Peer-to-Peer Sessions

Thursday, October 22, 2015

11:00 a.m. - 12:15 p.m.

Patient Satisfaction at the Epicenter of Healthcare Delivery: Centralized Access Leadership without Centralized Ownership

Connie Sawa, Regional Director, Patient Concierge Services, University of Pittsburgh Medical Center
As consumers become increasingly financially invested in their health care, patient access has evolved into the gatekeeper of the patient experience. At the University of Pittsburgh Medical Center (UPMC), patient access sits at the epicenter of healthcare delivery: UPMC patient access employees are the first and last face-to-face patient interaction and can make or break a patient experience. Meanwhile, these same employees must juggle countless responsibilities and cater to clinical, administrative, and financial stakeholders. To ensure success of these essential representatives, UPMC developed a centralized access leadership model―distinct from employee direct management―to recruit, train, monitor, and provide ongoing support to access employees. This presentation will outline how to address the challenge of standardizing point-of-service patient access―despite complex regional, clinical, and historical nuances―through a centralized access leadership model that enables agility and site-specific independence while maximizing consistency and patient satisfaction.

Curing Hepatitis C: A Longitudinal Care Story
Ajay K. Sahajpal, MD, FRCSC, Medical Director, Aurora Health Care
Bradley Kruger, Vice President Operations, Saint Luke's Medical Center
Laura Spurr, Director Medical Group Operations, Aurora Health Care

According to the Centers for Disease Control and Prevention, among those aged 49-70 there are 800,000 undiagnosed people with Hepatitis C, with more than 37,000 people in the State of Wisconsin alone. Within Aurora Health Care, it is estimated there are 8,000 patients with undiagnosed Hepatitis C based in this high-risk group. The healthcare costs equate to $10,000 more per year for patients with Hepatitis C versus those without in the same acuity level. The only way to know if you have Hepatitis C is to get tested. In order to address these concerns, Aurora Health Care implemented a team-based approach to care in order to effectively screen, diagnose, treat, manage, cure, and track all Hepatitis C patients throughout Wisconsin. Within the first two months of the initiative going live, approximately 200 patients tested positive for Hepatitis C and are now on a new treatment plan to improve their wellness, and many have personalized treatment plans that cure the disease. Based on these early results, it is estimated that within the first 12 months of the new care model in place, the system will return over $2 - $4 million in net revenue. Learn how Aurora Health Care implemented this enhanced care model to improve patient outcomes, improve the health of the communities they serve, and lower healthcare costs through early intervention and treatment.

Two High-Performing Health Systems’ Journeys to Excellence
Grace Terrell, MD, MMM, President and Chief Executive Officer, Cornerstone Health Care, PA
Ken Cohen, MD, FACP, Chief Medical Officer, New West Physicians

This special session will spotlight the initiatives of the 2015 Acclaim Award recipients. Representatives from the two esteemed organizations will describe their journeys towards becoming high-performing health systems and explore their winning initiatives and the elements that made them successful. The Acclaim Award, AMGA’s prestigious quality award, is presented annually by the American Medical Group Foundation to honor physician-directed organizations that bring the American healthcare system closer to a delivery model in which patients experience care that is safe, effective, patient-centered, timely, efficient, and equitable.

Four Phases to Population Health Management Maturity: How Care Delivery Models Evolve with Each Phase
Karen Kennedy, Senior Vice President, Family Care and Wellness, Dallas Children's Medical Center
Stephanie Copeland, MD, Chief Quality Officer, Head of Pediatrics, USMD Health System

As they make the population health journey, provider organizations will go through four phases of maturity—(1) the pilot, (2) care program development, (3) physician-driven services, and (4) true patient engagement—with increasing financial returns from shared savings, as well as performance-based or risk-based rewards following each phase. This presentation will explore ways your organization can best manage your population and risks, whether or not you have the foundation needed to run a population health management program. You will walk away with a checklist of dos and don’ts to avoid the pitfalls at each phase, along with data analytics and risk management tools. This session also will explore how a Pediatric Asthma Population Health program transitioned from Phase 2 to Phase 3 and plans to get to Phase 4 in the near future. The case study will highlight development predictive models for risk stratification, the design of a high-touch care management program leveraging patient insights analytics, integration of pediatric clinics with the hospital system and health plan to design the most effective outreach programs, and the leveraging of intervention performance measurement tools.

2:00 p.m. – 3:15 p.m.

A Tasting Menu of New Care Models
Beth Averbeck, MD, Senior Medical Director, Primary Care
Robert VanWhy, Senior Vice President, Primary Care and Practice Development, HealthPartners

Meeting the changing needs of patients requires innovative and customized care models. After building reliable workflows, HealthPartners has customized care to meet the varying needs of their patients. This presentation will examine technology, documentation, staffing models, and workflow automation as means for achieving new care models. It will provide an overview of HealthPartners’ methods, detail their results, and give tips and resources on how you can get started implementing innovative care models within your own organization.

Improving Adult Immunization Rates for High-Risk Patients
Leisa Hills, RN, MSN, Director of Clinical Excellence, Community Physicians of Indiana
Graham Lincoln, Manager, Market Solutions, Optum
OT Adcock, Associate Medical Director and Primary Care Service Line Chief, Riverside Medical Group
Christina Taylor, MD, Chief Quality Officer, The Iowa Clinic

Adult immunization continues to be a challenge for provider organizations, especially for high-risk adults and seniors. Data shows that the median pneumococcal vaccination rates across Anceta Collaborative participants is 60% for adults > 65 years and 16% for high-risk adults ages 18–65. This is well below the Healthy People 2020 goals of 90% for > 65 years and 60% for high-risk adults 18–65. AMGA members have been participating in a collaborative to identify optimal and efficient ways to improve adult immunizations, with a specific focus on pneumococcal and influenza vaccines, leveraging population analytics to support their initiatives. A panel of leaders from groups involved in the learning collaborative will discuss how they established successful processes to manage their patients and improve their adult immunization rates. Speakers will examine the leadership support necessary, tools and systems required, and how care is managed within their patient populations by sharing an outline of their chronic care models, intervention methods, outcomes, and lessons learned.

The Evolution of an Ambulatory Care Management Model as Part of the Patient-Centered Medical Home for Targeted Patient Population Management
Mary M. Morin, RN, MSN, NEA-BC, Vice President and Nurse Executive
Michael Charles, MD, Medical Director, Clinical Quality, Sentara Medical Group

In 2012, as part of its primary care redesign, Sentara Medical Group (SMG) established the ambulatory RN Care Management Service, designed to manage the care of an identified patient population comprised of high-risk, chronic disease patients from all payers across 11 SMG Patient-Centered Medical Home (PCMH) sites. This session will chart the group’s journey to provide a highly integrated population health management program, leveraging innovative RN care management and coordination strategies, including the identification of patients using stratification processes for high-risk and rising-risk patients. In addition, it will detail how the RN Care Management model has expanded across all PCP sites and evolved to include a new role of the RN Coordinator for Population Health Management.

What Does Walt Disney Have to Do With Health Care? The Importance of Quality, Reliability, and Engaged Physicians
Scott Hines, MD, Chief Quality Officer, Crystal Run Healthcare
Walt Disney once said, “Do what you do so well that they will want to see it again and bring their friends.” The same is true in health care. An organization that provides care that is of superior clinical quality and high reliability will retain current patients and attract new ones. While improving the quality of health care is a priority for all medical groups, most quality strategies focus on closing gaps in care through care management services. This presentation will outline the process of care optimization that aims to prevent care gaps from occurring. The presenter will review strategies that engage and empower physicians to lead variation reduction and quality improvement exercises, and will outline a novel way of closing gaps in care, when they inevitably occur, by differentiating between process-based and performance-based measures. This approach has been shown to significantly improve quality and reduce the cost of care.

Variation Reduction: A Building Block for Population Health Management
Stephanie Berkson, MPA, Vice President, Population Health
Jonathan Jaffery, MD, MS, MMM, Chief Population Health Officer, UW Health

Two topics are top-of-mind throughout today’s healthcare industry: the importance of managing the health of populations, and the need to reduce unnecessary variation. This interactive seminar highlights how UW Health is using Variation Reduction as an essential building block of Population Health Management, and how standardized approaches to delivering care facilitate innovation. The session will lead participants through an activity that will serve as a mock variation reduction working session.

3:45 p.m. – 5:00 p.m.

A Study in Community-Based Health Management and Delivery Empowering Healthier Lives
Grace Terrell, MD, MMM, President and Chief Executive Officer, Cornerstone Health Care, PA
Adam Goldston, MBA, Vice President, Business Development, Heritage Provider Network
Brian Bobby, PharmD, Director, Health Alliance, Rite Aid Corporation

Despite their best intentions, most patients need a support system to follow through on their last physician visit. In the presence of their physician or other healthcare provider, they make genuine promises of self-improvement because they know they must prioritize their health; however, a disconnect occurs when they leave our offices and are confronted with life’s many other priorities. The challenge then lies in developing a cost-effective wellness community that serves as an extension of our physician’s office. This presentation will focus on how to provide coordinated, patient-centered, clinically integrated, and accountable care to all eligible patients through innovative partnerships and care processes. Leaders from Cornerstone Health Care, Heritage Provider Network, and Rite Aid Health Alliance will discuss a fully collaborative model in which physicians, care managers, and other members of a patient care team interact and share clinical information with care coaches and pharmacists at select Rite Aid locations.

Countdown to ’16: A CG-CAHPS Preparedness Panel
Angie Beck, Director of Clinical Quality, The PolyClinic
Thom Thomas, Vice President, Quality Assurance, Meridian Health Services
Carter Ahl, Vice President, Engagement Services, Avatar Solutions

With a national mandate on the horizon, physician practices that haven’t already implemented the Consumer Assessment of Healthcare Providers and Systems – Clinician & Group Surveys (CG-CAHPS) are scrambling to identify the best course of action. If you’re a leader at one of these organizations, you’ve probably struggled yourself with the dizzying myriad of options or know a colleague who has. The CG-CAHPS Preparedness Panel is designed to help attendees navigate the tangle of risks, rules, and parameters to uncover the pathway that’s right for your organization. The panel will provide a comprehensive overview of the CMS CG-CAHPS program, including strategies for understanding how to use the data to implement effective improvement initiatives. It will include tips and techniques for effective implementation of CG-CAHPS, including stories from two organizations that are currently in the midst of CG-CAHPS surveying.

A Cost-Effective Approach of Coordinating Care to Improve Hypertension and Diabetes Control
Carolyn Koenig, MD, Associate Medical Director, Adult Primary Care, and Co-Chair Adult Quality Safety Value Committee, Mercy Clinic
Mercy Clinic has developed a multifaceted approach to improving patients’ diabetes and hypertensive control relying on coordination of care as well as patient and physician engagement. This session will detail their approach, including the use of outbound calling initiatives to reach patients, transparency reports, and diabetic educators, as well as involving specialty clinics in control of hypertension. It will describe how these measures have proven to be cost-effective and revenue generating.

Transitions of Care: Process Control and Clinical Management
Arthur Forni, MD, MMM, Vice President and Director of Quality and Analytics, Infectious Diseases, WESTMED Medical Group
Richard Morel, MD, MMM, Vice President and Medical Director, WESTMED Medical Group
Maureen Adams, RN, MBA, Director Clinical Operations and Case Management, WESTMED Medical Group

Many healthcare organizations have struggled with transitions in care and hospital readmissions. This is particularly true for patients who are transferred to short-term rehab facilities. This presentation will outline WESTMED Medical Group’s successful process, which can easily be replicated, to monitor patients as they move from outpatient to hospital to skilled nursing facility (SNF) rehab and back to outpatient. This process has resulted in a 26% decrease in total admissions at their main hospital and a 12% decrease in readmissions, even with a 16% increase in total population under their care, as well as a 70% reduction in SNF rehab to hospital admissions.

Warning: Some Forms of Value Contracts Can Be Hazardous to Your Group's Health
Robert E. Matthews Vice President, Quality, PriMed Physicians, and President and Chief Executive Officer, MediSync
In the majority of markets, payers are just starting to proffer value agreements. However, many of the initial contracts offered are bad for the medical group and unreasonably skewed towards the payer. For example, the amounts of “upside” monies are very limited in many proposed agreements and the carriers underestimate costs. There have now been several examples of organizations going broke while making care better. Further, it is widely assumed that, now or at some point in the future, payments will be based upon some sort of value equation. This poses many strategic and tactical contracting and operational questions for medical leaders, including: How can we improve the quality and cost-effectiveness of care successfully and in a manner that we can afford? This presentation will outline ways to improve contracts to allow you to pace improvement with the availability of monies to support the costs of improvement.

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