Key Physicians Value Driven Health Care

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Key PhysiciansValue Driven Health Care

• Conrad L. Flick MD
• John Meier MD, MBA

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Value 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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Value 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.

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The 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
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Wake County/Raleigh Market
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Key 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

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Key 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

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New 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

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Patient 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

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Key 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

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Defining 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.

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Keys ACO Network
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Accountable 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

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Current 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)

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Medium 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

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Future Strategic ElementsProviding Value Based
Care in a more complex market
Population Mgmt - Case Specific - Disease
Themes - Organize around Medical Condition
Broad

• Provider Network

Moderate
Population Mgmt - Case Specific - Disease Based
Narrow
Population Mgmt Case Specific
High
Moderate
Low
Insurance Price Sensitivity
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Value 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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