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  • June 25‐28
    Orlando, FL

  • Session Spotlights

    Implementing Patient-Centered Models Of Care

    Susan Frampton, PhD, CEO, Planetree 

    More information coming soon

    Session Spotlights

    A Total Systems Approach To Improving Patient Safety

    Tejal K. Gandhi, MD, MPH, CPPS, President and Chief Executive Officer, National Patient Safety Foundation

    More information coming soon

    Session Spotlights

    Behavioral Economics and Better Results

    David Asch MD, MBA, Executive Director, Center for Healthcare Innovation

    More information coming soon

    Session Spotlights

    Rating Agency Update: What Will The New Administration Bring?

    Mark Pascaris, Director, Fitch Ratings

    More information coming soon 

    Session Spotlights

    Patient Outcomes, Population Health, And Health System Performance

    Harlan Krumholz, MD, Director, Yale-New Haven Hospital Center for Outcomes Research & Evaluation (CORE)

    More information coming soon

    Session Spotlights

    Leadership & Organizational Change

    Donde Plowman, Executive Vice Chancellor and Chief Academic Officer, University of Nebraska-Lincoln

    More information coming soon

  • Maximizing Patient Access in Clinically Integrated Care

    HFMA News

    In an era of population health management, healthcare organizations must avoid giving patients reasons to go out of network, according to a presentation at ANI.

    June 29—As health systems move from fee-for-service to population health management through accountable care organizations and clinically integrated networks, “It is important that they have strategies for how they will engage the patient,” said Daniel Marino, executive vice president, GE Healthcare Camden Group.

    Maximizing patient access in clinically integrated care“The risk really comes in if organizations don’t expand their access approach,” Marino said, noting that if a patient goes outside of an organization’s existing network, the ability to manage costs and influence quality goes down dramatically.

    Factors that push patients outside a provider network include the need for services that are not in-network, along with issues of convenience and cost. In setting up referrals, Marino said, organizations should avoid giving patients reasons (e.g., long wait times for an appointment) to go out of network. Increasing levels of price transparency make patients more like consumers, able to compare the costs of different services. 

    Engagement means understanding the patient population being managed, including the percentage considered high-risk because of chronic diseases or multiple comorbidities, said Marino, who gave a presentation Wednesday at ANI called “The New Paradigm of Patient Access: Maximizing Access Through Clinically Integrated Care.” Analytics can identify gaps in care and ways to better leverage the services of the network. 

    Extending Access Beyond Traditional Models

    Marino described five broad areas of focus for ensuring in-network access and effective patient engagement:

    • Strategy and governance
    • Patient access and scheduling
    • Patient engagement and outreach
    • Innovative care delivery design
    • Consumer channels

    Retail clinics can provide convenience, patient portals can enable easier scheduling, and call centers can help efficiently connect patients to resources. Virtual care models using technology and a team-based approach can offer expanded access to services, Marino said. Instead of doctor visits, for example, smartphone-based technology can allow diabetic patients to upload glucometer readings to their personal health record and have the data monitored by a care coach.

    Building Innovative Methods to Engage Patients

    Understanding patient needs involves connecting with them. Marino cited a social media-based cancer support network in which physicians wrote short blogs in response to patient questions. Patients and their families saw “great value” in the approach, thereby increasing loyalty.  

    The concept of virtual care is starting to gain traction, Marino said. Certain patients can be treated online using a health portal managed by a physician or registered nurse. Payment for virtual care is still a challenge, however. “Payers are moving from straight fee for service to fee for value, because if you can proactively manage patients online, that provides a lot of downstream value in terms of cost management,” Marino said. 

    Virtual technology also can be used to support rural community hospitals, leveraging the expertise of large academic hospitals to help care for medically complex patients. 

    “The goal of value-based care is to create this organized system of clinically integrated care and a strong network in which you can offer services to patients in the community,” Marino said. “Then you wrap a value-based contract around it.” 

    Marino presented the session with Meredith Duncan, senior director of operations for Seton Health Alliance.

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