Munroe Regional Medical Center Medical Staff Education Session Prepared for: Medical Staff Munroe Regional Medical Center Ocala, FL September 15, 2011
6 Southwind Team Ken Keller Vice President Chris Rowe Vice President
7 Requirements for Success Linked to Payment Endgame Common Foundation of Physician/Hospital Initiatives for Success Pay-for-Performance Hospital-Physician Bundling Shared-Savings Model Episodic Bundling
Actions needed under all payment reforms Provider Quality and Cost Accountability Source: Health Care Advisory Board interviews and analysis; Southwind.
8 Foundation for Aligning Independent Physicians
9 Goals of Clinical Integration Goals of Clinical Integration Create a platform for the physicians and Munroe Regional to: Optimize clinical outcomes Enhance patient experience Create a culture of working together as a clinically integrated system Improve clinical outcomes through accelerating the adoption of evidence based protocols/medicine, clinical information technologies, and quality improvement techniques; Enable greater coordination of care among physicians and Munroe Regional across the continuum of care; Reduce unnecessary utilization, improve efficiency, and control the cost of care; Enable joint contracting with FFS payers based upon demonstrated ability to improve performance with financial incentives for continued improvement; and Align incentives for all those involved in healthcare financing and delivery
10 What does Clinical Integration Achieve? Benefits of Clinical Integration Collaboration among physicians and hospital(s) in a way that increases the quality and efficiency of patient care; A powerful business, clinical, and legal strategy for physicians and hospital(s) to thrive within the advent of consumerism, pay-for-performance and mandated transparency; Comprehensive physician networks which are able to assert themselves forthrightly in legally compliant collective negotiations with fee for service health plans; and The foundation and infrastructure for succeeding in the upcoming era of “accountable care”
11 Legal Compliance at Core of Success “Clinical Integration” Coined by the FTC Recognizes joint contracting may be acceptable on the basis of value creation for patients and payers Establishes a “Clinical Integration” concept as a defense against price-fixing challenges Allows for layering CI-related contracts on top of existing models of economic alignment Provides general concepts but limited detail on desired CI program structure “Clinical Integration is an active and ongoing program to evaluate and modify practice patterns by a network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.”
12 CI Gaining Momentum Across Diverse Systems Three Bright Lines for Program Design Program must be “real”
Containing authentic initiatives, actually undertaken by the network
Promotes collaboration and interdependence so physicians can achieve more than they likely could independently Program initiative have the potential to achieve “likely improvements” in health care quality and efficiency Joint contracting with fee-for-service health plans is “reasonably necessary” to achieve the efficiencies of the Clinical Integration program
13 Forming the Clinically Integrated Organization The Two Step Process at Munroe Regional Medical Center Step One – Strategy Formulation Stakeholder Analysis Education/Identification Gap Analysis
Focus groups and interviews
Review of key documents and strategic priorities
Step Two– Strategy Implementation Providing legal counsel and support Enfranchising key stakeholders
14 Key Functions of a Clinical Integration Program Program Leadership
Provide guidance, oversight and finaldecision making on key issues during the CI development process.Provide final approval ofrecommendations from other supportive functions led by physicians.
Develop quality performance measures for services across the care continuum including hospitals, physicians, ambulatory providers and ancillary care providers.
Infrastructure Development and Support
Ensure technology infrastructure and processes for collecting, sharing, and monitoring data and performance are optimized to support performance improvement and reporting
Develop the organizational structure, documents, contracts and related policies and procedures for the CI program
Discussion, Questions and Answers 15
16 Our Commitment to You Ken Keller Vice President Chris Rowe Vice President KellerK@advisory.com 818.669.2180 RoweC@advisory.com 985.788.1522 Please do not hesitate to contact your team with any questions or comments.