Clinical Integration in Health Care: A Check Up Private Initiatives - - PowerPoint PPT Presentation

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Clinical Integration in Health Care: A Check Up Private Initiatives - - PowerPoint PPT Presentation

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Clinical Integration in Health Care: A Check Up Private Initiatives to Improve Health Care Delivery Through Collaboration Among Health Care Providers Lee B. Sacks, M.D. President Advocate Physician Partners Washington, D.C. May 29, 2008 1

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Clinical Integration in Health Care: A Check Up

Private Initiatives to Improve Health Care Delivery Through Collaboration Among Health Care Providers

Lee B. Sacks, M.D. President Advocate Physician Partners Washington, D.C. May 29, 2008

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Overview

  • Advocate Physician Partners (APP)
  • Goals
  • Infrastructure
  • Obstacles
  • Mechanisms & Incentives to Increase

Compliance

  • Measures of Success
  • Joint Contracting/Exclusivity
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Advocate Physician Partners

  • Vision: To be the leading care

management and managed care contracting organization in Chicagoland

  • 7 physician hospital organizations and

Advocate’s medical groups - financial and clinical integration

  • 2,900 Physicians
  • 300,000 capitated lives / 700,000 PPO
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Goals

  • APP’s Clinical Integration Program is a

collaborative effort by over 2900 physicians and the eight Advocate hospitals to drive targeted improvements in health care quality and efficiency through our relationship with every major insurance plan offered in the Chicago metropolitan area, thus uniting payer, employer, patients, and physicians in a single program to improve outcomes.

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APP Infrastructure

  • 154 FTE’s
  • $24 Million Admin Expenses (2007)
  • Databases / Patient Registries
  • Governance
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APP Infrastructure Support for CI

  • Medical Directors

– Each of 7 PHOs – QI Committee Chair – Senior Medical Director

  • CI Director – 1 FTE
  • Analyst – 1 FTE
  • Quality staff - 6 FTE
  • Pharmacist - 2 FTE
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APP Infrastructure Support for CI

  • Provider Relations staff - 13 FTE
  • Data support staff - 3.5 FTE
  • Also contracting, finance and

administrative support

  • For CI only

– $1.65 M/year in salaries and benefits – 18.5 FTE’s

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Obstacles

  • Incomplete Data: Health Plans

– Technical Issues – HIPAA

  • Disease Management “Carve Outs”
  • Health Plan Disintermediation
  • Antitrust Review
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Mechanisms to Increase Compliance

  • APP QI/Credentials Committee
  • Membership Criteria
  • Peer Pressure / Local Medical Director
  • Mandatory Provider Education/CME
  • Physician’s Office Staff Training
  • Financial Incentives / Report Cards
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Advocate Physician Partners Incentive Fund Design

Dreyer Clinic AHC Group / PHO Incentives (30%) Individual Incentives (70%) Individual Criteria Individual Distribution Group/PHO Distribution Tier 1 (50%)

Group / PHO Criteria

Tier 2 (33%) Tier 3 (17%)

Individual Tiering Based On Physician’s Individual Score

*Residual Funds PHO 1-7 *Residual Funds

* Residual Funds are rolled over into general CI fund (not tied to individual physician or originating PHO) to be distributed in the following year

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Measures of Success

  • Clinical Outcomes
  • Patient Safety
  • Medical & Technological Infrastructure
  • Efficiency
  • Patient Satisfaction
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To obtain a copy of the 2008 Value Report, go to www.advocatehealth.com/app

  • r call 1.800.3ADVOCATE

(1.800.323.8622)

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. A H C D reyer A PP A L L N C Q A

M easure O verall P H O *

D B H g ba1 c 86 .7% 89 .8% 9 5.6 % 90.7% 92.5% D B H g ba1 c < 7 46 .8% 45 .4% 5 7.9 % 50.4% 48.2% D B H g ba1 c > 9 23 .9% 13 .4% 1 2.3 % 17.0% < 20.5% D B L D L 85 .0% 88 .1% 9 2.1 % 88.3% 88.1% D B L D L <1 00 56 .8% 49 .8% 5 6.9 % 55.0% 49.2% D B E ye E xa m 65 .1% 55 .9% 5 5.5 % 59.2% 73.2% D B N ep hro pathy 70 .7% 85 .7% 8 2.8 % 79.0% 85.4% D B < 140 /90m m /H g 67 .9% 55 .3% 8 1.2 % 69.4% 70.7% D B < 130 /80m m /H g 41 .8% 26 .4% 5 2.9 % 41.7% 42.2%

2007 Results Compared to “Best State” NCQA - Commercial

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Percent of Claims by EDI

EDI Claims

84% 88% 89% 83% 89% 90% 90% 91% 85% 85% 87% 86% 90% 84% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Christ Good Samaritan Good Shepherd Illinois Masonic Lutheran South Suburban Trinity PHO 2006 2007

  • -- Community performance per Managed Care Organization, 2007
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Adoption of eICU - 2007

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Cardiology Family Practice Surgery Internal Medicine Orthopedics Pulmonology APP Non-APP

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Joint Contracting & Non-Exclusivity

  • Joint contracting is essential for APP to

achieve its great results – Same measures across all payers – Common procedures at practice level for all contracted plans – Same network for all payers – Stable networks – Efficiency in credentialing

  • APP is non-exclusive
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To obtain a copy of the 2008 Value Report, go to www.advocatehealth.com/app

  • r call 1.800.3ADVOCATE

(1.800.323.8622)