{"id":9640,"date":"2017-03-03T13:22:24","date_gmt":"2017-03-03T20:22:24","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=9640"},"modified":"2019-11-18T14:40:53","modified_gmt":"2019-11-18T21:40:53","slug":"uchealth-aims-build-better-network","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/uchealth-aims-build-better-network\/","title":{"rendered":"UCHealth aims to build a better network"},"content":{"rendered":"
<\/div>

Stripped bare, the goals of value-based health care are refreshingly simple. Improve the quality of care while reducing cost. Oh, and improve the patient and provider experience. That\u2019s it.<\/p>\n

\"ThisAnd on the seventh day, go ahead and take a rest.<\/p>\n

It\u2019s hardly a news flash, but changing the present system \u2013 still highly fragmented and volume-driven \u2013 to one committed to meeting these lofty goals isn\u2019t quite so easy. But the federal government, a growing number of commercial payers, and hospitals and health care systems around the country are trying to pivot the multi-trillion-dollar goliath toward an approach that rewards those who do best at achieving superior clinical outcomes, safety, efficiency, quality, and satisfaction.<\/p>\n

With this in mind, UCHealth and University of Colorado Medicine are launching\u00a0UCHealth Integrated Network. It includes three dozen of UCHealth’s primary care practices in Colorado. CU Medicine, the organization that represents the faculty of the University of Colorado School of Medicine, is an \u201cequity partner\u201d with UCHealth in launching the network, said Charles Baumgart, MD, UCHealth\u2019s chief medical officer for population health.<\/p>\n

CU Medicine represents the participating practices in the Denver metro area, while UCHealth Medical Group, Associates in Family Medicine and Family Medicine Center represent those in northern and southern Colorado. Clinicians with CU Medicine will also receive support from the Office of Valued Based Performance<\/a>, which assists clinicians with coordinating transitions of care, notifying patients of needed tests, and other tasks essential to managing their health.<\/p>\n

\"This
The Centers for Medicare and Medicaid Innovation are driving “value-based” programs like CPC+.<\/figcaption><\/figure>\n

The network will be part of Comprehensive Primary Care Plus<\/a> (CPC+), an eight-state initiative of the Center for Medicare and Medicaid Innovation<\/a> (CMMI) that includes nearly 3,000 practices. It encourages primary care practices to deliver coordinated care that meets the particular needs of the patients they serve \u2013 from the healthiest to those with complex, chronic conditions.<\/p>\n

Dollars down<\/strong><\/p>\n

The program follows CMS\u2019s four-year Comprehensive Primary Care Initiative<\/a> (CPC), a kind of test run for the concept that payers and providers can work together to share data, tighten care coordination, improve quality and manage costs for defined groups of patients.<\/p>\n

A number of UCHealth practices participated in the CPC initiative and are among the 36 practices in UCHealth Integrated Network chosen to participate in the first round of CPC+, which CMS plans as a five-year project. The participants will receive per-member-per-month payments from CMS to support practice changes that address patient access, care management, care coordination, patient and caregiver engagement, and population health.<\/p>\n

The strength of both CPC and CPC+ is that they replace long-expressed lip-service support for health care reform with solid financial backing, said Travis Sherman, UCHealth\u2019s vice president of Population Health.<\/p>\n

\u201cThere is more support for practices and more payments available to fund their infrastructure,\u201d Sherman said. \u201cPrimary care is at the center, with additional resources to help measure our performance across populations of patients.\u201d<\/p>\n

Meeting needs<\/strong><\/p>\n

For example, he noted, participating practices will receive per-member-per-month care management fees to help them make changes necessary to manage their patients\u2019 health. At the same time, physicians in most CPC+ practices will receive their usual fee-for-service Medicare payments.<\/p>\n

The financial support doesn\u2019t mean that practices will go it alone. They will receive administrative support and guidance for their work through UCHealth\u2019s Population Health Services Office (PHSO).<\/p>\n

\u201cOur job is to look at our practices and help them to decide what resources they need to adhere to value-based arrangements,\u201d said Michelle Nauta, manager of practice transformation for the PHSO.<\/p>\n

Those needs will vary, Nauta said \u2013 from staffing to consultation about process improvement strategies to education about the data-collection requirements for practices participating in CPC+.<\/p>\n

\u201cThat\u2019s up to the practice,\u201d Nauta said. \u201cTheir staff and providers know their populations, their culture and the nuances of the practice.\u201d<\/p>\n

Talking Timberline<\/strong><\/p>\n

\"This
Timberline Medical’s Paul Fonken, MD, says regular access to data has helped the practice pivot toward care that meets the needs of the practice’s patient population.<\/figcaption><\/figure>\n

One such practice is UCHealth Primary Care Clinic – Estes Park, which reduced the total cost of patient care during its participation in CPC, said Paul Fonken, MD. Fonken is one of the practice\u2019s three physicians. From the first quarter of 2013 through the second quarter of 2016, Timberline reduced the average total cost of health care more than $100 per member, per month for its Medicare patients, a, a15 percent reduction.<\/p>\n

The major savings were in inpatient costs. Fonken attributed that to staff and providers putting more time and resources into managing patients\u2019 needs in the outpatient setting. A key to that, he added, was bringing on a care manager: a nurse practitioner who focuses particularly on the needs of patients at high risk of making avoidable trips to the hospital or ED. But medical assistants and front-desk receptionists chip in as well, working with patients to making sure they got their Medicare wellness exams, staying on top of needed tests and helping with follow-up, Fonken noted.<\/p>\n

\"This
UCHealth’s Timberline Medical, LLC in Estes Park has used a team-based approach to help reduce the total cost of care for Medicare patients.<\/figcaption><\/figure>\n

\u201cThe CPC helped us move along to team-based care,\u201d he said. \u201cHaving the data to track how we are doing has also been good. We\u2019ve been able to stratify our risk and focus on the patients who need care the most.\u201d<\/p>\n

The Timberline success \u201ccalls out the importance of awareness of preventive care and proactive outreach\u201d to patients, said DeeAnn Bannister, RN, quality improvement manager for transformation and innovation for UCHealth Medical Group. That requires time and commitment from the practice, she said.<\/p>\n

\u201cThe burden is on us to create relationships with the patients and families in our communities,\u201d Bannister said. The best way to meet that challenge is through versions of the teamwork model created at Timberline, she added. \u201cThey have proven that a coordinated, integrated team can do so much more to know and support a patient than any one provider can do alone.<\/p>\n

Down to the data<\/strong><\/p>\n

Crucially, CPC+ practices will also have access to claims data for their Medicare patients. That opens a previously closed window, giving them insight into their patients\u2019 care outside the practice.<\/p>\n

\u201cFor the first time, we will receive information about the individuals we have responsibility for prior to a contract going into effect,\u201d said UCHealth\u2019s chief population health officer, Jean Haynes. \u201cThat means we can truly take accountability for their care.\u201d<\/p>\n

It\u2019s vital, however, that CPC+ practices find ways to focus on the specific populations they serve, Haynes said. Whatever patient-care strategies a practice develops, they must not stop at the door of the clinic, she added. Providers of behavioral health, skilled nursing, home health care and others must be involved in caring for each patient.<\/p>\n

\u201cWe must share vital information with all providers who care for our patients so that we all understand the plan of care and avoid duplication of services,\u201d she said. \u201cWithout that commitment and alignment, we can\u2019t provide the care and outcomes for patients we want.\u201d<\/p>\n

Pulling levers<\/strong><\/p>\n

While the launch of UCHealth Integrated Network promises to be an important milestone for the organization, CPC and CPC+ are not isolated initiatives, Baumgart noted. The practices that are part of CPC+ can, for example, participate in CMS\u2019s Medicare Shared Savings Program, which also uses quality and cost measures to evaluate and improve a practice\u2019s performance.<\/p>\n

UCHealth Integrated Network was approved to participate in a Track 3 MSSP program starting Jan. 1. This allows the network to access claims data for the beneficiaries assigned to its practices. Track 3 also gives the network the opportunity to receive a greater share of savings if it manages the cost of the care for its beneficiaries efficiently. However, the network also accepts a higher level of financial risk for its assigned patient population.<\/p>\n

In addition, Baumgart said, the Medicare Shared Savings Program and CPC+ dovetail with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which launched Jan. 1. MACRA aims to tie clinician reimbursement to performance in four key areas of care that also align with the move to a new kind of health care system: cost, quality, use of electronic health records, and clinical practice improvement (read care management and coordination).<\/p>\n

While it\u2019s easy to flounder in this alphabet soup, the programs share a fundamental goal, Baumgart said. \u201cMACRA, Medicare Shared Savings, and CPC+ are all part of a movement to create more value in the way we deliver health care,\u201d he said. \u201cThere are different levers we can pull to move in that direction.\u201d<\/p>\n

UCHealth Integrated Network is one of those levers, Baumgart said. With roughly 40 primary care practices connected to UCHealth\u2019s hospitals, specialists and other providers, UCHealth aims to strengthen its negotiating position with insurers eager to manage the cost of care.<\/p>\n

\u201cWe think we can go to insurers and offer to share with them our knowledge and resources,\u201d Baumgart said. That, in turn, promises to bring more covered lives into the UCHealth network, thereby broadening the possibilities of developing new ways to coordinate care \u2013 \u201cpractice transformation,\u201d as he calls it, such as expanding the role of medical assistants in patient care to free up clinical time for physicians and advanced practice providers.<\/p>\n

Information, please<\/strong><\/p>\n

That effort requires strong tools for data collection, management and analysis, which points to another UCHealth strength: the maturing Epic electronic health record. In Baumgart\u2019s view, the EHR helps practices to manage larger numbers of patients more efficiently, not only by improving the ability to mine data for patients with conditions like diabetes and hypertension and use it to manage their care, but also by helping providers and staff standardize workflows, training, and documentation.<\/p>\n

That\u2019s a key to the care management that CPC+ and other reform programs emphasize \u2013 and are willing to pay for in the hope that they\u2019ll see returns in efficiency and improved health for patients \u2013 not to mention a tighter lid on costs, Baumgart said.<\/p>\n

The upcoming launch of the network is not an end, Haynes said, but rather a beginning.<\/p>\n

\u201cWe have a strong foundation of capability and infrastructure as we begin our work with Medicare Shared Savings and CPC+,\u201d she said. \u201cIt is important for people to realize that 2017 is a building year in a five-year program. We are willing to take the long journey of continuous improvement of our care-delivery model with a commitment to improved clinical integration.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Stripped bare, the goals of value-based health care are refreshingly simple. Improve the quality of care while reducing cost. Oh, and improve the patient and provider experience. That\u2019s it. And on the seventh day, go ahead and take a rest. It\u2019s hardly a news flash, but changing the present system \u2013 still highly fragmented and […]<\/p>\n","protected":false},"author":2143,"featured_media":9641,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[8],"tags":[],"class_list":["post-9640","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news"],"acf":[],"yoast_head":"\nUCHealth aims to build a better network - UCHealth Today<\/title>\n<meta name=\"description\" content=\"UCHealth and University of Colorado Medicine are launching\u00a0UCHealth Integrated Network. 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