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Munroe regional md education session 09 16-2011
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Munroe regional md education session 09 16-2011


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Integrated Health Systems

Integrated Health Systems

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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
  • Transcript

    • 1. Munroe Regional Medical Center
      Physician Education Session
      Prepared for:
      Key Physician Stakeholders
      Munroe Regional Medical Center
      Ocala, FL
      July 11, 2011
    • 2.
    • 3. Ken Keller
      Vice President
      Chris Rowe
      Vice President
    • 4.
    • 5. Munroe Regional Medical Center
      Medical Staff Education Session
      Prepared for:
      Medical Staff
      Munroe Regional Medical Center
      Ocala, FL
      September 15, 2011
    • 6. 6
      Southwind Team
      Ken Keller
      Vice President
      Chris Rowe
      Vice President
    • 7. 7
      Requirements for Success Linked to Payment Endgame
      Common Foundation of Physician/Hospital Initiatives for Success
      Hospital-Physician Bundling
      Shared-Savings Model
      • Collaborate with physicians
      • 8. Invest in chronic disease management
      • 9. Reduce utilization
      • 10. Collaborate with post-acute providers
      • 11. Standardize care site transitions
      Degree of Management Challenge
      • Standardize devices
      • 12. Reduce orders and consults
      • 13. Track and analyze performance
      • 14. Standardize care processes
      • 15. Align physician incentives
      • 16. Engage full physician enterprise
      Actions needed under all payment reforms
      Provider Quality and Cost Accountability
      Source: Health Care Advisory Board interviews and analysis; Southwind.
    • 17. 8
      Foundation for Aligning Independent Physicians
    • 18. 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
    • 19. 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”
    • 20. 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.”
    • 21. 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
      • 22. Involves all physicians in 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
    • 23. 13
      Forming the Clinically Integrated Organization
      The Two Step Process at Munroe Regional Medical Center
      Step One – Strategy Formulation
      Stakeholder Analysis
      Gap Analysis
      • Focus groups and interviews
      • 24. Review of key documents and strategic priorities
      • 25. Market conditions assessment
      • 26. Structure and staffing infrastructure
      • 27. Clinical protocols and performance targets
      • 28. Data monitoring and report processing
      • 29. Technology infrastructure
      • 30. Goal clarification and stakeholder identification
      • 31. Education and Q&A sessions with key executive and physician leaders
      • 32. Identify potential physician champions
      Step Two– Strategy Implementation
      Providing legal counsel and support
      Enfranchising key stakeholders
    • 33. 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.
      Program Development
      • 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
      Operations Development
      • Develop the organizational structure, documents, contracts and related policies and procedures for the CI program
    • Discussion, Questions and Answers
    • 34. 16
      Our Commitment to You
      Ken Keller
      Vice President
      Chris Rowe
      Vice President
      Please do not hesitate to contact your team with any questions or comments.