Clinically Integrated Networks, ACOs, and Physician Alignment

Transcription

1 Clinically Integrated Networks, ACOs, and Physician Alignment The Current Strategic Landscape and Critical Skills for the Journey A SHSMD/AAPL Collaborative Presentation Brian Borchardt, Director, Physician Relations, Baylor Scott & White Health Lorraine DeLuca Placido, System Director, Physician Relations & Recruitment Main Line Health System Alex Ellsworth, Director, Growth and Physician Relationship Management UHS of Delaware, Inc. The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA Society for Healthcare Strategy & Market Development

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3 Collaboration Name Organization Location Member Physician Employment Clinically Integrated Networks ACOs Brian Borchardt (Chair) Baylor Scott & White Health Temple, TX SHSMD, AAPL Kelly Campbell (Vice Chair) Seattle Children s Hospital Seattle, WA SHSMD Tom Anderson Brigham and Women's Hospital Boston, MA AAPL Kriss Barlow Barlow/McCarthy Hudson, WI SHSMD Claudio Capone Trinity Health - New England Hartford, CT SHSMD Lorraine DeLuca Placido Main Line Health System Philadelphia, PA SHSMD, AAPL Alex Ellsworth Universal Health Services King of Prussia, PA SHSMD Tracie King Nationwide Children's Hospital Columbus, OH AAPL Mary Molnar Einstein Healthcare Network Philadelphia, PA SHSMD, AAPL Affiliation Agreements Medical Homes Other

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6 2016 SHSMD/AAPL Survey of Physician Relations Professionals

7 What is a Clinically Integrated Network (CIN)? A CIN is a collaboration among independent and private practice physicians, employed physicians and a hospital or health system to develop an active and ongoing program of clinical initiatives focused on quality, performance, efficiency and value. CIN s enhance the ability to deliver value-based care through care coordination and superior quality outcomes.

8 Clinically Integrated Networks: Survey Results What priority does your organization place on a CIN strategy? High Medium Low None 66% 24% 8% 2% Score your market based on your perception of maturity Not Aligned Early Stages Medium Alignment Advanced Alignment Fully Aligned 2% 20% 41% 31% 6% How much of a role is your physician liaison team playing? High Medium Low No Role 31% 31% 27% 11%

9 A Vote for Involvement Strong liaison teams know the market, the targets and those who are looking for involvement. They can support the CIN strategy inside and outside the organization. Ask yourself: What do I know about clinical quality? What should I know? In a cluttered market, it s unlikely organization leaders will come to us to inquire about interest in role expansion. We need to leverage our position, show our skill and position our value

10 Case Study: Main Line Health Independent PCPs already aligned through a regional ACO but the ACO does not tether physicians closely to the health system and excludes specialists. CIN formed to strengthen ties and build new ones where possible Liaison director on steering committee during formation and launch of the CIN Liaison director is the executive sponsor of the network development committee responsible for assigning co-chairs, members and support staff that include physicians, administrators and physician liaisons

11 Main Line Health CIN Network Development Committee Purpose A critical success factor for the CIN is adequate network coverage to optimize patient value, access, quality, and efficiency and ensure eligibility for population health payer products and programs. The NDC will be tasked with assessing network adequacy and developing a plan to fill gaps.

12 Roles and responsibilities Main Line Health CIN Network Development Committee Assess and monitor network adequacy Develop plan to fill gaps Review and recommend changes to provider participation criteria Determine credentialing process Develop ongoing provider relations, education, and training processes Establish network management and reporting structure, including provider directories Facilitates and coordinates communications between providers (both members and non-members) and the CIN Coordinates new membership sign up and re-credentialing

13 Case Study: Seattle Children s Care Network Key findings two years after it all began Leverage the strength of the hospital brand and the knowledge of the physician liaison team Know what s in it for the PCP and believe in the value proposition and demonstrate it daily Gather baseline awareness data pre/post launch Build web content utilizing existing platforms Form a marketing committee with key leaders that have decision making authority-and meet regularly Develop a RACI from the start to streamline feedback The loudest voice in the room often wins, but that may not reflect the majority opinion

14 Leading Indicators of Success Proactive positioning of the liaison team and its value Clear expectations of the liaison role in clinical integration Training and knowledge about the initiative Strong existing physician knowledge to support targeting for CIN Support plan with internal stakeholders and experts who can support implementation for the practice after signature

15 ACOs: Survey Results Different than CINs in that the group of providers is collectively responsible for care outcomes of patient populations, and they contract with CMS and other payers to receive shared savings What priority does your organization place on an ACO strategy? High Medium Low None 49% 25% 17% 9% Score your market based on your perception of maturity Not Aligned Early Stages Medium Alignment Advanced Alignment Fully Aligned 15% 21% 26% 26% 11% How much of a role is your physician liaison team playing? High Medium Low No Role 9% 25% 34% 32%

16 Case study #1: Saint Mary s Health System Waterbury, CT ACO enrollment rate needed to increase Competitor actively promoting an IPA Key specialties needed to be targeted o Orthopedics o Pulmonary Limited Resources: Could ACO leverage existing organizational assets to accomplish tasks? Existing liaison was already well-connected in the physician community Enrolled physician numbers doubled

17 Case study #2: Baylor Scott & White Health Central Texas ACO growth necessitated a transition in structure o Business development managed initial ACO efforts and implementation in North Texas o With expansion to Central Texas, additional dedicated resources and collaboration was necessary Liaison team played an integral role in CTX expansion o Provided valuable input in development of target list o Product-specific education for liaisons o Developed messaging that would resonate with physicians o Liaisons were key to getting the foot in the door; partnered with new ACO leadership to communicate the more complex message Today the ACO is its own organization o Liaison team still helps initiate connections o ACO network field advisors act as the permanent liaison to the practice to engage in detailed and more complex activities

18 Case study #3: Brigham and Women s Hospital Boston, MA Member of the Pioneer ACO Model Business development liaisons are separate from the Population Health Management team (ACO) Monthly meetings for liaisons to share network information Toolkits were created that contained FAQs on the ACO for both the providers and the patients

19 Leading Indicators of Success Liaison involvement in the enrollment process: ACO leaders can benefit from leverage existing relationships built through the liaisons The liaisons knowledge of the market is an asset for network development Succinct talking points to physician benefits are needed during the recruitment process. The liaison communicator is valuable in helping develop and deliver the pertinent messaging Larger, more mature ACOs may require a more dedicated staff, but physician relations can still play a role Role clarity is crucial in outreach efforts Ongoing and regular communication between ACO and Physician Relations

20 Other Types of Alignment: Survey Results What priority does your organization place on the following strategies? Strategy High Medium Low None Physician Employment 60% 29% 7% 3% Affiliation Agreements 52% 32% 12% 4% Medical Homes 28% 39% 20% 13% Score your market based on your perception of maturity Strategy Not Aligned Early Stages Medium Alignment Advanced Alignment Fully Aligned Physician Employment 6% 5% 28% 44% 17% Affiliation Agreements 3% 14% 33% 40% 10% Medical Homes 22% 26% 29% 16% 8%

21 Employed Model System challenges Define and measure provider leakage Hardwiring on-boarding process with tailored liaison involvement New provider rounding Provider role in patient keepage for tests/procedures Creating effective timing and launching process for newly employed clinicians Recommendations Further coordination Standardized format to determine readiness to market Liaison more assertive on front-end ramp-up

22 Health Plan Model Liaison programs have encountered widely varying and often contradictory experiences of success and failure Handled insurance renewal documents for providers Eventually viewed as the deliverer of bad news Told to steer clear of hospital-owned health plans Successfully created a very narrow, targeted list of tasks in association with a larger health plan initiative Will these communications take attention away from the core mission?

23 What s Needed? Coordination between health plan and liaison teams Incentive plan alignment Future state alignment Murky! Due to stops and starts, and limited experience nationwide

24 Other Models Strategic Affiliations (Academic/Community/Rural Hospitals) Disease-specific best practices Benefits Cost containment Leverage depth of specialized services Enhanced educational support (CMEs) Alignment Strategies Non-traditional referral sources Urgent care EMS providers Bundled Payments to Physicians Participation in gain-sharing to drive incremental volume

25 Paradigm Shift or Current Need? Surveys revealed that physician alignment is key to healthcare strategy, but surveys also revealed... Liaison priorities have not shifted significantly Momentum not significant shifting toward activities Growth Relationships Market Knowledge Trust Valued Communicator

26 Your Choice: Liaison Role of the Future This? Or This??

27 Future Skills for Effective Role Transition Continue Providing in-depth medical practice and physician knowledge Building valuable relationships with physicians and within the organization Being a proactive and strategic resource for predicting change and ensuring the voice of customer is heard Enhance Embracing opportunity even when it comes through disruption Being a compelling communicator Analytical to leverage data opportunities Engaging storyteller Sharing knowledge of increasingly complex products, payment structures, and network dynamics (Don t wait to be fed the details, go get them) Being an influencer Developing skills Demonstrating value

28 Key Questions for You and Your Team Where are we when it comes to: Overall credibility? Analytic skills? Relationship sales? Content knowledge? Internal connections? How do we ready ourselves for the future? What will leadership allow us to be? Is there a desire for one professional who can do it all? Can we be the quarterback that brings in/coordinates the necessary additional people and resources? Is it a matter of what we want or what we get??

29 Questions and Answers Brian Borchardt, Director, Physician Relations Baylor Scott & White Health Lorraine DeLuca Placido, System Director, Physician Relations & Recruitment Main Line Health System Alex Ellsworth, Director, Growth and Physician Relationship Management UHS of Delaware, Inc * Refer to the Appendix for examples of communication documents and a link to the full survey results

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33 Clickable Full Survey Results