Integra HealthCare Centers, Inc.Integrated Care Program

Utilizing a “Continuum of Care” to optimize patient care and

practice revenues

Quality of Care:- Patient Experience

- Patient Education

-Patient Outcomes

Standards of Care:- Evidence Based Medicine

- Clinical Guidelines

- Payer Guidelines

Continuum of Care:- Assessment

- Therapies

- Management

Communication:- Patient Progress

- TEAM Communication

- Community Outreach

IPU

Clinical Program

INTEGRATED CARE DEFINED

Integrated care program model is Biopsychosocial vs. Biomedical

Defined around medical conditions, not business process

Condition based comprehensive services provided

Organized around medically integrated practice units (IPU’s)

Distinctive care delivery strategy offered in each practice unit

Patient results, experience, and methods measured, reported,

communicated

Services marketed based on excellence, uniqueness, and results

TYPES OF SERVICES PROVIDED – DIFFERENTIATION

Comprehensive assessment/diagnosis emphasis

Differentiation based on the comprehensiveness of services provided

over the care cycle (Continuum of Care)

Emphasis on comprehensive assessment, integrated therapies, and

condition management vs. acute care treatment

Distinguished based on IPU model (patient centric)

Distinguished based on availability of services (access to care)

Distinguished based on Continuity of Care (care consistency)

CHRONIC CARE CONDITIONS – EDUCATION & AWARENESS

Multiple provider coordinated delivery system

Patient centric self-management initiatives

Community wide education initiatives to improve health

All stakeholders included (employers, allied health providers, social service

organizations)

Comprehensive lifestyle education opportunities

Utilization of information management systems for health & lifestyle

education initiatives

The foundation of an Integrated Practice Unit (IPU) consists of three components…

Quality of Care

•Patient Experience•Patient Education•Patient Outcomes

Standards of Care

•Evidence Based Medicine

•Clinical Guidelines•Payer Guidelines

Continuum of Care

•Prevention•Assessment•Therapies•Management

Quality of Care - Defined

Utilizing processes and systems to make “QUALITY” measurable

Quality of Care

Patient Experience

Patient Outcomes

Patient Education

HOW DO WE MEASURE QUALITY?

Patient Experience (measurement of satisfaction)

Patient Education (measurement of understanding)

Patient Outcomes (measurement of progress)

Agreeing on a definition of quality of care may be healthcare's biggest challenge…

QUALITY OF CARE GOALS

Comprehensive assessment/diagnosis

Interdisciplinary therapies, individualized to the patients needs

Medical Condition Management (measure, report, communicate)

Education and support resources that allows patients to understand and

cope with their illness/disease

Communication between all of the stakeholders in the care delivery

process (patient, provider, payer)

Measurement and reporting of entire quality of care cycle

PATIENT EXPERIENCE A measure of patient satisfaction should be reportable to entire patient

population

Goal is to have patients experience a positive experience and enhance

their quality of life

Practice Environment ( a measure of satisfaction)

Satisfaction surveys (quality measures)

Will they refer friends and neighbors

3 levels of satisfaction (dissatisfied, satisfied, prophet)

PATIENT EDUCATION A measure of how well the patient understands their disease/condition

Measure of patient involvement in the treatment and/or management

of their condition

Objective measurement should include patient knowledge assessment

tools, group education, and/or journal entries

Comprehensive patient resources are provided as a component of care

PATIENT OUTCOMES Use this measure for patient progress, not physician performance

Use concrete metrics to determine the therapeutic progress made

Use objective versus subjective quantifiable clinical information to help patients understand their

condition and “plan of care”

CORE OUTCOMES DOMAINS: Pain QVAS (4 components – now, average, best, worst)

Physical Functioning (range of motion, muscle weakness/strength, pain intolerance, grip, pinch)

Emotional Functioning (quality of life, activities of daily living)

Experience and Satisfaction (access, communication, administration, environment, information provided,

pre-visit communication)

Understanding of Condition (medical condition education, self – management)

Building an evidence based practice with evidence based medicine, clinical

guidelines, and payer guidelines based on patient differential and/or working

diagnosis

Standards of Care

Evidence Based

Medicine

Clinical Guidelines

Payer Guidelines

EVIDENCE BASED MEDICINE:

Clinical Research / Trials

• www.nih.gov

Cochrane Collaboration

• www.cochrane.org

Scientific Literature Review

• www.mdconsult.com

CLINICAL GUIDELINES

E-Medicine

• www.emedicine.com

National Guidelines Clearinghouse

• www.guidelines.gov

Institute for Clinical Systems Improvement

• www.icsi.org

American College of Environmental and Occupational Medicine

• www.acoem.org

PAYER GUIDELINES

The identification of clinically correct, medically

necessary processes and procedures for which payers will

provide reimbursement

ODG Treatment

BCBS Technology Evaluation Committee

Medicare, BCBS, Aetna, others

Defined as the delivery of health care services over a period of time. In patients with a chronic medical condition, this covers all phases

of illness from diagnosis to the end of life.

Continuum of Care

Comprehensive Assessment

Medical Condition

Management

Interdisciplinary Therapies

DIAGNOSIS/ASSESSMENT IS PROCESS DRIVEN

Process is used to develop a plan of care based on “Components of

Care” for chronic medical conditions:

Physician Decision Support Toolset

Utilizes “Key Clinical Markers”

Location, duration, frequency, character

Measure, Report, Communicate

Neurological, Mechanical, Compressive, Inflammatory

BioPsychosocial vs. BioMedical

Mechanical Pain

Inflammatory Pain

Muscle Pain

Neuropathic Pain

ACUTE

SUB-ACUTE

CHRONIC

Components of Care in a Integrated Care Program:

Comprehensive Assessment (differential to working diagnosis)

Integrated Therapies (patient plan of care)

Medical Condition Management (coordination of care)

Stakeholder Communication (communication with all interested

stakeholders in the care delivery process)

Measurement and Reporting of Patient Progress (patient

outcomes)

COMPREHENSIVE ASSESSMENT

Radiological Studies

Behavioral Assessment

Functional Assessment

Interventional Studies

Physiological Studies

Evaluation

Differential Diagnosis

Working Diagnosis

INTEGRATED THERAPIES

Behavioral Therapies

Functional Therapies

Interventional Therapies

Pharmacological Therapies

Durable Medical Equipment

Working Diagnosis

Plan of Care

Maximum Medical Improvement

MEDICAL CONDITION MANAGEMENT

Behavioral Management

Functional Management

Pharmacological Management

Alternative Medicine

Complimentary Medicine

CAM Therapies

Patient Education

Long Term Management

COMMUNICATION

Critical to the treatment process

Provides outreach opportunities

Communicate Progress

Payer

ProviderPatient

MANAGEMENT

Measuring processes and progress

Progress reporting

Outcome measures

Objective information - patient pain levels

Objective information - functional improvements

Objective information – quality of life measures

Integrated practice unit differentiation from competition is achieved with the level of and types of services provided.

Integrated Practice

Unit

Multiple Specialty

Consultations

Competition -Differentiation

Services -Specialties

Integra HealthCare Centers, Inc.

Less Pain

Quality of Life

Restoration of Function