BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE FULL-BOARD MEETING WEDNESDAY, MAY 27, 2015 5:30 p.m. Buffet for board members & invited guests PALOMAR HEALTH DOWNTOWN CAMPUS 6:00 p.m. Meeting GRAYBILL AUDITORIUM 555 E. VALLEY PARKWAY, ESCONDIDO, CA 92025 ___________________________________________________________________________________________________ Form A Time Page Target CALL TO ORDER 6:00 Public Comments 1 ..………………..……………………….……..……………………………………. ....15 6:15 Information Item(s) 1. * Approval: Strategic & Facilities Planning Committee Meeting Minutes – April 22, 2015 (ADD A-Pp-8-11)……………..…………………………………………………………..……………. …...3 ……1 6:18 2. * Approval: Revised Strategic & Facilities Planning Committee Bylaws (ADD B-Pp13-15)….…. …...3 ……2 6:21 3. * Review/Approval: Committee Meeting Frequency…..................................................……….... ….10 ……3 6:31 4. * Review/Approval: Committee Standing Agenda Items …………………………….……………... ….10 ……4 6:41 5. Review: Corporate Health’s Business to Business Strategy (ADD C-Pp17-32)…….………….. ….30 ……5 7:11 6. Review: Population Health (ADD D-Pp34-81)……………………………………………………… .…30 ……6 7:41 Public Comments 1 ..………………………………………………..……………………………………. ….15 7:56 ADJOURNMENT 7:58 Board Strategic & Facilities Planning Committee Members Ray McCune, RN, Chair Linda Greer, RN, CCP Dara Czerwonka, MSW Robert Hemker, President & CEO 1 st Alternate: Dr. Aeron Wickes Della Shaw, EVP Strategy Diane Hansen, EVP Finance Jodi Mansfield, IEVP Operations Jean Larsen, Philanthropy Officer Lorie Shoemaker, VP PMC David Tam, VP PHDC / POM Maria Sudak, CNO PMC Dan Farrow, AVP Hospitality / Facilities Chiefs / Chiefs-elect PMC / POM Janine Sarti, General Counsel Brenda Turner, EVP Human Resources NOTE: If you have a disability, please notify us by calling 760-740-6375 72 hours prior to the event so that we may provide reasonable accommodations __________________________________ Asterisks indicate anticipated action. Action is not limited to those designated items. 1 5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in meeting room. The Board Strategic & Facilities Planning committee meeting is being agendized as a full board meeting due to the possibility of a quorum being present. Only committee business will be discussed at this meeting, however all board members may attend to participate in the discussion. Only those board members who sit on the Board Strategic & Facilities Planning committee are permitted to make a motion or vote on these matters.
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BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE
FULL-BOARD MEETING
WEDNESDAY, MAY 27, 2015 5:30 p.m. Buffet for board members & invited guests PALOMAR HEALTH DOWNTOWN CAMPUS 6:00 p.m. Meeting GRAYBILL AUDITORIUM 555 E. VALLEY PARKWAY, ESCONDIDO, CA 92025 ___________________________________________________________________________________________________
Lorie Shoemaker, VP PMC David Tam, VP PHDC / POM Maria Sudak, CNO PMC
Dan Farrow, AVP Hospitality / Facilities Chiefs / Chiefs-elect PMC / POM Janine Sarti, General Counsel
Brenda Turner, EVP Human Resources
NOTE: If you have a disability, please notify us by calling 760-740-6375 72 hours prior to the event so that we may provide reasonable accommodations
__________________________________ Asterisks indicate anticipated action. Action is not limited to those designated items. 1 5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in
meeting room. The Board Strategic & Facilities Planning committee meeting is being agendized as a full board meeting due to the possibility of a quorum being present. Only committee business will be discussed at this meeting, however all board members may attend to participate in the discussion. Only those board members who sit on the Board Strategic & Facilities Planning committee are permitted to make a motion or vote on these matters.
B O A R D S T R A T E G I C & F A C I L I T I E S P L A N N I N G C O M M I T T E E M E E T I N G A T T E N D A N C E R O S T E R - C A L E N D A R Y E A R 2 0 1 5
MEETING DATES:
MEMBERS 1/26/15 2/25/15 3/25/15 4/22/15 5/27/15
DIRECTOR LINDA GREER – COMMITTEE CHAIR X X X X
DIRECTOR RAY MCCUNE X X X X
DIRECTOR DARA CZERWONKA X X X X
DIRECTOR AERON WICKES, M.D. – ALTERNATE X
DIRECTOR HANS C.M. SISON – GUEST X X X
DIRECTOR JEFF GRIFFITH – GUEST
DIRECTOR JERRY KAUFMAN – GUEST
ROBERT HEMKER X X X
STAFF ATTENDEES
DELLA SHAW X X X X
DIANE HANSEN X X
JODI MANSFIELD, FACHE X X X X
JANINE SARTI X
JEAN LARSEN, CFRE X X
PH FOUNDATION BOARD MEMBER
LORIE SHOEMAKER, RN, DHA, MSN, NEA-BC X X X
DAVID TAM, MD, MBA, FACHE X X
MARIA SUDAK, RN, MSN, CCRN, NEA-BC X X
DAN FARROW X X
JEFF ROSENBURG, MD X X X X
FRANKLIN MARTIN, MD X X X X
PAUL NEUSTEIN, MD X X
CHARLES CALLERY, MD X X X X
DEBBIE HOLLICK – SECRETARY X X X X
INVITED GUESTS SEE TEXT OF MINUTES FOR NAMES OF GUEST PRESENTERS
TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Debbie Hollick, Committee Secretary Background: The minutes of the Board Strategic & Facilities Planning Committee meeting held on Wednesday, April 22, 2015 are respectfully submitted for approval (Addendum A). Budget Impact: N/A
Staff Recommendation: Staff recommends approval of the Wednesday, April 22, 2015 Board Strategic & Facilities Planning Committee meeting minutes as presented. Committee Questions:
TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Della Shaw, Executive Vice President Strategy Background: Section 6.1.1 of the Board Strategic & Facilities Planning Committee Bylaws was revised to reflect the changes in organizational structure. Budget Impact: None
Staff Recommendation: It is recommended that §6.1.1 of the Board Strategic & Facilities Planning Committee Bylaws be amended per the redline excerpt attached for the Committee’s review. Committee Questions:
Meeting Frequency Board Strategic & Facilities Planning Committee
TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Della Shaw, Executive Vice President Strategy Background: Per request of the Board of Directors, board committees are to review their committee meeting frequency. Budget Impact: None
Staff Recommendation: It is recommended that the Board Strategic & Facilities Planning Committee set the meeting frequency based on the pertinent issues within its scope. Committee Questions:
TO: Board Strategic & Facilities Planning Committee MEETING DATE: Wednesday, May 27, 2015 FROM: Della Shaw, Executive Vice President Strategy Background: Per request of the Board of Directors, board committees are to review their yearly standing agenda items. Budget Impact: None
Staff Recommendation: It is recommended that a yearly Environment of Care update report be added to the Board Strategic & Facilities Planning Committee Standing Agenda Items. Committee Questions:
Form A 2015.05 Board Strategic - Corp Hlth & B2B.doc
TO: Board Strategic & Facilities Planning Committee MEETING DATE: May 27, 2015 FROM: Russell Riehl, Director Employee, Corporate & Retail Health Duane Johnson, Business Development Background: The informational program presented to the Board Strategic & Facilities Planning Committee provides a high level overview of Corporate Health’s Occupational Medicine program, which has been actively deploying a business to business strategy. It further outlines the program’s successes and future strategies for growth. Budget Impact: N/A
Staff Recommendation: N/A
Committee Questions:
COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: X Required Time:
5
Population Health
Form A Population Health.doc
TO: Board Strategic & Facilities Planning Committee MEETING DATE: May 27, 2015 FROM: Alan Conrad, M.D. - Medical Director Clinical Outreach Services, Palomar Home Health, Diabetes Services, expresscare Background: Organizations are examining their role in Population Health in order to comply with the concepts of the Triple Aim. Palomar Health is evaluating its approach to Population Health. Budget Impact: N/A
STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES – WEDNESDAY, APRIL 22, 2015
AGENDA ITEM CONCLUSION/ACTION FOLLOW UP /
RESPONSIBLE PARTY
DISCUSSION
I. CALL TO ORDER
The meeting – held in the Graybill Auditorium at Palomar Health Downtown Campus, 555 E. Valley Parkway, Escondido, CA 92025 - was called to order at 6:18 p.m. by Board Chair Linda Greer, who then turned the meeting over to Board Strategic & Facilities Planning Committee Chair Ray McCune
II. ESTABLISHMENT OF QUORUM
Quorum comprised of Directors Greer, McCune, Czerwonka, Sison
Notice of Meeting was posted at PH’s Administrative Office; also posted with Full Agenda Packet on the PH web site on Wednesday, April 15, 2015, which is consistent with legal requirements. Notice of that posting was made via email to the Board and staff members
IV. PUBLIC COMMENTS
There were no public comments
IV. INFORMATION ITEMS
There were no information items
1. APPROVAL OF MEETING MINUTES – BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE MEETING – MARCH 25, 2015
No discussion
MOTION: By Director Czerwonka, 2nd
by Director McCune and carried to
approve the March 25, 2015 Board Strategic & Facilities Planning Committee meeting minutes as submitted. All in favor. None opposed
STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES – WEDNESDAY, APRIL 22, 2015
AGENDA ITEM CONCLUSION/ACTION FOLLOW UP /
RESPONSIBLE PARTY
DISCUSSION
Utilizing the presentation distributed in the meeting packet, the committee reviewed the second quarter updates to the FY15 strategic and operational initiatives
Executive Vice President Strategy Della Shaw reported that the committee would be reviewing a fairly high level update to the six initiatives as well as a deeper dive for Operational Initiative 2 given by Vice President Palomar Medical Center Lorie Shoemaker
Noted that Cardiovascular Center of Excellence (COE) Program Development Manager Serrina Bergstraesser would provide an update on strategic initiative 1 at this meeting; a deeper dive will be presented at the next meeting
FY2015 Strategic Initiative 1: Achieve and maintain Center of Excellence status in orthopedics/spine and rehabilitative care, cardiovascular care, neuroscience and women's services
Ms. Shaw and Ms. Bergstraesser provided the update:
Have already met outcome maximum for Milestone 2
New OR heart team video review process illustrates potential opportunities for improvement
o Dr. Rosenburg noted that great progress has been made re: efficiency, patient-first atmosphere and communication along the whole hospitalization process. Surgeries now start at 7:30 a.m. Latest outcomes data reflects a 0% mortality rate
FY2015 Strategic Initiative 2: Become the dominant provider of primary care in support of the total patient health experience provided, including the expansion and growth of Arch Health Partners, effective affiliations with local providers and development of a strong regional primary care network in the secondary markets
Ms. Shaw reported that the initiative is on target
o Completed Milestone 1
o Milestone 2 on track for completion by the end of fourth quarter
o Milestone 3 – anticipate surpassing 4% target for increasing baseline FY14 PCP alignment with targeted Area of Focus (AOF) Service line Specialists
o Still actively seeking involvement with Graybill
FY2015 Strategic Initiative 3: Develop a delivery model that supports care coordination and transitions across the continuum, with emphasis on chronic disease management, illness prevention, and patient involvement
Ms. Shaw reported that Milestones 1- 7 have been completed by their target dates; expectation for Milestones 8 and 9 to meet their respective target dates as well
Working on an interoperability platform to connect inpatient I.T. with outpatient I.T. and physician offices, skilled nursing facilities et al to fully exchange information for the care of the patient
Vice President Information Systems Prudence August reported that last two vendors are in the review process with discussion re: negotiation and implementation timelines. Currently evaluating the primary needs the organization has outlined. Next steps – develop communication plan
FY2015 Operational Initiative 1: Build and operate a decision analytics structure that supports the real time availability and standardized use of information and expertise for knowledge management and measurement of value based metrics of care
Ms. August provided the following update:
Milestones for this initiative are not in sequential order for target attainment
Milestone 1 – completed elements 1 and 3; 2 will be completed in May
STRATEGIC & FACILITIES PLANNING FULL BOARD MEETING MINUTES – WEDNESDAY, APRIL 22, 2015
AGENDA ITEM CONCLUSION/ACTION FOLLOW UP /
RESPONSIBLE PARTY
DISCUSSION
Milestone 3 - testing prototype
Milestone 4 – on target to identify 2 areas
Milestone 5 – have met and exceeded target of implementing five reports from the EDW and VHA/Truven for ongoing decision-making for clinical and operational improvement
Milestone 6 – education plans to be rolled out once corresponding tools are in place – will meet June target
FY2015 Operational Initiative 2: Create a positive experience for all key stakeholders by improving clinical and business throughput and efficiency through all transitions of care
Vice President Palomar Medical Center Lorie Shoemaker provided the following update:
On target to meet all milestones by fiscal year end
Milestone 3 almost at target – turnaround times for troponin and basic metabolic panel steadily improving.
o Current focus is on staffing model
HCAHPS scores for PMC and POM steadily rising
Expense reduction – over $600,000 thus far
Utilizing the presentation distributed in the meeting packet, Ms. Shoemaker shared an update on the Patient Flow initiative, noting that progress is being made to the reduce the time patients wait to be admitted or discharged from the hospital. Concentration on key focus areas drives successes achieved thus far
FY2015 Operational Initiative 3: Develop and implement a strong physician integration and alignment model that allows for effective communication, partnership and accountability in the management and care of patient
Palomar Medical Center Chief of Staff Dr. Jeffrey Rosenburg provided the following update:
Overall the initiative is on track for completion by target date
o Milestone 1- completed six of the eight elements for phase1. Currently focusing on identifying physician mentors, creating design for the orientation program and physician culture vision compact
o Modules 7 and 8 have been implemented
o Physician engagement survey currently under way;target is 55% participation; currently at 54.8%. Potential to extend survey to May 4th
to allow even greater participation
ADJOURNMENT
MOTION: By Director Czerwonka, 2
nd by
Director Greer and carried to adjourn the meeting. All in favor. None opposed
Committee Chair McCune adjourned the meeting at 7:09 p.m.
IT utilization essential for population health management
Scale increases in importance
VOLUME-BASED FIRST CURVE VOLUME Realigned incentives, encouraged
coordination
Value
Value
JOURNEY TO THE SECOND CURVE
36
Working Definition:
Applying systematic quality and process improvement approaches in order to achieve the IHI Triple Aim
An active, management approach
An organization works to manage a populations’ health
POPULATION HEALTH
37
•System level medical management:
•Clinical models, decreased variation, connect to the community
•Network Construction: full spectrum of care across geography, contracted discounts
•Delivery of care:
•Care pathways, quality, access, site of service, efficiency
•Populations served by each payer:
•Quality expectations
•Cost targets
•Effects of benefit design
Benefit & Product Design
Patient Level Care
Activities
Population Health
Management
Care Delivery Network
POPULATION HEALTH: Macro levers
Community:
Needs and
resources
Community
and External
Environment
38
Actionable information to address the new needs
• Population sub-segmentation is the key tactic to:
– Drive a clinical model
– Address special-cause variation among teams and clinical group practices
– Address common-caused variation by improving the system
POPULATION HEALTH
39
Transform Care delivery
POPULATION HEALTH
Physicians
Nursing: Advanced Practice, RN, Diabetes
Educators, LVN
Health Coaches, Medical Assistants, Care Coordinators, Behavioral Health
and Social Workers
Create population
health teams to do the
work
Standardization enables
delegating to a team
Maximally use each team
member’s skills
Physicians manage
exceptions
40
Actionable Information
Registries, ADT summaries, EHR reminders
Variation data from support teams
Clinical operations per clinical model
Primary Care Practice
Population Health teams including physicians, RNs, MAs, Care Coordinators
Communications and Processes
Leadership and communication from top to bottom of the organization
Processes that fit practice work flow
Practice level activities that roll up to the goals of the organization
Aligned Funding
Payment models that allow us to pay for population health management activities
Incentives aligned to goals at all levels of the organization
Success
POPULATION HEALTH 4 Areas for Success
41
ALIGNING HOSPITALS, PHYSICIANS AND OTHER PROVIDERS ACROSS THE CONTINUUM OF CARE
Evaluation Metrics A. Percentage of aligned and engaged physicians B. Percentage of physician and other clinical provider
contracts with performance and efficiency incentives aligned with ACO-type incentives
C. Availability of non-acute services D. Distribution of shared savings/performance
bonuses/gains to aligned physicians and clinicians E. Number of covered lives accountable for population
health F. Percentage of physicians in leadership
JOURNEY TO THE SECOND CURVE
Metrics for the Second Curve of Health Care
42
OPTIMIZING HIGH-RISK CARE MANAGEMENT
• The most costly 1% of patients account for one-fifth of national healthcare expenditures
• Complex co-occurring conditions
• High risk care management programs
• Clinicians and health care organizations are increasingly adopting programs of their own
JAMA January 22, 2015
POPULATION HEALTH MANAGEMENT
43
OPTIMIZING HIGH-RISK CARE MANAGEMENT
• Anchored in the practice where patients receive their care
• There is no substitute for person-to-person contact
• Traditional fee-for-service reimbursement actively hinders experimentation with care management
• New payment models
JAMA January 22, 2015
POPULATION HEALTH MANAGEMENT
44
OPTIMIZING HIGH-RISK CARE MANAGEMENT
• Purchasers have a fundamental role
• Employers and other purchasers of health care are the ultimate beneficiaries
• For most employers, it will entail working with payers and clinicians and health systems
JAMA January 22, 2015
POPULATION HEALTH MANAGEMENT
45
FINDING THE ROLE OF HEALTH CARE IN POPULATION HEALTH
• Compared with social, environmental, and behavioral factors, medical care has only a relatively small influence on health for populations
• To meet this responsibility, health systems will need to (1) take additional responsibility, (2) create and expand partnerships, and (3) respond to societal demands for equity and value
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
46
POPULATIONS
• Advances in health information technology make it easier to: identify populations of patients; measure and track risk factors, quality of care, and outcomes; and facilitate team-based care.
• Must address non-medical drivers of health such as housing, education, or remediation of environmental threats.
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
47
PARTNERSHIPS
• Health systems or payers must believe that their contributions will produce value for their own patients or members
• A health system’s influence on health will be greatest for those under direct care, but it also recognizes that the system can contribute to partnerships
• Innovative partnerships between health care system stake holders and other sectors
• Financial models that overtly foster partnership
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
48
EQUITY
• Must overcome the challenge of inequity of both access to and quality of medical care
• The first responsibility of any health care organization is to address disparities
• Health systems must be confident that a group-level focus will decrease disparities and that key stakeholders are engaged
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
49
HOSPITAL COMMUNITY BENEFIT PROGRAMS
• The geographic communities in which people live and work have a profound effect on their health and the health cate they receive
• CMMI has state grants to implement and test state innovations model plans
• Community benefits has been an obligation of tax-exempt hospitals
JAMA February 2, 2015
POPULATION HEALTH MANAGEMENT
50
HOSPITAL COMMUNITY BENEFIT PROGRAMS
Four principles could help guide the development of a strategy for leveraging community benefit programs:
2. ensuring that community benefit activities use evidence to prioritize interventions
3. increasing the scale and effectiveness of community benefit investments by pooling some resources
4. establishing shared measurement and accountability for regional health improvement
JAMA February 2, 2105
POPULATION HEALTH MANAGEMENT
51
A COMMUNITY HEALTH BUSINESS MODEL
• Health outcomes are produced by multiple factors, or health determinants
• The contribution of health care to health is modest-only 20 percent
• No single entity can be held accountable
• Collective effort is needed
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
52
A COMMUNITY HEALTH BUSINESS MODEL
• Contributions must come from those that have secondary influence on health outcomes
• Must form partnerships
• Michael Porter states “solution lies in the principle of shared value, which involves creating economic value in a way that also creates value for society by addressing its needs and challenges”
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
53
A COMMUNITY HEALTH BUSINESS MODEL
Some elements of the community health business model would be:
– All stakeholders must be engaged
– Transparency
– Common purpose
– Resources need to be identified
– Interventions to improve community health
– Economic incentives
– Each community needs to be assessed and monitored
– Continuous redesign
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
54
• One sector may take lead responsibility for population health improvement, using informal or formal authority
• This lead entity serves as the integrator to align activities across multiple sectors
A COMMUNITY HEALTH BUSINESS MODEL
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
55
A COMMUNITY HEALTH BUSINESS MODEL
• Resources can be identified
– Capture funding
– Better return on investment from policies and programs outside of healthcare
– Strengthen governmental funding
– Focus on philanthropy
– Engage corporate business leaders
Frontiers of Health Services Management Summer 2014
• Business case for population health improvement and determine the resources and policies each community actor requires
• Foundations and government should collaborate
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
57
CMS will award $665 million to support states in transformation. Key strategies are incorporating:
• Integration of Community-Based Services
• Population Health Focus
STATE INNOVATION MODEL INITIATIVE
58
Enabling Strategies to Support System Transformation
Quality Measurement Alignment Strategy
STATE INNOVATION MODEL INITIATIVE
59
Programs will examine multiple delivery models:
• Patient Centered Medical Homes
• Health Homes
• Accountable Care Organizations
• Bundled Payments
• Episode-Based Payments
• Accountable Care Communities
STATE INNOVATION MODEL INITIATIVE
60
Palomar
Health
Community Physicians
Government
61
Addenda
62
ALIGNING HOSPITALS, PHYSICIANS AND OTHER PROVIDERS ACROSS THE CONTINUUM OF CARE
Evaluation Metrics A. Percentage of aligned and engaged physicians B. Percentage of physician and other clinical provider
contracts with performance and efficiency incentives aligned with ACO-type incentives
C. Availability of non-acute services D. Distribution of shared savings/performance
bonuses/gains to aligned physicians and clinicians E. Number of covered lives accountable for population
health F. Percentage of physicians in leadership
JOURNEY TO THE SECOND CURVE
Metrics for the Second Curve of Health Care
63
OPTIMIZING HIGH-RISK CARE MANAGEMENT
• The most costly 1% of patients account for one-fifth of national healthcare expenditures
• Complex co-occurring conditions for which high-risk patients often receive poorly coordinated care, driving unnecessary utilization and poor outcomes
• High risk care management programs have the potential to improve care and reduce costs for this population
• Clinicians and health care organizations are increasingly adopting programs of their own
JAMA January 22, 2015
POPULATION HEALTH MANAGEMENT
64
OPTIMIZING HIGH-RISK CARE MANAGEMENT
• High risk care management programs are most effective when they are anchored in the practice where patients receive their care
• There is no substitute for person-to-person contact
• Traditional fee-for-service reimbursement actively hinders experimentation with care management
• Shared savings arrangements, capitated payments and per- member per-month payments for long term care management all afford care delivery organizations with the flexibility to reengineer care and create an environment where success improves financial performance
JAMA January 22, 2015
POPULATION HEALTH MANAGEMENT
65
OPTIMIZING HIGH-RISK CARE MANAGEMENT
• Purchasers have a fundamental role in promoting effective high-risk care management for their covered populations
• Employers and other purchasers of health care are the ultimate beneficiaries of any savings borne by successful care management
• For most employers, it will entail working with payers to (1) promote a shift away from payer and third party led systems and (2) drive employees to clinicians and health systems that can offer these services more effectively.
JAMA January 22, 2015
POPULATION HEALTH MANAGEMENT
66
FINDING THE ROLE OF HEALTH CARE IN POPULATION HEALTH
• Compared with social, environmental, and behavioral factors, medical care has only a relatively small influence on health for populations whether defined by health system or geographic boundaries.
• To meet this responsibility, health systems will need to (1)take additional responsibility for the health of the patient populations under their care, (2) create and expand partnerships with other entities with the potential to influence health, and (3) respond to societal demands for equity and value.
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
67
POPULATIONS
Advances in health information technology make it easier to
identify populations of patients; measure and track risk factors,
quality of care, and outcomes; and facilitate team-based care.
There is also increased potential for the identification and
management of at-risk individuals within a practice or delivery
system who may benefit from community resources to address
non-medical drivers of health such as housing, education (e.g.,
early intervention for children), or remediation of environmental
threats.
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
68
PARTNERSHIPS
• For meaningful contributions to population health initiatives to occur, health systems or payers must believe that such contributions will produce value for their own patients or members
• A health system’s influence on health will be greatest for those under direct care, but it also recognizes that the system can contribute to partnerships that are important to achieving desired population outcomes when health systems alone have less capacity and control
• Innovative partnerships between health care system stake holders and other sectors with influence on health (public health, education, transportation, employers and others) are increasing
• Financial models that overtly foster partnership may hold promise for improving population health
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
69
EQUITY
• Any effort by health care systems to improve the health of either the patients they serve directly or the broader population must overcome the challenge of inequity of both access to and quality of medical care
• The first responsibility of any health care organization is to address disparities in the provision and outcomes of clinical care within its system
• Health systems must be confident that a group-level focus will decrease disparities and that key stakeholders (group members and leaders) are engaged fully in setting priorities and implementing solutions
JAMA January 23, 2014
POPULATION HEALTH MANAGEMENT
70
HOSPITAL COMMUNITY BENEFIT PROGRAMS
• The geographic communities in which people live and work have a profound effect on their health and the health cate they receive
• CMMI has state grants to implement and test state innovations model plans with regional collaborative structures, sometimes called accountable health communities
• The provision of community benefits has been an obligation of tax-exempt hospitals for many decades
JAMA February 2, 2015
POPULATION HEALTH MANAGEMENT
71
HOSPITAL COMMUNITY BENEFIT PROGRAMS Four principles could help guide the development of a strategy for leveraging community benefit programs to increase their influence:
• defining mutually agreed-on regional geographic boundaries to align both community benefit and accountable health communities initiatives
• ensuring that community benefit activities use evidence to prioritize interventions
• increasing the scale and effectiveness of community benefit investments by pooling some resources
• establishing shared measurement and accountability for regional health improvement
JAMA February 2, 2105
POPULATION HEALTH MANAGEMENT
72
A COMMUNITY HEALTH BUSINESS MODEL
• Health outcomes are produced by multiple factors, or health determinants-including medical care, health behaviors and the social and physical environments
• The contribution of health care to health is modest-only 20 percent
• No single entity can be held accountable for achieving the goals of improved population health
• Collective effort is needed by sectors not accustomed to working together and by stakeholders who may not be aware of how their actions affect population health
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
73
A COMMUNITY HEALTH BUSINESS MODEL
• Contributions must come from those that have secondary influence on health outcomes, such as business, education, state and local government, community development and philanthropy.
• Must form partnerships drawn from all sectors and the partnerships must be integrated using a community health business model
• Michael Porter states “solution lies in the principle of shared value, which involves creating economic value in a way that also creates value for society by addressing its needs and challenges”
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
74
A COMMUNITY HEALTH BUSINESS MODEL
• Some elements of the community health business model would be:
– All stakeholders must be engaged in the process
– Transparency with engagement and reporting to the public
– Common purpose needs to be established
– Resources need to be identified
– Interventions are directed at the overall purpose of improving community health
– Economic incentives need to be identified
– The state of health in each community needs to be assessed and monitored
– Continuous redesign
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
75
• One sector may take lead responsibility for population health improvement, using informal or formal authority
• This lead entity serves as the integrator to align activities across multiple sectors
A COMMUNITY HEALTH BUSINESS MODEL
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
76
A COMMUNITY HEALTH BUSINESS MODEL
• Resources can be identified – Capture funding from reduction of ineffective
healthcare spending – Better return on investment from policies and
programs outside of healthcare – Strengthen governmental funding for population
health improvements at all levels – Focus on philanthropy – Engage corporate business leaders
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
77
A COMMUNITY HEALTH BUSINESS MODEL
• Care should be taken to identify those improvements and opportunities that fall within the sector’s primary control; those not under primary control should move to multi-sectoral partnerships
• Policymakers should make the business case for population health improvement and determine the resources and policies each community actor requires
• Foundations and government should collaborate to develop a group of cost-effective health policies in sectors beyond health, which could be reinforced by financial or regulatory incentives
Frontiers of Health Services Management Summer 2014
POPULATION HEALTH IMPROVEMENT
78
CMS will award $665 million to support states in transformation:
Key strategies are incorporating:
Integration of Community-Based Services
• Integration of public health, community-based and behavioral health services across the entire care continuum
Population Health Focus
• Target the preventable drivers of poor health
STATE INNOVATION MODEL INITIATIVE
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Enabling Strategies to Support System Transformation
• Workforce development plans, HIT improvements and data analytics to enhance health care delivery
Quality Measurement Alignment Strategy
• Outline a statewide plan for aligning quality measures by convening private and public payers to accelerate quality improvement and ease the administrative burden for all clinicians