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A non-profit health system began its journey to population health management by first aligning physicians through the formation of an IPA and then designing and implementing a system-wide population health management program, including bundled payments.


Background

The System was formed in 1997 and  was a partnership of three not-for-profit healthcare systems based in a large metro area, which together sponsored five acute-care hospitals, with a total of 2100 beds, and several ambulatory surgery centers and clinics. The medical staffs were comprised of 2200 physicians, approximately half of whom were employed by the System. The management team of  the System made the decision to form an independent practice association (“IPA”) to include all its facilities and both employed and voluntary physicians to explore the potential for contracting with payers as a clinically integrated delivery system.

In September 2013, the System merged with an academic medical center to become a part of the newly formed New Health System (“New System”). The New System  encompasses a School of Medicine and seven member hospital campuses, 12 free-standing ambulatory surgery centers, 2,800 full and part-time employed physicians, and 3,783 voluntary physicians. The New System includes an expanding network of multi-specialty services including more than 45 ambulatory care practices, an ACO, and two IPAs involving provider members from throughout the state.

Our Approach

The System engaged GE Healthcare Camden Group to perform a gap analysis of the current infrastructure and systems, design and develop a program of clinical integration, and support their efforts for physician alignment to prepare for value-based reimbursement. GE Healthcare Camden Group assisted the System by undertaking a facilitated planning process to form an IPA, to contract with the employed and voluntary provider network, and to identify and develop the infrastructure and processes needed to become clinically integrated.

GE Healthcare Camden Group supported the New System in the creation of a system-wide population health management program. The engagement involved multiple inter-related planning activities and development milestones. Core elements of the scope of work include an enterprise wide assessment, strategic planning, future state vision, governance oversight, work plan development and implementation, clinical and quality program development, board and committee facilitation, payer contracting strategy, and financial modeling. We also assisted in designing and implementing bundled payments as part of the population health management program and helped the New System set up their integrated population health management infrastructure.

Results

  • Clinical Integration
    Facilitated planning process to form an IPA, to contract with the provider network, and to identify and develop the infrastructure and processes needed to become clinically integrated.
  • Pop Health Program  Created  a system-wide population health management program, including integrated care and disease management programs, IT infrastructure, network management infrastructure, performance reporting, and bundled payments as part of the program.
  • Aligned StakeholdersCollaborative approach to developing  population health management programs ensured alignment with leadership, physicians, board and other key stakeholders.

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