practicalities of integration - napc · practicalities of integration nhs confed june 2019 3. ......
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Practicalities of integration
Sam Jones, CEO/President, Centene UK
Supporting & enabling integration
Confidential & proprietary Incorporating:
Practicalities of integrationNHS ConfedJune 2019
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Supporting & enabling integration
Confidential & proprietary Incorporating:
What we are:
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Investments in Spanish based Ribera Salud and a UK portfolio consisting of
SimplifyHealth, a mental health integration service, and The Practice Group, an at
scale primary care and community services provider
EUROPE
on Forbes’ Global
2000: Growth Champions List (2018)
#43
WHO WE ARE
St. Louisbased company founded in Milwaukee in 1984
48,100 employees
#51Fortune 500 (2019)
£47.2Brevenue for 2018
#210Fortune Global 500
£ 57.2 – 57.8Bexpected revenue for 2018
#49 Fortune 100 Fastest Growing Companies (2018)
WHAT WE DO
32 stateswith government sponsored healthcare programs
14.7 million patients
Medicaid(27 states)
Marketplace(20 States)
Medicare(20 States)
Correctional(14 States)
~300 Product / Market Solutions
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Who we are:
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• We are proud of the NHS - we want to work as a partner to make it even better. In particular where care is fragmented we can bring the coordination and structure to support clinicians be the best they can be.
• 95% of our work support’s governments around the world provide healthcare - often to extremely deprived communities. We do this by adding value and reducing waste
• We passionately believe that the best solutions are local solutions – there is no one size fits all and each health economy or system must have its own solution
• Supporting integrated care for 14.7 million patients around the worlds means we understand the practicalities of integration from an operational not just a theoretical level
• We believe in or staff so much we have created a University to help them grow and flourish
Supporting & enabling integration
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PHM: aiming to achieve the triple aim
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The efficient and constant management over time the health needs of the population, through care coordination, disease management, preventive detection and proactive action
PHM
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Population Health Management: Achieving the Quadruple Aim
The Main Goals of the Quadruple Aim
● Better Outcomes: improvement of health population outcomes
● Reducing Cost: achieve the goals through efficiency and lower costs per capita
● Patient Satisfaction: the quality improvement should be transmitted to the patients to increase their perception and experience
● Professional Commitment: professionals commitment is the key to achieve the 3 previous goals
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Predictive Personalised
Preventive Participatory
Population
Development of a
predictive model of the
risk associated with each
patient based on different
risk adjustment systems
Each citizen has a health
plan adapted to their
needs, general condition
and chronic diseases
Each citizen is directly
involved in their care
plans
The program includes
interventions for disease
prevention and health
promotion
Actionable Population Health Management - Predictive 5Ps model
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Actionable Population Health ManagementLearning from International Experience
Clinical Management
WorkforceTechnology
Patient & Citizen
The Model Combines the Strengths of:
• A citizen-centred clinical management strategy
• Modern workforce management
• A cross functional information system
• The Citizens are at the heart of the model
These elements are self-reinforcing in a continuous process of improvement
Ribera Salud: Triangle of Success
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Practicalities of integration:
Integration function
Supporting & enabling integration
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The right intent alone doesn’t create integration – functions and tools make it operationally happen
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Integrated care systems take a number of different forms :
• Networked
• Integrated delivery system
• Fully integrated
Fully integratedIntegrated delivery systemNetworked
• Clearly defined integrator• Manage large external provider network to
meet needs of patients• Integrator holds risk for population contracts
• Integration functions present but less clearly defined entity
• Takes form of management structure and ‘business units
• Organisation collectively holds risk
• Clearly defined integrator• Manage smaller, mostly ‘internal’
provider network• Integrator holds risk for population
contracts
In all of these systems there is a core role of integrator that conducts vital
integration functions supported by a range of tools and technologies
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Alignment to Integrated Care Framework
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Enablers• Shared outcomes for system
and population• Single set of guidelines• Shared data and information
including cost and activity
Functions• Majority of functions in place• Used to monitor and embed
enablers – such as decision-support tools
Technology• Used to enhance application
of integration functions and embed enablers
• Improve access and improve outcomes
Supporting & enabling integration
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The role of integration functions in supporting care delivery
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Enablers
Integration functions
Acute
Community
Mental health
Primary Care
Social care
Population
• Functions are often delivered by a defined entity
• Allows for independence and objectivity in holding separate organisations to account on behalf of the ‘system’
• Agree guidelines and standards enable open and transparent monitoring of performance
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The heart of population health management - understanding population risk to manage system
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Understand Total Individual Risk Factor (TIRF) to inform aggregate
analysis. This considers demographic, socioeconomic, and
health information.
Illustrative Utilisation Risk FactorsAssumed GN Population Distribution
(Deprivation Status based on IDACI/IDAOP)Illustrative Commissioner Spend (£ PPPM)
Non-Deprived Deprived GN Composite Non-Deprived Deprived Total GN
Under 1 M/F 0.808 1.371 0.946 5,616 1,822 7,438
1 - 5 M/F 0.234 0.645 0.335 32,603 10,537 43,140
6 - 13 M/F 0.221 0.542 0.297 51,116 16,041 67,157
14 - 17 M 0.189 0.668 0.302 11,415 3,521 14,936
14 - 17 F 0.421 0.785 0.507 10,816 3,349 14,165
18 - 34 M 0.253 0.567 0.330 81,742 26,480 108,222
18 - 34 F 0.555 1.535 0.791 78,374 24,815 103,189
35 - 44 M 0.458 1.256 0.633 38,464 10,805 49,269
35 - 44 F 0.722 1.750 0.938 35,791 9,498 45,289
45 - 64 M 1.055 1.336 1.105 74,033 16,125 90,158
45 - 64 F 1.155 1.429 1.203 71,745 15,357 87,102
65 - 74 M 1.865 3.854 2.199 26,238 5,299 31,537
65 - 74 F 1.713 2.958 1.920 27,401 5,457 32,858
75 - 84 M 2.911 4.404 3.160 14,092 2,819 16,911
75 - 84 F 2.471 3.627 2.666 17,362 3,505 20,867
Over 85 M 3.703 5.294 3.972 4,768 967 5,735
Over 85 F 3.224 4.384 3.419 8,642 1,754 10,396
Total GN 0.888 1.418 1.000 590,215 158,154 748,369
GenderAge Bands
Develop a composite (segment/cohort) view of risk factors: Understanding individual risk factors enables to understand wider risk by
segment and/or cohorts
Use risk factors to project future utilisation: An understanding of risk factors provides
ability to forecast/project expected utilisation. From this it is possible to monitor performance
to identify variation in performance
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Bringing this all together - using technology to support care coordination – Jim’s story
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Frequent, comprehensive stratification of the population identifies patients who could
benefit from coordinated care
The outcome of the assessment results in a personalised care plan which is uploaded and
shared electronically
Care management teams share the care plan and work to the
same care plan with designated tasks. Patients remain part of care management until goals
achieved
Care plan delivery
Primary care
Care management
Hospital teams
Jim has multiple long term conditions including heart failure and diabetes. He is
identified as high risk.
Jim is invited to meet with the care management team to explore goals and ways to
manage his condition
Jim is able to access a copy of his care plan via the portal
Jim attends appointments with relevant professionals as agreed in care plan. Continues to have
regular meetings with care coordinator
Dedicated multi-disciplinary care management team performs personalised
assessment with patient
Assessment and Care Plan
Jim is able to access results of appointments, upload
information and contact is care team if he has any concerns or
issues
Patient portal
Patients are able to access their care plan via a patient portal. It also enables them to interact with health care professionals
digitally
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Confidential & proprietary Incorporating:
Investing in people - Centene University
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• Centene University is our internal strategic tool designed to equip our staff with the technical and leadership skills they need today and in the future to reach their goals
• Includes a curriculum focused on the Healthcare industry, Core Operations, Functional skills and Leadership. It is also developing a state-of-the-art executive education center dedicated to accelerating the readiness of leaders.
• In addition, our eLearning platform, Cornerstone, gives employees 24/7 access to hundreds of educational programs, on topics such as: Leadership Development, New Supervisor Skills, Effective People Skills, Business Writing, and other department specific courses
Apex leadership model
Supporting & enabling integration
Confidential & proprietary Incorporating:
Results
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Reducing the burden on emergency admission
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Supporting & enabling integration
Confidential & proprietary Incorporating:
Admission avoidance using digitally enabled care
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Data from Case Study: Universal Healthcare system in Spain Adopts TruCare and experiences significant improvements in quality care initiatives
Decreased time to intervention
Improved patient engagement & outcomes
Increased efficiency & lower costs£
Adapted to Ribera Salud’s EMR
Department Torrevieja Vinalopó TOTAL
1st consultations -26 % -26 % -26 %
Medical admissions -19 % -20 % -19 %
Medical stays -18 % -27 % -22 %
Hospital at Home (HaH) admissions -7 % 47 % 22 %
Hospial emergencies -18 % -9 % -13 %
Readmissions within 30 days -22 % -36 % -28 %
Supporting & enabling integration
Samantha Jones | Chief [email protected]