Munroe Regional Medical Center<br />Physician Education Session<br />Prepared for:<br />Key Physician Stakeholders<br />Mu...
Ken Keller<br />Vice President<br />Chris Rowe<br />Vice President<br />
Munroe Regional Medical Center<br />Medical Staff Education Session<br />Prepared for:<br />Medical Staff<br />Munroe Regi...
6<br />Southwind Team<br />Ken Keller<br />Vice President<br />Chris Rowe<br />Vice President<br />
7<br />Requirements for Success Linked to Payment Endgame<br />Common Foundation of Physician/Hospital Initiatives for Suc...
Invest in chronic disease management
Reduce utilization
Collaborate with post-acute providers
Standardize care site transitions</li></ul>Degree of Management Challenge<br /><ul><li>Standardize devices
Reduce orders and consults
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Munroe regional md education session 09 16-2011

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  • CI is the foundation that underpins any of the revised payment formatsCI needed to do any and/or allCI supports development of ACO requirements; whatever that may be
  • Munroe regional md education session 09 16-2011

    1. 1. Munroe Regional Medical Center<br />Physician Education Session<br />Prepared for:<br />Key Physician Stakeholders<br />Munroe Regional Medical Center<br />Ocala, FL<br />July 11, 2011<br />
    2. 2.
    3. 3. Ken Keller<br />Vice President<br />Chris Rowe<br />Vice President<br />
    4. 4.
    5. 5. Munroe Regional Medical Center<br />Medical Staff Education Session<br />Prepared for:<br />Medical Staff<br />Munroe Regional Medical Center<br />Ocala, FL<br />September 15, 2011<br />
    6. 6. 6<br />Southwind Team<br />Ken Keller<br />Vice President<br />Chris Rowe<br />Vice President<br />
    7. 7. 7<br />Requirements for Success Linked to Payment Endgame<br />Common Foundation of Physician/Hospital Initiatives for Success<br />Pay-for-Performance<br />Hospital-Physician Bundling<br />Shared-Savings Model<br />Episodic <br />Bundling<br /><ul><li>Collaborate with physicians
    8. 8. Invest in chronic disease management
    9. 9. Reduce utilization
    10. 10. Collaborate with post-acute providers
    11. 11. Standardize care site transitions</li></ul>Degree of Management Challenge<br /><ul><li>Standardize devices
    12. 12. Reduce orders and consults
    13. 13. Track and analyze performance
    14. 14. Standardize care processes
    15. 15. Align physician incentives
    16. 16. Engage full physician enterprise</li></ul>Actions needed under all payment reforms<br />Provider Quality and Cost Accountability<br />Source: Health Care Advisory Board interviews and analysis; Southwind. <br />
    17. 17. 8<br />Foundation for Aligning Independent Physicians<br />
    18. 18. 9<br />Goals of Clinical Integration<br />Goals of Clinical Integration<br />Create a platform for the physicians and Munroe Regional to:<br />Optimize clinical outcomes<br />Enhance patient experience<br />Create a culture of working together as a clinically integrated system<br />Improve clinical outcomes through accelerating the adoption of evidence based protocols/medicine, clinical information technologies, and quality improvement techniques;<br />Enable greater coordination of care among physicians and Munroe Regional across the continuum of care;<br />Reduce unnecessary utilization, improve efficiency, and control the cost of care;<br />Enable joint contracting with FFS payers based upon demonstrated ability to improve performance with financial incentives for continued improvement; and <br />Align incentives for all those involved in healthcare financing and delivery<br />
    19. 19. 10<br />What does Clinical Integration Achieve? <br />Benefits of Clinical Integration<br />Collaboration among physicians and hospital(s) in a way that increases the quality and efficiency of patient care;<br />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;<br />Comprehensive physician networks which are able to assert themselves forthrightly in legally compliant collective negotiations with fee for service health plans; and <br />The foundation and infrastructure for succeeding in the upcoming era of “accountable care”<br />
    20. 20. 11<br />Legal Compliance at Core of Success<br />“Clinical Integration” Coined by the FTC<br />Recognizes joint contracting may be acceptable on the basis of value creation for patients and payers<br />Establishes a “Clinical Integration” concept as a defense against price-fixing challenges<br />Allows for layering CI-related contracts on top of existing models of economic alignment <br />Provides general concepts but limited detail on desired CI program structure<br />“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.” <br />
    21. 21. 12<br />CI Gaining Momentum Across Diverse Systems<br />Three Bright Lines for Program Design<br />Program must be “real”<br /><ul><li>Containing authentic initiatives, actually undertaken by the network
    22. 22. Involves all physicians in the network</li></ul>Promotes collaboration and interdependence so physicians can achieve more than they likely could independently<br />Program initiative have the potential to achieve “likely improvements” in health care quality and efficiency<br />Joint contracting with fee-for-service health plans is “reasonably necessary” to achieve the efficiencies of the Clinical Integration program<br />
    23. 23. 13<br />Forming the Clinically Integrated Organization<br />The Two Step Process at Munroe Regional Medical Center<br />Step One – Strategy Formulation<br />Stakeholder Analysis<br />Education/Identification<br />Gap Analysis<br /><ul><li>Focus groups and interviews
    24. 24. Review of key documents and strategic priorities
    25. 25. Market conditions assessment
    26. 26. Structure and staffing infrastructure
    27. 27. Clinical protocols and performance targets
    28. 28. Data monitoring and report processing
    29. 29. Technology infrastructure
    30. 30. Goal clarification and stakeholder identification
    31. 31. Education and Q&A sessions with key executive and physician leaders
    32. 32. Identify potential physician champions</li></ul>Step Two– Strategy Implementation<br />Providing legal counsel and support<br />Enfranchising key stakeholders<br />
    33. 33. 14<br />Key Functions of a Clinical Integration Program<br />Program Leadership<br /><ul><li>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.</li></ul>Program Development<br /><ul><li>Develop quality performance measures for services across the care continuum including hospitals, physicians, ambulatory providers and ancillary care providers.</li></ul>Infrastructure Development and Support<br /><ul><li>Ensure technology infrastructure and processes for collecting, sharing, and monitoring data and performance are optimized to support performance improvement and reporting</li></ul>Operations Development<br /><ul><li>Develop the organizational structure, documents, contracts and related policies and procedures for the CI program</li></li></ul><li>Discussion, Questions and Answers<br />15<br />
    34. 34. 16<br />Our Commitment to You<br />Ken Keller<br />Vice President<br />Chris Rowe<br />Vice President<br />KellerK@advisory.com<br />818.669.2180<br />RoweC@advisory.com<br />985.788.1522<br />Please do not hesitate to contact your team with any questions or comments.<br />
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