MaineGeneral Health Aging Advocacy Summit

1. MaineGeneral HealthAging Advocacy Summit November 14th, 2012

2. Why do we need change? Costs are increasing Overall health is deteriorating The patient experience is often poorly coordinated Provider workforce is dissatisfied

3. What are our goals? MaineGeneral’s fundamental objectives align with the Institute for Healthcare Improvement’s (IHI) Triple Aim: Better health Better care Lower cost And, we need to add a fourth: Recruit and retain an experienced, quality workforce

4. Advancing Accountability in Healthcare Principles of accountable care: Founded on primary care and the principles of the patient-centered medical home (PCMH) Based on the community and populations served by the organization Integrating the system of care, across the continuum, outpatient to inpatient to home Incentivized based on positive health outcomes and efficient care

5. Reimbursement Methodology: Incentivize Efficiency and Reward Quality Implementing ACO Framework Medicare Self-Pay Fully Insured Commercial Self-Insured Commercial Medicaid Specialty Care - Outpatient Outpatient Diagnostics & Surgery Acute Care - ED and Inpatient Home Health and Hospice Primary Care - Outpatient Post-Acute and LTC End of Life Chronic Healthy Acute

6. At the Primary Care Practice Level On-site licensed clinical social workers and/or registered nurses Enhance Care Management Increased communication between hospitalists and primary care practices Coordinate Care Transitions Practices receiving quality and utilization performance measurement reports Reduce Practice Pattern Variation Expand Shared Decision-Making Implementation of patient advisory councils Manage Utilization Practices receiving and monitoring daily ED and inpatient discharge reports

7. Framework for Population Health ManagementData driven risk stratification to support intervention strategy GOAL INTERVENTION • Manage high costs • Help members navigate system Care Management Disease Management and monitoring Wellness programs HIGH Cost HIGH Cost KVCCT A • Close gaps in care HIGH Care Gaps HIGH Care Gaps Our Service Area KRHA 25 Practices 110,289 Patients Winthrop Family Medicine 7,185 Patients Internal and external data sources HIGH Disease Burden HIGH Disease Burden • Monitor compliance rates LOW Care Gaps B Primary Care LOW Cost LOW Cost • Manage risk factors LOW Disease Burden LOW Disease Burden C Priorities A, B, C

8. What it will take? better health better care lower costs A fundamental re-thinking of healthcare A movement from volume to value An engagement of patients and families A change from silos to integration