Effective Care Delivery Across the Continuum
Steve Hester, MD, MBA
Senior SVP, Chief Medical Officer
Norton Healthcare
Norton Healthcare
2013 Total encounters
2,214,079
Per Day Statistics:
• Average Daily Census…………………………………….…….875
• Admissions………………………………………………………….168
• Surgeries (IP & OP)………………………………………………134
• Outpatient visits (excluding ER)…………………………1,080
• ER visits……………………………………………………………….570
• Freestanding Diagnostic visits………………………………..69
• Practice visits (primary care & specialists)…………4,045
• Total encounters per day…………………………………..6,066
Norton Medical Group
Norton Medical Group Profile 2013
Total Visits
1,465,657
Primary Care, ICC, and Pediatrics
674,334
Specialist Visits
791,323
Total Locations
128
Total Visits per day
4,015
Total Primary Care Visits per day
1,847
Total Specialist Visits per day
2,168
Total ICC Visits
161,805
Healthcare – A System in Chaos
• The health care system is under duress
• Irresistible drivers of change include:
– Medical progress
– Aging population
– Global economy
• Challenges for providers and patients:
– Too many people involved, too much to do, no one with all
the information, no one with full accountability
– Result: Chaos  gaps in quality and safety, inefficiency
Value in the Future = Patient Care Continuum
Hospital - ER services,
OP services, IP stays
Skilled
Nursing; LTAC;
Rehab
Specialty
Physician
Home
Care Team
Center
Wellness
Center
Diagnostic
Center
ICC
Patient
Home
Home
Health
Changing Care Delivery
•
•
Hospital Practices: Improved management of complex patients
–
Complex Care Management
–
Multidisciplinary Plans of Care through electronic health record
–
Increased emphasis to social barriers
Physician Practices: Patient-centered care
–
Patient Centered Medical Home (PCMH)
–
Practice redesign
–
Payor collaboration
–
Wellness – increased screening & lifestyle coaching
Why now?
Physician Centered Care

Patient Centered Care
Physician
Patient
Physical
Therapist
Nurse
Social
Worker
Pharmacist
Patient
Physician
Social
Worker
Pharmacist
Nurse
Physican
Therapist
Required Support for Patient Success
Overcoming health system barriers
Education where knowledge
deficits exist
Communication between patient,
care provider, and the community
The Future Patient Experience
• Patient Navigation: Result of Fragmented Healthcare
• Patients will truly be in control of their care.
• Never have to traverse the complicated health system
alone.
• Be informed of the care they are provided and be
better able to make knowledgeable decisions.
Navigation Results
• Cancer patient rates as an example:
– The screening rate improved 10.8 - 17.1%
– Adherence to diagnostic services after an
abnormality was detected improved 21 - 29.2%.
This information provided by: a patient
navigation intervention. Cancer. 2007;
109(2 suppl):359-367.
Next Steps in Patient Navigation
Commitment from all stakeholders for
sustainability
Standardization of the methodology and
certification process
Defined standards and metrics for billing
Norton Healthcare’s Patient Navigator Program
Discuss Medications
Schedule Follow-ups
NHC Patient
Navigators
Go over discharge instructions
Provide additional information
Answers all questions
Assists the patient in overcoming barriers
Questions?