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A Blueprint for Building a
Medical Group’s Internal
Quality and Cost Efficiency Infrastructure
+ Disclosures:
Timothy Harlan: I have no actual or potential conflict of interest in relation to this presentation.
Eric Gallagher: I have no actual or potential conflict of interest in relation to this presentation.
Nicholas Bernard: I have no actual or potential conflict of interest in relation to this presentation.
+ Objectives:
Upon completion of this activity, participants should be able to develop a roadmap for initiating population health/quality improvement initiatives and successfully engaging physicians in those efforts.
+ Tulane University School of
Medicine:
Background
Size
Faculty
Katrina context
HCA partnership
Regional competitive, M&A landscape
EMR Decision
HITECH
+ Roadmap:
Introduction
Planning
Execution
Assessment
PDSA Cycle
+ Introduction:
Healthcare landscape in NOLA?
Our eClinicalWorks relationship
Meaningful Use team
MU practice transformation as a model for quality improvement.
GPRO reporting
+ Introduction:
GSQN – March 2013
July 2013 - The Imperative : 2012 QRUR
Need for data aggregation
Acquisition of data analytics tool
+ Planning: Strategy
Alignment with Medical Group Strategy
External vs. Internal
Outpatient vs. Inpatient
Quality vs. Cost
Public Providers vs. Private Insurers
Achievability
Resources
Data Access
Scalability
Core Competencies
+ Planning: Prioritization
Prioritize Analyze
Financial Driver Strength/Weakness
PQRS/HEDIS/AHRQ
Specialty Groups
Private Payers
Metric
Industry Quality Sources
+ Planning: Approach
+ Execution – Data Strategy:
Analytics Needs
Real-time
Platform Agnostic
Payer Agnostic
Point of Care Integration
eClincalWorks CCMR product selected
+ Execution – Data Connectivity:
Data Sources
Outpatient EMR 1 and EMR 2
Practice Management System
--------------------------------------------------------
CMS Claims Data
Payer Claims Data ☐☐☐
Inpatient EMR Data ☐
Other systems Data ☐☐☐
80% of ambulatory quality data
80% of financial drivers
+ Execution - Team:
Program Manager
Act as primary liaison for managing multiple programs – MSSP ACO, Quality/CI network, Private Payer programs
Act as project manager for organizational quality ops - Physician Engagement, Care Coordination Ops, Process Improvement Ops
Quality Analyst
Performance Improvement Specialist
Clinical Training, Education, Workflow, Data Capture
+ Execution:
Care Coordination
Outreach
Follow-up
Engagement
Communication
Navigation
Medicine
Evidence-Based
Treatment Protocols
Process Improvement
Workflow
Data Capture
Team
Engagement
Training
Education
+ Execution:
Care Coordination
Medicine
Evidence-Based
Treatment Protocols
Process Improvement
+ Execution:
Care Coordination
Medicine
Evidence-Based
Treatment Protocols
Process Improvement
Workflow
Data Capture
Team
Engagement
Training
Education
+ Execution - Team:
Nurse Navigator
Patient Care Coordinator
Scribes (“Quality Extenders”)
Quality Analyst
Physician Committees
+ Care Coordination: Outreach
Strategy: Address Tulane’s patient care opportunities
Patient Care Coordinator
Pay for Performance
Shared Savings
Index Score
+ Care Coordination: Patient
Engagement
Strategy: Ensure that patients have all resources to manage their health
Nurse Navigator
Target Population
Means of Communication
Daily Census and Rounding
+ Care Coordination: Patient
Engagement
Strategy: Ensure that patients have all resources to manage their health
Nurse Navigator
Target Population
Means of Communication
Daily Census and Rounding
+ Care Coordination: Follow Up
Strategy: Build programs to reduce Tulane’s overall readmission rate
Quality Analyst
Hypertension Pilot
Other Chronics
+ Care Coordination:
Communication/Navigation
Strategy: Implement technology to track a patient throughout the continuum of care
Nurse Navigator and Quality Extenders
Addressing Care Gaps
Care Coordination Medical Record
“Payer Agnostic”
+ Care Coordination:
Training/Education
Strategy: Engage office staff to improve outcomes
Quality Analyst
Blood Pressure Technique
Excel
“Structured Fields”
Group Physician Reporting Option
+ Execution – Physician Engagement
Strategy: Construct governing bodies to direct quality and cost initiatives
Board of Managers
Quality Committee
Medical Subspecialties Committee
Surgical Subspecialties Committee
Payer Committee
+ Assessment:
Outcomes data
Incentives paid
Penalties avoided
Cultural shift
+ Plan, Do, Study, Act:
Next Steps
Cost analyses
Expansion of payer program management
Resource allocation
Depth vs. Breadth
Physician compensation
+ Plan, Do, Study, Act:
Key Information
AMGA
FPSC
AAMC
+ Plan, Do, Study, Act:
Strategic Partnerships
Vision 2020?
LPHI
HIE
LSU / ILH
PTN Network
+
A Blueprint for Building a
Medical Group’s Internal
Quality and Cost Efficiency Infrastructure
