Seattle Children’s Care Network “Journey to Value - based Contracting” Private and Confidential October 2017
Agenda National and local background: market drivers for accountable care • Our journey to establish our Clinically Integrated Network (CIN) • SCCN today • Governance and Leadership • Role of advanced IT • Patient Centered Care • Developing Capacity to assume risk • Example Global Outcomes Contract (GOC): Total Cost of Care • Lessons Learned • 2 Confidential and proprietary information
Multiple forces driving movement towards value regardless of ACA repeal / replace outcome Health system Expectations consolidation / for access and fragmentation convenience Emerging Growing accountable care financial Consumers Providers networks (ACNs) responsibility with new Proliferation of capabilities for Information pediatric population health and risk Medicare MIPS, Direct employer MSSP, MACRA contracting State and ACA outcome Increasing Purchasers Federal DSRIP and other appetite for risk state initiatives Government Inclusion of Medicaid changes quality / service measures MEMBER LOGO 3 Melzer
Children’s hospitals responding with a wide range and combination of strategic choices • Doubling down on traditional quaternary service delivery FFS model • Experimenting in small scale (<50,000 lives) population health initiatives (e.g. foster care, CSHCN) • Creating new structural entities and ACOs for alignment and/or risk contracting (e.g. networks, CIN, IPA,) • Bolting on to adult systems for ACO contracting • Betting the farm by taking on large scale population risk with or without owned health plans • Investing in consumer facing strategies (e.g. retail, telemedicine, virtual health, consumer apps) • Building new capabilities to deliver population health (care management, contracting, IT platforms, enterprise integration) • Taking risk at different levels in Medicaid or commercial risk contracts 4
Role of market consolidation • Over a 3-year period, 30 community hospitals consolidated into 5 systems in Puget Sound area • Rising costs prompted changes in employer sponsored health care and contracts with new consolidated systems • Commercial and Medicaid payers became interested in new risk arrangements for both ACO and PPO products MEMBER LOGO
Seattle Market: increased sense of urgency for CIN development • Dramatic consolidation raised anxiety among community pediatricians – Concerns of being ‘locked out’ of newborn referrals – Exclusion from narrow networks or concern about being restricted from referring patients to Seattle Children’s Hospital – Real and perceived contracting disadvantages – Inability to participate in direct-to-employer contracts – Highlighted weaknesses in IT capabilities – Difficulty demonstrating quality or unique value • National trend facing children’s hospitals from emerging ‘mega - systems’ – Leading to ‘make or buy decisions’ – Prospect of dramatic increases in competitive forces from large systems MEMBER LOGO
Bringing all the Pieces Together Seattle Children’s Care Network: Pediatric Population Health G LO B A L C O N T R A C T I N G P L AT F O R M Focus: Defined / Distinct Populations VA LU E - B A S E D C O N T R A C T S Commercial: Employer Direct: Medicaid: Managed Provider-based Self-Insured Premera (current), Boeing, HCA CMS Grant - PPIC Medicaid Narrow Network Plan: SCH Aetna, Regence (future) S e a t t l e C h i l d r e n ’s C l i n i c a l l y I n t e g ra t e d N e t w o r k ( C I N ) A pediatric organized system of care that is a collaboration between physicians, other providers and administrators who share a commitment for the quality, cost, and patient experience across the care continuum . Community Transitional & Clinics: Clinics: Hospitals: Mental Public school based Home Care Long Term FQHCs Primary Care Specialty SCH Health Health services Care VA LU E - B A S E D C A R E C A PA B I L I T Y S E T S Care Analytics: Quality Chronic Disease Facilitation of Total Cost Patient Advanced IT Management Outcomes Predictive Risk Value-Based Co- New of Care Experience Tools Across the Monitoring & Contracting Modeling and Collaborations Management Reporting Reporting Continuum Reporting Stratification
SCCN is a key component of our Population Health Strategy SCCN is a pediatric organized system of care that is a collaboration between physicians, other providers and administrators who share a commitment to quality, cost, and patient and provider experience, across the care continuum . OUR VISION To be the best “manager of pediatric lives” in the Pacific Northwest with superior clinical outcomes, and exceptional patient and provider experience, while reducing the cost trends 8
SCCN Goals commitment to patients across the care continuum commitment to patients across the care continuum Build a clinically Collect data from Analyze and Facilitate patient- integrated members and report on that provider network where other important data to address collaboration and members share a data sources to gaps in care and accountability by commitment to drive population measure implementing patients across health improved health capabilities key to the care management outcomes accountable care continuum MEMBER LOGO
In 2017, SCCN includes nearly 1,000 primary care and specialty physicians over a wide area • 20 community primary care practices SCCN • Children’s University Membership Medical Group (CUMG) • Seattle Children’s Hospital SCCN extends across six • Island, King, Kitsap, Pierce, counties, from Skagit and Thurston Olympia to Skagit MEMBER LOGO
Our Timing 2015: Standup the 2017: Engage CUMG in “governance” structure for specialty care capabilities to Seattle Children’s Care manage populations Network (SCCN) • Metrics / measures • Seattle Children’s Hospital • Co-management pilots • CUMG: 605+ pediatric specialists • Complete GOC w/ commercial #2 • 21 Primary Care Pediatric Clinics: • Complete a GOC w/ commercial #3 with 200+ pediatricians • Funds Flow 2018: Implement our 2016: Develop our “accountable care “capabilities” in primary care to manage populations capabilities ” for the Medicaid populations • Metrics / measures • Technology: WellCentive • Complete TCOC contract w/ • Care management Medicaid payor • Completed a GOC with commercial #1 • New direct to employer VBC 11 Confidential and proprietary information
SCCN: Foundational Capability Sets MEMBER LOGO
Effective governance and leadership are dependent on trust • Physician-led culture • Aligned culture of collaboration • Physician & executive leadership Integration and resources Joint Contracting Governance • Representation of all sites of care Leadership and Patient- • Equal representation among Culture Centered Care employed and aligned physicians • Multi-level degrees of decision- Advanced IT and making based on degree of Communications commitment (future) Financial Accountability • Ongoing leadership training for physicians & executives MEMBER LOGO
Oversight and Implementation Governance and Quality Planning/ Financial And Contracting Communication Monitoring/ Analysis/ and Planning And Analysis. Sharing of Best Practice Funds Flow FINANCE AND QUALITY CONTRACTING INTEGRATION PHYSICIANS (Providers) NETWORK TECHNOLOGY DEVELOPMENT AND CREDENTIALING IT, Analytics Alignment / Development Infrastructure: of Provider “Delivery” Development and Network Integration SEATTLE CHILDREN’S CARE NETWORK BOARD OF MANAGERS Ratification and System Approval 14
Current State Interface Architecture Regence Payer Files Cross System Integration Engine FHIR 837 HL7 CCDA XCA SIU MDM ORU Epic/Cerner only Advanced PHINConnect Analytics Challenges resulting from direct interface between EMR systems & Wellcentive: • 1:1 interface results in expensive redundancies vs 1:Many • Inability to rapidly transform data as needed prior to sending data to WC • Reliance on Wellcentive to provide outbound data feed to the Enterprise Data Warehouse for Advanced Analytics. Raw data is not passed on. • Long onboarding times for PHIN HIE and additional downstream systems resulting from reliance on EMR Vendor timelines
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