Improving Care Quality Through Clinical Integration

Patrick J Brennan, MD, senior vice president and chief medical officer of the Perelman Center for Advanced Medicine at Penn Medicine, discussed approaches taken by Penn Medicine to integrate and collaborate with payers.

“I’m hoping to describe to you and have you understand what Penn Medicine is doing as an approach to clinical integration in an otherwise fragmented system and to understand our payer relationships better,” Dr Brennan explained to the audience.

Dr Brennan explained to the attendees that Penn is transforming its data into value through a three-phase process—phase 1 is the foundation, phase 2 is meaningful use, and phase 3 is precision medicine.  He explained that Penn Medicine’s blueprint for quality and patient safety will improve the health of patients and assure safe care.

“We state that it will improve the health of our patients, and by that we mean we’re not just focused on in-patient environment anymore, we really need to be focused on the entire continuum of care and that we’re going to ensure safe care,” Dr Brennan said about Penn’s blueprint.  “We’re not just going to prevent harm, we’re going to design our care so that its safer.”

Dr Brennan said that Penn’s blueprint for improving patient care consists of engagement, continuity, and value. He explained that engagement involves physicians and staff as partners with patients and families to achieve goals of care. Continuity should deliver seamlessly coordinated care across all settings and service lines. Finally, value will provide high quality, efficient care and the best outcomes for all patients.

One of Penn Medicines newest health care model—in early stages—is a value-based partnership with Independence Blue Cross (IBC). Through the partnership the IBC value equation provides claims data, authorization data, member data, actuarial expertise, a direct link to employer/market needs, network connections and innovative network and benefit design. Penn Medicine’s value equation provides HER data, patient experience data, pathway adherence data, clinical care redesign, expertise, a direct link to provider and patient barriers to improve value, and community partnerships.

Dr Brennan explained that the goal is to drive lower total cost of care. He explained that care utilization for patient populations across the continuum of care—ambulatory, inpatient, post-acute, and home—must be observed. Further, he explained that in order to achieve these goals, it takes many teams, not just one.

He then explained the health systems Independence Readmission Program, which began in June 2017. Dr Brennan said that as part of the new IBC contract, Penn Medicine is now at risk for 30-day all-cause readmissions. Further, he said that Penn Medicine now has the opportunity to improve patient care through reducing readmissions.

Following the start of the new program, Penn Medicine was able to align efforts across the organization. Dr Brennan said that by August 2017, readmission inventory identified over 80 initiatives across the health system. He said that the aligned value leadership structure was made up of a value steering group and value operations committee. The responsibilities of the steering group leadership structure included identification of opportunities, set value priorities, allocate resources, tack outcomes, quality, finance, and Ops Efficiency. The responsibilities of the operation committee included, determining priorities for key value initiatives and system-wide learning.

“Preventing avoidable readmissions and ensuring coordinated care post discharge are core elements in our patient care delivery approach,” Dr Brennan said. “Two multi-entity, multidisciplinary teams were formed to develop a framework for a safe discharge and an accountable care coordination model to help prevent readmissions.”

The teams included a patient identification, accountability, and care coordination workgroup and a discharge workgroup.

Dr Brennan explained that patients under the IBC Readmission Program experienced a 30% reduction in readmissions. Comparatively, all patients experienced an 8% reduction in readmissions. Dr Brennan said that it was the largest single-year reduction in readmissions.

According to Dr Brennan, the joint payer-provider operations committee was able to provide post-acute care management, prescription cost transparency, they were able to address pain-opioid dependence, and opportunities to improve access.

“These programs are driving improved patient outcomes—including fewer hospitalizations, lower readmissions, and better functional status—that matter to patients and IBC and that also lead to lower costs,” according to Dr Brennan.

—Julie Gould