Population Health

Wednesday, March 25, 2015
2:00 p.m. – 3:15 p.m.

A Blueprint for Building an Internal Quality and Cost-Efficiency Infrastructure
Timothy Harlan, MD, Assistant Dean for Clinical Affairs, Tulane University Medical Group
Eric Gallagher, MBA, Director of Clinical Services and Payer Contracting, Tulane University Medical Group
This case study will highlight the Tulane University Medical Group, a large multispecialty and academic medical group, and their experiences in building an internal quality, cost-efficiency, and population health infrastructure.  This presentation will provide you with a roadmap―including challenges, opportunities, and lessons learned―that will aid in perfecting your organization’s population health strategy.

Overcoming Psychosocial Hurdles During Transition of Care Interventions
Matt Eisenhower, Director of Foundation and Community Health Development, PeaceHealth Medical Group
Peter Rice, MD, Medical Director, PeaceHealth Medical Group
PeaceHealth Ketchikan Medical Center in Alaska was chosen by the Centers for Medicare and Medicaid Services (CMS) for a demonstration project focusing on primary care redesign in rural settings, with the goal of reducing unnecessary hospital readmissions.  The resultant program uses care coordinators to facilitate better project management with a special focus on mental health and psychosocial issues. This new program is demonstrating the effectiveness of an integrated psychosocial and nursing approach for transition of care of patients leaving the in-patient environment, and has produced significant improvements in clinical and financial outcomes.  Learn the “on-ramp” details of building a program that you can emulate to improve your care transition processes.

Wednesday, March 25, 2015
3:45 p.m. – 5:00 p.m.

Leading Change by Using Metrics to Focus on Patient-Centered Service
Stephen Russ, MD, Associate Professor, Emergency Medicine, Associate Chief of Staff, Vanderbilt Access Services, Vanderbilt Medical Group
Paul Schmitz, MLAS, EPIC Certified, Director, Capacity Management Department, Vanderbilt Access Services, Vanderbilt Medical Group
Initiating a custom access toolkit with transparent data reporting at the individual and institutional level is one approach to help change the internal dialogue and execute action plans.  Learn how Vanderbilt Medical Group took this approach to transition to a population health strategy.  In this presentation, Vanderbilt Medical Group will share their experience during this transition―including their processes, barriers, and wins―to help you shorten your learning curve in adopting a population health strategy.
Patient Engagement and the Learning Organization:  Lessons, Outcomes, and Next Steps
Valerie Overton, DNP, VP of Quality and Innovation, Fairview Medical Group
Patient activation is a patient-reported measure of health that has been shown to be related with improved Triple Aim outcomes.  This session will describe how Fairview Medical Group has utilized patient activation to drive population health, including their current outcomes, struggles, successes, new care pathways, IT implications, and next steps for promoting patient activation.

Succeed with Population Health Management in a Fee-for-Service Environment While Transitioning to Value-Based Care
Michael J. Tronolone, MD, MMM, Chief Medical Officer, The Polyclinic
Michelle Matin, MD, Associate Medical Director for Quality, The Polyclinic

This presentation will review the experience of a medium-sized, non-integrated delivery system in successfully taking on risk for nearly half its patient population with the aid of innovative population health management strategies and technologies. Learn how The Polyclinic’s approach enables their practices to increase patient volume and improve clinical quality measures under the current fee-for-service environment while transitioning to value-based reimbursement.

Thursday, March 26, 2015
11:00 a.m. – 12:15 p.m.

Look Both Ways Before You Treat: Transition of Care Improvements Begin with Horizontal Integration
Philip Oravetz, MD, MPH, MBA, Medical Director, Accountable Care, Ochsner Health System
Mark Green, MBA, PMP, Director, Ochsner Care Coordination Center, Ochsner Health System

Success with any transitional care initiative requires leaders to implement programs that measure, engage, align, and monitor their program performance. This session will describe how to develop an integrated, post-discharge, transitional care program across multiple facilities, clinics, and providers for optimal results. This solution begins with data science analytics driving risk-stratified solutions for the transitional management program. In addition, this solution shows how to optimize discharge touch points through a mixture of direct oversight and collaborative partnerships to drive consistent interventions across the continuum.

BreakThrough Care Center: A New Care Model for High-Risk Patients
Paul Merrick, MD, President, DuPage Medical Group
Richard Krouse, MD, Associate Medical Director, BreakThrough Care Center, DuPage Medical Group

Learn how a large, multispecialty physician group developed a new care delivery model using their EMR and other technology tools to identify and manage their highest risk patients to achieve improved outcomes and reduce healthcare costs. As a result, their participating patients have also experienced fewer health episodes, minimized hospital admissions, and improved their health status.

Thursday, March 26, 2015
2:00 p.m. – 3:15 p.m.

You’ve Got Mail ... or Video.  Your Choice!  Improving Patient Satisfaction and Adherence and Physician Engagement Using Virtual Medicine
Samuel Bauzon, MD, MMM, CPE, Medical Director of Clinical Documentation and Quality Improvement, Southwest Medical Associates
How does one meet an increasing demand for health care while preserving quality of healthcare delivery at a reduced cost by providers who already feel over-burdened? Learn how Southwest Medical Associates used innovative virtual tools, namely e-visits and video on-demand (NowClinic), to successfully accomplish these goals.

Engaging Patient Partners: A Framework for Transforming Health Care
Joseph A. Bianco, MD, FAAFP, Division Chief – Minnesota Regional and Community Clinics, Essentia Health
Amy Vanderscheuren, MHA, Director of Patient and Family Centered Care, Essentia Health
Frank Fifo, Patient Partner, Essentia Health

This presentation will outline Essentia Health’s model for engaging patient partners across the continuum of care, and how that relationship can transform care delivery, health system design, and the overall patient experience.   You’ll come away with principles, analysis, and tools to engage patient partners direct from the physician, administrative, and patient perspective.
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