Montana Health CO-OP: Who We Are

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Goals

• To create value through quality outcomes, efficiency and service

• Move from silo health care delivery to integrated and coordinated care for population members thus eliminating gaps in care, redundancy and waste

• To “bend the cost curve” for healthcare • To reward the value based services and

align financial incentives to achieve the measured goals

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Activities

• Development a HPN/ACO Formalizing legal entity• Allows for engagement of disparate physician practices with a

focus on quality improvement • Single organization structure with Regional Service Areas • Health Care provider leadership of HPN • Opportunity to participate in CMS innovation projects like

ACO/shared savings programs • Restructure of Pay for Performance program and

reimbursement methodologies for self funded and fully insured individuals and employers

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HPN Structure RSO (Regional Service Organization)

HPN

RSO1 RSO2 RSO3

CHC (PCP)

Clinic (PCP)

Acute Care

Hospital

CAH

Specialist Clinic

Clinic (PCP)

CAH

Specialist Clinic

Acute Care

Hospital 1

Acute Care

Hospital 2

Clinic

(PCP)

Specialist Clinic

CAH

Acute Care

Hospital

RHC(PCP)

CAH

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Technology enables system to identify gaps in preventative care; use of Evidenced Based Medicine (EBM) standards

• Patient proactively contacted

• Better outcomes and lower future costs

• Examples: Colon cancer screening, mammography, osteoporosis screening, AAA screening, pneumonia vaccine, prostate screening, diabetes screening, eye exams, PCP appointments

Care Gaps

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Gain Share

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HPN Operational Challenges• Ability to share data for defined patient

population when participants have: Disparate electronic medical records systems

• Various practice management systems • Non standard clinical nomenclature • Separate patient identifiers • Differing methods for disease identification

& performance measures