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
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 />
8<br />Foundation for Aligning Independent Physicians<br />
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 />
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 />
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 />
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
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 />
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
Review of key documents and strategic priorities
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 />
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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