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Integra Continuum Of Care

Integra Continuum Of Care



Integrated Care System

Integrated Care System



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    Integra Continuum Of Care Integra Continuum Of Care Presentation Transcript

    • Integra HealthCare Centers, Inc. Integrated Care Program Utilizing a “Continuum of Care” to optimize patient care and practice revenues
    • Quality of Care: Standards of Care: - Patient Experience - Evidence Based Medicine - Patient Education - Clinical Guidelines -Patient Outcomes - Payer Guidelines IPU Clinical Program Continuum of Care: Communication: - Assessment - Patient Progress - Therapies - TEAM Communication - Management - Community Outreach
    •  INTEGRATED CARE DEFINED  Integrated care program model is Biopsychosocial vs. Biomedical  Defined around medical conditions, not business process  Condition based comprehensive services provided  Organized around medically integrated practice units (IPU’s)  Distinctive care delivery strategy offered in each practice unit  Patient results, experience, and methods measured, reported, communicated  Services marketed based on excellence, uniqueness, and results
    •  TYPES OF SERVICES PROVIDED – DIFFERENTIATION  Comprehensive assessment/diagnosis emphasis  Differentiation based on the comprehensiveness of services provided over the care cycle (Continuum of Care)  Emphasis on comprehensive assessment, integrated therapies, and condition management vs. acute care treatment  Distinguished based on IPU model (patient centric)  Distinguished based on availability of services (access to care)  Distinguished based on Continuity of Care (care consistency)
    •  CHRONIC CARE CONDITIONS – EDUCATION & AWARENESS  Multiple provider coordinated delivery system  Patient centric self-management initiatives  Community wide education initiatives to improve health  All stakeholders included (employers, allied health providers, social service organizations)  Comprehensive lifestyle education opportunities  Utilization of information management systems for health & lifestyle education initiatives
    • The foundation of an Integrated Practice Unit (IPU) consists of three components… • Patient Experience Quality of Care • Patient Education • Patient Outcomes • Evidence Based Standards Medicine of Care • Clinical Guidelines • Payer Guidelines • Prevention Continuum • Assessment of Care • Therapies • Management
    • Quality of Care - Defined Patient Experience Quality of Care Patient Patient Education Outcomes Utilizing processes and systems to make “QUALITY” measurable
    •  HOW DO WE MEASURE QUALITY? Patient Experience (measurement of satisfaction) Patient Education (measurement of understanding) Patient Outcomes (measurement of progress)
    • Agreeing on a definition of quality of care may be healthcare's biggest challenge…  QUALITY OF CARE GOALS  Comprehensive assessment/diagnosis  Interdisciplinary therapies, individualized to the patients needs  Medical Condition Management (measure, report, communicate)  Education and support resources that allows patients to understand and cope with their illness/disease  Communication between all of the stakeholders in the care delivery process (patient, provider, payer)  Measurement and reporting of entire quality of care cycle
    •  PATIENT EXPERIENCE  A measure of patient satisfaction should be reportable to entire patient population  Goal is to have patients experience a positive experience and enhance their quality of life  Practice Environment ( a measure of satisfaction)  Satisfaction surveys (quality measures)  Will they refer friends and neighbors  3 levels of satisfaction (dissatisfied, satisfied, prophet)
    • PATIENT EDUCATION  A measure of how well the patient understands their disease/condition  Measure of patient involvement in the treatment and/or management of their condition  Objective measurement should include patient knowledge assessment tools, group education, and/or journal entries  Comprehensive patient resources are provided as a component of care
    •  PATIENT OUTCOMES  Use this measure for patient progress, not physician performance  Use concrete metrics to determine the therapeutic progress made  Use objective versus subjective quantifiable clinical information to help patients understand their condition and “plan of care” CORE OUTCOMES DOMAINS:  Pain QVAS (4 components – now, average, best, worst)  Physical Functioning (range of motion, muscle weakness/strength, pain intolerance, grip, pinch)  Emotional Functioning (quality of life, activities of daily living)  Experience and Satisfaction (access, communication, administration, environment, information provided, pre-visit communication)  Understanding of Condition (medical condition education, self – management)
    • Evidence Based Medicine Standards of Care Payer Clinical Guidelines Guidelines Building an evidence based practice with evidence based medicine, clinical guidelines, and payer guidelines based on patient differential and/or working diagnosis
    •  EVIDENCE BASED MEDICINE: Clinical Research / Trials • www.nih.gov Cochrane Collaboration • www.cochrane.org Scientific Literature Review • www.mdconsult.com
    •  CLINICAL GUIDELINES  E-Medicine • www.emedicine.com  National Guidelines Clearinghouse • www.guidelines.gov  Institute for Clinical Systems Improvement • www.icsi.org  American College of Environmental and Occupational Medicine • www.acoem.org
    •  PAYER GUIDELINES  The identification of clinically correct, medically necessary processes and procedures for which payers will provide reimbursement  ODG Treatment  BCBS Technology Evaluation Committee  Medicare, BCBS, Aetna, others
    • Comprehensive Assessment Continuum of Care Medical Interdisciplinary Condition Therapies Management Defined as the delivery of health care services over a period of time. In patients with a chronic medical condition, this covers all phases of illness from diagnosis to the end of life.
    •  DIAGNOSIS/ASSESSMENT IS PROCESS DRIVEN  Process is used to develop a plan of care based on “Components of Care” for chronic medical conditions:  Physician Decision Support Toolset  Utilizes “Key Clinical Markers”  Location, duration, frequency, character  Measure, Report, Communicate  Neurological, Mechanical, Compressive, Inflammatory  BioPsychosocial vs. BioMedical
    • Mechanical Pain ACUTE Neuropathic Inflammatory SUB-ACUTE Pain Pain CHRONIC Muscle Pain
    •  Components of Care in a Integrated Care Program:  Comprehensive Assessment (differential to working diagnosis)  Integrated Therapies (patient plan of care)  Medical Condition Management (coordination of care)  Stakeholder Communication (communication with all interested stakeholders in the care delivery process)  Measurement and Reporting of Patient Progress (patient outcomes)
    • COMPREHENSIVE ASSESSMENT Evaluation Radiological Studies Behavioral Assessment Differential Functional Assessment Diagnosis Interventional Studies Physiological Studies Working Diagnosis
    •  INTEGRATED THERAPIES Working Diagnosis Behavioral Therapies Functional Therapies Plan of Care Interventional Therapies Pharmacological Therapies Maximum Medical Durable Medical Equipment Improvement
    •  MEDICAL CONDITION MANAGEMENT CAM Behavioral Management Therapies Functional Management Pharmacological Management Patient Education Alternative Medicine Complimentary Medicine Long Term Management
    • COMMUNICATION Critical to the treatment process Payer Provides outreach opportunities Communicate Progress Patient Provider
    •  MANAGEMENT Measuring processes and progress Progress reporting Outcome measures Objective information - patient pain levels Objective information - functional improvements Objective information – quality of life measures
    • Multiple Specialty Consultations Integrated Practice Unit Services - Competition - Specialties Differentiation Integrated practice unit differentiation from competition is achieved with the level of and types of services provided.
    • Restoration of Function Quality of Life Less Pain Integra HealthCare Centers, Inc.