Population Health Management healthcare design through strategic planning Barry Bittman, MD Senior Vice President Chief Population Health Officer Highmark Allegheny Health Network Senior Fellow – Estes Park Institute Perhaps It’s Time to Tear Down the Walls • Healthcare is delivered in silos. • Lack of integration predictably results in medical errors, poor communications, unnecessary cost and failure to work together cohesively. The problem is severely compounded beyond • the walls of the hospital in the post ‐ acute care environment. • As a direct result, quality outcomes erode and cost outstrips available resources. The Institute of Medicine estimates $750 billion wasted healthcare spending each year that results in unnecessary suffering. • There has never been a better time to establish a cultural shift that reenergizes and inspires our staff and our physicians. 2 1
PHM Definition We have redefined Population Health Management as: “an amalgamated series of integrated strategies that achieve Triple Aim objectives through four essential pillars: Clinical Provider Technology Payor Integration Integration Integration Integration Key Advantages • Population Health Management establishes the infrastructure for aligning and coordinating clinical services, while building a collaborative sustainable culture among hospitals, physicians and post acute care providers. • Our future depends to a great extent on alignment − among patients, hospitals, physician, employers and community partners. • The value added components delivered through PHM enable us to advance toward Triple Aim objectives in a fragmented challenging healthcare environment. 4 2
Why should you be concerned? • We are in the midst of moving from a fee ‐ for ‐ service model to risk ‐ based contracts. • Quality achievement now plays a significant role in payment. Hospitals and physicians can • no longer function independently. • The ultimate survival of community ‐ based healthcare is at stake. 5 PHM: Foundational Insights Our nation’s healthcare system is fragmented, unaffordable and unsustainable. Numerous factors including poor patient outcomes, excess readmissions, physician burnout and the radical transformation from fee ‐ for ‐ service to global payments and risk ‐ based contracts threaten the survival of our healthcare system. Our purpose is to offer the highest quality healthcare through an innovative patient ‐ centric PHM model that focuses on the MISSION optimization of patient outcomes and patient/family care experiences, along with lower per capita costs. 3
Objectives • To create a Triple Aim ‐ based high quality, cost ‐ effective, fully integrated patient ‐ centered population health management (PHM) strategy system ‐ wide. • To design, progressively refine and deploy a system ‐ based comprehensive fully ‐ integrated strategy that enables us to optimally serve our communities in the healthcare reform environment and well into the future. • To build a sustainable coordinated healthcare strategy that optimizes efficiency and care alignment. 7 Rationale • Successful healthcare reform requires the development and deployment of comprehensive innovative redesign strategies. • We have an unprecedented opportunity to optimize outcomes ‐ based quality through: – innovative clinical population health management strategies – physician integration and leadership – Cutting edge technological innovation – payor alignment 8 4
Developing A Connection With Each Patient A Sample of Health Meadville Medical Center Allegheny College Coach Programs St. Vincent Hospital Gannon University Jefferson Hospital Washington & Jefferson College Wooster Community Hospital College Of Wooster Pocono Hospital East Stroudsburg University White River Medical Center Lyon College (Arkansas) Canton-Pottsdam Hospital St. Lawrence University Rochester General Hospital Rochester Institute of Technology Washington Regional Medical Center University of Arkansas Shannon Medical Center University of Texas 5
• Planning is essential. Benchmarking is critical. Knowing where you are is essential. • An extraordinary need exists for PHM care coordination toolsets as well as algorithms and protocols that enable quantitative real ‐ time tracking. • Care coordination tools must be shared among hospitals, physicians, navigators, health coaches and post ‐ acute care partners. 11 PHM: A Practical Analogy 6
PHM: A Practical Analogy Airline Industry PHM Objectives To safely and efficiently transport a To safely and efficiently transform group of people from one location the health of a population from to another (Point A to Point B) in a sickness to enhanced health and cost effective manner. well ‐ being in a cost effective manner. Goals Safety Safety Timely departures and arrivals Positive Health Outcomes Efficiency Efficiency Convenience Convenience Customer Satisfaction Patient/Family Satisfaction Affordability Affordability Strategies Streamlined processes Streamlined processes Reproducible algorithms Reproducible algorithms Best practices Best practices Numerous checks and balances Numerous checks and balances Real ‐ time assessments Real ‐ time assessments Airline Cockpit 7
PHM Cockpit Outpatient PAC Providers Physicians Hospitals Centers Meaningful Prevention Acute Disease Best Practices Wellness Incentives Patient Family Chronic Palliation Data Clinician Conditions Hospice Management Training Health Care Managers Navigators Data Managers Coaches Airline Command Center Collision Avoidance Weather Flight Warning Routing Airport Control Tower Flight Gate Redirection Scheduling Runway Clearance 8
PHM Command Center Call Center Patient & Physician Support No ‐ Consult Discharge Referral Care Center Continuum Your Hospital Quality and Post ‐ Acute Adherence Care Monitoring Providers Physician Integration Education It takes a coordinated team to take off and land safely. 9
TO DO List Re ‐ evaluate your clinical strategies with a critical perspective for ensuring quality, efficiency and seamless delivery. Coordinate your providers (employed and non ‐ employed) and provide the leadership for fostering cohesive working relationships. Learn the ropes − focus on the clinical and operational benchmarks that are critical for your success. Build the toolset, and learn to function effectively as a Control Tower. Focus on Strategic Planning that does not serve to reinvent a better yesterday . This is an extraordinarily challenging new environment that requires innovation and out ‐ of ‐ the ‐ box thinking. Celebrate your successes and build a new culture that truly inspires your vision for the future. 19 When they entrust their lives to us, we owe them more... 10
Thank You For more information: bbittman@iihealthcare.or g 11
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