Managing the Unmanageable: Providers, Partners, and Patients T - PowerPoint PPT Presentation

Managing the Unmanageable: Providers, Partners, and Patients T HURSDAY , O CTOBER 24, 2019 – 12:00PM S PEAKERS : ▪ S ANJAY S ETH , M.D., E XECUTIVE V ICE -P RESIDENT , H EALTH EC ▪ C LIFF F RANK , I NTERIM E XECUTIVE D IRECTOR , S HORE Q UALITY P ARTNERS

Critical Elements of Every ACO Patients Providers Partners

Managing the Unmanageable Patients Prevention - What causes them to become unmanageable 1. Limited access to providers 2.Unsatisfied encounters with the providers 3.Social Determinants of Health Issues 4.Chronic illnesses • Symptoms • Don’t keep appointments • Go to the emergency room • Self referrals to specialists • Consequences • Low satisfaction scores • Low quality scores from lack of cooperation • Cause of attribution reduction

Managing the Unmanageable Patients Cure – Through Provider Engagement • Practice Transformation to • Improve access and engaged encounters • Address Social Determinants of Health Issues • Chronic care management • Transitions of Care and Wellness Cure – Through Payer Negotiations • Management of auto-assigned patients • Assistance with unreachable/uncooperative patients • Focused management of patients with unique and exclusive problems • Contract re-negotiations

Managing the Unmanageable Providers Prevention – What causes them to be unmanageable • Provider compensation – the non-incentivized / rewarded providers • No support for ACO activities, multiple programs, manual effort for MD • Symptoms • Does not interact with administration • Refuses to share data • Refuses to work with the care coordinators • Does not assimilate in to the ACO community Cure – Improved Provider Engagement • Strategies to improve engagement • Provider education; early success strategy • Define and include Citizenship • Better flow-of-funds for providers criteria in bonus calculations • ACO strategy support with data, practice support and care coordination • Use peer pressure • Different strategies for PCP and Specialist • Incentivize participation in ACO activities

Managing the Unmanageable Partners Types of Partners: Home Hospice and Urgent Care Skilled Nursing Super Specialty Centers of Healthcare and Palliative Care Centers Facilities Groups Excellence DME Providers Providers Cure Prevention • Solve the unmanageable patients and providers • Formal contracts • Include partners as stake holders • Better provider participation with in-network providers • Urgent care as off-hours solution, waiver for SNF use etc. • Monitor utilization and services

Questions and Discussion

Stop by our ACO Exhibit Hall Virtual Booth https://www.acoexhibithall.com/vendor-booth/healthec/population-health-ii-software-tools-data-analytics/114/

Thank You Dr. Sanjay Seth, Executive Vice President, HealthEC Sanjay.seth@healthec.com Cliff Frank, Interim Executive Director, Shore Quality Partners Cfrank@partnerahealth.com www.HealthEC.com www.Shorequalitypartners.com www.ACOExhbithHall.com

Managing the Unmanageable: Providers, Partners, and Patients T - PowerPoint PPT Presentation

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