Active Partners’ Participation Key to 2017 Success
FROM THE CHIEF CLINICAL INTEGRATION OFFICER
By Michele Mercer, RN, MSHA
At Millennium Collaborative Care, “Clinical Integration” refers to the coordination of care across a continuum of services including, preventive; outpatient; inpatient hospital care; post-acute care including skilled nursing; rehabilitation; home health services; and palliative care.
Additionally, community-based services are fundamental aspects of “Clinical Integration” to improve the value of the care provided.
In our developing, clinically integrated organization, Millennium is building a structure where participating providers share clinical and other information to encourage improved coordination of care and adherence to evidence-based care protocols.
Millennium’s goal with the development of the clinically integrated network is to negotiate with payers to reward incentives for shifting payment from volume of services to value; rewarding better quality outcomes, improved patient access to needed services, and improved efficient use of healthcare resources.
Millennium’s “Clinical Integration” maintains a focus on quality, value, and population health management.
Millennium Collaborative Care and our partners are making great strides in developing our clinically integrated organization as evidenced by a focus on the following foundational steps in 2016:
- Increased Collaboration: Based on a primary care model, provided support for achievement of Patient Centered Medical Home and Meaningful Use.
- Improved Efficiency: Defined a “warm hand-off” process among partners.
- Integrated Data Systems: Established an IT/Data sharing interoperability infrastructure plan.
- Improved Care Management: Built a Care Transitions and Care Coordination Strategy across settings.
- Integrated Continuum of Care: Implemented training across settings regarding clinical integration, tools and communication for coordination.
- Payer Partnerships: Facilitated support with regional payers for Value Based Payment arrangements.
- Patient-Centered Communication: Launched a multi-pronged approach to cultural competency and health literacy.
- Improved Community Health: Strengthened partnerships with Community-Based Organizations to achieve a community-wide wellness agenda.
The challenge in 2017 is putting these foundational steps into action with our partners. Active participation by our partners with the Clinical Integration workgroups and implementation of clinical integration principles into partner organizations will yield measureable results that will demonstrate value to all.