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Integrated Care System
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Integra HealthCare Centers, Inc.Integrated Care Program
Utilizing a “Continuum of Care” to optimize patient care and
practice revenues
Quality of Care:- Patient Experience
- Patient Education
-Patient Outcomes
Standards of Care:- Evidence Based Medicine
- Clinical Guidelines
- Payer Guidelines
Continuum of Care:- Assessment
- Therapies
- Management
Communication:- Patient Progress
- TEAM Communication
- Community Outreach
IPU
Clinical Program
INTEGRATED CARE DEFINED
Integrated care program model is Biopsychosocial vs. Biomedical
Defined around medical conditions, not business process
Condition based comprehensive services provided
Organized around medically integrated practice units (IPU’s)
Distinctive care delivery strategy offered in each practice unit
Patient results, experience, and methods measured, reported,
communicated
Services marketed based on excellence, uniqueness, and results
TYPES OF SERVICES PROVIDED – DIFFERENTIATION
Comprehensive assessment/diagnosis emphasis
Differentiation based on the comprehensiveness of services provided
over the care cycle (Continuum of Care)
Emphasis on comprehensive assessment, integrated therapies, and
condition management vs. acute care treatment
Distinguished based on IPU model (patient centric)
Distinguished based on availability of services (access to care)
Distinguished based on Continuity of Care (care consistency)
CHRONIC CARE CONDITIONS – EDUCATION & AWARENESS
Multiple provider coordinated delivery system
Patient centric self-management initiatives
Community wide education initiatives to improve health
All stakeholders included (employers, allied health providers, social service
organizations)
Comprehensive lifestyle education opportunities
Utilization of information management systems for health & lifestyle
education initiatives
The foundation of an Integrated Practice Unit (IPU) consists of three components…
Quality of Care
•Patient Experience•Patient Education•Patient Outcomes
Standards of Care
•Evidence Based Medicine
•Clinical Guidelines•Payer Guidelines
Continuum of Care
•Prevention•Assessment•Therapies•Management
Quality of Care - Defined
Utilizing processes and systems to make “QUALITY” measurable
Quality of Care
Patient Experience
Patient Outcomes
Patient Education
HOW DO WE MEASURE QUALITY?
Patient Experience (measurement of satisfaction)
Patient Education (measurement of understanding)
Patient Outcomes (measurement of progress)
Agreeing on a definition of quality of care may be healthcare's biggest challenge…
QUALITY OF CARE GOALS
Comprehensive assessment/diagnosis
Interdisciplinary therapies, individualized to the patients needs
Medical Condition Management (measure, report, communicate)
Education and support resources that allows patients to understand and
cope with their illness/disease
Communication between all of the stakeholders in the care delivery
process (patient, provider, payer)
Measurement and reporting of entire quality of care cycle
PATIENT EXPERIENCE A measure of patient satisfaction should be reportable to entire patient
population
Goal is to have patients experience a positive experience and enhance
their quality of life
Practice Environment ( a measure of satisfaction)
Satisfaction surveys (quality measures)
Will they refer friends and neighbors
3 levels of satisfaction (dissatisfied, satisfied, prophet)
PATIENT EDUCATION A measure of how well the patient understands their disease/condition
Measure of patient involvement in the treatment and/or management
of their condition
Objective measurement should include patient knowledge assessment
tools, group education, and/or journal entries
Comprehensive patient resources are provided as a component of care
PATIENT OUTCOMES Use this measure for patient progress, not physician performance
Use concrete metrics to determine the therapeutic progress made
Use objective versus subjective quantifiable clinical information to help patients understand their
condition and “plan of care”
CORE OUTCOMES DOMAINS: Pain QVAS (4 components – now, average, best, worst)
Physical Functioning (range of motion, muscle weakness/strength, pain intolerance, grip, pinch)
Emotional Functioning (quality of life, activities of daily living)
Experience and Satisfaction (access, communication, administration, environment, information provided,
pre-visit communication)
Understanding of Condition (medical condition education, self – management)
Building an evidence based practice with evidence based medicine, clinical
guidelines, and payer guidelines based on patient differential and/or working
diagnosis
Standards of Care
Evidence Based
Medicine
Clinical Guidelines
Payer Guidelines
EVIDENCE BASED MEDICINE:
Clinical Research / Trials
• www.nih.gov
Cochrane Collaboration
• www.cochrane.org
Scientific Literature Review
• www.mdconsult.com
CLINICAL GUIDELINES
E-Medicine
• www.emedicine.com
National Guidelines Clearinghouse
• www.guidelines.gov
Institute for Clinical Systems Improvement
• www.icsi.org
American College of Environmental and Occupational Medicine
• www.acoem.org
PAYER GUIDELINES
The identification of clinically correct, medically
necessary processes and procedures for which payers will
provide reimbursement
ODG Treatment
BCBS Technology Evaluation Committee
Medicare, BCBS, Aetna, others
Defined as the delivery of health care services over a period of time. In patients with a chronic medical condition, this covers all phases
of illness from diagnosis to the end of life.
Continuum of Care
Comprehensive Assessment
Medical Condition
Management
Interdisciplinary Therapies
DIAGNOSIS/ASSESSMENT IS PROCESS DRIVEN
Process is used to develop a plan of care based on “Components of
Care” for chronic medical conditions:
Physician Decision Support Toolset
Utilizes “Key Clinical Markers”
Location, duration, frequency, character
Measure, Report, Communicate
Neurological, Mechanical, Compressive, Inflammatory
BioPsychosocial vs. BioMedical
Mechanical Pain
Inflammatory Pain
Muscle Pain
Neuropathic Pain
ACUTE
SUB-ACUTE
CHRONIC
Components of Care in a Integrated Care Program:
Comprehensive Assessment (differential to working diagnosis)
Integrated Therapies (patient plan of care)
Medical Condition Management (coordination of care)
Stakeholder Communication (communication with all interested
stakeholders in the care delivery process)
Measurement and Reporting of Patient Progress (patient
outcomes)
COMPREHENSIVE ASSESSMENT
Radiological Studies
Behavioral Assessment
Functional Assessment
Interventional Studies
Physiological Studies
Evaluation
Differential Diagnosis
Working Diagnosis
INTEGRATED THERAPIES
Behavioral Therapies
Functional Therapies
Interventional Therapies
Pharmacological Therapies
Durable Medical Equipment
Working Diagnosis
Plan of Care
Maximum Medical Improvement
MEDICAL CONDITION MANAGEMENT
Behavioral Management
Functional Management
Pharmacological Management
Alternative Medicine
Complimentary Medicine
CAM Therapies
Patient Education
Long Term Management
COMMUNICATION
Critical to the treatment process
Provides outreach opportunities
Communicate Progress
Payer
ProviderPatient
MANAGEMENT
Measuring processes and progress
Progress reporting
Outcome measures
Objective information - patient pain levels
Objective information - functional improvements
Objective information – quality of life measures
Integrated practice unit differentiation from competition is achieved with the level of and types of services provided.
Integrated Practice
Unit
Multiple Specialty
Consultations
Competition -Differentiation
Services -Specialties
Integra HealthCare Centers, Inc.
Less Pain
Quality of Life
Restoration of Function
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