board strategic & facilities planning committee full-board … · 2015-05-27 · meeting...

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 Comments1..………………………………………………..……………………………………. ….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 1st 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.

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

Minutes Board Strategic & Facilities Planning Committee

Wednesday, April 22, 2015

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:

COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:

1

Bylaws 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: 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:


2

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:


3

Standing Agenda Items 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 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:


4

Corporate Health’s Business to Business Strategy

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

Staff Recommendation: N/A

Committee Questions:


6

ADDENDUM A

7

042215 DRAFT Board Strat & Facil Planning Cmtee Mtg Min.doc 1

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

Excused Absences: Directors Kaufman, Griffith, Wickes

III. NOTICE OF MEETING

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

2. Q3 FY2015 STRATEGIC & OPERATIONAL INITIATIVES REVIEW

8




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

Milestone 2 – creating implementation plan

9




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.

SIGNATURES: COMMITTEE CHAIR

RAY MCCUNE, R.N.

10




RESPONSIBLE PARTY

DISCUSSION

BOARD ASSISTANT

DEBBIE HOLLICK

11

ADDENDUM B

12

REVISED February 18, 2014 January 26, 2015 May 27, 2015

STRATEGIC & FACILITIES PLANNING

COMMITTEE

AMENDED AND RESTATED

BYLAWS

13


6.1.1 Strategic and Facilities Committee.

(a) Voting Membership. The Committee shall consist of six voting

members, including three members of the Board and one alternate

who shall attend Committee meetings and enjoy voting rights on the

Committee only when serving as an alternate for a voting Committee

member, the President and Chief Executive Officer and the Chiefs of

Staff of the Hospitals or the designees of the Chiefs of staff as

approved by the Committee Chairperson.

(b) Non-Voting Membership. The Executive Vice President Strategy,

Executive Vice President Finance, Executive Vice President Human

Resources, Executive Vice President Operations, General Counsel, , ,

Vice Presidents of Palomar Medical Center, Palomar Health

Downtown Campus and Pomerado Hospital, a nurse representative

from Palomar Medical Center or Pomerado Hospital, Assistant Vice

President Hospitality & FacilitiesDirector of Facilities Planning and

Development, Chief Foundation Philanthropy Officer, a board

member of the Palomar Health Foundation recommended by the

Foundation and approved by the Committee Chairperson and an

additional physician from each hospital as recommended by each

hospital’s Chief of Staff and as approved by the Committee

Chairperson. As needed, other appropriate relevant staff in

engineering, architectural, planning and compliance, and a Physician

Advisory Committee member may be requested to attend along with

Palomar Health staff to facilitate the work of the Committee.

(c) Duties. The duties of the Committee shall include but are not limited

to:

Regarding the Strategic Function:

(i) Review and make recommendations to the Board regarding the

District’s short and long range strategic plans, master and

facility plans, physician development plans and strategic

collaborative relationships; and

14


Review annually those policies within the Committee’s purview and

report the results of such review to the Governance, Audit and

Compliance Committee. Such reports shall include recommendations

regarding the modification of existing, or creation of new policies;

and

(ii) Undertake planning regarding physician recruitment and

retention and program development of new and enhanced

services and Facilities; and

(iii) Monitor new initiatives and programs; and

(iv) Perform such other duties as may be assigned by the Board.

Regarding the Facilities Function:

(i) Review construction estimates and expenses for accuracy and

architectural plans for completeness and effectiveness;

(ii) Approve construction project change orders in accordance with

applicable district law and Palomar Health policies;

(iii) Receive reports from the Construction Manager and the

Director of Facilities Planning and Development; recommend

action to the Board regarding facilities design and maintenance;

(iv) Review regulations and reports regarding facilities and grounds

from external agencies, accrediting bodies and insurance

carriers; make recommendations for appropriate action

regarding the same to the Board;

(v) Approve the annual Facilities Development Plan and regularly

review updates on implementation of plan;

(vi) Receive a biannual Environment of Care report;

(vii) Perform such other duties as may be assigned by the Board

15

ADDENDUM C

16

Corporate Health Services

Business to Business Strategy through Occupational Medicine

17

Philosophy

• Mission – Heal, comfort, and promote health throughout the

business community.

• Vision – Provide peace of mind for work related risks and

injuries, allowing organizations to focus on the total health of their business.

18

Background

• Opened Poway Clinic 2004

• Onsite Wellness & Vaccination Services 2006

• Interim Director – Focus on growth 2008

• Opened San Marcos Clinic 2010

• Expand Onsite Services - Surveillance 2012

• First Responder Surveillance Program 2014

19

Our Services

PREVENTION

• New Hires

• Physicals

• Drug Test

• HRA Biometrics

• Medical Surveillance

CONTAINMENT

• Injury Mgmt

• Return to Work

• Case Mgmt

• Claims Review

EDUCATION

• Ergonomics

• Presentations

• Consulting

• Medical Oversight

20

Touch Points

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

FY2012 FY2013 FY2014 FY15 Proj

9,805 10,654

12,185

13,718

Ou

tpat

ien

t C

linic

Vis

its

Patient Encounters

GOOD

21

Referral Benefit

0

100

200

300

400

500

FY2012 FY2013 FY2014 FY15 Proj

168 178 224

235 271 284 270 258

439 462 494 493

Direct Care Referrals

Specialist Rehab Total

FY14

• $00,000

• $00,000

$000,000

FY15

• $00,000

• $00,000

$000,000

22

Breadth of Connection

0

200

400

600

800

1000

FY2012 FY2013 FY2014 FYTD 15

778 726

778 812

Em

plo

ye

rs S

erv

ice

d

Employer Clients

GOOD

23

Bridging the Gap

40,456

37,752

41,234 43,036

25,000

30,000

35,000

40,000

45,000

50,000

FY2012 FY2013 FY2014 FYTD 15

Connected Employer Lives

GOOD

Connected

Healthcare

Solution

C

H

S

24

The Power of Relationships

Newsletters

Annual Conference

Quarterly Roundtable

Personal Connections

25

Newsletter

Newsletters

•96 Consecutive Issues Issues

•14,167 Total Opens

•700+ Employers Subscribers

•33% (National Average 24.87%) Open Rate

•25% (National Average 7.24%) Click Through

• .01% (National Average 1.05%) Opt Out

26

Annual Conference

Newsletters

• 47 attendees 2010

• 56 attendees 2011

• 69 attendees | 11 vendors 2012



• 100+ Estimated | 21 vendors 2015

27

Employer Roundtables

Newsletters

•Burnham Benefits Healthcare

Reform

•Palomar Health Rehabilitation Ergonomics

•ALPHA Fund Insurance Aging Workforce

•Burnham Benefits Affordable Care

Act Impacts

•Barney & Barney CA Work Comp

Update

28

Personal Connections

• Employers who take time to tour take relationship seriously

• 90% close rate when we get employer to walk through our doors Clinic Tours

• Strengthens relationship when doctor takes time to tour workplace

• Clearer understanding of environment when writing work restrictions Workplace Tours

• Great opportunity to gain INTEL and build relationship with HR reps

• No charge for to participate Employer Health Fairs

• Influencers of occupational health care

• Build trust and recognition through education presentation to this group

TPA/Insurance Presentation

• Business park associations, HR associations, Insurance, etc.

• Network, Network, Network!!! Professional Associations

29

Traditional Occupational Medicine

Corporate Health

Employer

Medical Groups

Palomar Health

Services

Brokers Insurance

30

Corporate Health Model

Corporate Health

Insurance

Connected

Healthcare

Solution

C

H

S

31

Questions

32

ADDENDUM D

33

CONTINUUM OF CARE | POPULATION HEALTH

ALAN, J. CONRAD, MD, MMM, CPE, FACHE

34

INSTITUTE FOR HEALTHCARE IMPROVEMENT

• Improving the patient experience of care

• Improving the health of populations

• Reducing the per capita cost of care

TRIPLE AIM

35

VOLUME TO VALUE Fee-for-Service reimbursement VALUE VALUE-BASED SECOND CURVE

High quality not rewarded

No shared financial risk Payment rewards population value -

quality and efficient

Acute inpatient hospital focus Quality impacts reimbursement

IT investment incentives not seen by hospital

LIVING IN THE GAP

Partnerships with shared risk

Stand-alone care Systems can thrive Increased patient severity

Regulatory actions impede hospital-physician collaboration

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


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


• 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



44


• 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



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



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.



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



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



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


50


Four principles could help guide the development of a strategy for leveraging community benefit programs:

1. defining mutually agreed-on regional geographic boundaries

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



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


• 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”



53


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



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




55


• 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



56


• Sector’s primary control; multi-sectoral partnerships

• Business case for population health improvement and determine the resources and policies each community actor requires

• Foundations and government should collaborate



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


59

Programs will examine multiple delivery models:

• Patient Centered Medical Homes

• Health Homes

• Accountable Care Organizations

• Bundled Payments

• Episode-Based Payments

• Accountable Care Communities


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


Metrics for the Second Curve of Health Care

63


• 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



64


• 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



65


• 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.



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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.



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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.



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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



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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



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• 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



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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



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• 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



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• 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”



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• 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



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• 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




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• 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



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• 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



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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


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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


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Programs will examine multiple delivery models:

• Patient Centered Medical Homes

• Health Homes

• Accountable Care Organizations

• Bundled Payments

• Episode-Based Payments

• Accountable Care Communities


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board strategic & facilities planning committee full-board … · 2015-05-27 · meeting...

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