Emerging and Evolving Trends in Ambulatory Care - a presentation summary by Phil DeBruzzi. © Copyright 2015. Blue Cottage Consulting. All Rights Reserved.

1. Phil DeBruzzi, FACHE
Emerging and Evolving Trends in
Ambulatory Care
March 27, 2015

2. BLUE COTTAGE CONSULTINGEmerging and Evolving Trends in Ambulatory Care 2
The World is Changing
• Aging population driving
different services
• Payment reform shaping
incentives, care models
• Primary care shortage
hindering access
• Increasing competition
• Technology advances
• Patient financial burden
increasing
16,000
10,000/day

3. BLUE COTTAGE CONSULTINGEmerging and Evolving Trends in Ambulatory Care 3
Value-Based Care Trend Accelerates
Better, Smarter, Healthier: In historic announcement, HHS sets clear
goals and timeline for shifting Medicare reimbursements from volume
to value…
Source: www.cms.gov
“Better care, smarter
spending, healthier
people: Paying providers
for value, not volume.”
January 26, 2015
Value-based
reimbursement
increasing (away
from fee for service)
20172014 20162015 20182013
COMMERCIAL
PAYMENTS
MEDICARE
PAYMENTS
50%
11% 40%
??

4. BLUE COTTAGE CONSULTINGEmerging and Evolving Trends in Ambulatory Care 4
Implication for Providers
• Declining inpatient volumes,
increasing outpatient volumes
posing financial challenges and
requiring performance
improvement across all sites and
resources
• Increased care coordination across
the continuum and among
providers to deliver high value care
• Being patient centered is a given,
shifting to patient engaged is
imperative
• Managing the cost structure of the
entire network is paramount –
‘expect to do less with less’

5. BLUE COTTAGE CONSULTINGEmerging and Evolving Trends in Ambulatory Care 5
Keys for Success
In order to affect
the health of a
population and
be financially
viable…
Access
Patient
Experience
Quality
of
Care
Operational
Efficiency

6. BLUE COTTAGE CONSULTINGEmerging and Evolving Trends in Ambulatory Care 6
The Value of Digital Health

7. BLUE COTTAGE CONSULTINGEmerging and Evolving Trends in Ambulatory Care 7
Emerging Technologies
• TeleHealth
• Scheduling
• mHealth
• Diagnostics
• Patient Portal
• eVisits
• Wellness
• Documentation

8. BLUE COTTAGE CONSULTINGEmerging and Evolving Trends in Ambulatory Care 8
Evolving Operations
Increased patient engagement, changing behaviors
Financial counselors, educators, nurse triage
Team based care, care managers, navigators
Virtual visits and tele-health technology, resources
Re-evaluate physician productivity expectations based on
the above

9. BLUE COTTAGE CONSULTINGEmerging and Evolving Trends in Ambulatory Care 9
Emerging Models
Healthcare System/group of providers
take clinical and financial responsibility
for a patient population
– Communication & Access :
Provider to Provider and
Provider to Patient
– Physician Involvement &
Empowerment
– Data Integration
Accountable Care Organizations/Population Health Management:

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Emerging Models
Penny George Institute at Allina Health
Combining leading medical practice
with ancient healing wisdom to
optimize health and wellness in the
whole person—mind, body and spirit
– promote health through
education, coaching, self-care
and wellness practices
– tap into the body's natural
healing capabilities
– involve individuals as
empowered partners
Integrative Health Centers:

11. BLUE COTTAGE CONSULTINGEmerging and Evolving Trends in Ambulatory Care 11
Emerging Models
Team works together with patient
to enhance continuity and
coordination, encouraging self-
care, measure and managing
patient populations
– Team-Based Care: PCP, RN,
MA, APRN/PA
– Mental Health Integration:
Delivered at PC Office by
psychologist,
LSW
Personalized Primary Care/Patient-Centered Medical Home:

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Emerging Models
Functional Medicine:
Personalized, systems-oriented
model that empowers patients
and practitioners to address
the underlying causes
of disease