Peer-to-Peer Sessions

Routes to Tomorrow's Health Care
Successful Models of Accountable Care
IQL 2012 Annual Conference, October 3-5, 2012
Gaylord National Harbor Resort & Conference Center, National Harbor, Maryland (Washington, DC Metro Area)

Thursday, October 4, 2012
10:30 a.m. - 12:00 p.m.

Creating Accountable Physician Leadership: Essential to the Successful ACO
Mark J. Werner, MD, CPE, Senior Vice President and Chief Clinical Integration Officer, and David W. Moen, MD, President, Fairview Physician Associates and Fairview Health Network, Fairview Health Services
The presenters will discuss Fairview's use of design criteria-based approaches to care innovation and the means to engaging accountable physician leaders. They will share their efforts in building culture, developing clinical leaders, optimzing dyad leadership models in a multispecialty group, setting expectations for physician "owner operators," evolving the role of an independent physician association board, moving service lines beyond an academic center across community hospitals, deploying care transition, and patient navigation programs.
Upon completion of this activity, participants should be able to describe key attributes of culture and design criteria within an accountable physician network, describe the design criteria for their particular envisioned organization and the essential physician leadership needed for success, describe strategies for developing, deploying and supporting accountable physician leaders, and develop a gap analysis of physician leadership needs within their organization and identify approaches to addressing those needs.

You Can't Eat an Elephant in One Bite: Bending the Cost Curve in a Multispecialty Practice
Scott Hines, MD, Clinical Transformation Officer, and Jonathan Nasser, MD, Internal Medicine and Pediatrics, Crystal Run Healthcare LLP
This interactive presentation will outline effective techniques employed by a multispecialty group to re-engineer the care team and reduce the cost of care. Examples will include a PCP clinical management enhancement series, the implementation of a home care program, and the utilization of the process of variation reduction. An interactive demonstration of Crystal Run Healthcare's variation reduction platform will be included.
Upon completion of this activity, participants should be able to identify the unique challenges facing a multispecialty group ACO, describe the emerging role and importance of the primary care physician in controlling healthcare cost and identify mechanisms for enabling PCPs to do this successfully, describe how a home care program can be used to reduce the cost of health care, articulate how the process of variation reduction can be used to standardize work and control utilization of resources, and participate in a variation reduction project and implement this project at their organization.

Post-Acute Care Transitions: An Essential Component of Accountable Care
Bruce C. Smith, MD, Associate Medical Director, Strategy Deployment, Group Health Physicians
In 2009, Group Health embarked on a comprehensive program to re-design patient care before, during, and after hospitalization using a Lean management model to improve patient satisfaction and quality of care while reducing overall costs of care. This presentation will provide an overview of this extensive initiative with important take-home lessons for other practices involved in coordinating overall costs of care and improved care quality.
Upon completion of this activity, participants should be able to improve the quality of post-acute care transitions, reduce avoidable costs during and after care transitions, and reduce avoidable hospital admissions, readmissions, and ER visits.

How Care Teams Are Using Predictive Analytics and Comparative Data to Optimize Interventions for High-Risk Patients
Stephen A. Morgan, MD, Vice President of Medical Informatics, and Marcus Speaker, MD, Medical Informaticist, Carilion Clinic; John Cuddeback, MD, PhD, Chief Medical Informatics Officer, Anceta; and Mary Lantin, MPH, Director of Operations, Provider Markets, Humedica
Participants in AMGA's Anceta collaborative will share how they are using Humedica MinedShare® clinical intelligence to target timely interventions aimed at reducing hospital admissions and ED visits in patients with congestive heart failure. Employing predictive analytics in the context of a patient-centered medical home, care teams are identifying patients who are likely to be admitted to the hospital or ED with a CHF-related condition. This session will explore PCMH work flows and protocols that take advantage of predictive models.

Thursday, October 4, 2012
1:45 p.m. - 3:15 p.m.

Medical Group Leadership: Transitioning from Popularity to Performance
Jeffrey Bailet, MD, Executive Vice President, Aurora Health Care and President, Aurora Medical Group, and Brent R. Phillips, FACMPE, Senior Vice President, Medical Group Operations, Aurora Medical Group
As medical groups prepare for an uncertain future, the need for performance-based physician leadership is critical. The selection process must shift from a popularity vote to ensure success in a rapidly changing environment. Aurora Health Care has successfully implemented a new process and will share the transition, job descriptions, and lessons learned.
Upon completion of this activity, participants should be able to articulate the value of a performance based leadership selection process, organize and implement this new selection process while enhancing the buy in and engagement of the physicians, ensure alignment with overall strategic goals and changing healthcare environment, determine physicians with the greatest leadership potential, and strengthen the physician/administrator dyad model to ensure greater overall performance and success.

HealthPartners' National Quality Forum-endorsed Measure of Total Cost of Care
Sue Knudson, MA, Vice President, Health Informatics, and Beth Averbeck, MD, Associate Medical Director, Primary Care, HealthPartners
HealthPartners received NQF-endorsement for its measure of Total Cost of Care. This complements existing quality measures to provide a common reference point supporting the development of accountable care organizations and payment reform models. Providers, insurers, employers, consumers and others can use this to manage costs, drive affordability, and improve healthcare.
Upon completion of this activity, participants should be able to describe how HealthPartners' NQF-endorsed Total Cost of Care Measure was developed and how HealthPartners uses it, and identify how their system could apply Total Cost of Care to provide better health, better experience, and lower cost for their patients.

Value-Based Ambulatory Operations at the Cleveland Clinic: Linking an Accountable Population Health Model with Business Intelligence Analytics
Brian Harte, MD, Director, Business Intelligence/Medical Operations, President, South Pointe Hospital, and Meghan Snow, MHA, Administrator, Medicine Institute, Cleveland Clinic
Cleveland Clinic has embarked on an ambitious program to implement and study various models to primary care practice redesign, as preparation for Accountable Care. The presenters will explore the steps of the development, execution, and measurement of these pilots, and review the investments needed to successfully execute this strategy.
Upon completion of this activity, participants should be able to describe the efforts in the past year in aligning Cleveland Clinic senior leadership around developing a strategy for accountable care, describe several proposed models of primary care delivery and elaborate on the decision-making process that resulted in a business plan to test multiple models simultaneously, including the challenges and unique opportunities of each, demonstrate the challenges in providing the data necessary to study and support these models of care, and the forum and structure in which performance is reviewed, describe the substantial staffing and technological investments required to successfully execute an ACO strategy and practice redesign, and explain how an effective group practice model in a patient-centered environment can lead to innovation and uncover opportunities for improving quality of care while increasing safety and lowering costs.

Changing Directions:  Planning and Executing the Shift from a "Fee-for-Service" to a "Pay for Value" Medical Group
Robert E. Matthews, Vice President for Quality, PriMed Physicians and President and CEO, MediSync; and Douglas Romer, MD, Family Practice Physician, Chairman of the Board, PriMed Physicians
Most medical groups' revenues have been based solely on volumes of services provided. As medical groups are contemplating or are actually engaging in the shift to value based revenue, leaders must plan and execute a massive change in their group infrastructure, operational practices and culture. This presentation will feature some of the key elements in the change strategy from the perspective of PriMed Physicians, a group that has been undertaking this transition for a decade.
Upon completion of this activity, participants should be able to identify and define five major areas of change that must occur in a major organizational transformation, describe the elements of "change management" especially as they apply to a medical groups, and describe the need for physician leaders to simultaneously have both a "big picture" perspective of the changes that they are planning and a detailed list of change projects.

From Transaction to Total Value Care: Geisinger's Transformation Roadmap
Maria Susan Kobylinski, M.D., Department Director, Community Practice Service Line, Geisinger Health System; and Lisa Cone-Swartz, Vice President of Product Management, Press Ganey Associates
The shift from volume to value will be a transformative experience for healthcare providers, and as an early adopter of value-based care delivery, Geisinger Health System is in a unique position to share lessons learned through this process. This presentation will focus on how effective redesign and care coordination can deliver rapid and long-term impact on clinical quality measures and cost of care. Recommendations on how to ensure that the voice of the patient and provider are both drivers and evaluators of these changes will be detailed, including results from a newly designed Care Coordination survey.
Upon completion of this activity, participants should understand Geisinger's process to effectively redesign their organization to focus on care coordination; describe key initiatives, processes, and results; explain specific tactics they can employ within their own organizations; and utilize expert advice on how to ensure that they include the patient and provider voice in change initiatives.

Friday, October 5, 2012
8:30 a.m. - 10:00 a.m.

Practice Operations Coaching: Supporting Physicians to Improve Care Results
Kevin McCune, MD, Chief Medical Officer, Advocate Medical Group; Judith Miller MHSA, RHIA, CHP, Vice President, Medical Services, Scott Kent, MA, Hospital and Health Administration, Vice President, Field Operations; Janet Skoda, MBA, Vice President, Field Operations, Richard Bobos, MBA, Practice Operations Coach, and Katherine Kalthoff, MBA, Practice Operations Coach, Advocate Physician Partners
This presentation will explore tactics and organizational changes Advocate Physician Partners and Advocate Medical Group implemented to support practice improvements necessary to be successful in an accountable care world. Practice methods, analytic data systems and tools for evaluating and assessing practice operations, key metrics, and coaching techniques will be discussed.
Upon completion of this activity, participants should be able to describe an organizational model for providing feedback and practice coaching to independent and employed physician practices, design an infrastructure for providing data, feedback, and methods for improvement to physicians about key metrics important to the goals of the larger organization, and delineate the use of information technology in providing useful and actionable data to physicians on their performance meeting key targets.

Who Needs The Hospital?  Hardwiring Clinical Pathways for Ambulatory Care Coordination Improves Quality, Efficiency, and Outcomes
Arthur L. Forni, MD, MMM, Associate Medical Director, and Barney D. Newman, MD, Medical Director, WESTMED Medical Group
WESTMED is implementing Ambulatory Care Pathways to optimize treatment of many common conditions. This presentation will explore how structured care coordination is expected to limit unnecessary variation in clinical practice (especially overutilization), prevent medical errors, provide a more comfortable experience for the patient, and ultimately decrease cost by reducing unnecessary ER visits and hospitalizations.
Upon completion of this activity, participants should be able to describe the rationale for standardization and coordination of care for "ambulatory sensitive" conditions, describe the development and implementation of ambulatory pathways to structure care in a multispecialty group practice, and discuss the need for physician engagement and analysis by appropriate metrics to guide the use of ambulatory pathways and their ongoing refinement.

Engaging the Patient and Family to Improve Health Care Outcomes
Amy Compton-Phillips, MD, Associate Executive Director of Quality, The Permanente Federation, and Doug Bonacum, Vice President of Safety Management, Kaiser Permanente
Partnering with patients and families is the key ingredient to transforming the healthcare system and improving patients' health, health outcomes, and care experience. This session will describe how partnerships with patients are formed and result in improved care, and provide specific tools and case study examples from Kaiser Permanente.
Upon completion of this activity, participants should be able to describe Kaiser Permanente's holistic and universal approach to including the patient and their family in the care model, explain why patient- and family-centered care can help to improve quality, safety, service, and affordability, apply core components of patient- and family-centered care in their own organizations, and describe tools or tactics to increase partnerships with members, patients, and families.

Physician Incentives, Unbundling of Payments and the "C" Word: Facing the Impending Realities of Healthcare Payment Reform
Jennifer Close, Vice President of Operations, Dean Health System
As healthcare providers seek to redefine themselves as accountable care organizations, it will be crucial that delivery systems master the ability to design incentive models that align physicians, to craft mechanisms to un-bundle payments, and to bear risk via capitation or other evolving reimbursement strategies. This presentation highlights Dean Health System's experience in all three domains.
Upon completion of this lecture, participants should be able to discuss the array of future payment-reform models that CMS and other payers will likely develop to reward physicians and hospitals for delivering value-based and accountable care; describe Dean's experiences in designing primary care and specialty physician incentive models aimed at maximizing the delivery of high-quality and efficient care; and explain the complexities of bundled payments, by reviewing Dean's experience with bearing risk and with the "unbundling" of gain-sharing between physicians, hospitals, and other care-givers.

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