perating in the medical neighborhood:
the future of prevention
2013 mental health &
addiction conference
phil atkins, licdc, ocps2
the spf-sig medical neighborhood project
• funded through a grant from ODMHAS
• three components:
– education
– media and development of public information
– training and information dissemination
• Collaboration
– Mental Health & Recovery Services Board of Allen, Auglaize
and Hardin Counties
– ODMHAS – Dawn Thomas
– MODO Media
– Jim Ryan, Ryan Training
takeaways
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key components of health care reform
population health management
medical neighborhoods
measuring health outcomes
prevention of the future
getting ready for “prevention of tomorrow!”
preventable health concerns:
the big dollar items
heart disease and stroke: $312.6 billion
diabetes: $245 billion
substance abuse: $600 billion
www.drugabuse.gov
how will these and other health care
costs be managed while maintaining
and improving the quality of care?
the triple aim:
1. improving the health of populations
2. improving the patient experience of care (quality +
satisfaction)
3. reducing the per capita cost of health care
thinking about populations:
health care of large groups
Accountable Care Organization
Patient Centered Medical Homes
Medical Neighborhood
our first stop…
Accountable Care Organization (ACO)
Accountable Care Organizations
• Accountable Care Organizations (ACOs) are groups of
doctors, hospitals, and other health care providers, who come
together voluntarily to give coordinated high quality care to
their population of patients.
• The goal of coordinated care is to ensure that patients,
especially the chronically ill, get the right care at the right
time, while avoiding unnecessary duplication of services and
preventing medical errors.
• When an ACO succeeds both in both delivering high-quality
care and spending health care dollars more wisely, it will share
in the savings it achieves for the program.
essential elements of
population health management
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address health needs at all points along the continuum of health and
well being through:
– coordinated participation in care
– patient engagement
– targeted interventions
maintain and/or improve the physical and psychosocial well being of
individuals through cost-effective and tailored health solutions
focusing on:
– central leadership role of the physician
– importance of patient engagement, education, activation
– capacity expansion of care coordination through non-physician
team members
delivering population health management
in any care setting
assess
stratify
implement
solutions
measure
& report
population health management functions
population health management
• identify population
• identify gaps in care
• comprehensive health assessment
SPF
ASSESSMENT
• stratify risks
risk levels:
universal, selective, indicated
• integrated practice team
CAPACITY
• evidence-based guidelines
• development of performance measures
• selection of interventions
PLANNING
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engage patients
evidence-based practices
care management
eliminating barriers
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outcome measurement
data analysis
report performance
customer satisfaction
• cost-effective
• demonstrate quality
• reimbursement diversification
• ensure access
• culturally and linguistically appropriate
• integration of community resources
prevention tools
workforce development
IMPLEMENTATION
EVALUATION
SUSTAINABILITY
CULTURAL
COMPETENCE
technology for planning and
evaluation (POPS)
our next stop…
Patient Centered Medical Homes
Patient Centered Medical Home
a practice in which an individual can
receive quality, timely, efficient, and
patient-centered comprehensive care
and care coordination from a
compassionate team of health-care
professionals.
A PCMH is an approach to deliver comprehensive care, coordinated by
a primary care physician-led extended care team.
personal relationship
with a PCP* and
care team
+
proactive focus on
health, care intervention
and chronic disease
management
*primary care physician
+
technology,
services &
applications to
support the new
collaborative
model
a Patient Centered Medical Home is…
• …a model for re-designing primary care practices.
• …intended to improve the quality and efficiency of
care delivery.
• …based on the principles of:
– having a personal physician/provider
– a physician directs the practice team
– whole-person orientation
– care coordination and integration
– quality and safety
– enhanced access
– payment/reimbursement changes
PCMH as the foundation for
Accountable Care Organizations
our next stop…
Medical Neighborhood
a medical neighborhood
a medical neighborhood can be
conceptualized as a PCMH plus the
constellation of other clinicians and
specialists providing health care services
to patients within it, along with
community and social service
organizations and state/local public
health agencies.
a medical neighborhood
emanates from PCMH
no one size/shape fits all communities
can include institutional providers.
not all neighbors are “equal” (“core” v. others)
compatible with a broad range of payment
structures
• formal, mutual expectations for PCMH and
neighbors
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a medical neighbor…
• communicates, coordinates and integrates bidirectionally with the PCMH as well as with patient.
• ensures appropriate & timely consultations and
referrals.
• ensures effective flow of information.
• addresses responsibility in co-management
situations.
• supports patient centered care.
• supports the PCMH practice as the “hub” of care
and as the provider of whole person primary care
to the patient.
a look into the future
improving our data through
outcome measurement
health care organizations use HEDIS measures
to track and report outcomes.
H – healthcare
E – effectiveness
D – data and
I – information
S – set
• most widely used set of standardized performance
measures in the health care industry
• system for establishing accountability in health care
measuring outcomes with HEDIS
health care organizations use HEDIS measures
to track and report outcomes.
H – healthcare
E – effectiveness
D – data and
I – information
S – set
• most widely used set of standardized performance
measures in the health care industry
• system for establishing accountability in health care
what does HEDIS measure?
HEDIS currently has 81 measures across 5
domains:
• effectiveness of care – what is the quality of the care or
service that was received?
• access and availability of care – can people get the care
and services they need?
• experience of care – are people satisfied with things like the
communication skills of the provider or how easy it was to
access services?
• utilization and relative resource use – how many and how
often were services utilized and were costs competitive
compared to other providers?
• health plan descriptive information – specific characteristics
of the particular health plan such as certifications, diversity
HEDIS has both population-based
measures (e.g. how many women
in a particular population received
a breast cancer screening) and
event/diagnosis-based measures
(e.g. how many people were
diagnosed with diabetes).
HEDIS has both population-based
measures (e.g. how many women
in a particular population received
a breast cancer screening) and
event/diagnosis-based measures
(e.g. how many people were
diagnosed with diabetes).
why is this important to us?
1. knowing how health care is held accountable is
essential to our understanding of their “world” and
our cultural competence needed to develop
relationships with primary health care.
2. creating prevention outcome measures that follow
the format of HEDIS and other health care
outcome systems helps us communicate in their
language.
3. we can learn from physical health care how to
demonstrate our effectiveness and value.
4. we need to learn to evaluate our efforts at both
the population level (environmental strategies) and
at the event level (individual strategies).
what does my community based
agency need to do to become
part of a medical neighborhood?
laying the foundation of our own house
• Become prevention scientists - understand the research
behind what we do.
• Know our new neighbors - develop competence in this
“new culture” of primary care.
• Demonstrate value - show that what we are doing is
making a difference in people’s lives - with DATA!
• Be proud of our product – we are prevention specialists
providing a specialty health care service.
putting it all together