OU Sooner HAN (Master) - Community Service Council of Greater

Report
Improving health and healthcare one
network connection at a time . . .
Copyright 2011, Sooner Health Access
Network
The Opportunity
• Need to increase access to care
– Build a network of SoonerCare Providers
• Primary Care
• All Specialties (including behavioral health)
• Other Services
• Poor consumption of social services
– Incorporate Social Services into:
• Clinical Practice
• Everyday lives
Copyright 2011, Sooner Health Access
Network
The Opportunity
• SoonerCare Patient Centered Medical Home
Reduce barriers to achieve tier status
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Tools to enable practices
Operational Design
Assist practices with PCMH audits
QA / QI Projects at macro and micro level
Health Literacy
Care Coordination
Disease Management & Interventions
Prevention
Copyright 2011, Sooner Health Access
Network
The HAN: What is it?
An organization selected by OHCA to:
• Increase Member access by assembling a network of
SoonerCare Providers that incorporates Social Services
• Assist Providers with meeting Tier 3 PCMH Status and
Achieving Meaningful Use
• Provide technology and support to achieve those goals
and improve patient care quality
• Provide improved access to specialists and specialty
care for their SoonerCare patients
• Provide targeted Care Management for selected
populations
Copyright 2011, Sooner Health Access
Network
Care Coordination
Loop Closure
• Lack of care coordination, especially surrounding
care transitions
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Relationship between PCP and specialists has eroded
Volume drives workflows on both sides
Non-clinical personnel drive much of the referral process
Significant numbers of unnecessary visits happen, and
important necessary visits are delayed or missed entirely
– No effective way to monitor quality surrounding care
transitions
Care Coordination
• Provide free software tool to improve care
coordination
• Two components:
– Clerk2Clerk: provides accurate and easy
management of patient referrals and tracking,
24/7 access to specialists
– Doc2Doc: Enables direct provider to provider
conversations about patient cases . . . Some of
which are eligible for reimbursement
Copyright 2011, Sooner Health Access
Network
Status Changed FROM (Phase) by Week; Last Quarter
1/3/2010
1/10/2010
1/17/2010
1/24/2010
1/31/2010
VR Initiation
Scheduling
2/7/2010
Visit
Consult In Progress
2/14/2010
VR Complete
2/21/2010
VR Final Complete
VR Failed
2/28/2010
(blank)
3/7/2010
3/14/2010
3/21/2010
3/28/2010
0
200
400
600
800 2011,
1000
1200 Access
1400
Copyright
Sooner Health
Network
1600
1800
Telemedicine Interactions
• Currently under pilot
• Working with OHCA to gain approval for new
fee schedule for Store and Forward
Telemedicine
– Get 24/7 access to specialists for online
consultations
– Gain insight into patient movements around the
healthcare system– when to see them back
– Get paid to have electronic consultations with
specialists
Copyright 2011, Sooner Health Access
Network
Specialist
The answer is here.
PCP
The question/case is here.
Copyright 2011, Sooner Health Access Network
Copyright 2011, Sooner Health Access Network
Data, Data, Data
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Development of Clinical Analytics Platform
Only group to have full claims data set
Beacon, NQF, HEDIS Measures
Ability to do meaningful and targeted
performance improvement projects
• Mechanism for practices to define
performance improvement projects and
measure their own performance without
investing the analytics resources
Copyright 2011, Sooner Health Access
Network
Better reporting: Data you care about
Prospectively Identify Care Gaps:
• Identify those in need of screens, refills,
treatments
• Follow up on ER visits
• Better communication between providers
• Improved efficiency in the office
All drive & improve business, as well as improve
patient outcomes
Copyright 2011, Sooner Health Access
Network
Enhanced Data Access
• Data provided by HAN from OHCA specific to your
population: ER, cancer screening needs, etc.
Copyright 2011, Sooner Health Access
Network
What is happening to my SoonerCare enrollment over time?
80
Month to Month Population Changes
60
40
20
IM
0
-20
2009-12
2010-01
2010-02
2010-03
2010-04
2010-05
2010-06
2010-07
2010-08
2010-09
2010-10
-40
-60
Where are my SoonerCare patients getting ED care?
Top 7 ED Providers by Month
30
Claremore Regional Hospit
25
Hillcrest Medical Center
20
Jane Phillips Ep Hsp
15
Oklahoma State University Medical Center
10
Saint Francis Hospital
5
Southcrest Hospital
0
St John Med Ctr
2010-08
2010-09
Copyright 2011, Sooner Health Access
Network
Care Management
Dedicated team of Care Managers to serve you
and your patients. Focused on:
• Hemophilia
• Breast Cancer
• Cervical Cancer
• High Risk Pregnancy
• Persistent ER Utilizers
• Pharmacy Lock-In
Copyright 2011, Sooner Health Access
Network
Copyright 2011, Sooner Health Access
Network
Copyright 2011, Sooner Health Access
Network
Lessons Learned
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Relationships are critical
Behavioral comorbidities are key
Social support is a necessity
Clinical & community services must be aligned
You have to go to them
Tomorrow is more important than today
Comprehensive view of member is required
– MyHealth / Beacon
Copyright 2011, Sooner Health Access
Network
One Year In
• Approximate enrollment: 35,000 Members
• Over 689 Providers have joined
• Over 20,000 Referrals using Care Coordination
Tool
• Completed or Active Care Management: 200
• Establishment of Hemophilia Clinic
• 100% Viable Birth Rate in HROB Program
• Continued Growth of Network
• Expansion of Care Management Interventions
Copyright 2011, Sooner Health Access
Network
Who qualifies for this program?
• All Sooner Care Providers
• Appropriate licensures and certifications in
place to practice
• Appropriate med-mal and other insurances in
place
Copyright 2011, Sooner Health Access
Network
How do my members get service?
1. Complete the initial application form
2. Review the Sooner HAN Membership
Agreement
3. Sign the Membership Agreement
4. Communicate your goals to HAN (increase Tier
level, better manage specific populations, etc.)
5. Training of staff and providers
6. Participate
Copyright 2011, Sooner Health Access
Network
More Information?
Matthew Clark
OU School of Community Medicine
[email protected]
918-271-1496
Copyright 2011, Sooner Health Access
Network

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