Presentation - North Carolina Community Health Center Association

Report
Delivering High Value Care
Through Clinical Integration
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Triad HealthCare Network
Overview
• Triad HealthCare Network is a new Clinically Integrated
Network that has formed in the Piedmont Triad area.
• THN is a new model of care designed to bring employed
physicians, independent physicians, and Cone Health into a
more clinically and financially aligned business partnership
to improve access, improve quality and lower costs.
• THN seeks to better prepare its members for the inevitable
changes to the nation’s health care system driven by either
or both government and market-based reform.
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Triad HealthCare Network
Structure and Governance
MANAGEMENT
Executive Medical Director
Thomas Wall, M.D.
Board of Managers
Executive Director
Steve Neorr
Nominating
Committee
21 members:
17 Physicians (9 Ind./8 Emp.)
3 Cone Representatives
1 Community Representative
Credentialing
Committee
Initial and ongoing
membership criteria
Operating
Committee
Quality
Set clinical
performance criteria
and review member
performance
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8 members:
3 Physicians (2 Ind./1 Emp.)
2 Cone Representatives
3 Community Representatives
Assist development
of physician board
memberships
Oversees day-to-day
operations
Contracting and
Finance
Committee
Look at 3rd-party agreements
and determine potential
bonus distributions
Triad HealthCare Network
Proposed Quality Committee Structure
Quality Committee
Patrick Wright, M.D. – Chairman
Mary Jo Cagle, M.D. – Vice Chairman
Medicine
CPC
Primary Care
CPC
Heart and
Vascular CPC
Surgery
CPC
Women’s and
Children’s CPC
Hospital Clinical
Services CPC
Carl Gessner, MD
John Bednar, MD
Doug Shaw, MD
Yvonne Lowne, DO
Ed Gerhardt, MD
Tom Stuckey, MD
David Newman, MD
John Hewitt, MD
Kelly Leggett, MD
Ron Young, MD
Practice
Management
Josh Kish, MD
Mark Shogry, MD
John Nosek
TBD
Administrative Chair
Administrative Chair
Administrative Chair
Administrative Chair
Administrative Chair
Administrative Chair
Administrative Chair
Ob/Gyn
Pathology
Neonatology
Radiology
Pediatrics
Radiation
Oncology
Cardiology
Anesthesia
Gastroenterology
Family Medicine
Hem/Oncology
Internal Medicine Cardiovascular Surg. General Surgery
Infectious Disease
Hospital Medicine
Nephrology
Psychiatry
Vascular Surgery
Orthopedics
Ophthalmology
Rheumatology
ENT
Dermatology
Urology
Emergency Medicine
Neurosurgery
Endocrinology
Hospital Medicine
Pulmonology
Hospice /Palliative Care
Neurology
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Community
Practice
Administrators
ADMINISTRATIVE CHAIRS
would be composed of Cone Health
System employees or non-physician
health leaders – Hospital presidents,
vice presidents, directors of nursing,
practice administrators, etc.
Value for Physicians
• THN to provide value-added services and resources to assist
practices
– Deployment of Clinical Performance Reporting System to:
• Capture and analyze clinical data
• Implement in-office Point-of-Care decision support
• Generate patient disease registries
– Case Management
– Assistance to achieve Meaningful Use and Patient-Centered
Medical Home recognition
– Submission of quality measures for the Physician Quality Reporting
System (PQRS)
– Joint contracting for quality/cost savings incentive plans with payers
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Triad HealthCare Network
Business Strategy
Insurers and
Employers
P4P
Shared Gain
Savings Sharing
Negotiated
Incentive-Based
Contracts
Continue Current
Fee-For-Service
Claims & Payment
Structure
Quality
Bonus Payout
Based On THN
Goals and
Performance
Measures
Clinical Performance
Reporting System
POC, Registry, Performance Data
Physicians
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Claims and EMR Data
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Clinical Performance
Reporting System is Critical
Data from Practice
Management
Systems
Data from EMRs
Clinical
Data
Repository
(“CDR”)
Clinical
Protocol
Engine
Point-of-Care
Decision Support
• “Real “ time
• Patient Summary
• Preventive Care &
CDM Reminders
Patient
Disease
Registries
Data from
Hospitals
Practice
Performance
Feedback
Lab data from
Reference Labs
Pharmacy data
Data is extracted,
aggregated,
standardized and
stored by a third-party
intermediary vendor
Data is processed through
protocols and algorithms
to support clinical metrics
and benchmarks
established by Physicians
Electronic claims
data from payers
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Web Portal Access
and Reporting
External Reporting
• Community
• NCQA, BTE
• PQRS
• Payers
Sample Clinical Decision Support
at the Point-of-Care
Practice Performance Feedback
Diagnoses and
Meds are
prioritized to
highlight chronic
conditions
Targeted
reminders for
nursing staff
allow better
leverage of
provider time
and more
efficient
workflow
Labs,
Calculations and
Diagnostic
Procedures
pertinent to the
Action Items are
displayed for
easy reference
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Goals Not Met
are highlighted
for quick
reference and
visibility
Information Technology/Analytics Systems
Health Information Exchange (“HIE”)
Clinical Performance Reporting System
• Expertise in clinical data extraction
• Provides clinical protocol engine
• Point-of-care reports
• Patient disease registries
• “Manual” population analytics
• Claims data integration
• Reports compliance with metrics
• Submits PQRS/ACO data to CMS
PCPs with EMRs
Specialists w/
EMRs using POC
Claims Data from
Payers
• Expertise in community data aggregation
• Provides longitudinal view of patient across
community – all pertinent activity over time
• Interfaces with EHRs
• Master Patient Index (“MPI”)
• Provides portal view to all providers
• Ability to enter data for non-EMR physicians
CPRS
Clinical
Data
Repository
HIE
Community
Data
Repository
All Other PCPs and
Specialists
Data from
Hospitals
Pharmacy data
Lab data from
Reference Labs
Radiology
Population analytics, utilization, case management module
• “Automatic” population analytics - patient stratification
• Prospective identification of patient risk – case mgmt targets
• Retrospective analytics – utilization and cost efficiency
• Admits/1000, hi-tech imaging, ETGs - Episode Treatment Groups
• Identify opportunity for savings and improvement
• Case Management module – care documentation, communication
• Patient portal – patient engagement
HIE View
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HIE View
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Triad HealthCare Network
Membership Requirements
Physician Eligibility
Requirements
Physician Participation
Requirements
– North Carolina Licensure
– Participation Agreement
– Clinical Integration Program
– Education
– Compliance
– Quality Assurance
– Provide Claims/Clinical
Information
– All-Contracts Participation
– High-speed internet
– Actively Used E-mail
– Attend Orientation
– Board Certification
– DEA License
– Liability Insurance
– Credentialing Requirements
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Opportunities
• Medicare Shared Savings Program
– Submitted application to participate as an “ACO” with Medicare
effective July 1, 2012
– Submitted 170 adult Primary Care Physician network with
application – 5 counties – will include over 34,000 beneficiaries
– Will seek conversion from opt-in to executed participation
agreements for specialists by June 30, 2012
– Must report and meet 33 “quality” metrics to access savings
• All major payers interested in discussing arrangement
• Cone Health Employee population (12,000+)
– Development of THN-based “narrow” network
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Triad HealthCare Network Value
Practice Performance Feedback
GIVE
GET
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Cone Health
Physicians
Financial
Support,
Resources
Commitment,
Participation,
Leadership
Performance
Incentive
Payments
Trust,
Proactive
Involvement
Efficiency,
Partnership,
Mission
Increased
Efficiency,
Coordination
Transparency,
Efficiency,
Quality
Better
Health
Care
Cone Health
Physicians
Payers
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Payers
Patients
Patients
Questions?
For further information, please visit
www.TriadHealthCareNetwork.com or
call (855) 4 THN NOW (484-6669)
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