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GE Healthcare Camden Group Insights Blog

Best of 2015: Six Benefits System Execs Can Achieve Via Clinical Integration

Posted by Matthew Smith on Dec 29, 2015 10:37:54 AM

By William K. Faber, M.D., Vice President, GE Healthcare Camden Group

clinically integrated careLeading into the new year, GE Healthcare Camden Group will be re-publishing the most shared and popular blog posts of 2015.

What’s in it for me? That’s a question systems should ask--and answer--before taking on the challenges of forming a clinical integration program or becoming an accountable care organization. Failure to create a shared vision, and an informed commitment to that vision despite all obstacles and concerns, can easily derail change management initiatives down the road. It is important to identify likely concerns and objections, and formally articulate a response to them, early on in the planning process.

Some of the most common concerns we’ve heard from system executives are one or more of the following:

  1. Why change at all?  Fee-for-service is still working for us in this market. In fact, our entire business model is predicated upon it. Specifically, the Medicare penalties for excess rates of readmissions – an early area of focus for many Accountable Care Organizations ("ACOs") - are a just a small “cost of doing business” compared to the potential lost revenue from commercial insurers if we really improved in this area.
  2. Why change now?  We’ve been told before that “the end is near” and that we have to change. Those predictions did not come true then, so why should I believe they’ll come true now?  In particular, what happens to ACOs and shared savings-type contracts once all the savings have been wrung out?
  3. Can we afford it?  How much will it cost, and for how long will we have to subsidize the program?  We have a lot of competing demands for dollars.
  4. What’s the ROI?  Traditional financial models struggle to find a reasonable return on investment. In fact, some show material losses.
  5. Do we have to partner with “community” physicians to do this?  Many systems have invested heavily in physician employment. Some are struggling to integrate them or to see demonstrably better quality as a result of these investments. Why spend more now with non-system employed physicians?

Here are some of the more common responses to physician concerns:

  1. Better Care for Patients: The investments the network will make in information technologies, care coordination, performance feedback and other initiatives can drastically improve outcomes for patients. It has been demonstrated by other successful clinical integration programs. The vision statement for most every healthcare system talks to the preeminence of caring for the patient. Clinical integration and accountable care structures allow systems to reach whole new levels of quality, value and care.
  2. Responsive to Market Demands: The sheer number of ACOs – both Medicare and commercial – that have emerged in just the past year or so is the best evidence that value-based payment arrangements are in demand. More and more insurers are moving to narrow network products too, as employers have become more open to these kinds of models to help rein in their healthcare benefits expense.
  3. Avoid Risks of Non-Participation: A common characteristic of ACO and shared savings-type contract arrangements is that network physicians – or at least primary care physicians – can only be listed in one ACO in the market. Furthermore, commercial insurers are moving more and more into narrow network products that only contract with organized networks of physicians – primary care and specialists. Few systems are able to employ enough physicians to satisfy the network requirements of even the narrowest of these networks. As more and more organizations are forming ACOs, and as narrow networks are increasingly introduced to markets, systems face increasing risk of being “left out in the cold” as markets mature around them.
  4. Upside Payment Potential: Reductions to “unit price” fee schedules by both Medicare and commercial insurers are widely anticipated. Participation in value-based payment models offer systems some opportunity to access additional payment streams from various “value based” contracting forms that are recently or will shortly be emerging.
  5. The Program Can Increase My Business: One of the concerns commonly expressed by system executives is that greater access to primary care services, care coordination and the creation of other efficiencies – typical areas of focus for ACOs – will cut into traditional hospital “profit centers” such as longer than necessary lengths of stay, excessive Level 1 and 2 ER visits, avoidable readmissions, etc. Appropriately designed, there are many ways in which programs can help direct care “in network” to ensure quality- and efficiency-enhancing protocols are followed. Furthermore, many healthcare systems are now contracting with their own clinical integration programs for the health benefits of their employees. Savings realized by more efficient care management of system employees and family members can represent a significant offset to other lost or diminished sources of revenue.
  6. Our Prospects Are Better Together: There are those systems that think they could participate as effectively in value based payment models by themselves or with just their employed base of physicians. There are certain areas of value creation that can only be achieved through close working relationship with a broad base of physicians in specialties and geographic locations beyond those in which they have employed physicians.
Clinical Integration Networks, CIN, Daniel J. Marino

Dr. Faber is a vice president with The Camden Group. As a physician executive, he specializes in the development of accountable care organizations and clinically integrated networks, physician engagement, and health information technology. Prior to joining The Camden Group, Dr. Faber served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s clinical integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an electronic health records system. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Care, Clinically Integrated Networks

Asked and Answered: Frequently Asked Questions by Physicians About Clinically Integrated Networks

Posted by Matthew Smith on Sep 21, 2015 3:35:11 PM

By Daniel J. Marino, MBA, MHA, Senior Vice President, and William K. Faber, M.D., Vice President, The Camden Group

FAQ, Clinically Integrated NetworkWhile clinical integration development continues to build momentum, many questions still remain. The following questions and answers will help communicate the value of clinical integration and clinically integrated networks ("CINs") to your physicians. If you're a physician, these questions and answers should help you with some recurring and nagging issues.

What is clinical integration?

Clinical integration is an effort among physicians, often in collaboration with a hospital or health system, to develop active and ongoing clinical initiatives focused on delivering quality, performance, efficiency and value to the patient.

What’s driving the movement toward clinical integration?

In the years ahead, physicians and hospitals must partner more closely than ever before to ensure that the community receives the highest quality and value. As we move from today’s fee-for-service reimbursement models to new performance- and value-based pay models, CINs enable healthcare providers to join together to enhance the health of a community. These networks bring value to patients, payers, and physicians by improving transitions of care, coordinating chronic disease management, and managing the health of a population.

What does a CIN do?

A CIN helps physicians align with the hospital to coordinate care across caregivers, focus on quality and performance, and prepare for new, incentive-based compensation programs in addition to the base compensation they already receive. The network will develop new payment systems and methods that focus on achieving quality, efficiency, cost-management measures, and enhancing value.

What is the purpose of the CIN?

The principal purpose is to enhance the quality and efficiency of patient care services provided by the participating providers to the community. A CIN with participating providers works together to develop clinical performance standards and protocols for the network. These will form the basis for the network to negotiate contracts with payers for performance incentive programs.

How is it structured?

The CIN is a wholly owned subsidiary of the health system managed by its own Board of Directors, with community physicians and hospital members. Physicians willing to participate in a meaningful way have the opportunity to be involved in the organizational committees that drive the network.

What are the benefits of joining?

For physicians, the network offers the opportunity to:

  • Become available as a preferred network provider to members
  • Use care management resources provided by the CIN
  • Identify and measure best practices
  • Improve outcomes for patients
  • Receive financial rewards for value-based outcomes and achievements

The goal of the CIN is to provide an exemplary patient experience and improve the health of individuals in our community in a continuum of care that is focused on quality, performance, efficiency, and value. This serves as the platform that will determine financial incentives for physicians.

Who can join?

To ensure the best value for patients and payers, the CIN welcomes physicians who want to be accountable and raise the quality of care. These physicians can be:

  • Independent community physicians who seek clinical and quality alignment
  • Physicians employed by a health system
  • Physicians who contract with the hospital to provide services in specialties such as emergency medicine, anesthesiology, and pathology

Do physicians join as individuals, or do all the physicians in a practice need to join?

For independent physicians, a delegated representative from a group practice may sign the participation agreement and code of conduct on behalf of the practice to enroll all providers. However, in most instances, each individual physician in the group will need to complete a short application packet. Physicians employed by the health system will be enrolled with other members of their practice groups.

Will members be required to refer enrolled patients to other network members?

In-network referrals allow for the efficient accumulation and reporting of data, promote coordination and continuity of care and ensure adherence to evidence-based medicine.

What type of data is monitored?

Network leaders and physician advisory committees will determine details on clinical initiatives and data to be monitored and reported. Collected data likely will be similar to that being measured for Medicare programs, such as the Physician Quality Reporting System.

How will clinicians submit data to the network?

Providers will submit clinical and claims data on a timely basis to a secure, web-based platform that is HIPAA compliant and password protected. The web-based platform enables physicians to conveniently and easily submit data from any device with internet access.

What is the difference between a CIN and an Accountable Care Organization ("ACO")?

According to the Centers for Medicare and Medicaid Services, an ACO is accountable specifically for Medicare beneficiaries. It is an organization of healthcare providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries enrolled in the traditional fee-for-service program who are assigned to the ACO. Similarly, a CIN is an alignment model, coordinating care across affiliated caregivers and developing contracts with payers to improve quality while controlling growth in total cost of care, including value-based contracting initiatives with commercial payers and Medicare.

Clinical Integration Networks, CIN, Daniel J. Marino


Daniel J. Marino, The Camden Group, Clinically Integrated NetworksMr. Marino is a senior vice president with The Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. He may be reached at dmarino@thecamdengroup.com or 312-775-1701.

 

 

William K. Faber, MD, Clinical IntegrationDr. Faber is a vice president with The Camden Group. As a physician executive, he specializes in the development of accountable care organizations and clinically integrated networks, physician engagement, and health information technology. Prior to joining The Camden Group, Dr. Faber served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s clinical integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an electronic health records system. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

 

Topics: Population Health, William K. Faber MD, Clinically Integrated Care, Clinically Integrated Networks, Clinically Integrated Network, Daniel J. Marino

 3 Important Considerations for Funding Your Clinical Integration Project

Posted by Matthew Smith on Sep 15, 2015 1:58:54 PM

By Daniel J. Marino, MBA, MHA, Senior Vice President, The Camden Group

Funding Clinically Integrated NetworksHealthcare leaders are asking some serious questions about clinical integration. How much will it cost to develop a clinically integrated network ("CIN")? How and when will the CIN begin paying for itself?

Here are answers to three important questions about the economics of clinical integration.

Q. What Initial Investment Will Clinical Integration Require?

The upfront investment depends on the resources each participant can contribute to the network. The initial primary cost drivers of a CIN are information technology, professional and legal support, and staffing. The good news is that all three cost components can usually be managed within the available resources of the hospital partner.

Based on the work The Camden Group is doing with clients, new CINs typically require $500,000 to $3 million in investment capital. This money funds the network build and launch over a two- to three-year period.

Q. What is the Net Impact of Clinical Integration?

Leading organizations are developing CINs with the idea that they will not achieve true return on investment until two or three years down the road. The sooner a CIN can manage population health and build an organized system of care, the sooner it will realize a net positive return. Two areas are key:

Network Impact

The CIN as a whole should focus on securing incentive payments. These include incentives tied to reducing the cost of care and meeting/exceeding quality thresholds under value-based and risk-based contracts. Networks can also pursue employer contracts that provide care management fees and revenue from employee health outreach, wellness, and prevention services.

Participant Impact

Hospitals and physicians that participate in a CIN can expect a positive impact within their separate operations.

  • As network-driven care matures, patient outmigration (commonly referred to as patient leakage) outside the CIN should decrease by 10 percent to 15 percent. Hospitals will see their utilization increase, even though typical indicators such as length-of-stay and readmissions will decrease.
  • Many CINs begin by enrolling the hospital’s self-insured employed population. These hospitals will see a decrease in their variable employee costs and a decline in overall spending per employee per year.
  • Integration will also complement a hospital’s internal quality improvement initiatives. Hospitals that participate in a CIN will have a greater ability to bend the cost curve, achieve quality targets, and improve patient access.
  • Physicians have the opportunity to receive performance incentives in the form of shared savings distributions. Medical providers should also see a stabilization and eventual increase in their practice population, resulting in stronger practice revenue.
Q. What is the Financial Value of Clinical Integration?

Ultimately, CINs need to look beyond short-term incentives and start developing the ability to assume financial risk for groups of beneficiaries.

Payers are beginning to offer complementary insurance products that leverage population health management. These payers need high-performing CINs that:

  • Deliver a strong network of providers focused around organized care principles
  • Demonstrate the ability to drive down costs for high-risk population cohorts
  • Incorporate care coordination functions that result in high-quality care outcomes

CINs that can deliver on these points will build undisputed financial value, giving them a commanding position within emerging provider/payer partnerships.

Start with a Financial Model

Will your CIN be economically viable? The answer depends on many variables, including market forces and assumptions inherent in population health management.

The first step for any new CIN is careful financial modeling. Successful CINs get a fast start by building sophisticated financial models that take into account changing conditions and sensitivity analyses. These models help CINs build strong provider networks, align participants with a population health vision, maximize their net economic impact, and create true financial value. 

Clinical Integration Networks, CIN, Daniel J. Marino


Mr. Marino is a senior vice president with The Camden Group with more than 25 years of experience in the healthcare field. Mr. Marino specializes in shaping strategic initiatives for healthcare organizations and senior healthcare leaders in key areas such as population health management, clinical integration, physician alignment, and health information technology. He may be reached at dmarino@thecamdengroup.com or 312-775-1701.

Topics: Clinically Integrated Care, Funding Clinical Integration, Clinically Integrated Network, Daniel J. Marino, Funding CINs

Using a Collaborative to Build a Clinically Integrated Culture

Posted by Matthew Smith on May 12, 2015 10:46:42 AM

By William K. Faber, M.D., MHCM, Vice President, The Camden Group

blueprint.jpgTo succeed in emerging payment models, providers must cooperate to improve patient outcomes and control costs. This requires not just new workflows, but a new provider culture. 

The traditional fee-for-service payment model rewards the isolated efforts of providers. But patient outcomes are not maximized by individual effort. They are maximized by team effort. In accountable care systems, providers must coordinate their efforts to improve health outcomes and contain costs. Systems must transform both clinical operations and clinical culture to achieve success. One proven strategy for developing a new provider culture is to create a Practice Transformation Collaborative.

What is a Collaborative?

A Practice Transformation Collaborative is a longitudinal and interactive learning program that helps healthcare providers understand and use the tools of quality improvement. It brings together physicians and key clinical team members to learn practice management and quality improvement principles. It focuses on specific quality metrics and the best evidence-based means to reach them. Participants receive practical guidance on improving office efficiency and effectiveness. They share their experiences, receive peer support and learn best practices from one another.

Used effectively, a Practice Transformation Collaborative can help providers within a clinically integrated system become adept at improving population health outcomes and simultaneously minimizing costs.

Well-designed collaboratives share six key elements:

  1. Clinical leaders with quality improvement experience. Effective programs are spearheaded by clinicians with experience in quality improvement. A good candidate might be a physician with a Master of Public Health or Master of Science degree in Quality Improvement. Support faculty should include physicians and nurses with experience, certification, or training in quality. Successful teams also benefit from instructors with expertise in lean process improvement.
  2. An operational director. A collaborative is a large undertaking that needs a focused director. Responsibilities include developing the budget and curriculum, setting up meetings, enrolling providers, developing promotional materials, designing incentives, and organizing ongoing events. This role does not need to be a full-time position. In smaller organizations, these responsibilities could be handled by a Physician-Hospital Organization director, a Quality Improvement director or someone in business development.
  3. A curriculum. A strong curriculum will introduce participants to the concepts of population management, clinical integration, process improvement, chronic disease management, and practical statistics. It is important to include a “workshop” component that gives participants an opportunity to work together, compare notes, and learn from real-life projects.
  4. Peer-to-peer Interactions. The heart of a Collaborative is the peer sharing process. Instructors teach principles and give assignments, but the true learning occurs as clinicians attempt to change specific processes back in their practices and then share what they have learned with their peers. Participants can learn just as well from successes as they can from failures, and the personal sharing of successes and failures, insights, struggles, and innovative ideas is both practically useful and motivational for others in the group.
  5. An ongoing support structure. Devise ways to support providers between sessions. One option is to require participants to turn in monthly progress reports on their projects. This could be as simple as a one-page form for reporting accomplishments and challenges. Monthly conference calls help keep participants focused on program goals. In addition, create a “tool kit” (patient education hand-outs, chronic disease management protocols, etc.) to support participants in their efforts.
  6. Strong incentives for provider participation. An organization could provide points towards incentive payment thresholds for collaborative participation. Other options include providing a stipend or arranging for participants to receive continuing medical education credit. It is also possible to obtain specialty board credit towards recertification for those fully participating in the collaborative.

Executive Sponsorship is Critical

As with all change initiatives, executive commitment is critical to a Practice Transformation Collaborative. Effective collaboratives are backed by a key executive leader who supports the concept, works to secure resources and provides high-level sponsorship.


William K. Faber, Primary Care Access

Dr. Faber is a vice president with The Camden Group. As a physician executive, he specializes in the development of accountable care organizations and clinically integrated networks, physician engagement, and health information technology. Prior to joining The Camden Group, Dr. Faber served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s clinical integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an electronic health records system. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Care, Collaborative, Practice Transformation Collaborative

Population Health Alliances: Rethinking the Business Model

Posted by Matthew Smith on Mar 26, 2015 12:01:00 PM

By Tara Tesch, Senior Manager, MHSA, The Camden Group

PopHealthAlliance3Healthcare systems are increasingly choosing to partner with other provider organizations to pursue population health initiatives on a more regional and sometimes state-wide basis. These “alliances” are often viewed as alternatives to more traditional mergers and acquisitions, and are created through the collaboration of more than one health system, hospital, or physician group. This emerging collaboration model provides opportunities to share common infrastructure, expand geographic reach, and increase access to additional clinical and support resources. These alliances also face additional challenges associated with sponsorship by multiple organizations that in some cases have historically been competitors.

The Next Generation of Physician Engagement Strategies

The healthcare environment is changing at a rapid pace and the path toward population health requires committed physicians, administrators, and clinicians at all levels and across the continuum of care. These leaders must commit to taking accountability for clearly communicating the transformational vision, goals, and objectives of the population health alliance to unite its members around this effort. Success in engaging the providers will be around demonstrating a true desire and understanding of the critical importance of integrating physician and clinicians into all levels of the alliance’s governance and operations.

Key to meeting this strategic imperative is to engage dynamic, knowledgeable physician leaders with creditability among the broader physician network to proactively meet with the front-line physicians and build support and engagement. Do not assume that established structures (e.g., medical staff meetings, etc.) will always be an effective means to distribute information and build engagement.

Additional strategies that have proven successful for alliances include:

  • Ongoing education for community-based providers in clinical integration, innovative care models, and tracking of clinical quality and outcomes aimed at increasing their understanding of the value of participation in the alliance network. Education requirements should be included in all physician agreements, and dedicated staff and resources assigned to support these efforts.
  • Leadership training and support to empower the next generation of physician leaders to jointly problem-solve and collaborate in achieving the tenets of population health. Set the tone that this is a transformational journey that will have successes and mistakes; jointly learning from them will offer new insights and promote future efficiencies in ongoing value-based care delivery planning and implementation.
  • Transparency in communication and evolving metrics are necessary to keep providers informed and engaged, and to elicit critical behavioral change. Adjustments in reimbursement, care models, coding requirements, IT systems and capabilities, and alliance-wide goals should be distributed regularly followed by timely educational sessions. Physicians can no longer focus only on their individual performance; rather, focus must shift to the care of their patients across the network continuum, and feedback on how appropriate interventions and utilization of care can improve the health of the populations served.

Adding Value to Physicians

Another critical concept in understanding best practices in physician engagement and network development is the realization by alliance and member system leadership that physicians only practice one model of care; they do not change that approach based on what payer or “bucket” the patient may be attributed. Where alliances can add true value to physicians and actively engage providers is in support services such as care management and IT platform/analytics – areas to support efficiency and provide actionable information in real time.

  • Create a centralized care management institute at the network level that includes performance improvement and care management resource support that can be accessed by other organizations if they do not have their own resources for local work efforts.
  • Establish an ongoing monitoring process, overseen by the alliance clinical committee to measure and track improvement in a clinical indicators over time. This active monitoring and validation helps to test whether or not the data is accurate, the metric(s) is (are) appropriate, and if the process in place actually impacts performance/outcomes.

A consistent challenge remains around providing meaningful data at the point-of-care to educate and engage providers around their performance on clinical quality and financial outcomes. As value-based care delivery relies on care model transformation, physicians rely more and more on receiving actionable information around their clinical outcomes, adherence to evidence-based guidelines and protocols, and value-based metric performance to impact behavior change and operational tools to support practices in care redesign.

The new care models and payment methodologies associated with population health management will require more tightly aligned financial and clinical incentives between hospitals and physicians. Initiatives in these areas must be physician-led to achieve sustained success clinically and financially.

One final consideration: employment does not guarantee physician alignment or integration. The same principles of engagement hold true whether employed or independent, and incentives that align with targeted behavioral change become increasingly important for longer-term success and transformation. Design incentive plans that not only encourage productivity, but reward physician efforts to achieve shared goals in care, quality, and cost control.

Parts two and three in this series will focus on Care Redesign and Data Governance, respectively.


 

taraMs. Tesch is a senior manager with The Camden Group in the clinical integration practice with more than 18 years of experience as a healthcare leader and strategist. Ms. Tesch specializes in value-based care delivery strategic planning, CIN development and implementation for commercial, Medicare, and Medicaid populations, health information technology data governance and analytics strategy, as well as care management strategy, design, and implementation. She has worked with a variety of healthcare providers, including integrated delivery networks, academic health centers, regional referral centers, rural community providers, and national non-profit and faith-based health systems. She may be reached at ttesch@thecamdengroup.com or 312-775-1700.

Topics: Clinical Integration, Population Health, Clinically Integrated Care, Physician Engagement, Population Health Alliance, Tara Tesch

New Download: Managing the Newly Eligible Medicaid Population

Posted by Matthew Smith on Feb 19, 2015 11:36:00 AM

Medicaid, The Camden Group, Tawnya Bosko, Medicaid EligibilityAs more states begin to take on newly eligible Medicaid populations, there are a number of lessons that can be learned from health systems that have already begun managing these patients. Not all institutions within a state will be equally prepared to manage the newly eligible population due to organizational, information technology, and provider network constraints.

This new download from The Camden Group examines challenges associated with the newly eligible Medicaid population and takes a closer look at:

  • Challenges facing hospitals
  • Approaches to assessing readiness
  • Key stakeholders
  • Key formation components
  • Expectations for clinically integrated network formation
  • Lessons learned from other providers

To download this PDF, simply click on the button below, complete the necessary fields, and press the "Click for Download" button. Your file will appear and will be available for you to save to your device.

Medicaid Population, The Camden Group, Population Health

Topics: Clinical Integration, Hospitals, Clinically Integrated Care, Medicaid, Clinically Integrated Network, Health Systems

Six Strategies for Improving Primary Care Access

Posted by Matthew Smith on Jan 23, 2015 9:52:00 AM

By William K. Faber, MD, MHCM
Vice President, The Camden Group

Primary Care Access, The Camden Group, William K. FaberPrimary care providers are the heart of clinical integration. Ready access to primary care services is fundamental to disease prevention, chronic illness management and the reduction of unnecessary testing and treatment. Unfortunately, primary care physicians are scarce and getting harder to find.

Approximately 40% of primary care physicians are over the age of 55, and many will retire before age 65. Fewer medical school graduates are going into primary care. Most primary care physicians feel stretched to capacity and often work 12-hour days, and financial incentives alone are inadequate to entice these physicians to add more patients to their schedules.

Given these constraints, healthcare systems need to expand primary care access through other means. Following are six strategies to increase primary care access by improving staffing models and practice operations.

1. Hire more non-MD providers

Physician Assistants (PAs) and Nurse Practitioners (NPs) can meet the needs of most primary care patients and both are more plentiful than primary care physicians. Integrating these providers into a practice will expand access for patients and allow physicians to focus on more challenging cases that require a more skilled level of expertise.

2. Sync the practice schedule to patient demand

Many practices are open from 8:30 a.m. to 4:30 p.m. (and closed over the lunch hour) Monday to Friday, but many patients prefer early-morning, evening or weekend appointments. Adjusting practice office hours to match patient demand will accommodate more volume, even if the total hours of patient appointments remain the same. Monday is typically the busiest day of the week in doctors’ offices; therefore, the greatest number of physician appointment hours should be provided on Monday. Similarly, patient demand is usually greatest during the winter flu season, so limit adult care providers vacations during this time. Similarly, pediatricians should be most available during school physical season.

3. Simplify appointment types and frequency

Practices create many different appointment types—well visits, sick visits, physicals, pap visits, follow-ups, etc. To better manage patient flow, reduce the number of appointment types to two: 15 minutes and 30 minutes (or any base appointment length and one twice as long). You can determine what kind of patient is best suited to each of these two types, rather than letting the name of the appointment determine whether a patient fits in that slot. Providers should also reconsider the interval at which they recommend follow-up appointments. Some physicians routinely tell their hypertensive or diabetic patients to return every three months. This clogs their schedules unnecessarily so they have inadequate appointments for those that are acutely ill. A better practice is to tailor the follow up interval to the specific patient. If they are well-controlled and self-monitored, certain patients may only need to be seen twice a year. Some patients should be seen more frequently than quarterly to keep them out of the hospital. 

4. Fix practice bottlenecks

All practices can stand to improve patient throughput and efficiency by identifying bottlenecks. Conduct a time-flow study on a sample of patients as they move through each phase of their visit. Reduce delays by redesigning processes and redeploying staff. For example, give patients a clipboard to fill out while they are in the waiting room, so they can list their concerns for the day and verify the medications they are currently taking. Better yet, let them do this through an advanced patient portal. Better patient flow can increase patient access without extending the workday.

5. Create standing orders

Staff members often ask physicians questions for which the answer is always the same. When this is the case, everyone would benefit from standing orders. An example would be a nurse waiting for a doctor’s signature on an order for a mammogram or diabetic retinal exam when it is documented that the patient is due for one of these tests. The physician can designate that they always approve under certain circumstances by creating standing orders. Rooming protocols can also improve throughput. For instance, assistants should always have diabetic patients remove their shoes and socks while rooming the patient, so the doctor can examine the patient’s feet without delay.

6. Break the “face to face” pattern

Clinical integration aims to reward physicians for improving patient outcomes. In the fee-for-service world, physicians are rewarded only for face-to-face encounters, so they have become accustomed to having patients come in to the office when it is not actually necessary. To succeed in new systems of payment, physicians must become comfortable with managing low-risk patients outside of the face-to-face visit, so they are available to see the high-risk patient who truly needs to be seen. In many cases, diagnosis and treatment over the phone is entirely appropriate.

What about patient satisfaction?

Implementing these strategies can help physicians increase their availability to patients. A more efficiently run office can actually expand that amount of “face time” a patient has with their doctor. This also opens up appointments when patients actually want to be seen, which is a big satisfier.

About the Author

William K. Faber, Primary Care AccessDr. Faber is a vice president with The Camden Group. As a physician executive, he specializes in the development of accountable care organizations and clinically integrated networks, physician engagement, and health information technology. Prior to joining The Camden Group, Dr. Faber served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s clinical integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an electronic health records system. He may be reached at wfaber@thecamdengroup.com or 312-775-1703.

Clinically Integrated Networks, CIN, Clinical Integration, The Camden Group

Topics: Clinical Integration, William K. Faber MD, Clinically Integrated Care, Primary Care Access, The Camden Group

Six Benefits System Execs Can Achieve Via Clinical Integration

Posted by Matthew Smith on Jan 8, 2015 12:17:00 PM

Clinical Integration, Clinically Integrated Care, Population HealthWhat’s in it for me? That’s a question systems should ask--and answer--before taking on the challenges of forming a clinical integration program or become an accountable care organization. Failure to create a shared vision, and an informed commitment to that vision despite all obstacles and concerns, can easily derail change management initiatives down the road. It is important to identify likely concerns and objections, and formally articulate a response to them, early on in the planning process.

Some of the most common concerns we’ve heard from system executives are one or more of the following:

  1. Why change at all?  Fee-for-service is still working for us in this market. In fact, our entire business model is predicated upon it. Specifically, the Medicare penalties for excess rates of readmissions – an early area of focus for many ACOs - are a just a small “cost of doing business” compared to the potential lost revenue from commercial insurers if we really improved in this area.
  2. Why change now?  We’ve been told before that “the end is near” and that we have to change. Those predictions did not come true then, so why should I believe they’ll come true now?  In particular, what happens to ACOs and shared savings-type contracts once all the savings have been wrung out?
  3. Can we afford it?  How much will it cost, and for how long will we have to subsidize the program?  We have a lot of competing demands for dollars.
  4. What’s the ROI?  Traditional financial models struggle to find a reasonable return on investment. In fact, some show material losses.
  5. Do we have to partner with “community” physicians to do this?  Many systems have invested heavily in physician employment. Some are struggling to integrate them or to see demonstrably better quality as a result of these investments. Why spend more now with non-system employed physicians?

Here are some of the more common responses to physician concerns:

  1. Better Care for Patients: The investments the network will make in information technologies, care coordination, performance feedback and other initiatives can drastically improve outcomes for patients. It has been demonstrated by other successful clinical integration programs. The vision statement for most every healthcare system talks to the preeminence of caring for the patient. Clinical integration and accountable care structures allow systems to reach whole new levels of quality, value and care.
  2. Responsive to Market Demands: The sheer number of ACOs – both Medicare and commercial – that have emerged in just the past year or so is the best evidence that value-based payment arrangements are in demand. More and more insurers are moving to narrow network products too, as employers have become more open to these kinds of models to help rein in their healthcare benefits expense.
  3. Avoid Risks of Non-Participation: A common characteristic of ACO and shared savings-type contract arrangements is that network physicians – or at least primary care physicians – can only be listed in one ACO in the market. Furthermore, commercial insurers are moving more and more into narrow network products that only contract with organized networks of physicians – primary care and specialists. Few systems are able to employ enough physicians to satisfy the network requirements of even the narrowest of these networks. As more and more organizations are forming ACOs, and as narrow networks are increasingly introduced to markets, systems face increasing risk of being “left out in the cold” as markets mature around them.
  4. Upside Payment Potential: Reductions to “unit price” fee schedules by both Medicare and commercial insurers are widely anticipated. Participation in value-based payment models offer systems some opportunity to access additional payment streams from various “value based” contracting forms that are recently or will shortly be emerging.
  5. The Program Can Increase My Business: One of the concerns commonly expressed by system executives is that greater access to primary care services, care coordination and the creation of other efficiencies – typical areas of focus for ACOs – will cut into traditional hospital “profit centers” such as longer than necessary lengths of stay, excessive Level 1 and 2 ER visits, avoidable readmissions, etc. Appropriately designed, there are many ways in which programs can help direct care “in network” to ensure quality- and efficiency-enhancing protocols are followed. Furthermore, many healthcare systems are now contracting with their own clinical integration programs for the health benefits of their employees. Savings realized by more efficient care management of system employees and family members can represent a significant offset to other lost or diminished sources of revenue.
  6. Our Prospects Are Better Together: There are those systems that think they could participate as effectively in value based payment models by themselves or with just their employed base of physicians. There are certain areas of value creation that can only be achieved through close working relationship with a broad base of physicians in specialties and geographic locations beyond those in which they have employed physicians.
Clinical Integration, Health Directions, Clinically Integrated Network

Topics: Accountable Care, ACO, Clinical Integration, Population Health, Clinically Integrated Care, 4 Pillars, Accountable Care Organizations

New Download: Population Health Management--What Does It Mean To Your Practice?

Posted by Matthew Smith on Sep 8, 2014 11:00:00 AM

Clinical Integration, Clinically Integrated Care, Population Health

The time has come for primary care physicians to reboot their practice operations and begin the process of managing population health. Many physicians are delaying the planning and implementation process that will prepare them for a transformation of how they are paid from fee-for-service to reimbursement-for-results. 

This new PDF presentation from Health Directions examines current trends in Population Health Management as they pertain to physician practices and addresses such topics as:

  • Population Health Defined
  • The Building Blocks of Clinical Integration
  • ACO/Clinically Integrated Network Components
  • Case Study: Forming an ACO
  • Key Implementation Steps
  • Implications for Physicians and Office Managers
  • Participation Considerations

To access this presentation, please click the button below:

Population Health, Practice Management, Clinical Integration

Topics: Clinical Integration, Population Health, Clinically Integrated Care, Physician Practice, Clinically Integrated Network, Download

HD Download: Top Questions From Physicians About Clinical Integration

Posted by Matthew Smith on Aug 21, 2014 4:14:00 PM

FAQ, Clinical IntegrationClinical Integration programs unite physicians for the purpose of delivering higher quality health outcomes. Payers in certain markets reward systems with Clinical Integration programs due to the savings created by better population health management. Physicians are sometimes reluctant to join Clinical Integration programs and appropriately ask “What’s in it for me?” 

While our previous article, titled "5 Incentives for Enlisting Physicians in a Clinical Integration Program" examined the "What's in it for me" question, we received some great feedback asked for more answers to commonly received questions. This FAQ will help you communicate the value and details of clinical integration and a clinically integrated network to your physicians. If you're a physician, these questions and answers should help you with some recurring and nagging questions.

Top Questions Include:

  • What’s driving the movement toward clinical integration?
  • What is the purpose of the clinically integrated network?
  • What are the benefits of joining?
  • Who can join?
  • Do physicians join as individuals, or do all the physicians in a practice need to join?
  • What type of data is monitored?
  • How will clinicians submit data to the network?
  • What is the difference between a Clinically Integrated Network and an Accountable Care Organization (ACO)?
  • and more.

Do you have a question that is not included in the FAQ? Feel free to share your question in the comments section and we will address these in a follow-up document.

To download the FAQ, simply click on the button, below:

FAQ_Button_Orange.png

Topics: ACO, Clinical Integration, Hospitals, Clinically Integrated Care, FAQ, Physicians

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