Integrated Care System

1. Integra HealthCare Centers, Inc.
Integrated Care Program
Utilizing a “Continuum of Care” to optimize patient care and
practice revenues

2. Quality of Care: Standards of Care:
- Patient Experience - Evidence Based Medicine
- Patient Education - Clinical Guidelines
-Patient Outcomes - Payer Guidelines
IPU
Clinical Program
Continuum of Care: Communication:
- Assessment - Patient Progress
- Therapies - TEAM Communication
- Management - Community Outreach

3.  INTEGRATED CARE DEFINED
 Integrated care program model is Biopsychosocial vs. Biomedical
 Defined around medical conditions, not business process
 Condition based comprehensive services provided
 Organized around medically integrated practice units (IPU’s)
 Distinctive care delivery strategy offered in each practice unit
 Patient results, experience, and methods measured, reported,
communicated
 Services marketed based on excellence, uniqueness, and results

4.  TYPES OF SERVICES PROVIDED – DIFFERENTIATION
 Comprehensive assessment/diagnosis emphasis
 Differentiation based on the comprehensiveness of services provided
over the care cycle (Continuum of Care)
 Emphasis on comprehensive assessment, integrated therapies, and
condition management vs. acute care treatment
 Distinguished based on IPU model (patient centric)
 Distinguished based on availability of services (access to care)
 Distinguished based on Continuity of Care (care consistency)

5.  CHRONIC CARE CONDITIONS – EDUCATION & AWARENESS
 Multiple provider coordinated delivery system
 Patient centric self-management initiatives
 Community wide education initiatives to improve health
 All stakeholders included (employers, allied health providers, social service
organizations)
 Comprehensive lifestyle education opportunities
 Utilization of information management systems for health & lifestyle
education initiatives

6. The foundation of an Integrated Practice Unit (IPU) consists of three components…
• Patient Experience
Quality of
Care
• Patient Education
• Patient Outcomes
• Evidence Based
Standards Medicine
of Care • Clinical Guidelines
• Payer Guidelines
• Prevention
Continuum • Assessment
of Care • Therapies
• Management

7. Quality of Care - Defined
Patient
Experience
Quality
of Care
Patient Patient
Education Outcomes
Utilizing processes and systems to make “QUALITY” measurable

8.  HOW DO WE MEASURE QUALITY?
Patient Experience (measurement of satisfaction)
Patient Education (measurement of understanding)
Patient Outcomes (measurement of progress)

9. Agreeing on a definition of quality of care may be healthcare's biggest challenge…
 QUALITY OF CARE GOALS
 Comprehensive assessment/diagnosis
 Interdisciplinary therapies, individualized to the patients needs
 Medical Condition Management (measure, report, communicate)
 Education and support resources that allows patients to understand and
cope with their illness/disease
 Communication between all of the stakeholders in the care delivery
process (patient, provider, payer)
 Measurement and reporting of entire quality of care cycle

10.  PATIENT EXPERIENCE
 A measure of patient satisfaction should be reportable to entire patient
population
 Goal is to have patients experience a positive experience and enhance
their quality of life
 Practice Environment ( a measure of satisfaction)
 Satisfaction surveys (quality measures)
 Will they refer friends and neighbors
 3 levels of satisfaction (dissatisfied, satisfied, prophet)

11. PATIENT EDUCATION
 A measure of how well the patient understands their disease/condition
 Measure of patient involvement in the treatment and/or management
of their condition
 Objective measurement should include patient knowledge assessment
tools, group education, and/or journal entries
 Comprehensive patient resources are provided as a component of care

12.  PATIENT OUTCOMES
 Use this measure for patient progress, not physician performance
 Use concrete metrics to determine the therapeutic progress made
 Use objective versus subjective quantifiable clinical information to help patients understand their
condition and “plan of care”
CORE OUTCOMES DOMAINS:
 Pain QVAS (4 components – now, average, best, worst)
 Physical Functioning (range of motion, muscle weakness/strength, pain intolerance, grip, pinch)
 Emotional Functioning (quality of life, activities of daily living)
 Experience and Satisfaction (access, communication, administration, environment, information provided,
pre-visit communication)
 Understanding of Condition (medical condition education, self – management)

13. Evidence
Based
Medicine
Standards
of Care
Payer Clinical
Guidelines Guidelines
Building an evidence based practice with evidence based medicine, clinical
guidelines, and payer guidelines based on patient differential and/or working
diagnosis

14.  EVIDENCE BASED MEDICINE:
Clinical Research / Trials
• www.nih.gov
Cochrane Collaboration
• www.cochrane.org
Scientific Literature Review
• www.mdconsult.com

15.  CLINICAL GUIDELINES
 E-Medicine
• www.emedicine.com
 National Guidelines Clearinghouse
• www.guidelines.gov
 Institute for Clinical Systems Improvement
• www.icsi.org
 American College of Environmental and Occupational Medicine
• www.acoem.org

16.  PAYER GUIDELINES
 The identification of clinically correct, medically
necessary processes and procedures for which payers will
provide reimbursement
 ODG Treatment
 BCBS Technology Evaluation Committee
 Medicare, BCBS, Aetna, others

17. Comprehensive
Assessment
Continuum
of Care
Medical
Interdisciplinary
Condition
Therapies
Management
Defined as the delivery of health care services over a period of time.
In patients with a chronic medical condition, this covers all phases
of illness from diagnosis to the end of life.

18.  DIAGNOSIS/ASSESSMENT IS PROCESS DRIVEN
 Process is used to develop a plan of care based on “Components of
Care” for chronic medical conditions:
 Physician Decision Support Toolset
 Utilizes “Key Clinical Markers”
 Location, duration, frequency, character
 Measure, Report, Communicate
 Neurological, Mechanical, Compressive, Inflammatory
 BioPsychosocial vs. BioMedical

20. Mechanical
Pain ACUTE
Neuropathic Inflammatory
SUB-ACUTE
Pain Pain
CHRONIC
Muscle Pain

21.  Components of Care in a Integrated Care Program:
 Comprehensive Assessment (differential to working diagnosis)
 Integrated Therapies (patient plan of care)
 Medical Condition Management (coordination of care)
 Stakeholder Communication (communication with all interested
stakeholders in the care delivery process)
 Measurement and Reporting of Patient Progress (patient
outcomes)

22. COMPREHENSIVE ASSESSMENT
Evaluation
Radiological Studies
Behavioral Assessment
Differential
Functional Assessment
Diagnosis
Interventional Studies
Physiological Studies Working
Diagnosis

24.  INTEGRATED THERAPIES Working Diagnosis
Behavioral Therapies
Functional Therapies
Plan of Care
Interventional Therapies
Pharmacological Therapies
Maximum Medical
Durable Medical Equipment Improvement

26.  MEDICAL CONDITION MANAGEMENT CAM
Behavioral Management Therapies
Functional Management
Pharmacological Management Patient
Education
Alternative Medicine
Complimentary Medicine
Long Term
Management

28. COMMUNICATION
Critical to the treatment process
Payer
Provides outreach opportunities
Communicate Progress
Patient Provider

29.  MANAGEMENT
Measuring processes and progress
Progress reporting
Outcome measures
Objective information - patient pain levels
Objective information - functional improvements
Objective information – quality of life measures

30. Multiple
Specialty
Consultations
Integrated
Practice
Unit
Services - Competition -
Specialties Differentiation
Integrated practice unit differentiation from competition is
achieved with the level of and types of services provided.

31. Restoration
of Function
Quality of
Life
Less Pain
Integra HealthCare
Centers, Inc.