BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE
FULL-BOARD MEETING
WEDNESDAY, MAY 27, 2015 5:30 p.m. Buffet for board members & invited guests PALOMAR HEALTH DOWNTOWN CAMPUS 6:00 p.m. Meeting GRAYBILL AUDITORIUM 555 E. VALLEY PARKWAY, ESCONDIDO, CA 92025 ___________________________________________________________________________________________________
Form
A
Time Page Target
CALL TO ORDER 6:00
Public Comments
1..………………..……………………….……..……………………………………. ....15 6:15
Information Item(s)
1. * Approval: Strategic & Facilities Planning Committee Meeting Minutes – April 22, 2015 (ADD A-Pp-8-11)……………..…………………………………………………………..…………….
…...3 ……1 6:18
2. * Approval: Revised Strategic & Facilities Planning Committee Bylaws (ADD B-Pp13-15)….…. …...3 ……2 6:21
3. * Review/Approval: Committee Meeting Frequency…..................................................……….... ….10 ……3 6:31
4. * Review/Approval: Committee Standing Agenda Items …………………………….……………... ….10 ……4 6:41
5. Review: Corporate Health’s Business to Business Strategy (ADD C-Pp17-32)…….………….. ….30 ……5 7:11
6. Review: Population Health (ADD D-Pp34-81)……………………………………………………… .…30 ……6 7:41
Public Comments1..………………………………………………..……………………………………. ….15 7:56
ADJOURNMENT 7:58
Board Strategic & Facilities Planning Committee Members
Ray McCune, RN, Chair Linda Greer, RN, CCP Dara Czerwonka, MSW
Robert Hemker, President & CEO 1st Alternate: Dr. Aeron Wickes Della Shaw, EVP Strategy
Diane Hansen, EVP Finance Jodi Mansfield, IEVP Operations Jean Larsen, Philanthropy Officer
Lorie Shoemaker, VP PMC David Tam, VP PHDC / POM Maria Sudak, CNO PMC
Dan Farrow, AVP Hospitality / Facilities Chiefs / Chiefs-elect PMC / POM Janine Sarti, General Counsel
Brenda Turner, EVP Human Resources
NOTE: If you have a disability, please notify us by calling 760-740-6375 72 hours prior to the event so that we may provide reasonable accommodations
__________________________________ Asterisks indicate anticipated action. Action is not limited to those designated items. 1 5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in
meeting room. The Board Strategic & Facilities Planning committee meeting is being agendized as a full board meeting due to the possibility of a quorum being present. Only committee business will be discussed at this meeting, however all board members may attend to participate in the discussion. Only those board members who sit on the Board Strategic & Facilities Planning committee are permitted to make a motion or vote on these matters.
B O A R D S T R A T E G I C & F A C I L I T I E S P L A N N I N G C O M M I T T E E M E E T I N G A T T E N D A N C E R O S T E R - C A L E N D A R Y E A R 2 0 1 5
MEETING DATES:
MEMBERS 1/26/15 2/25/15 3/25/15 4/22/15 5/27/15
DIRECTOR LINDA GREER – COMMITTEE CHAIR X X X X
DIRECTOR RAY MCCUNE X X X X
DIRECTOR DARA CZERWONKA X X X X
DIRECTOR AERON WICKES, M.D. – ALTERNATE X
DIRECTOR HANS C.M. SISON – GUEST X X X
DIRECTOR JEFF GRIFFITH – GUEST
DIRECTOR JERRY KAUFMAN – GUEST
ROBERT HEMKER X X X
STAFF ATTENDEES
DELLA SHAW X X X X
DIANE HANSEN X X
JODI MANSFIELD, FACHE X X X X
JANINE SARTI X
JEAN LARSEN, CFRE X X
PH FOUNDATION BOARD MEMBER
LORIE SHOEMAKER, RN, DHA, MSN, NEA-BC X X X
DAVID TAM, MD, MBA, FACHE X X
MARIA SUDAK, RN, MSN, CCRN, NEA-BC X X
DAN FARROW X X
JEFF ROSENBURG, MD X X X X
FRANKLIN MARTIN, MD X X X X
PAUL NEUSTEIN, MD X X
CHARLES CALLERY, MD X X X X
DEBBIE HOLLICK – SECRETARY X X X X
INVITED GUESTS SEE TEXT OF MINUTES FOR NAMES OF GUEST PRESENTERS
Minutes Board Strategic & Facilities Planning Committee
Wednesday, April 22, 2015
TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Debbie Hollick, Committee Secretary Background: The minutes of the Board Strategic & Facilities Planning Committee meeting held on Wednesday, April 22, 2015 are respectfully submitted for approval (Addendum A). Budget Impact: N/A
Staff Recommendation: Staff recommends approval of the Wednesday, April 22, 2015 Board Strategic & Facilities Planning Committee meeting minutes as presented. Committee Questions:
COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:
1
Bylaws Board Strategic & Facilities Planning Committee
TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Della Shaw, Executive Vice President Strategy Background: Section 6.1.1 of the Board Strategic & Facilities Planning Committee Bylaws was revised to reflect the changes in organizational structure. Budget Impact: None
Staff Recommendation: It is recommended that §6.1.1 of the Board Strategic & Facilities Planning Committee Bylaws be amended per the redline excerpt attached for the Committee’s review. Committee Questions:
COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:
2
Meeting Frequency Board Strategic & Facilities Planning Committee
TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Della Shaw, Executive Vice President Strategy Background: Per request of the Board of Directors, board committees are to review their committee meeting frequency. Budget Impact: None
Staff Recommendation: It is recommended that the Board Strategic & Facilities Planning Committee set the meeting frequency based on the pertinent issues within its scope. Committee Questions:
COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:
3
Standing Agenda Items Board Strategic & Facilities Planning Committee
TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Della Shaw, Executive Vice President Strategy Background: Per request of the Board of Directors, board committees are to review their yearly standing agenda items. Budget Impact: None
Staff Recommendation: It is recommended that a yearly Environment of Care update report be added to the Board Strategic & Facilities Planning Committee Standing Agenda Items. Committee Questions:
COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:
4
Corporate Health’s Business to Business Strategy
Form A 2015.05 Board Strategic - Corp Hlth & B2B.doc
TO: Board Strategic & Facilities Planning Committee MEETING DATE: May 27, 2015 FROM: Russell Riehl, Director Employee, Corporate & Retail Health Duane Johnson, Business Development Background: The informational program presented to the Board Strategic & Facilities Planning Committee provides a high level overview of Corporate Health’s Occupational Medicine program, which has been actively deploying a business to business strategy. It further outlines the program’s successes and future strategies for growth. Budget Impact: N/A
Staff Recommendation: N/A
Committee Questions:
COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: X Required Time:
5
Population Health
Form A Population Health.doc
TO: Board Strategic & Facilities Planning Committee MEETING DATE: May 27, 2015 FROM: Alan Conrad, M.D. - Medical Director Clinical Outreach Services, Palomar Home Health, Diabetes Services, expresscare Background: Organizations are examining their role in Population Health in order to comply with the concepts of the Triple Aim. Palomar Health is evaluating its approach to Population Health. Budget Impact: N/A
Staff Recommendation: N/A
Committee Questions:
COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:
6
ADDENDUM A
7
042215 DRAFT Board Strat & Facil Planning Cmtee Mtg Min.doc 1
STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES – WEDNESDAY, APRIL 22, 2015
AGENDA ITEM CONCLUSION/ACTION FOLLOW UP /
RESPONSIBLE PARTY
DISCUSSION
I. CALL TO ORDER
The meeting – held in the Graybill Auditorium at Palomar Health Downtown Campus, 555 E. Valley Parkway, Escondido, CA 92025 - was called to order at 6:18 p.m. by Board Chair Linda Greer, who then turned the meeting over to Board Strategic & Facilities Planning Committee Chair Ray McCune
II. ESTABLISHMENT OF QUORUM
Quorum comprised of Directors Greer, McCune, Czerwonka, Sison
Excused Absences: Directors Kaufman, Griffith, Wickes
III. NOTICE OF MEETING
Notice of Meeting was posted at PH’s Administrative Office; also posted with Full Agenda Packet on the PH web site on Wednesday, April 15, 2015, which is consistent with legal requirements. Notice of that posting was made via email to the Board and staff members
IV. PUBLIC COMMENTS
There were no public comments
IV. INFORMATION ITEMS
There were no information items
1. APPROVAL OF MEETING MINUTES – BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE MEETING – MARCH 25, 2015
No discussion
MOTION: By Director Czerwonka, 2nd
by Director McCune and carried to
approve the March 25, 2015 Board Strategic & Facilities Planning Committee meeting minutes as submitted. All in favor. None opposed
2. Q3 FY2015 STRATEGIC & OPERATIONAL INITIATIVES REVIEW
8
042215 DRAFT Board Strat & Facil Planning Cmtee Mtg Min.doc 2
STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES – WEDNESDAY, APRIL 22, 2015
AGENDA ITEM CONCLUSION/ACTION FOLLOW UP /
RESPONSIBLE PARTY
DISCUSSION
Utilizing the presentation distributed in the meeting packet, the committee reviewed the second quarter updates to the FY15 strategic and operational initiatives
Executive Vice President Strategy Della Shaw reported that the committee would be reviewing a fairly high level update to the six initiatives as well as a deeper dive for Operational Initiative 2 given by Vice President Palomar Medical Center Lorie Shoemaker
Noted that Cardiovascular Center of Excellence (COE) Program Development Manager Serrina Bergstraesser would provide an update on strategic initiative 1 at this meeting; a deeper dive will be presented at the next meeting
FY2015 Strategic Initiative 1: Achieve and maintain Center of Excellence status in orthopedics/spine and rehabilitative care, cardiovascular care, neuroscience and women's services
Ms. Shaw and Ms. Bergstraesser provided the update:
Have already met outcome maximum for Milestone 2
New OR heart team video review process illustrates potential opportunities for improvement
o Dr. Rosenburg noted that great progress has been made re: efficiency, patient-first atmosphere and communication along the whole hospitalization process. Surgeries now start at 7:30 a.m. Latest outcomes data reflects a 0% mortality rate
FY2015 Strategic Initiative 2: Become the dominant provider of primary care in support of the total patient health experience provided, including the expansion and growth of Arch Health Partners, effective affiliations with local providers and development of a strong regional primary care network in the secondary markets
Ms. Shaw reported that the initiative is on target
o Completed Milestone 1
o Milestone 2 on track for completion by the end of fourth quarter
o Milestone 3 – anticipate surpassing 4% target for increasing baseline FY14 PCP alignment with targeted Area of Focus (AOF) Service line Specialists
o Still actively seeking involvement with Graybill
FY2015 Strategic Initiative 3: Develop a delivery model that supports care coordination and transitions across the continuum, with emphasis on chronic disease management, illness prevention, and patient involvement
Ms. Shaw reported that Milestones 1- 7 have been completed by their target dates; expectation for Milestones 8 and 9 to meet their respective target dates as well
Working on an interoperability platform to connect inpatient I.T. with outpatient I.T. and physician offices, skilled nursing facilities et al to fully exchange information for the care of the patient
Vice President Information Systems Prudence August reported that last two vendors are in the review process with discussion re: negotiation and implementation timelines. Currently evaluating the primary needs the organization has outlined. Next steps – develop communication plan
FY2015 Operational Initiative 1: Build and operate a decision analytics structure that supports the real time availability and standardized use of information and expertise for knowledge management and measurement of value based metrics of care
Ms. August provided the following update:
Milestones for this initiative are not in sequential order for target attainment
Milestone 1 – completed elements 1 and 3; 2 will be completed in May
Milestone 2 – creating implementation plan
9
042215 DRAFT Board Strat & Facil Planning Cmtee Mtg Min.doc 3
STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES – WEDNESDAY, APRIL 22, 2015
AGENDA ITEM CONCLUSION/ACTION FOLLOW UP /
RESPONSIBLE PARTY
DISCUSSION
Milestone 3 - testing prototype
Milestone 4 – on target to identify 2 areas
Milestone 5 – have met and exceeded target of implementing five reports from the EDW and VHA/Truven for ongoing decision-making for clinical and operational improvement
Milestone 6 – education plans to be rolled out once corresponding tools are in place – will meet June target
FY2015 Operational Initiative 2: Create a positive experience for all key stakeholders by improving clinical and business throughput and efficiency through all transitions of care
Vice President Palomar Medical Center Lorie Shoemaker provided the following update:
On target to meet all milestones by fiscal year end
Milestone 3 almost at target – turnaround times for troponin and basic metabolic panel steadily improving.
o Current focus is on staffing model
HCAHPS scores for PMC and POM steadily rising
Expense reduction – over $600,000 thus far
Utilizing the presentation distributed in the meeting packet, Ms. Shoemaker shared an update on the Patient Flow initiative, noting that progress is being made to the reduce the time patients wait to be admitted or discharged from the hospital. Concentration on key focus areas drives successes achieved thus far
FY2015 Operational Initiative 3: Develop and implement a strong physician integration and alignment model that allows for effective communication, partnership and accountability in the management and care of patient
Palomar Medical Center Chief of Staff Dr. Jeffrey Rosenburg provided the following update:
Overall the initiative is on track for completion by target date
o Milestone 1- completed six of the eight elements for phase1. Currently focusing on identifying physician mentors, creating design for the orientation program and physician culture vision compact
o Modules 7 and 8 have been implemented
o Physician engagement survey currently under way;target is 55% participation; currently at 54.8%. Potential to extend survey to May 4th
to allow even greater participation
ADJOURNMENT
MOTION: By Director Czerwonka, 2
nd by
Director Greer and carried to adjourn the meeting. All in favor. None opposed
Committee Chair McCune adjourned the meeting at 7:09 p.m.
SIGNATURES: COMMITTEE CHAIR
RAY MCCUNE, R.N.
10
042215 DRAFT Board Strat & Facil Planning Cmtee Mtg Min.doc 4
STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES – WEDNESDAY, APRIL 22, 2015
AGENDA ITEM CONCLUSION/ACTION FOLLOW UP /
RESPONSIBLE PARTY
DISCUSSION
BOARD ASSISTANT
DEBBIE HOLLICK
11
ADDENDUM B
12
REVISED February 18, 2014 January 26, 2015 May 27, 2015
STRATEGIC & FACILITIES PLANNING
COMMITTEE
AMENDED AND RESTATED
BYLAWS
13
REVISED February 18, 2014 January 26, 2015 May 27, 2015
6.1.1 Strategic and Facilities Committee.
(a) Voting Membership. The Committee shall consist of six voting
members, including three members of the Board and one alternate
who shall attend Committee meetings and enjoy voting rights on the
Committee only when serving as an alternate for a voting Committee
member, the President and Chief Executive Officer and the Chiefs of
Staff of the Hospitals or the designees of the Chiefs of staff as
approved by the Committee Chairperson.
(b) Non-Voting Membership. The Executive Vice President Strategy,
Executive Vice President Finance, Executive Vice President Human
Resources, Executive Vice President Operations, General Counsel, , ,
Vice Presidents of Palomar Medical Center, Palomar Health
Downtown Campus and Pomerado Hospital, a nurse representative
from Palomar Medical Center or Pomerado Hospital, Assistant Vice
President Hospitality & FacilitiesDirector of Facilities Planning and
Development, Chief Foundation Philanthropy Officer, a board
member of the Palomar Health Foundation recommended by the
Foundation and approved by the Committee Chairperson and an
additional physician from each hospital as recommended by each
hospital’s Chief of Staff and as approved by the Committee
Chairperson. As needed, other appropriate relevant staff in
engineering, architectural, planning and compliance, and a Physician
Advisory Committee member may be requested to attend along with
Palomar Health staff to facilitate the work of the Committee.
(c) Duties. The duties of the Committee shall include but are not limited
to:
Regarding the Strategic Function:
(i) Review and make recommendations to the Board regarding the
District’s short and long range strategic plans, master and
facility plans, physician development plans and strategic
collaborative relationships; and
14
REVISED February 18, 2014 January 26, 2015 May 27, 2015
Review annually those policies within the Committee’s purview and
report the results of such review to the Governance, Audit and
Compliance Committee. Such reports shall include recommendations
regarding the modification of existing, or creation of new policies;
and
(ii) Undertake planning regarding physician recruitment and
retention and program development of new and enhanced
services and Facilities; and
(iii) Monitor new initiatives and programs; and
(iv) Perform such other duties as may be assigned by the Board.
Regarding the Facilities Function:
(i) Review construction estimates and expenses for accuracy and
architectural plans for completeness and effectiveness;
(ii) Approve construction project change orders in accordance with
applicable district law and Palomar Health policies;
(iii) Receive reports from the Construction Manager and the
Director of Facilities Planning and Development; recommend
action to the Board regarding facilities design and maintenance;
(iv) Review regulations and reports regarding facilities and grounds
from external agencies, accrediting bodies and insurance
carriers; make recommendations for appropriate action
regarding the same to the Board;
(v) Approve the annual Facilities Development Plan and regularly
review updates on implementation of plan;
(vi) Receive a biannual Environment of Care report;
(vii) Perform such other duties as may be assigned by the Board
15
ADDENDUM C
16
Corporate Health Services
Business to Business Strategy through Occupational Medicine
17
Philosophy
• Mission – Heal, comfort, and promote health throughout the
business community.
• Vision – Provide peace of mind for work related risks and
injuries, allowing organizations to focus on the total health of their business.
18
Background
• Opened Poway Clinic 2004
• Onsite Wellness & Vaccination Services 2006
• Interim Director – Focus on growth 2008
• Opened San Marcos Clinic 2010
• Expand Onsite Services - Surveillance 2012
• First Responder Surveillance Program 2014
19
Our Services
PREVENTION
• New Hires
• Physicals
• Drug Test
• HRA Biometrics
• Medical Surveillance
CONTAINMENT
• Injury Mgmt
• Return to Work
• Case Mgmt
• Claims Review
EDUCATION
• Ergonomics
• Presentations
• Consulting
• Medical Oversight
20
Touch Points
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
FY2012 FY2013 FY2014 FY15 Proj
9,805 10,654
12,185
13,718
Ou
tpat
ien
t C
linic
Vis
its
Patient Encounters
GOOD
21
Referral Benefit
0
100
200
300
400
500
FY2012 FY2013 FY2014 FY15 Proj
168 178 224
235 271 284 270 258
439 462 494 493
Direct Care Referrals
Specialist Rehab Total
FY14
• $00,000
• $00,000
$000,000
FY15
• $00,000
• $00,000
$000,000
22
Breadth of Connection
0
200
400
600
800
1000
FY2012 FY2013 FY2014 FYTD 15
778 726
778 812
Em
plo
ye
rs S
erv
ice
d
Employer Clients
GOOD
23
Bridging the Gap
40,456
37,752
41,234 43,036
25,000
30,000
35,000
40,000
45,000
50,000
FY2012 FY2013 FY2014 FYTD 15
Connected Employer Lives
GOOD
Connected
Healthcare
Solution
C
H
S
24
The Power of Relationships
Newsletters
Annual Conference
Quarterly Roundtable
Personal Connections
25
Newsletter
Newsletters
•96 Consecutive Issues Issues
•14,167 Total Opens
•700+ Employers Subscribers
•33% (National Average 24.87%) Open Rate
•25% (National Average 7.24%) Click Through
• .01% (National Average 1.05%) Opt Out
26
Annual Conference
Newsletters
• 47 attendees 2010
• 56 attendees 2011
• 69 attendees | 11 vendors 2012
• 81 attendees | 16 vendors 2013
• 97 attendees | 17 vendors 2014
• 100+ Estimated | 21 vendors 2015
27
Employer Roundtables
Newsletters
•Burnham Benefits Healthcare
Reform
•Palomar Health Rehabilitation Ergonomics
•ALPHA Fund Insurance Aging Workforce
•Burnham Benefits Affordable Care
Act Impacts
•Barney & Barney CA Work Comp
Update
28
Personal Connections
• Employers who take time to tour take relationship seriously
• 90% close rate when we get employer to walk through our doors Clinic Tours
• Strengthens relationship when doctor takes time to tour workplace
• Clearer understanding of environment when writing work restrictions Workplace Tours
• Great opportunity to gain INTEL and build relationship with HR reps
• No charge for to participate Employer Health Fairs
• Influencers of occupational health care
• Build trust and recognition through education presentation to this group
TPA/Insurance Presentation
• Business park associations, HR associations, Insurance, etc.
• Network, Network, Network!!! Professional Associations
29
Traditional Occupational Medicine
Corporate Health
Employer
Medical Groups
Palomar Health
Services
Brokers Insurance
30
Corporate Health Model
Corporate Health
Insurance
Connected
Healthcare
Solution
C
H
S
31
Questions
32
ADDENDUM D
33
CONTINUUM OF CARE | POPULATION HEALTH
ALAN, J. CONRAD, MD, MMM, CPE, FACHE
34
INSTITUTE FOR HEALTHCARE IMPROVEMENT
• Improving the patient experience of care
• Improving the health of populations
• Reducing the per capita cost of care
TRIPLE AIM
35
VOLUME TO VALUE Fee-for-Service reimbursement VALUE VALUE-BASED SECOND CURVE
High quality not rewarded
No shared financial risk Payment rewards population value -
quality and efficient
Acute inpatient hospital focus Quality impacts reimbursement
IT investment incentives not seen by hospital
LIVING IN THE GAP
Partnerships with shared risk
Stand-alone care Systems can thrive Increased patient severity
Regulatory actions impede hospital-physician collaboration
IT utilization essential for population health management
Scale increases in importance
VOLUME-BASED FIRST CURVE VOLUME Realigned incentives, encouraged
coordination
Value
Value
JOURNEY TO THE SECOND CURVE
36
Working Definition:
Applying systematic quality and process improvement approaches in order to achieve the IHI Triple Aim
An active, management approach
An organization works to manage a populations’ health
POPULATION HEALTH
37
•System level medical management:
•Clinical models, decreased variation, connect to the community
•Network Construction: full spectrum of care across geography, contracted discounts
•Delivery of care:
•Care pathways, quality, access, site of service, efficiency
•Populations served by each payer:
•Quality expectations
•Cost targets
•Effects of benefit design
Benefit & Product Design
Patient Level Care
Activities
Population Health
Management
Care Delivery Network
POPULATION HEALTH: Macro levers
Community:
Needs and
resources
Community
and External
Environment
38
Actionable information to address the new needs
• Population sub-segmentation is the key tactic to:
– Drive a clinical model
– Address special-cause variation among teams and clinical group practices
– Address common-caused variation by improving the system
POPULATION HEALTH
39
Transform Care delivery
POPULATION HEALTH
Physicians
Nursing: Advanced Practice, RN, Diabetes
Educators, LVN
Health Coaches, Medical Assistants, Care Coordinators, Behavioral Health
and Social Workers
Create population
health teams to do the
work
Standardization enables
delegating to a team
Maximally use each team
member’s skills
Physicians manage
exceptions
40
Actionable Information
Registries, ADT summaries, EHR reminders
Variation data from support teams
Clinical operations per clinical model
Primary Care Practice
Population Health teams including physicians, RNs, MAs, Care Coordinators
Communications and Processes
Leadership and communication from top to bottom of the organization
Processes that fit practice work flow
Practice level activities that roll up to the goals of the organization
Aligned Funding
Payment models that allow us to pay for population health management activities
Incentives aligned to goals at all levels of the organization
Success
POPULATION HEALTH 4 Areas for Success
41
ALIGNING HOSPITALS, PHYSICIANS AND OTHER PROVIDERS ACROSS THE CONTINUUM OF CARE
Evaluation Metrics A. Percentage of aligned and engaged physicians B. Percentage of physician and other clinical provider
contracts with performance and efficiency incentives aligned with ACO-type incentives
C. Availability of non-acute services D. Distribution of shared savings/performance
bonuses/gains to aligned physicians and clinicians E. Number of covered lives accountable for population
health F. Percentage of physicians in leadership
JOURNEY TO THE SECOND CURVE
Metrics for the Second Curve of Health Care
42
OPTIMIZING HIGH-RISK CARE MANAGEMENT
• The most costly 1% of patients account for one-fifth of national healthcare expenditures
• Complex co-occurring conditions
• High risk care management programs
• Clinicians and health care organizations are increasingly adopting programs of their own
JAMA January 22, 2015
POPULATION HEALTH MANAGEMENT
43
OPTIMIZING HIGH-RISK CARE MANAGEMENT
• Anchored in the practice where patients receive their care
• There is no substitute for person-to-person contact
• Traditional fee-for-service reimbursement actively hinders experimentation with care management
• New payment models
JAMA January 22, 2015
POPULATION HEALTH MANAGEMENT
44
OPTIMIZING HIGH-RISK CARE MANAGEMENT
• Purchasers have a fundamental role
• Employers and other purchasers of health care are the ultimate beneficiaries
• For most employers, it will entail working with payers and clinicians and health systems
JAMA January 22, 2015
POPULATION HEALTH MANAGEMENT
45
FINDING THE ROLE OF HEALTH CARE IN POPULATION HEALTH
• Compared with social, environmental, and behavioral factors, medical care has only a relatively small influence on health for populations
• To meet this responsibility, health systems will need to (1) take additional responsibility, (2) create and expand partnerships, and (3) respond to societal demands for equity and value
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
46
POPULATIONS
• Advances in health information technology make it easier to: identify populations of patients; measure and track risk factors, quality of care, and outcomes; and facilitate team-based care.
• Must address non-medical drivers of health such as housing, education, or remediation of environmental threats.
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
47
PARTNERSHIPS
• Health systems or payers must believe that their contributions will produce value for their own patients or members
• A health system’s influence on health will be greatest for those under direct care, but it also recognizes that the system can contribute to partnerships
• Innovative partnerships between health care system stake holders and other sectors
• Financial models that overtly foster partnership
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
48
EQUITY
• Must overcome the challenge of inequity of both access to and quality of medical care
• The first responsibility of any health care organization is to address disparities
• Health systems must be confident that a group-level focus will decrease disparities and that key stakeholders are engaged
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
49
HOSPITAL COMMUNITY BENEFIT PROGRAMS
• The geographic communities in which people live and work have a profound effect on their health and the health cate they receive
• CMMI has state grants to implement and test state innovations model plans
• Community benefits has been an obligation of tax-exempt hospitals
JAMA February 2, 2015
POPULATION HEALTH MANAGEMENT
50
HOSPITAL COMMUNITY BENEFIT PROGRAMS
Four principles could help guide the development of a strategy for leveraging community benefit programs:
1. defining mutually agreed-on regional geographic boundaries
2. ensuring that community benefit activities use evidence to prioritize interventions
3. increasing the scale and effectiveness of community benefit investments by pooling some resources
4. establishing shared measurement and accountability for regional health improvement
JAMA February 2, 2105
POPULATION HEALTH MANAGEMENT
51
A COMMUNITY HEALTH BUSINESS MODEL
• Health outcomes are produced by multiple factors, or health determinants
• The contribution of health care to health is modest-only 20 percent
• No single entity can be held accountable
• Collective effort is needed
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
52
A COMMUNITY HEALTH BUSINESS MODEL
• Contributions must come from those that have secondary influence on health outcomes
• Must form partnerships
• Michael Porter states “solution lies in the principle of shared value, which involves creating economic value in a way that also creates value for society by addressing its needs and challenges”
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
53
A COMMUNITY HEALTH BUSINESS MODEL
Some elements of the community health business model would be:
– All stakeholders must be engaged
– Transparency
– Common purpose
– Resources need to be identified
– Interventions to improve community health
– Economic incentives
– Each community needs to be assessed and monitored
– Continuous redesign
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
54
• One sector may take lead responsibility for population health improvement, using informal or formal authority
• This lead entity serves as the integrator to align activities across multiple sectors
A COMMUNITY HEALTH BUSINESS MODEL
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
55
A COMMUNITY HEALTH BUSINESS MODEL
• Resources can be identified
– Capture funding
– Better return on investment from policies and programs outside of healthcare
– Strengthen governmental funding
– Focus on philanthropy
– Engage corporate business leaders
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A COMMUNITY HEALTH BUSINESS MODEL
• Sector’s primary control; multi-sectoral partnerships
• Business case for population health improvement and determine the resources and policies each community actor requires
• Foundations and government should collaborate
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CMS will award $665 million to support states in transformation. Key strategies are incorporating:
• Integration of Community-Based Services
• Population Health Focus
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Enabling Strategies to Support System Transformation
Quality Measurement Alignment Strategy
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Programs will examine multiple delivery models:
• Patient Centered Medical Homes
• Health Homes
• Accountable Care Organizations
• Bundled Payments
• Episode-Based Payments
• Accountable Care Communities
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Palomar
Health
Community Physicians
Government
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Addenda
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ALIGNING HOSPITALS, PHYSICIANS AND OTHER PROVIDERS ACROSS THE CONTINUUM OF CARE
Evaluation Metrics A. Percentage of aligned and engaged physicians B. Percentage of physician and other clinical provider
contracts with performance and efficiency incentives aligned with ACO-type incentives
C. Availability of non-acute services D. Distribution of shared savings/performance
bonuses/gains to aligned physicians and clinicians E. Number of covered lives accountable for population
health F. Percentage of physicians in leadership
JOURNEY TO THE SECOND CURVE
Metrics for the Second Curve of Health Care
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OPTIMIZING HIGH-RISK CARE MANAGEMENT
• The most costly 1% of patients account for one-fifth of national healthcare expenditures
• Complex co-occurring conditions for which high-risk patients often receive poorly coordinated care, driving unnecessary utilization and poor outcomes
• High risk care management programs have the potential to improve care and reduce costs for this population
• Clinicians and health care organizations are increasingly adopting programs of their own
JAMA January 22, 2015
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OPTIMIZING HIGH-RISK CARE MANAGEMENT
• High risk care management programs are most effective when they are anchored in the practice where patients receive their care
• There is no substitute for person-to-person contact
• Traditional fee-for-service reimbursement actively hinders experimentation with care management
• Shared savings arrangements, capitated payments and per- member per-month payments for long term care management all afford care delivery organizations with the flexibility to reengineer care and create an environment where success improves financial performance
JAMA January 22, 2015
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OPTIMIZING HIGH-RISK CARE MANAGEMENT
• Purchasers have a fundamental role in promoting effective high-risk care management for their covered populations
• Employers and other purchasers of health care are the ultimate beneficiaries of any savings borne by successful care management
• For most employers, it will entail working with payers to (1) promote a shift away from payer and third party led systems and (2) drive employees to clinicians and health systems that can offer these services more effectively.
JAMA January 22, 2015
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FINDING THE ROLE OF HEALTH CARE IN POPULATION HEALTH
• Compared with social, environmental, and behavioral factors, medical care has only a relatively small influence on health for populations whether defined by health system or geographic boundaries.
• To meet this responsibility, health systems will need to (1)take additional responsibility for the health of the patient populations under their care, (2) create and expand partnerships with other entities with the potential to influence health, and (3) respond to societal demands for equity and value.
JAMA January 23, 2014
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POPULATIONS
Advances in health information technology make it easier to
identify populations of patients; measure and track risk factors,
quality of care, and outcomes; and facilitate team-based care.
There is also increased potential for the identification and
management of at-risk individuals within a practice or delivery
system who may benefit from community resources to address
non-medical drivers of health such as housing, education (e.g.,
early intervention for children), or remediation of environmental
threats.
JAMA January 23, 2014
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PARTNERSHIPS
• For meaningful contributions to population health initiatives to occur, health systems or payers must believe that such contributions will produce value for their own patients or members
• A health system’s influence on health will be greatest for those under direct care, but it also recognizes that the system can contribute to partnerships that are important to achieving desired population outcomes when health systems alone have less capacity and control
• Innovative partnerships between health care system stake holders and other sectors with influence on health (public health, education, transportation, employers and others) are increasing
• Financial models that overtly foster partnership may hold promise for improving population health
JAMA January 23, 2014
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EQUITY
• Any effort by health care systems to improve the health of either the patients they serve directly or the broader population must overcome the challenge of inequity of both access to and quality of medical care
• The first responsibility of any health care organization is to address disparities in the provision and outcomes of clinical care within its system
• Health systems must be confident that a group-level focus will decrease disparities and that key stakeholders (group members and leaders) are engaged fully in setting priorities and implementing solutions
JAMA January 23, 2014
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HOSPITAL COMMUNITY BENEFIT PROGRAMS
• The geographic communities in which people live and work have a profound effect on their health and the health cate they receive
• CMMI has state grants to implement and test state innovations model plans with regional collaborative structures, sometimes called accountable health communities
• The provision of community benefits has been an obligation of tax-exempt hospitals for many decades
JAMA February 2, 2015
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HOSPITAL COMMUNITY BENEFIT PROGRAMS Four principles could help guide the development of a strategy for leveraging community benefit programs to increase their influence:
• defining mutually agreed-on regional geographic boundaries to align both community benefit and accountable health communities initiatives
• ensuring that community benefit activities use evidence to prioritize interventions
• increasing the scale and effectiveness of community benefit investments by pooling some resources
• establishing shared measurement and accountability for regional health improvement
JAMA February 2, 2105
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A COMMUNITY HEALTH BUSINESS MODEL
• Health outcomes are produced by multiple factors, or health determinants-including medical care, health behaviors and the social and physical environments
• The contribution of health care to health is modest-only 20 percent
• No single entity can be held accountable for achieving the goals of improved population health
• Collective effort is needed by sectors not accustomed to working together and by stakeholders who may not be aware of how their actions affect population health
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A COMMUNITY HEALTH BUSINESS MODEL
• Contributions must come from those that have secondary influence on health outcomes, such as business, education, state and local government, community development and philanthropy.
• Must form partnerships drawn from all sectors and the partnerships must be integrated using a community health business model
• Michael Porter states “solution lies in the principle of shared value, which involves creating economic value in a way that also creates value for society by addressing its needs and challenges”
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A COMMUNITY HEALTH BUSINESS MODEL
• Some elements of the community health business model would be:
– All stakeholders must be engaged in the process
– Transparency with engagement and reporting to the public
– Common purpose needs to be established
– Resources need to be identified
– Interventions are directed at the overall purpose of improving community health
– Economic incentives need to be identified
– The state of health in each community needs to be assessed and monitored
– Continuous redesign
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• One sector may take lead responsibility for population health improvement, using informal or formal authority
• This lead entity serves as the integrator to align activities across multiple sectors
A COMMUNITY HEALTH BUSINESS MODEL
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A COMMUNITY HEALTH BUSINESS MODEL
• Resources can be identified – Capture funding from reduction of ineffective
healthcare spending – Better return on investment from policies and
programs outside of healthcare – Strengthen governmental funding for population
health improvements at all levels – Focus on philanthropy – Engage corporate business leaders
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A COMMUNITY HEALTH BUSINESS MODEL
• Care should be taken to identify those improvements and opportunities that fall within the sector’s primary control; those not under primary control should move to multi-sectoral partnerships
• Policymakers should make the business case for population health improvement and determine the resources and policies each community actor requires
• Foundations and government should collaborate to develop a group of cost-effective health policies in sectors beyond health, which could be reinforced by financial or regulatory incentives
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CMS will award $665 million to support states in transformation:
Key strategies are incorporating:
Integration of Community-Based Services
• Integration of public health, community-based and behavioral health services across the entire care continuum
Population Health Focus
• Target the preventable drivers of poor health
STATE INNOVATION MODEL INITIATIVE
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Enabling Strategies to Support System Transformation
• Workforce development plans, HIT improvements and data analytics to enhance health care delivery
Quality Measurement Alignment Strategy
• Outline a statewide plan for aligning quality measures by convening private and public payers to accelerate quality improvement and ease the administrative burden for all clinicians
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Programs will examine multiple delivery models:
• Patient Centered Medical Homes
• Health Homes
• Accountable Care Organizations
• Bundled Payments
• Episode-Based Payments
• Accountable Care Communities
STATE INNOVATION MODEL INITIATIVE
81