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ACO, PCMH, PCSP The Ingredients for a Medical Neighborhood

ACO, PCMH, PCSP The Ingredients for a Medical Neighborhood. Presented by: Cindy Friend, RN, BSN, MSN, MBA/HCA Executive Consultant November 8, 2013. Healthcare Reform Future of Healthcare PCMH PCSP ACO Payment Reform Healthcare Organization Fundamentals

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ACO, PCMH, PCSP The Ingredients for a Medical Neighborhood

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  1. ACO, PCMH, PCSP The Ingredients for a Medical Neighborhood Presented by: Cindy Friend, RN, BSN, MSN, MBA/HCA Executive Consultant November 8, 2013

  2. Healthcare Reform Future of Healthcare PCMH PCSP ACO Payment Reform Healthcare Organization Fundamentals Organize, Prioritize & Strategize Agenda

  3. Healthcare Reform • ACO • PCMH • ARRA/MU • PQRS/eRx • HIPAA

  4. The Future of Healthcare • Medical Neighborhoods • ACO • PCMH • Meaningful Use • HIPAA, PQRS & eRx

  5. The Medical Neighborhood Hospital Pharmacy Lab/Rad Home Health Patients Payers LTC/Rehab Employers Government Physicians/Clinics

  6. The Name Means the Same ACO PHO CIN IDN ICO CCO

  7. PCMH – Patient Centered Medical Home PCSP – Patient Centered Specialty Practice ACO – Accountable Care Organization Medical Neighborhood Foundation

  8. Today vs. Tomorrow Source: The University of Oklahoma-Tulsa (revised)

  9. Primary Care Providers Recognition programs NCQA 2011Standards Includes Stage 1 Meaningful Use Requirements PCMH

  10. Started with 38 in 2008 Over 6,000 medical practices Almost 30K clinicians 49 States ~15% of all primary care practices PCMH Numbers Source: The Commonwealth Fund Source: Market Watch, Business Wire, 2013

  11. PCMH Standards Source: NCQA

  12. Specialty practices NCQA recognition program Launched end of 3/2013 Includes Stage 1 and Stage 2 Meaningful Use Requirements PCSP

  13. PCSP Standards Source: NCQA

  14. Community collaborations Almost 500 ACOs among private and public payers Accreditation available ACO

  15. Number of ACOs Source: Levitt Partners, 2013

  16. Medicare Reimbursement Source: Dartmouth Atlas, 2010

  17. Medicare ACOs Source: RUPRI Center for Rural Health Policy Analysis, 2013

  18. ACO by State Source: Levitt Partners, 2013

  19. ACO Standards Source: NCQA

  20. Aetna and WellSpan form ACO (10/11/13) River Health applies for MSSP (8/30/13) Memorial Hermann Physician Network and BCBS of Tx (9/18/13) Rutgers and Robert Wood Johnson Medical School form ACO (10/16/13) More than 300 Physicians Join Brown & Toland’s ACO with Cigna (10/15/13) The Effort Continues

  21. Payment Reform Source: United Healthcare

  22. Fundamental Components

  23. Shared Governance Legal, Policy & Compliance Operations Finance Population Management Risk Management Performance Reporting Business

  24. IT Infrastructure Clinical Systems & Tools Regulations Data Analytics Reporting Requirements ACO Connectivity Patient Connectivity Health Information Exchange Technical

  25. Staff Assessment, Engagement & Education Population Management Evidenced-Based Care Management Care Coordination Care Transitions Care Planning Clinical

  26. Clinical Workflow Patient Engagement Quality Measures Performance Analysis Quality Improvement PCMH Practice/ Recognition Clinical

  27. The Subcomponents

  28. Initiate stakeholder outreach and education Establish a separate entity with authority and accountability Conduct organizational assessments, improve deficiencies, and obtain recognition Improve medical management Identify technology requirements and implement systems Establish performance evaluation, reporting, and improvement process Develop a strategic plan and execute! Organize, Prioritize & Strategize

  29. For more information, please contact: Cindy Friend, RN, BSN, MSN, MBA/HCA cfriend@beaconpartners.com 443.413.6901

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