Johns Hopkins Community Physicians Presentation to MCMS October 25, 2012

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Johns Hopkins Community Physicians

Presentation to MCMSOctober 25, 2012

Presented by: Matt Poffenroth, MD, MBADirector of Clinical Integration, JHCP

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JHM Organizational Structure………focusing on strategic interfaces

The Johns HopkinsHealth System

Corporation (JHHSC)

The Johns HopkinsUniversity (JHU)

The Johns

HopkinsHospital

JohnsHopkinsBayviewMedicalCenter,

Inc.

HowardCountyGeneral Hospital

JohnsHopkins

CommunityPhysicians

SchoolOf

Medicine

JohnsHopkins

HealthCareLLC

JHVentures,

LLC

Johns HopkinsMedicine

(JHM)

JohnsHopkinsMedicine

International,LLC

JohnsHopkinsHomeCare

Group

SuburbanHospital,

Inc.

SuburbanHospital

HealthcareSystem,

Inc.

= Unincorporated board or division

= Legal entity

SibleyMemorialHospital

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JHCP SectionsFY 12

• Each section with clinical chiefs and administrators

JHCP FY 2012

• 36 outpatient sites• 11 counties,

Baltimore City• 400+ providers• 1000 staff• 800 K encounters• 230 K patients

4** Bayview Internal Medicine, practice managed by JHCP

JHM Clinical Enterprise

TRENDED VOLUME

FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 (est)

FY 2013 (budget)

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

Encounters

Encounters

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Provider Growth Summary

FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 20110

50

100

150

200

250

FTE - Providers

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JHCP Challenges

In many ways, similar to private practice:• Insure access to growing volume of patients • Coordinate care for patients in a fragmented delivery

system• Meet demands of payers to measure and report data• How to position ourselves for payment reform• Physician work:life balance

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How is JHCP meeting these challenges?

• Strategically adding capacity, based on access needs• Partnering with other private practice physicians in

the community• New models of care – PCMH, extended hours, etc. • Participating with various P4P programs• Implementing EPIC in April, 2013• Evaluating physician compensation model

Pay for Performance Programs at JHCP• Value Based Purchasing (JHHC)• Meaningful Use of EHR’s• Patient Centered Medical Home (PCMH)

– Maryland Multi-Payer Pilot (MMPP)- 5 sites– CareFirst– USFHP

• ACO-prepared• PQRS• ePrescribing• Maryland State-Regulated Payer EHR Adoption

Incentive Program

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Future of healthcare in Maryland• Payment reform is happening – providers

increasingly will be asked to take risk• Quality and transparency is be demanded by payers

and patients• Shift towards population health management• Uncertainty about HSCRC waiver and how this could

affect providers

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How will the system respond?

• Continued and accelerated consolidation– Physicians increasingly seeking “safe haven” of

employment– Hospitals increasingly reliant on physicians to

meet access and quality needs– Bundled payments, shared savings programs, etc.

• Alignment of incentives between providers, patients, payers and purchasers (is this a dream?)

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JHM Strategic Response

• Developing an integrated delivery system is one of JHM’s Mission Imperatives

• Alignment with private physicians is a JHM priority to achieve clinical integration

• Strategies include:1. Employment2. Shared EHR3. Accountable Care Organizations4. Other

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Employment

• Typically not “purchasing” practices• Not always an appealing option for either side

– Financial risk– Culture

• Requires a shared Mission and Vision

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Shared EHR

• JHM begins transitioning to EPIC in April 2013, beginning with our ambulatory practices

• JH Community Division to offer EPIC Community Connect to private practices

• Full EHR and practice management system, without billing module

• Marketing to begin late fall 2012, implementation fall 2013

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ACOs

• CMMI grant approval for J-CHiP in June 2012 – “academic ACO”

• Exploring community ACO model with intent to file letter of intent by June 2013 with implementation January 2014

• Success (i.e. improved quality at lower cost) will require:– Infrastructure– Resources– Expertise in population health management

• Not all “ACOs” will succeed

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Other methods to enhance alignment• Improved access to JH clinics• Part-time faculty appointments• CME• Shared purchasing agreements • Networking with JH health plans• MSO services• “True” clinical integration model with shared contracting

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Questions?

Matt Poffenroth, MD, [email protected]

240-235-9130

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