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Medicaid and State Level APMs: Implications for Health Plans, Hospitals, and Physicians
Francois de Brantes will discuss how states across the country are working to develop or implement payment and delivery system reform programs.
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Using Data to Improve Patient OutcomesHarlan Krumholz, MD will share his experience using data from EHRs and claims to improve care delivery. His approach focuses on “asking” the right questions and choosing measurable metrics that will illuminate operational improvements that result in better clinical outcomes at a lower total cost of care.
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A Total Systems Approach to Improving Patient Safety
In this session, Tejal Gandhi, MD will address health care’s progress in the patient safety arena, the intangible dimensions of patient harm, and the strategies and tools needed to ensure that patient safety.
Behavioral Economics and Better Results
David Asch will focus on innovative ways of applying insights from behavioral economics toward the goal of improving individual health behaviors.
Driving Transparency and Innovation in Health Care
In this session, Eddie Segel will outline the forces and trends behind the industry-wide trend toward transparency and consumer empowerment.
Patient Centered Leadership for Accountable Care
Susan Frampton will share successful strategies for developing a patient-centered leadership culture that creates the foundation for accountable care.
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
“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.
Marino described five broad areas of focus for ensuring
in-network access and effective patient engagement:
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.
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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