MaineGeneral Health Aging Advocacy Summit November 14 th, 2012

Why do we need change? Costs are increasing Overall health is deteriorating The patient experience is often poorly coordinated Provider workforce is dissatisfied

What are our goals? MaineGeneral’s fundamental objectives align with the Institute for Healthcare Improvement’s (IHI) Triple Aim: – Better health – Better care – Lower cost And, we need to add a fourth: – Recruit and retain an experienced, quality workforce

Advancing Accountability in Healthcare Principles of accountable care: – Founded on primary care and the principles of the patient-centered medical home (PCMH) – Based on the community and populations served by the organization – Integrating the system of care, across the continuum, outpatient to inpatient to home – Incentivized based on positive health outcomes and efficient care

Implementing ACO Framework Healthy Chronic Acute Post- Acute and LTC End of Life Primary Care - Outpatient Outpatient Diagnostics & Surgery Specialty Care - Outpatient Acute Care - ED and Inpatient Home Health and Hospice Reimbursement Methodology: Incentivize Efficiency and Reward Quality Medicare Self-Insured Commercial Medicaid Fully Insured Commercial Self-Pay

At the Primary Care Practice Level Expand Shared Decision- Making Reduce Practice Pattern Variation Coordinate Care Transitions Enhance Care Management Manage Utilization Implementation of patient advisory councils Practices receiving quality and utilization performance measurement reports Increased communication between hospitalists and primary care practices On-site licensed clinical social workers and/or registered nurses Practices receiving and monitoring daily ED and inpatient discharge reports

Framework for Population Health Management Data driven risk stratification to support intervention strategy Our Service Area KRHA 25 Practices 110,289 Patients Priorities A, B, C Primary Care KVCCT LOW Disease Burden LOW Cost HIGH Care Gaps HIGH Cost Internal and external data sources Winthrop Family Medicine 7,185 Patients Winthrop Family Medicine 7,185 Patients HIGH Diseas e Burde n Care Management Disease Management and monitoring Wellness programs Manage highcosts Help membersnavigatesystem Close gaps incare Monitorcompliancerates Manage riskfactors GOAL INTERVENTION HIGH Cost A LOW Cost HIGH Disease Burden LOW Disease Burden C B HIGH Care Gaps LOW Care Gaps

What it will take? better health better care lower costs A fundamental re-thinking of healthcare A movement from volume to value An engagement of patients and families A change from silos to integration