Bridge to Pop Health (West)
-社群健康管理移转年会-
日期:2018年2月12-13日
地点:美国加州旧金山,Moscone South Convention Center

随著可获得医疗数据增加,健康照护领域已经从个人照护移转到社群健康管理的层面(PHM)。此外IT及分析技术应用的进步,也成为PHM促进即时医疗移转至预测医疗、预防医疗的原动力。然而除了病患照护的优点之外,在基于价值的医疗新典范中,对应风险契约及偿还问题的持续努力及进展,成为真正改善临床及财务面结果的关键。大部分医疗机关皆同时提供按次计酬及以价值为基础的医疗服务,这是让事态更加复杂的原因之一。

Cambridge Healthtech Institute (CHI)与Clinical Informatics News将于2018年2月12日~13日在美国旧金山Moscone South Convention Center举办Bridge to Pop Health。本会议为期2日,保险业者、医疗机构、医疗领域的金融机构、调查公司、技术平台供应商、零售商等组织代表将齐聚一堂,针对从按次计酬到价值为基础医疗的移转过渡期中PHM导入策略展开富有启发性的讨论。


Final Agenda - Just Released!


Monday, February 12, 2018

Operationalizing Value and Innovation into a Healthcare Organization

8:25 am Chairperson's Opening Remarks

Eric Glazer, CEO, Shared Purpose Connect, Host of Population Health Executive Roundtable

8:35 TWO-PART CASE STUDY CO-PRESENTATION: Changing Behavior to Drive Higher Value, How UPenn Built Its Innovation Center

Part 1: Connected Health and Population Health Management at the Center for Health Incentives and Behavioral Economics at Penn

Kevin_VolppKevin Volpp, M.D., Ph.D., Janet and John Haas President's Distinguished Professor; Director, Center for Health Incentives and Behavioral Economics, University of Pennsylvania

The Center for Health Incentives and Behavioral Economics at Penn is 1 of 2 NIH Centers in behavioral economics and health. Dr. Volpp will discuss challenges in changing patient and provider behavior to drive higher value and improve population health and highlight observations on behavior change from extensive research in behavioral economics with organizations around the country.

Part 2: Penn Medicine Innovation Center's Approaches to Improve Health Services

Roy_RosinRoy Rosin, MBA, Chief Innovation Officer, Center for Health Care Innovation, University of Pennsylvania

This presentation will discuss how the Penn Medicine Innovation Center approaches the many challenges of care delivery and population health. We will share some of the approaches used by the team to improve health services and steps taken to achieve the Triple Aim.

9:10 CO-PRESENTATION: Using Predictive Analytics to Enable Value-Based Care in an Ambulatory Setting

Joe_KimuraJoe Kimura, M.D., MPH, CMO, Atrius Health


Craig_MonsenCraig Monsen, M.D., Medical Director, Analytics and Reporting, Atrius Health

Though it is now possible to accurately identify in real-time which patients are at greatest risk for health status decline, hospitalizations, missed appointments, and other adverse clinical events, emerging technologies and frank hype can distract from the aim of measurably improving outcomes by integrating predictive models seamlessly into clinical and operational workflows. In this talk, Atrius Health will describe its experience successfully developing and integrating several predictive models into the front-line workflows of clinical care. Topics discussed will include technical foundations, model development, obtaining clinical and operational support, and program evaluation.

9:40 INTERACTIVE PANEL: Creating a Successful Value-Based Care Organization through Innovation and New Models of Care Delivery

Moderator:
Roy_RosinRoy Rosin, Chief Innovation Officer, Center for Health Care Innovation, University of Pennsylvania


John_MattisonJohn Mattison, M.D., Assistant Medical Director, CMIO, CHIO, National and Regional Leadership, Kaiser Permanente


Pat_CarrollPatrick Carroll, M.D., Division Vice President/CMO, Healthcare Clinics, Walgreens


Bruce_BethancourtBruce Bethancourt, M.D., CMO, Dignity Health Medical Group, Dignity Health


Joe_KimuraJoe Kimura, M.D., CMO, Atrius Health

In today's world that is shifting toward value and quality, how do you create a successful value-based organization? There are financial and risk considerations, models of delivery and population care, and technical solutions to support these efforts. This short panel will discuss:


  • What are the challenges to creating a successful value-based care organization through new models of care delivery?
  • Can personalized medicine and community-based health enrich (or replace) traditional models of population care?
  • Where are the greatest opportunities to achieve improved clinical and financial outcomes, whether through advanced analytics or improved coordination?

10:15 Morning Coffee Break

 

Strategies for Successful Population Health Management: Infrastructure, Operations and Culture

10:55 Chairperson's Remarks

Harry Saag M.D., Medical Director, Greater New York City Practice Transformation Network, NYU Langone Medical Center

11:00 A Recipe for Population Management Success: Mix Embedded Care Management, Clinical Pharmacy and Integrated Behavioral Health with a Base of Technology Solutions

Julie_DayJulie Day, M.D., Medical Director of Quality Improvement and Population Health Management, Community Physician Group, University of Utah

The University of Utah Community Physician Group is building an infrastructure to meet current contractual value based payment arrangements and to prepare for the transition to more risk bearing contracts. We have risk stratified our population which has enabled us to address high risk patients at local clinic care conferences that include the primary care physician and their MA, the care manager, the integrated social worker, as well as clinical pharmacy. This presentation will share how we then deploy various resources and teams to identify red flags, coordinate care, do outreach and close care gaps.

11:25 CO-PRESENTATION: Quality Cancer Care for Populations: Geisinger Health System Closing Care Gaps Experience

Christian_AdonizioChristian Adonizio, M.D., Medical Director, Oncology Innovation and Analytics, Cancer Services, Geisinger Health System


Matthew HackenbergMatthew Hackenberg, RN, Director, Innovation Implementation, Center for Clinical Innovation, Geisinger Health System

A care gap exists when an incidence of care that should occur for all members of a population does not occur. For example, in diabetes care, a patient should have a Hemoglobin A1C of a specific level. The implementation of these types of analytic systems in cancer care has some additional challenges: frequently changing guidelines, large amounts of clinical data needed for decision making, proper identification of patient populations, and co-morbidity management. This presentation will review our approach to the identification of these care gaps and the implementation of an analytic system that provides clinical decision support at the point of care, and ultimately its effect on a population served by the health system.

11:55 INTERACTIVE PANEL: Implementing a Population Health Management Program to Improve Clinical and Financial Outcomes

Moderator:
Harry_SaagHarry Saag, M.D., Medical Director, Greater New York City Practice Transformation Network, NYU Langone Medical Center


Christian_AdonizioChristian Adonizio, M.D., Medical Director, Oncology Innovation and Analytics, Cancer Services, Geisinger Health System


Julie_DayJulie Day, M.D., Medical Director of Quality Improvement and Population Health Management, Community Physician Group, University of Utah


Kevin_VolppKevin Volpp, M.D., Ph.D., Janet and John Haas President's Distinguished Professor; Director, Center for Health Incentives and Behavioral Economics, University of Pennsylvania

In this interactive panel we will explore the fundamentals of population health management such as closing care gaps, managing high-risk patients, and designing interventions at the point-of-care to effectively manage populations. Further, we will explore how health systems with a mix of Fee-For-Service and Risk-based contracts optimize their performance in a hybrid environment. This short panel will discuss:

  • What population health program approaches are working best in your organization? What are some small wins you can share? Big wins?
  • What tools and approaches have led to the greatest improvements and why? What were the challenges to implementation?
  • How to bridge the worlds of FFS with value/risk contracts?

12:30 pm Sponsored Luncheon Presentation

1:30 Post-Lunch Break

 

Improving Health through Care Coordination: Individuals, Communities, Underserved Populations

1:55 Chairperson's Remarks

Julie Day, M.D., Medical Director of Quality Improvement and Population Health Management, Community Physician Group, University of Utah

2:00 Implementation of Community Based Healthcare for the Medically Underserved Using Self-Collection and Risk-Assessment Pre-Screen Modeling

Jerome_BelinsonJerome Belinson, M.D., CEO, Medworks; Professor of Surgery, Cleveland Clinic Lerner College of Medicine

This presentation will discuss the development of self-collection and screening technologies and the healthcare delivery models to implement them. The model is for medically underserved individuals and communities to assume the role of screening (identifying those individuals in need of diagnosis or management), thereby allowing the healthcare infrastructure to focus its human and financial resources on the management of the "positives." Medworks provides FREE care to the uninsured and is now designing a self-collection and risk-assessment pre-screen model to apply to communities or high-risk portions of communities in Northeast Ohio.

2:15 IT-Enhanced Care Coordination: Essential Mortar for the Foundation of Your Population Health Management Strategy

Tabassum_SalamTabassum Salam, M.D., Senior Physician Advisor, Population Health, Christiana Care Health System

When the goal is to enable populations to achieve better clinical outcomes at lower cost, it is essential to support the longitudinal clinical and social care needs of the members. Partnership with an interdisciplinary care coordination team equipped with IT enhancements reinforces the clinical efforts of healthcare providers and self-management by patients. A well-integrated care coordination team will help move the population from episodic and fragmented healthcare to a seamless longitudinal experience inclusive of transitions of care. The human touch from the care coordination team is advantageous, especially in supporting patients with chronic medical conditions, who are often the most frequent utilizers of healthcare.

2:30 Improving Health through Effective, Sustainable Community Health Worker Programs

Jill_FeldsteinJill Feldstein, COO, Penn Center for Community Health Workers, University of Pennsylvania Health System

Though health care professionals at hospitals work tirelessly to help patients get and stay healthy, some patients struggle with real-life challenges, such as job pressures, difficulty paying for medications, hunger or trauma, which can affect their health. To address these issues, University of Pennsylvania Health System researchers partnered with Philadelphia community members and health system leadership to develop IMPaCT-Individualized Management for Patient-Centered Targets-an evidence-based, nationally recognized model for recruiting and training community health workers (CHWs). Community health workers are front-line staff who are trusted members of the communities they serve. They provide tailored support to help high-risk patients achieve individualized health goals.

2:55 CO-PRESENTATION: Two Counties Leverage Their Strong Relationship to Provide "Whole Person Care" for the Most Complex High-Risk Residents

Maria_MartinezMaria X. Martinez, Director, Whole Person Care, San Francisco Department of Public Health


Dov_MaroccoDov Marocco, Chief Innovation & Improvement Officer & Director, Center of Population Health Improvement, Santa Clara Valley Health & Hospital System

San Francisco (SFDPH) has been a trailblazer in Pop Health Improvement. SFDPH began to match and merge data from medical, mental health, substance abuse, EMS, jail, benefits, and shelter datasets to develop an understanding of their most vulnerable populations. As a result, HUMS (High Users of Multiple Systems), a unique point-based system was created to identify service gaps and improve coordination of services. Nearby Santa Clara County (SCCVHHS) launched its first Center for Pop Health Improvement and looked to SF for ideas. The issue was not always high-cost ED "superutilizers." The county's infrastructure had become so difficult to navigate that patients were developing patterns of episodic, poorly coordinated care because of system issues. SCCVHHS thus developed a nearly identical point-based system. The efforts paid off in 2016 when California announced as part of the 2020 California MediCal Waiver an additional $1.5B was available to counties to demonstrate how shared data and integrating services could improve the quality and life of vulnerable patients while being cost neutral. As the counties are now entering program year three, this session will share various PDSA improvement cycles the counties are implementing as part of its commitment to constant innovation.

3:25 Sponsored Presentation

3:40 Afternoon Refreshment Break


Interactive Breakout Discussion Groups

4:15 Find Your Table and Meet Your Moderators

4:20 Interactive Breakout Discussion Groups

Concurrent breakout discussion groups are interactive, guided discussions hosted by a set of co-facilitators to discuss some of the key issues presented earlier in the day's sessions. Delegates will join a table of interest and become an active part of the discussion at hand. To get the most out of this interactive session and format, please come prepared to share examples from your work, vet some ideas with your peers, be a part of group interrogation and problem solving, and, most importantly, participate in active idea-sharing. We will run all table topics below two times, meaning attendees get to join two tables, each for 30 minutes.

4:20 to 4:50 Session A (join a table for first round for a half-hour discussion, then switch tables)

5:00 to 5:30 Session B (join a different table for second round, same tables run again for another half-hour discussion)

TABLE 1: Integrating Alternative Sites of Care in Consumer-Centric Health

Moderators:

Pat_CarrollPatrick Carroll, M.D., Division Vice President/CMO, Healthcare Clinics, Walgreens


David_ClaudDavid Claud, M.D., Ph.D., CMO, Executive Leadership Team, Activate Healthcare


Maria_MartinezMaria X. Martinez, Director, Whole Person Care, San Francisco Department of Public Health


  • How are retail health, telemedicine and urgent care playing a bigger role as value-based consumer-centric sites of care?
  • Where is the biggest ROI for provider organizations and when considering an overall telehealth, retail health and urgent care strategy?
  • How can retail healthcare programs and alternative services serve as an extension of physician services and support care and engagement of chronic and poly-chronic individuals?

TABLE 2: Utilizing Predictive Analytics, Risk Scores and Predictive Models: What Tools and Models Are Working?

Moderators:

Haley_BoltonHaley Bolton, Senior Manager, Regulatory Strategy and Value Management, Emory Healthcare


Rosalie_BakkenRosalie Bakken, Ph.D., Director, Healthcare Analytics and Research, Mayo Clinic


Christian_AdonizioChristian Adonizio, M.D., Medical Director, Oncology Innovation and Analytics, Cancer Services, Geisinger Health System


Madeline_SwartMadeleine Swart, MPH, Health Care Program Manager, Center for Population Health Improvement, Santa Clara Valley Health & Hospital System


Dov_MaroccoDov Marocco, Chief Innovation & Improvement Officer, Director, Center of Population Health Improvement, Santa Clara Valley Health & Hospital System


Kevin_VolppKevin Volpp, M.D., Ph.D., Janet and John Haas President's Distinguished Professor; Director, Center for Health Incentives and Behavioral Economics, University of Pennsylvania


  • How are data from disparate sources being incorporated into predictive models in an integrative fashion (clinical, claims, health assessment, SDH, sensor, pharmacy, etc.)?
  • What non-traditional types of data are being utilized in predictive models, and which are proving to hold the most promise in identification/stratification for care management intervention (retail, sensor, social media, credit card, geography, weather/climate, etc.)?
  • Are traditional approaches to development of predictive algorithms being replaced with machine learning and AI, or do traditional methods continue to provide unique value? If so, what is that value?

TABLE 3: Care Coordination and Leveraging Social Determinants of Health (SDOH): How Are Organizations Deploying Care Management Resources?

Moderators:

Tabassum_SalamTabassum Salam, M.D., Senior Physician Advisor, Population Health, Christiana Care Health System


Jill_FeldsteinJill Feldstein, COO, Penn Center for Community Health Workers, University of Pennsylvania Health System


Jerome_BelinsonJerome Belinson, M.D., CEO, Medworks; Professor of Surgery, Cleveland Clinic Lerner College of Medicine


Pamela Stoddard, Ph.D., Director of Research, Public Health, Center for Population Health Improvement, Santa Clara Valley Health & Hospital System

Harry_SaagHarry Saag M.D., Medical Director, Greater New York City Practice Transformation Network, NYU Langone Medical Center


Ricardo_YoungRicardo Young, M.D., Regional Medical Officer, CareMore Health/Anthem


  • How to leverage Lifestyle Based Analytics (LBA) and identify and manage social determinants of health ("SDOH") including housing, food, finances, transportation, personal safety, and environmental hazards in order to improve overall pop health management
  • How to identify patients with underlying behavioral health problems, and to stratify those patients by risk and treatment needs
  • Challenges of integrating Lifestyle Based Analytics (LBA) with traditional clinical markers

TABLE 4: Physician Engagement and Dashboards to Promote Pop Health Accountability

Moderators:

Michael_SheinbergMichael Sheinberg, M.D., Medical Director, Medical Informatics, Lehigh Valley Health Network


David_SheinDavid Shein, M.D., Medical Director, The Mount Auburn Cambridge Independent Practice Association (MACIPA)


Bruce_BethancourtBruce Bethancourt, M.D., CMO, Dignity Health Medical Group, Dignity Health


Hackenberg_MatthewMatthew Hackenberg, RN, Director, Innovation Implementation, Center for Clinical Innovation, Geisinger Health System


  • Provider Dashboards: How to interface technology with workflows to drive outcomes
  • What are possible organizational structures that support the use of analytics and population health?
  • What cultural, technical and process barriers must be overcome to facilitate sharing of CDS and analytics? What is the expected benefit from sharing CDS and analytics?

6:30 End of Day One

Tuesday, February 13, 2018

Leveraging Predictive Analytics and Modeling to Drive Quality and Inform Care Planning

8:00 am Sponsored Continental Breakfast

8:35 Chairperson's Remarks

David Claud, M.D., Ph.D., Chief Medical Officer, Executive Leadership Team, Activate Healthcare

8:40 CO-PRESENTATION: Leveraging Predictive Analytics to Inform Care Planning and Coordination across the Healthcare System

Haley_BoltonHaley Bolton, Senior Manager, Regulatory Strategy and Value Management, Emory Healthcare


Gregory_EsperGregory Esper, M.D., MBA, Associate Professor, Neurology, Emory University School of Medicine; Director, New Care Models, Emory Healthcare

Harnessed sophisticated analytics to predict patients' likelihood to no-show for clinical appointments, to detect patients' risk for readmission, and to estimate patients' medical complexity. Overcame operational and cultural barriers to implement dashboards and change the care planning process. Improved the clinic's no-show rate and improved patient outcomes. With the evolving nature of the healthcare landscape, it is critical that healthcare organizations position themselves to leverage data to gain insight to patient health status and to better plan for patient care. Our talk will provide the audience with key takeaways and recommendations to interpret patient information, organize data, and implement predictive models within their organization.

9:10 Use of Predictive Modeling and Outcomes Analytics: Connecting Providers, Patients, Employers, Community Resources and the Payer to Improve Population Health

Rosalie_BakkenRosalie Bakken, Ph.D., Director, Healthcare Analytics and Research, Mayo Clinic

This presentation will highlight the use of predictive analytics and action-oriented reporting as part of a novel, community-based, multi-faceted approach to achieving population health goals. The approach brings together stakeholders from a variety of settings, including health systems, employers, providers, and patients, to achieve mutually desirable goals of improved health outcomes, appropriate access, and decreased costs. By identifying desired outcomes from each perspective at the outset, a solution was developed to meet multiple needs, increase collaboration, and provide ongoing and action-oriented monitoring to inform decision-making ongoing.

9:35 CO-PRESENTATION: Using Real-Time Dashboards, Reports and Decision Support to Drive Quality Metrics

Michael_SheinbergMichael Sheinberg, M.D., Medical Director, Medical Informatics, Lehigh Valley Health Network


Jen_SchlegelJen Schlegel, MSN, RN, Senior Clinical Business Intelligence Analyst, Enterprise Analytics, Lehigh Valley Health Network

Our organization has leveraged real-time dashboards and inline reports to drive numerators for network goals as well as national metrics such as GPRO and Meaningful Use. We'll share how we operationalized the tools and utilized a governance and accountability structure to effectively improve our process and quality measures.

10:05 Sponsored Presentation

10:20 Morning Coffee Break

 

Improving Outcomes in a Value-Based World: Case Studies and Closing Panel Discussion

10:55 Chairperson's Remarks

Jerome Belinson, M.D., CEO, Medworks; Professor of Surgery, Cleveland Clinic Lerner College of Medicine

11:00 Translating Evidence into Practice: An Essential Key to Success in Value-Based Care

Uli_ChettipallyUli Chettipally, M.D., CTO, CREST Network, Kaiser Permanente

Success in switching from volume-based care to value-based care is hinged on providing care that can deliver positive outcomes in the most efficient way possible. This is possible only when organizations develop and support an IT infrastructure that can provide clinical decision support to providers at the point of care. A description of a successful clinical project, bedside application of knowledge, real-time collection of data and implementing new findings back into practice will be shared. Various aspects of selecting a problem, building an IT platform, implementing the solution and refining the solution will be discussed.

11:15 Managing Populations with a Mix of Patients: Bringing Value across the Divide

David_SheinDavid Shein, M.D., Medical Director, The Mount Auburn Cambridge Independent Practice Association (MACIPA)

As value-based contracts evolve, many organizations continue to serve patients who remain in fee-for-service and other non-value based payment methods. This mix poses a number of challenges which Dr. Shein has been addressing as the Medical Director at MACIPA (Mt Auburn Cambridge IPA). He will share insights and strategies to bring 'value' to all patients regardless of their insurance status.

11:40 CO-PRESENTATION: Employer Onsite Clinics: A Glimpse into the Future Where Clinicians Know Who Their Population Is and Are Engaged in Improving Outcomes for That Population

David_ClaudDavid Claud, M.D., Ph.D., CMO, Executive Leadership Team, Activate Healthcare


Michelle_HuangMichelle Huang, Actuary, Finance, Activate Healthcare

When physicians know exactly the population they are accountable for and have IT tools and data that that enhance their ability to provide care that is needed, supported by evidence, and delivered in a patient-centric way, ground can be taken in the battle to improve costs, outcomes, and physician and patient satisfaction. We would like to share our experience employing IT solutions at Activate Healthcare, where primary care clinicians provide care for specific populations of employees at employer sponsored primary care clinics. Specifically, we will share our experiences using IT solutions to: identify patients "falling through the cracks" using a population analytics platform; use electronic specialty consultations to increase extent patients are referred to specialists in person only when needed; facilitate routine, anonymous shared chart review where focused improvement is desirable (i.e. referrals to specialists).

12:10 pm INTERACTIVE PANEL: The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement

Moderator:
Eric_GlazerEric Glazer, CEO, Shared Purpose Connect, Host of Population Health Executive Roundtable


David_SheinDavid Shein, M.D., Medical Director, The Mount Auburn Cambridge Independent Practice Association (MACIPA)


Dov_MaroccoDov Marocco, Chief Innovation & Improvement Officer, Director, Center of Population Health Improvement, Santa Clara Valley Health & Hospital System


John_MattisonJohn Mattison, M.D., Assistant Medical Director, CMIO, CHIO, National and Regional Leadership, Kaiser Permanente


Ricardo_YoungRicardo Young, M.D., Regional Medical Officer, CareMore Health/Anthem

It is critical that CEOs and CMOs seek risk-shared contracts to fundamentally change the culture of their organizations. In this high-level discussion, we will ask industry leaders to share approaches to the following:


  • How do we drive essential behavior to create successful value-based care organizations?
  • How has your organization responded to CMS's issuance of MACRA?
  • How do organizations create a culture where the focus is "care goals for the patient" vs. traditional operational process?
  • How do you assume more of a team-based orientation rather than the traditional physician-patient relationship where the physician is in charge and the patient is a passive partner?
  • What are the key metrics of success for such investments?

12:45 End of Conference.

Stay on to attend Cambridge Healthtech Institute's Healthcare Internet of Things (IoT)

 

* 活动内容有可能不事先告知作更动及调整。



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