhanced accesspayment/reimbursement changes
16 PCMH as the foundation for Accountable Care Organizations
19 a medical neighborhood a medical neighborhood can be conceptualized as a PCMH plus the constellation of other clinicians and specialists providing health care services to patients within it, along with community and social service organizations and state/local public health agencies.
20 a medical neighborhood emanates from PCMHno one size/shape fits all communitiescan include institutional providers.not all neighbors are “equal” (“core” v. others)compatible with a broad range of payment structuresformal, mutual expectations for PCMH and neighbors
21 a medical neighbor…communicates, coordinates and integrates bi-directionally with the PCMH as well as with patient.ensures appropriate & timely consultations and referrals.ensures effective flow of information.addresses responsibility in co-management situations.supports patient centered care.supports the PCMH practice as the “hub” of care and as the provider of whole person primary care to the patient.
23 improving our data through outcome measurement health care organizations use HEDIS measures to track and report outcomes.H – healthcareE – effectivenessD – data andI – informationS – setmost widely used set of standardized performance measures in the health care industrysystem for establishing accountability in health care
24 measuring outcomes with HEDIS health care organizations use HEDIS measures to track and report outcomes.H – healthcareE – effectivenessD – data andI – informationS – setmost widely used set of standardized performance measures in the health care industrysystem for establishing accountability in health care
25 what does HEDIS measure? HEDIS currently has 81 measures across 5 domains:effectiveness of care – what is the quality of the care or service that was received?access and availability of care – can people get the care and services they need?experience of care – are people satisfied with things like the communication skills of the provider or how easy it was to access services?utilization and relative resource use – how many and how often were services utilized and were costs competitive compared to other providers?health plan descriptive information – specific characteristics of the particular health plan such as certifications, diversity
26 HEDIS has both population-based measures (e. g HEDIS has both population-based measures (e.g. how many women in a particular population received a breast cancer screening) and event/diagnosis-based measures (e.g. how many people were diagnosed with diabetes).
27 HEDIS has both population-based measures (e. g HEDIS has both population-based measures (e.g. how many women in a particular population received a breast cancer screening) and event/diagnosis-based measures (e.g. how many people were diagnosed with diabetes).
29 knowing how health care is held accountable is essential to our understanding of their “world” and our cultural competence needed to develop relationships with primary health care.creating prevention outcome measures that follow the format of HEDIS and other health care outcome systems helps us communicate in their language.we can learn from physical health care how to demonstrate our effectiveness and value.we need to learn to evaluate our efforts at both the population level (environmental strategies) and at the event level (individual strategies).
30 what does my community based agency need to do to become part of a medical neighborhood?
31 laying the foundation of our own house Become prevention scientists - understand the research behind what we do.Know our new neighbors - develop competence in this “new culture” of primary care.Demonstrate value - show that what we are doing is making a difference in people’s lives - with DATA!Be proud of our product – we are prevention specialists providing a specialty health care service.