Peer-to-Peer Sessions

Thursday, September 25, 2008

Universal Coverage: Why and How
Allen L. Horn, M.D., President, CentraCare Clinic
This session will provide a foundation for discussing healthcare reform by providing an overview of our escalating national healthcare expenditures, rising health insurance premiums, and the limited value resulting from our spending on medical care. The health and economic consequences of uninsurance and underinsurance for individuals, families, and society will further illustrate that universal coverage is needed. Dr. Horn will discuss five major reform options for achieving universal coverage, as well as describing the unique role that can be played by healthcare professionals in the healthcare reform debate and in advocating for universal coverage.

Reversing the Paradigm: Spending More Money on Doctors and Patients to Save Health Premium and Reinvest the Savings in Technology, Quality, and Access
Tom Doerr, M. D., Practicing General Internist, Esse Health and Cofounder and Chairman, Executive Committee, Essence Group Holdings and Frank Ingari, Chairman and CEO, Essence HealthCare.
This interactive presentation will give a brief overview of Medicare Advantage and report milestones for a model developed at this medical group, including performance metrics that demonstrate strong profitability. The speakers will describe how a Medicare Advantage health plan shares the management of the Medicare premium with medical groups and allows physicians to make decisions about what is best for their patients. Critical success factors will be discussed, as well as the qualifications necessary for medical groups to anchor a similar plan in their market.

Friday, September 26, 2008

Implementing the Guided Care Model of the Medical Home
Chad Boult, M.D., M.P.H., M.B.A., Professor and Director, Lipitz Center for Integrated Health Care Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; and Barbara Cook, M.D., President, Johns Hopkins Community Physicians
Many primary care practices may wish to qualify as “Medical Homes” to receive supplemental management payments as part of a CMS Demonstation. Most practices, however, do not currently provide all of the services required of Medical Homes. This session will provide a guide to providing Medical Home services by adopting the “Guided Care” model of primary care. The session will assist attendees in understanding the model, assessing its alignment with organizational goals, and knowing how to access guidance and tools for implementing the model en route to becoming qualified as a Medical Home.

Implementing a Community-Based Medical Home Coordination System
Rick MacCornack, Ph.D., Chief Systems Integration Officer, Northwest Physicians Network
A Medical Home requires primary medical care to be delivered through a team partnership among all providers and staff who serve the patient, even when the patient receives care in several different locations among different providers. For the Medical Home concept to be functional, there needs to be a system of secure communication and HIE that enables a patient to move among providers and locations with their pertinent medical information available, current, and intact. In the context of a large IPA, Dr. MacCornack describes the structure and performance of an evolving connectivity platform that hosts a provider and patient portal with EMR and automated referral interfaces and direct links to patient data suppliers across the community.

Participating in the CMS Physician Group Practice Demonstration: Lessons Learned
Theodore A. Praxel, M.D., M.M.M., FACP, Medical Director of Quality Improvement and Care Management, Marshfield Clinic
Marshfield Clinic is one of ten Physician Group Practice Demonstration sites. All sites made improvements in quality; however, only two earned a performance payment. Marshfield Clinic achieved substantial savings for CMS in year one of the project. Learn what strategies Marshfield Clinic put in place that contributed to this success. This presentation will define and explore the multiple simultaneous strategies and interventions used to improve quality and reduce hospitalizations. The initiatives that Marshfield Clinic implemented to achieve efficiencies and quality in this demonstration are being utilized for all patients, not just Medicare beneficiaries.

Turning Data into Information: Successful Use of an EMR and Point- of-Care Decision Support tool to Improve Clinical Outcomes and Reduce Variation in a Primary Care Physician Practice
Lister Robinson, R.N., M.B.A., Director of Nursing and Clinical Services, Medical Clinic of North Texas; and Cathy Bryan, R.N., M.H.A., Chief Clinical Officer, CINA
Pay-for-performance (P4P) has been discussed within the healthcare industry for a number of years as the next primary driver toward efforts to improve quality and reduce cost. Last year, Congress authorized funding for the first P4P program through CMS. Although the program is voluntary, it has been re-funded for 2008, a clear indication of continual movement towards some form of performance-based reimbursement. Additionally, commercial payors are continuing to explore similar efforts. This presentation will describe the processes MCNT found successful in uniting a group of 100 physician-owners, practicing in 35 disparate clinics, with a variety of attitudes related to the EMR in general, and moving toward the consistent, guideline-concordant care needed to engage in P4P contracting.

Enhancing Health Care Quality Through a Clinically Integrated Model of Care
Lee Sacks, M.D., Executive Vice President and Chief Medical Officer and President, Advocate Physician Partners; and Mark Shields, M.D., M.B.A., Senior Medical Director, Advocate Physician Partners and Vice President, Medical Management, Advocate Health Care
This presentation will describe the steps required to build a clinically integrated program with proven results in medical outcomes, saved lives, improved productivity, and overall industry cost savings. Drs. Sacks and Shields will discuss the development of an infrastructure, for 2,100 independent and 800 employed physicians, that is able to support a provider-driven, integrated delivery system and achieve dramatic improvements in clinical outcomes. A few of the twenty-one clinical initiatives will be presented as case studies with specifics on program objectives and clinical and financial results.

Transitions of Care: Activating the Patient and the Healthcare System to Improve Patient Transitions Across Care Settings
Rebecca Cline, B.S.N., Onsite Case Manager, Physician Health Partners; and Alan Lazaroff, M.D., President, Geriatric Medicine Associates
Health care has become increasingly fragmented as complex patients require care in multiple settings. Providers have little time to prepare patients for transition to other settings, and processes for communication between providers are non-existent. Each setting is under increasing pressure to move patients through the system quickly, leaving little time to prepare patients and caregivers for a successful transition to the next setting. A Transitions of Care model that addresses the lack of patient knowledge and self-management skills regarding their illness and transition, as well as standard processes for communication of critical health information across care settings is required to successfully address these issues. This presentation will outline a model for activation of both the patient and the health care system to improve care transitions across healthcare settings.

Applying the Theory of Constraints to Ambulatory Care: A Pathway to Efficiency and Quality
Charles O. Frazier, M.D., FAAFP, CPHIMS, Director, Medical Informatics, Riverside Health System; and Peter B. Anderson, M.D., Medical Director, Riverside Hilton Family Practice
There is fairly strong evidence that where there is adequate primary care available in the United States, the cost of medicine is lower and the measured quality is higher. And yet, family medicine, general internal medicine, and general pediatrics are having an extremely difficult time attracting medical students to their specialties. While adequate funding of primary care could solve some of these problems, the outlook for such funding is not particularly rosy. Something has to be done in the way we practice primary care, or it will not survive. Drs. Frazier and Anderson will describe the Theory of Constraints (TOC), its five focusing steps, and how it can be applied to ambulatory practices. They will give a real-world example of how theory of constraints was applied to the practice to create “Team Care.”

Saturday, September 27, 2008

Complexists: Caring for the Complex Patient
Osmundo R. Saguil, M.D., Senior Medical Director, Talbert Medical Group
As our population grows, so too does the prevalence of complex and chronic diseases, such as diabetes and its complications. By definition, these diseases are not curable, but they must be managed to avoid rapid progression of the disease process. Case Management and Disease Management programs have been existence for decades; however, there is often a disjointed effort between different programs and primary physicians, themselves. In order to better coordinate and concentrate costly resources to those patients who need care the most, Talbert Medical Group has developed the Complex Care Program. This is a group approach to healthcare delivery lead by a “Complexist ,” a physician who serves as “captain of the ship” and guides the team members who are case managers, social workers, palliative care specialists, clinical nursing, and front office and back office personnel.

The Role of Leadership and Execution in Improving Care Delivery
Bruce McCarthy, M.D., M.P.H., Chief Medical Officer, Thomas D. Holets, President; and Cheryl A. Hermann, Vice President, Operations, Allina Medical Clinic
Everyone agrees that leadership is the key to successful diffusion of care improvements, but what exactly should the leader be doing? In an interactive session, Allina Medical Clinic will share techniques that have enabled them to successfully lead change across 40 sites. Attendees will discuss and practice communication techniques that will ensure your message is carried intact. Specific techniques that will lead to successful execution while increasing physician and staff in the process will be explored.

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