Title: Key Physicians Value Driven Health Care
1Key PhysiciansValue Driven Health Care
- Conrad L. Flick MD
- John Meier MD, MBA
2Value Driven Health Care
- Key Physicians
- Primary Care based
- HEDIS based quality metrics
- Shared cost savings based contracting
- Viable independent primary care physicians and
specialists within an interdependent network - Integrating patient data systems without a single
EMR - Population management across the network
3Value Driven Health Care
- Value Patient health outcomes per dollar spent
- Coverage
- Moving toward universal coverage
- Delivery system
- Coordinating across the full cycle of care
- Primary care coordinating the medical condition
- Reimbursement
- Moving toward bundled payments
- A Strategy for Health Care Reform Toward a
Value Based System, Michael Porter, NEJM July 9,
2009, 361 109-112.
4The Relationship of Organization Type and Payment
Methods
Integrated system capitation Global DRG fee
hospital and physician inpatient Global DRG fee
hospital only Global ambulatory care
fees Global primary care fees Blended FFS and
medical home fees FFS and DRGs
Outcome measures large of total payment
Care coordination and intermediate outcome
measures moderate of total payment
Continuum of Payment Bundling
Continuum of P4P Design
Simple process and structure measures small
of total payment
Small practices unrelated hospitals
Independent Practice Associations Physician
Hospital Organizations
Fully integrated delivery system
Continuum of Organization
Source Shih et al, The Commonwealth Fund, August
2008
5Wake County/Raleigh Market
6Key Physicians History
- 1994 Organization Formed as an IPA
- 1995-1996 Capitated / Risk Contract
- HealthSource
- 1997-2009 Fee-for-Service Contracting
- Pay-for-Performance where possible
- 2009/2010 NCQA Patient-Centered Medical Home
Recognition - Catalyst for Keys Accountable Transformation
- 2011 Blue Quality Physician Recognition
- 2012/2013 Accountable Care Shared Savings
Contracting - Cigna
- BCBSNC
7Key Physicians TodayPrimary Care Medical Homes
- 51 Independent Primary Care Practice Locations in
the Triangle - 184 Physicians and 51 Mid-Level Providers
- 11 PCP Practices with 35 Physicians and 13
Mid-Levels in process of joining
8New Models of Care Delivery
- Patient Centered Medical Home The Triple Aim
- Improve the health and safety of the population
served - Improve the experience of each individual
- Improve affordability as measured by the total
cost of care - Accountable Care Organizations (ACOs)
- Medical Home on Steroids
- Exclusive or Preferred Networks
- Clinical Integration
- Interdependence Cooperation across an
exclusive provider network - Care Coordination and Care Management
- Capability to measure and report quality and
value
9Patient Centered Medical HomePrinciples
- Personal physician
- Physician directed medical practice
- Team approach
- Whole person orientation
- Coordination of care
- Quality safety
- Enhanced access
- Payment for added value
10Key Physicians Goals
- Support Member Practices with PCMH and BQPP
- Position Key for Success in Accountable Care
(ACO) Contracting - IT System Requirements
- Care Management Resources
- Accountable Transformation of Network
- 2010 Patient Centered Medical Home Recognition
- 2012 Virtual Integration across Medical
Neighborhood - Infina Intelligent Care Coordinator
- 2012 Accountable Care Contracting as a Network
- 2013/2014 Clinical Integration
11Defining the ACO
- CMS Accountable Care Organization is an
organization of health care providers that agree
to be accountable for the quality, cost, and
overall care of Medicare beneficiaries who are
enrolled in the traditional fee-for-service
program who are assigned to it. The ACO will
promote evidence based medicine, be able to
report quality and cost measures, and coordinate
care including the use of technological systems. - HIMSS ACOs are provider organizations that
accept responsibility and financial risk for the
cost and quality of care delivered to a specific
population of patients cared for by the
organizations and clinicians. The collaborative
effort of the ACO model centers on the patient by
coordinating and managing care to deliver
wellness, economic and clinical value rather than
treating episodes of disease and sickness. - Key Physicians Definition A provider-led
organization whose mission is to manage the full
continuum of care and be accountable for the
overall costs and quality of care for a defined
population.
12Keys ACO Network
13Accountable Care Contracting
- Integration Connect Medical Homes to Medical
Neighborhood - Co-Management Agreements for patient care and
adherence to evidenced based guidelines - Electronic communication , referral tracking and
care coordination - Population Management
- Care Coordinators (Patient Care Advocates)
- Actionable Data shared by Health Plan to ACO
- Physician Identifies and Refers High Risk
Patients - Discharge Planning and Gaps in Care
- Valued member of the care team
14Current Tactical Focus
- Patient Steerage to High Quality / Value
Providers - Keys ACO Network
- Urgent Care
- Cigna Care Designated / BCBS Tier 1 Practice
Specialists - Co-Management Agreements
- Choosing Wisely Awareness and Mind-Set
- Address Preventable Events
- Duplicate Services, Un-needed Services, Avoidable
ED visits, Readmissions, Reducing Complications - Delivery System Redesign Patient/Population
Management - Care coordination, Care transition,
Post-discharge management - Patient engagement and education (Employers,
Insurers/Payers, Practice, Community)
15Medium Term Priorities
- Improve Quality and Reduce Costs
- Quality HEDIS
- Costs Avoidance, Reducing Price Variation
- Expand the ACO Network
- Counties outside of Wake County
- Network Identification/Marketing
- Ensuring patients are steered (via benefit
design) to our practices, never away from them - Employers, Insurance Companies, Third Party
Providers - Information Technology
- Integrating EMRs
- Sharing Information
- Within the network
- From health systems/data systems outside the
network - Patient engagement and education
16Future Strategic ElementsProviding Value Based
Care in a more complex market
Population Mgmt - Case Specific - Disease
Themes - Organize around Medical Condition
Broad
Moderate
Population Mgmt - Case Specific - Disease Based
Narrow
Population Mgmt Case Specific
High
Moderate
Low
Insurance Price Sensitivity
17Value Driven Health Care
- Key Physicians
- Primary Care based
- HEDIS based quality metrics
- Shared cost savings based contracting
- Viable independent primary care physicians and
specialists within an interdependent network - Integrating patient data systems without a single
EMR - Population management across the network
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