Delivering High Value Care Through Clinical Integration

Delivering High Value Care Through Clinical Integration

www.TriadHealthCareNetwork.com

Triad HealthCare NetworkOverview

• Triad HealthCare Network is a new Clinically Integrated Network that has formed in the Piedmont Triad area.

• THN is a new model of care designed to bring employed physicians, independent physicians, and Cone Health into a more clinically and financially aligned business partnership to improve access, improve quality and lower costs.

• THN seeks to better prepare its members for the inevitable changes to the nation’s health care system driven by either or both government and market-based reform.


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Triad HealthCare NetworkStructure and Governance

Board of Managers

Operating Committee

Nominating Committee

Contracting and Finance

CommitteeQualityCredentialing

Committee

Initial and ongoing membership criteria

Set clinical performance criteria and review member

performance

Look at 3rd-party agreements and determine potential

bonus distributions

Assist development of physician board

memberships

Oversees day-to-day operations


8 members:3 Physicians (2 Ind./1 Emp.)

2 Cone Representatives3 Community Representatives

21 members:17 Physicians (9 Ind./8 Emp.)

3 Cone Representatives1 Community Representative

MANAGEMENTExecutive Medical Director

Thomas Wall, M.D.

Executive DirectorSteve Neorr

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Triad HealthCare NetworkProposed Quality Committee Structure


Family Medicine

Quality Committee

Patrick Wright, M.D. – Chairman

Mary Jo Cagle, M.D. – Vice Chairman

Medicine

CPC

Carl Gessner, MD

John Bednar, MD

Primary Care

CPC

Doug Shaw, MD

Yvonne Lowne, DO

Heart and

Vascular CPC

Ed Gerhardt, MD

Tom Stuckey, MD

Surgery

CPC

David Newman, MD

John Hewitt, MD

Women’s and

Children’s CPC

Kelly Leggett, MD

Ron Young, MD

Hospital Clinical

Services CPC

Josh Kish, MD

Mark Shogry, MD

Internal Medicine

Hospital Medicine

Gastroenterology

Hem/Oncology

Infectious Disease

Nephrology

Rheumatology

Dermatology

Emergency Medicine

Endocrinology

Hospital Medicine

Pulmonology

Neurology

Neurosurgery

Cardiology

Cardiovascular Surg.

Vascular Surgery

Anesthesia

General Surgery

Orthopedics

Ophthalmology

ENT

Urology

Ob/Gyn

Neonatology

Pediatrics

Pathology

Radiology

Radiation

Oncology

Practice

Management

John Nosek

TBD

Community

Practice

Administrators

Administrative Chair

ADMINISTRATIVE CHAIRSwould be composed of Cone Health System employees or non-physician health leaders – Hospital presidents, vice presidents, directors of nursing,

practice administrators, etc. Hospice /Palliative Care

Administrative Chair Administrative Chair Administrative Chair Administrative Chair Administrative ChairAdministrative Chair

Psychiatry

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Value for Physicians

• THN to provide value-added services and resources to assist practices– Deployment of Clinical Performance Reporting System to:

• Capture and analyze clinical data• Implement in-office Point-of-Care decision support• Generate patient disease registries

– Case Management– Assistance to achieve Meaningful Use and Patient-Centered Medical

Home recognition– Submission of quality measures for the Physician Quality Reporting

System (PQRS)– Joint contracting for quality/cost savings incentive plans with payers

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Triad HealthCare NetworkBusiness Strategy


Continue CurrentFee-For-Service

Claims & PaymentStructure

QualityBonus Payout

Based On THN Goals and

PerformanceMeasures

Insurers and Employers

Negotiated Incentive-Based

Contracts

Clinical Performance Reporting System

PhysiciansClaims and EMR Data

POC, Registry, Performance Data

P4PShared Savings

Gain Sharing

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Clinical Performance Reporting System is Critical

Data from Practice Management

Systems

Data from EMRs

Data from Hospitals

Lab data from Reference Labs

Pharmacy data

Electronic claims data from payers

Data is extracted, aggregated,

standardized and stored by a third-party intermediary vendor

Clinical Data

Repository (“CDR”)

Clinical ProtocolEngine

Data is processed through protocols and algorithms to support clinical metrics

and benchmarks established by Physicians

• “Real “ time• Patient Summary• Preventive Care &

CDM Reminders

Point-of-CareDecision Support

PatientDisease

Registries

Practice Performance

Feedback

• Community• NCQA, BTE• PQRS• Payers

External Reporting

Web Portal Access and Reporting

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Sample Clinical Decision Supportat the Point-of-Care


Practice Performance Feedback

Diagnoses and Meds are prioritized to highlight chronic conditions

Goals Not Met are highlighted for quick reference and visibility

Targeted reminders for nursing staff allow better leverage of provider time and more efficient workflow

Labs, Calculations and Diagnostic Procedures pertinent to the Action Items are displayed for easy reference

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Information Technology/Analytics Systems

PCPs with EMRs

Specialists w/ EMRs using POC

Data from Hospitals

Lab data from Reference Labs

Pharmacy data

Clinical Data

Repository Claims Data from Payers

• Expertise in clinical data extraction• Provides clinical protocol engine• Point-of-care reports• Patient disease registries

• “Manual” population analytics• Claims data integration• Reports compliance with metrics• Submits PQRS/ACO data to CMS

CommunityData

Repository

All Other PCPs and Specialists

Radiology

• Expertise in community data aggregation• Provides longitudinal view of patient across

community – all pertinent activity over time• Interfaces with EHRs

• Master Patient Index (“MPI”)• Provides portal view to all providers• Ability to enter data for non-EMR physicians

• “Automatic” population analytics - patient stratification • Prospective identification of patient risk – case mgmt targets

• Retrospective analytics – utilization and cost efficiency• Admits/1000, hi-tech imaging, ETGs - Episode Treatment Groups

• Identify opportunity for savings and improvement• Case Management module – care documentation, communication• Patient portal – patient engagement

Clinical Performance Reporting System

HIE

Health Information Exchange (“HIE”)

CPRS

Population analytics, utilization, case management module


HIE View

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HIE View

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Triad HealthCare NetworkMembership Requirements


– North Carolina Licensure

– Board Certification

– DEA License

– Liability Insurance

– Credentialing Requirements

– Participation Agreement– Clinical Integration Program

– Education– Compliance – Quality Assurance

– Provide Claims/Clinical Information

– All-Contracts Participation– High-speed internet– Actively Used E-mail– Attend Orientation

Physician Eligibility Requirements

Physician Participation Requirements

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Opportunities

• Medicare Shared Savings Program– Submitted application to participate as an “ACO” with Medicare

effective July 1, 2012– Submitted 170 adult Primary Care Physician network with

application – 5 counties – will include over 34,000 beneficiaries– Will seek conversion from opt-in to executed participation

agreements for specialists by June 30, 2012– Must report and meet 33 “quality” metrics to access savings

• All major payers interested in discussing arrangement• Cone Health Employee population (12,000+)

– Development of THN-based “narrow” network

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Triad HealthCare Network Value


Practice Performance Feedback

Physicians PatientsPayersCone Health

Physicians PatientsPayersCone Health

GIVE

GET

FinancialSupport,

Resources

Commitment,Participation,Leadership

PerformanceIncentivePayments

Trust,Proactive

Involvement

Efficiency,Partnership,

Mission

IncreasedEfficiency,

Coordination

Transparency,Efficiency,

Quality

BetterHealthCare

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Questions?

For further information, please visit www.TriadHealthCareNetwork.com or

call (855) 4 THN NOW (484-6669)


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http://www.triadhealthcarenetwork.com/

Documents

Delivering High Value Care Through Clinical Integration