Transcript Slide 1

Strategy Management in the Military Health System:
Achieving the Quadruple Aim
Ms. Paula Evans
Office of Strategy Management
Office of the Assistant Secretary of Defense for Health Affairs
[email protected]
27 July 2010
Goals for this briefing
At the conclusion of the session, participants will be
able to:
• Understand the MHS Quadruple Aim
• Understand the MHS Strategic Imperatives
• Understand the Pt Centered Medical Home
• Understand the critical importance of MEPRS in
monitoring strategic performance
The Quadruple Aim
MHS Quadruple Aim
• Readiness
–
–
–
–
Pre- and post-deployment
Family health
Behavioral health
Professional competency/currency
• Population Health
– Healthy service members, families, and retirees
– Reduced tobacco, ETOH and unhealthy eating
• A Positive Patient Experience
– Quality healthcare outcomes
– Patient and family centered care, access, satisfaction
• Cost
– Responsibly managed
– Focused on value
4
Achieving Excellence in the Delivery of Care
•
Performance is a characteristic of a system
• Every system is perfectly designed to achieve exactly the results
it gets
• Design leads to performance; reliability leads to excellence
• So if you want different performance, you need a different design
•
Process-by-process, change-by-change we can get better and
improve across all six areas that described experience of care
(Crossing the Chasm, 2001):
•
• Safe
• Effective
• Patient-Centered
• Timely
• Efficient
• Equitable
But, we need data…..
Source: “Achieving the Quadruple Aim – Military Health Leading the Nation”, Don Berwick, MD, MPP, MHS Conference, January 27, 2010.
Aligning the Incentives:
Rewarding Both Outputs and Outcomes
Deliver patient centered primary care
and optimize performance around:
Direct Care
Prevention
Purchased Care
PMPM
Enrollment
Continuity
ER
Utilization
Patient
Satisfaction
PMPM (Focus on pharmacy)
• Improve health (HEDIS)
• Enhance access and continuity (reducing no shows, ER visits)
• Care is rewarding to patient and provider (satisfaction, retention, staff turnover)
• Synchronize direction and incentives for TRO/MTF/Regional Commander,
including initiatives that are:
–
–
–
–
Facility-specific
Good for entire region or service
Good for all military patients
Beneficial to the MHS as a whole
MHS Strategic Imperatives
Strategic Imperatives
• The MHS has developed a set of strategic imperatives that
Strategic Imperatives are the
we believe will positively impact the Quadruple Aim
critical few things we must
• Strategic Imperatives are the things that will yield the
do to achieve the Quadruple
greatest return from the finite resources available
Aim
Each Strategic Imperative
has one or more performance
measures
As an organization, we will
align resources and focus
management efforts on our
Strategic Initiatives over the
next 1-5 years
• Each measure has specific targets for FY10, FY12, FY14
• The difference between our current performance and target
performance is our performance gap
• Each imperative will have an Executive Sponsoring Coalition
(i.e. one of the Integration Councils)
• To close our performance gap – we will concentrate
efforts on a few strategic initiatives (i.e. Patient
Centered Medical Home)
MHS Strategic Imperatives Scorecard
Strategic Imperative
Readiness
Individual and Family
Medical Readiness
Exec
Sponsor
Performance Measure
FHPC
Individual Medical Readiness
TBD
Psychological Health &
Resiliency
Population
Health
Engaging Patients in
Healthy Behaviors
Development
Status
Measure of Family Readiness (i.e., PHA for families)
Current
Performance
Current
Target
Target
(2012)
Target
(2014)
71%
80%
82%
85%
-
-
-
-
FHPC
PTSD Screening, Referral and Engagement (R/T)
44%/69%
40%/65%
40%/65%
40%/65%
FHPC
Depression Screening, Referral and Engagement
(R/T)
60%/73%
40%/65%
40%/65%
40%/65%
CPSC
MHS Cigarette Use Rate (Will transition to: Percent of
Patients Advised to Quit Tobacco Use)
22%
20%
18%
16%
CPSC
Body Mass Index
-
-
-
-
CPSC
HEDIS Index – Preventative Screens
12
12
13
14
CPSC
HEDIS Index – Clinical Practice Guidelines
8
8
9
10
CPSC
Overall Hospital Quality Index (ORYX)
87%
88%
90%
92%
CPSC
MEBs Completed Within 30 Days
30%
80%
-
-
CPSC
MEB Experience Rating
46%
45%
55%
65%
CPSC
Effectiveness of Care for Complex Medical/Social
Problems
-
-
-
-
JHOC
3rd Available Appointment (Routine / Acute)
Experience of Care
24/7 Access to Your
Medical Home
77%/63%
90%/75%
92%/77%
94%/79%
JHOC
Getting Timely Care Rate
74%
78%
80%
82%
-
-
-
-
Personal Relationship with
Your Doctor
45%
60%
65%
70%
59%
60%
62%
64%
Per Capita Cost
Align Incentives to Promote
Outcomes and Increase
Value for Stakeholders
-
-
-
-
10%
6%
-
-
72/100
65/100
60/100
55/100
Learning &
Growth
Effective Knowledge
Management
Using Research to Improve
Performance
Fully Capable MHS
Workforce
Concept Only
JHOC
Potential Recapturable Primary Care Workload for
MTF Enrollees
Percentage of Visits Where MTF Enrollees See Their
PCM
JHOC
Satisfaction with Health Care
JHOC
Impact of Deployments on MTFs
CFOIC
Annual Cost Per Equivalent Life (PMPM)
CFOIC
Enrollee Utilization of Emergency Services
CPSC
User Assessment of EHR
-
-
-
-
CFOIC
Effectiveness in Going from Product to Practice
(Translational Research)
-
-
-
-
CFOIC
Human Capital Readiness
-
-
-
-
CFOIC
Staff Satisfaction / Team Function
-
-
-
-
Measure Algorithm
Developed
Current Performance Known and
FY10 Target Approved
IMR programs (e.g., addressing
dental class 4, overdue PHAs, etc.)
Psychological Health
Evidence-Based Care
Wounded Warrior Care
Strategic Initiatives
Healthy Behaviors/Lifestyle
Programs
Evidence Based Care
Wounded Warrior Programs
Patient Centered Medical Home
Disability Evaluation System
Redesign
Evolution of Performance Planning
EHR Way Ahead
Out-Year Targets Approved
Centers of Excellence
BRAC / Facility Transformation
Design Phase
Approved
Funded
How Do We Support Change in the Right Direction?
• Understand desired end-state
– Balanced approach to Quadruple Aim
– Readiness maximized
– Healthy Outcomes and Patient Experience
improved
– Sustainable Costs
• Emergency Department Use
• Retail Pharmacy
• Agree on goals
– One size does not fit all
– Year over year improvement
• Facilitate and incentivize the change
Balance
Key MHS Initiative for Achieving
the Quadruple Aim is the
“Patient Centered Medical Home (PCMH)”
Team-Based
Healthcare Delivery
Access to Care
•Creation of Clinical Micropractices
•Appropriate utilization of medical
personnel
•Improve communication among team
members
•Improve phone and electronic appt
scheduling
•Open access for acute care
•Emphasis on coordination of care
•Proactive appointing for chronic and
preventive care
Advanced IT Systems
•Secure mode of e-communication
•Creation of education portal
•Reminders for preventive care
•Easy, efficient tracking of population data
Decision Support Tools
•Evidence-Based Training
•Integrated Clinical Guidelines
•Decision Support Tools at the point of
care
Population
Health
•Emphasis on preventive care
•Form basis of productivity measures
•Evidence-based medicine at the
point of care
Patient
Center
ed
Medical
Home
Patient & Physician
Feedback
Patient-Centered Care
•Empower active patient
participation
•Seamless communication
•Encourage patient
participation in process
improvement
Refocused Medical
Training
•Emphasize health team leadership
•Incorporate patient-centered care
•Focus on quality indicators
•Evidence-based practice
•Real-time data
•Performance reporting
•Patient feedback
•Partnership between patients and care
teams to improve care delivery
Model adapted from the NNMC Medical Home
MHS PCMH Journey
NNMC
Services Develop nd
MHS PCMH HA
2 MHS PCMH
PCMH Pilot
PCMH Policy &
Policy
Summit
Performance
Begins
Guidance
Sep 2009
Oct 2010 Planning Pilots
Jun 2008
Apr– Jul 2010
Edwards &
Begin
MHS Conference
Ellsworth
Oct 2010
(Enterprise-Wide
FHI Pilots
Communications)
Aug 2008
Jan 2010
Services Present
Early Results of
PCMH
Performance
Aug 2009 (R&A)
1st MHS
PCMH
Summit
Sep 2009
Resources
Aligned in
2012-17 POM
Jun 2010
“Framework for
Analysis” Approved
(i.e. Measures and
Standards)
Dec 2009
ASD/HA and SG
Congressional
Testimony (for
Stakeholders Buy-in)
Feb 2010
2,634,614
Enrollees in a
Level II PCMH
End of FY 2012
Enterprise-Wide
Secure Messaging
Capability Available
Jan - Mar 2011
Business Case to Support PCMH
What should PCMH accomplish
within Primary Care?
•
•
•
•
•
•
Reduce visits/person
Maintain total “touches” (visits + non-visits)
Increase enrollment
Increase market share
Recapture PSC (savings)
Increase preventive services
What do we need to do?
•
•
•
•
•
What should PCMH accomplish
outside of Primary Care?
Direct Care
•
•
•
Right number of providers for enrolled
population
Right number of support staff per
provider
Right space for efficient operations
Right information systems
Train our people to more effectively
function as a team
PMPM
ER
Patient
PreventionEnrollment Continuity
Reduce ER demand (savings)
UtilizationSatisfaction
Reduce inpatient demand (savings)
Reduce specialty demand (savings) Purchased Care PMPM (Focus on pharmacy)
Standards & Measures
What They Are & Why They Are Different?
• Standard: An established norm or requirement; usually manifested in a formal
document that establishes uniform specifications, criteria, methods, or practices
• Measure: A number or quantity that records an observable value or
performance
Example: Hybrid Car
Standards
•Uses two or more distinct power
sources to move the vehicle
•Low emissions (i.e. SULEV rated
[Super-Ultra-Low-Emission Vehicle])
Measures
•Fuel economy (mpg city/hwy)
•Acceleration (time from 0-60 mph)
In this example, standards distinguish hybrids from other cars while measures allow consumers to
compare the performance hybrids against other cars.
Why Do We Need Standards and Measures?
• Standards and measures allow us to test a hypothesis:
– Hypothesis: “The PCMH is a model of primary care that will have a significant
positive impact on MHS’ pursuit of the Quadruple aim: enhanced patient
experience, improved population health, better managed per capita cost, and
increased medical readiness.”
• Standards allow us to differentiate medical homes from traditional
models for primary care
– Standards describe the key characteristics required for a practice to qualify as
a medical home
– Standards do not force “one-size-fits-all”; they are simply a set of fundamental
criteria that must be met
– Without standards, the term medical home can be used loosely, potentially
damaging the credibility of the medical home initiative
• While standards can be used to determine what a medical home is,
measures allow us to determine how they are performing
– Performance versus control groups (Are medical homes doing better than
traditional models for primary care?)
– Longitudinal performance (How is a medical home doing over a span of time?)
– Best performers (Where are the opportunities for best practice transfer?
Tracking PCMH Implementation
Number and percentage of enrollees getting their care from a
Level 2 Patient Centered Medical Home
1.
We have standards that define the patient centered medical home
2.
We have measures and targets that describe the outcomes we want to
achieve
3.
We should articulate the number of patients that will migrate to a patient
centered medical home, and by when
17
PCMH Enrollment Projections
“THE TARGET”
Total MHS Prime
Enrollment
With Plus (2009)
Projected PCMH
Prime Enrollees
with Plus (end of
FY 2010)
Projected PCMH
Prime Enrollees
with Plus (end of FY
2011)
Projected PCMH
Prime Enrollees with
Plus (end of FY 2012)
Air Force
1,218,891
304,723 (25%)
731,335(60%)
1,103,864 (88%)
Army
1,407,531
47,856 (3.4%)
281,506 (20%)
633,389 (45%)
Navy
780,486
132,683 (17%)
390,243 (50%)
597,361 (75%)
HCSC
1,500,000
45,000 (3%)
135,000 (9%)
300,000 (20%)
Total
4,906,908
530,262 (11%)
1,538,084 (31%)
2,634,614 (54%)
Notes:
HCSC = Health Care Support Contractors
(X) = % of enrolled population with Plus
Estimated Overall Impact of
PCMH on the Quadruple Aim
Expected
Performance from
Level 2 PCMH
Current
Performance
Measure
X
Expected
Improvement
R
IMR
↑ TBD
G
HEDIS –
Preventive
↑ 7%
G
HEDIS –
Evidence Based
Guidelines
↑ 4%
Beneficiary
Satisfaction
↑ 10%
Y
Y
R
Y
R
R
Time to Next
Available
Appointment
3.75M - 75%
54%
31%
↑ 15%
Getting Timely
Care
↑ 14%
PCM Continuity
↑ 16%
PMPM
↓ TBD
ER Utilization
% of Enrollees
Getting Care from
Level 2 PCMH
11%
↓ 24
Projections 2010
2.5M - 50%
1.25M - 25%
500K - 10%
250K -
5%
Projections 2011
=
Overall Impact on
Quadruple Aim
Beneficiary Satisfaction: 59%  64% (62%)
G
Getting Timely Care: 74%  81% (78%)
G
PCM Continuity: 45%  53% (60%)
Y
ER Utilization: 72/100  60/100 (60)
G
Beneficiary Satisfaction: 59%  62% (62%)
Y
Getting Timely Care: 74%  78% (78%)
G
PCM Continuity: 45%  49% (60%)
Y
ER Utilization: 72/100  66/100 (60)
Y
Beneficiary Satisfaction: 59%  60% (62%)
Y
Getting Timely Care: 74%  76% (78%)
Y
PCM Continuity: 45%  47% (60%)
Y
ER Utilization: 72/100  69/100 (60)
R
Beneficiary Satisfaction: 59%  59% (62%)
Y
Getting Timely Care: 74%  75% (78%)
R
PCM Continuity: 45%  46% (60%)
Y
ER Utilization: 72/100  70/100 (60)
R
Projections 2012
(XX) Denotes FY12 target
Importance of MEPRS in All This
The MHS Value Equation for Measuring PCMH Success
Experience
Population
Readiness +
+
of Care
Health
Value =
Cost (Over a Span of Time)
Creating a high value Military Health System is
predicated on defining and measuring value.
21
MHS Strategic Imperatives Scorecard & MEPRS Data
Strategic Imperative
Readiness
Individual and Family
Medical Readiness
Psychological Health &
Resiliency
Population
Health
Engaging Patients in
Healthy Behaviors
Exec
Sponsor
Performance Measure
FHPC
Individual Medical Readiness
Development
Status
Current
Performance
Current
Target
Target
(2012)
Target
(2014)
71%
80%
82%
85%
TBD
Measure of Family Readiness (i.e., PHA for families)
-
-
-
-
FHPC
PTSD Screening, Referral and Engagement (R/T)
44%/69%
40%/65%
40%/65%
40%/65%
FHPC
Depression Screening, Referral and Engagement
(R/T)
60%/73%
40%/65%
40%/65%
40%/65%
CPSC
MHS Cigarette Use Rate (Will transition to: Percent of
Patients Advised to Quit Tobacco Use)
22%
20%
18%
16%
CPSC
Body Mass Index
-
-
-
-
CPSC
HEDIS Index – Preventative Screens
12
12
13
14
CPSC
HEDIS Index – Clinical Practice Guidelines
8
8
9
10
CPSC
Overall Hospital Quality Index (ORYX)
87%
88%
90%
92%
CPSC
MEBs Completed Within 30 Days
30%
80%
-
-
CPSC
MEB Experience Rating
46%
45%
55%
65%
CPSC
Effectiveness of Care for Complex Medical/Social
Problems
-
-
-
-
Experience of Care
24/7 Access to Your
Medical Home
JHOC
3rd Available Appointment (Routine / Acute)
77%/63%
90%/75%
92%/77%
94%/79%
JHOC
Getting Timely Care Rate
74%
78%
80%
82%
-
-
-
-
45%
60%
65%
70%
59%
60%
62%
64%
-
-
-
-
10%
6%
-
-
72/100
65/100
60/100
55/100
JHOC
Personal Relationship with
Your Doctor
Per Capita Cost
Align Incentives to Promote
Outcomes and Increase
Value for Stakeholders
Learning &
Growth
Effective Knowledge
Management
Using Research to Improve
Performance
Fully Capable MHS
Workforce
Concept Only
JHOC
Potential Recapturable Primary Care Workload for
MTF Enrollees
Percentage of Visits Where MTF Enrollees See
Their PCM
JHOC
Satisfaction with Health Care
JHOC
Impact of Deployments on MTFs
CFOIC
Annual Cost Per Equivalent Life (PMPM)
CFOIC
Enrollee Utilization of Emergency Services
CPSC
User Assessment of EHR
-
-
-
-
CFOIC
Effectiveness in Going from Product to Practice
(Translational Research)
-
-
-
-
CFOIC
Human Capital Readiness
-
-
-
-
CFOIC
Staff Satisfaction / Team Function
-
-
-
-
Measure Algorithm
Developed
Current Performance Known and
FY10 Target Approved
IMR programs (e.g., addressing
dental class 4, overdue PHAs, etc.)
Psychological Health
Evidence-Based Care
Wounded Warrior Care
Strategic Initiatives
Healthy Behaviors/Lifestyle
Programs
Evidence Based Care
Wounded Warrior Programs
Patient Centered Medical Home
Disability Evaluation System
Redesign
Evolution of Performance Planning
EHR Way Ahead
Out-Year Targets Approved
Centers of Excellence
BRAC / Facility Transformation
Design Phase
Approved
Funded
Magic Linkage
MEPRS Code
Work Center
Input
• DMHRSi
• DMLSS
• Local Financial
Systems
Output
• CHCS
• SIDR
• SADR
Outcome
• Surveys
• M2
• Pop Health Portal
What PCMH questions do we need answered
that MEPRS would help on?
•
•
•
•
•
•
•
•
•
How many people are enrolled to a PCMH?
What are the demographics of those enrolled to a team?
What is the enrollment ratio, i.e. enrollee to providers?
What is the demand rate for those enrolled in PCMH?
How much primary care of those enrolled in PCMH is not
seen by providers within the PCMH team?
How much primary care seen by the team is for those
not enrolled in the team?
What is the productivity of the team?
What is the overall cost of the team?
What is the PMPM of individuals enrolled in PCMH?
MEPRS Based Data is Essential for Knowledge Transfer
• Having aggregate measures isn’t enough—we need
information at the team level to evaluate performance
and support best practice transfer of PCMH
• At a fourth level MEPRS, data can be aggregated and
analyzed by medical home team within a given MTF
• A PCMH’s performance can then be compared with
others.
• We believe that as teams learn from each other, their
performance will improve over time
• Leadership has asked OSM to propose a single
approach for measuring all aspects of a PCMH team
and present to the JHOC on 11 Aug 10
Our Challenges
• Labor intensive to create individual identification
of teams
• Lack of standard implementation rules
• Not so simple; very complicated
• Inefficient processes for data entry
• Inadequate training of staff to appropriately
account for time
• IM/IT disconnects
Pay Off by Measuring Individual PCMH Teams
• Identify top performers
• Report to our investors using hard evidence
(facts) on the results of the PCMH initiative
• Prove something that no one has proven in the
country
• Share best practices and eliminate unwarranted
variation
What Will It Take?
• Agreement to work together to find an optimal
solution
• Skill in designing efficient processes and
procedures to capture data and allocate
resources
• Pilot testing to avoid unintended consequences
• Willingness to act quickly and get to yes
“It is not the strongest of the
species that survives, nor the
most intelligent, but the one
most responsive to change.”
- Charles Darwin
29
Back-up Slides
Definitions – Strategic Imperatives
Quadruple
Aim
Readiness
Population
Health
Experience of
Care
Strategic Imperative
Individual Medical
Readiness
Increasing the proportion of the Total Force (Active and Reserve Components) across six
elements that define IMR: Periodic Health Assessment (PHA), no deployment-limiting
conditions, dental readiness, immunization, readiness laboratory tests, and individual medical
equipment.
Psychological Health Improving health outcomes for the 20-30% of OIF/OEF Service member that report some
form of psychological stress. Continued focus on research into and adoption of evidencebased care treatments for PTSD and TBI.
Engaging Patients in
Encouraging and incentivizing patients and families to take a more active role in their health.
Healthy Behaviors
Promoting a shift from “healthcare to health” by fostering the adoption of healthier lifestyles,
particularly the reduction/elimination of tobacco and alcohol usage, increase in physical
activity, and improvement in nutrition.
Evidence-Based Care Transitioning from intuitive medicine to precision medicine through the development,
proliferation, and adherence to evidence-based guidelines. Achieving lowest decile
performance in the Dartmouth Atlas measures by reducing unwarranted variation.
Coordinated Care for For medically and socially complex patients, establishing partnerships among individuals,
Complex Cases
families and caregivers, including identifying a family member or friend who will be supported
and developed to coordinate services among multiple providers of care.
24/7 Access to Your
Team
Per Capita
Cost
Learning &
Growth
Definition
Personal Relationship
with Your Doctor
Patients are provided information about how to access medical care at any time, 24 hours per
day, every day of the year. The Medical Home ensures on-call coverage (pre-arranged
access to a clinician) when the Medical Home is not open.
All patient medical home visits are with the same team which is responsible for providing for
all the patient’s health care needs or taking responsibility for appropriately arranging care with
other qualified professionals (i.e. whole-person orientation). The physician listens carefully to
the patient and, when appropriate the patients caregivers. Compassionate and easy-tounderstand instructions are provided about taking care of health concerns.
Value-Based
Incentives and
Reimbursement
Deliver Information to
Enable Better
Decisions
MHS Contribution to
Medical Science
Capable Medical
Workforce
Shifting from volume-driven to value-driven health care. Disincentivizing fragmented
approaches of care delivery to performance-based payments and enhanced value that can
improve health outcomes and decrease costs.
Improve the Electronic Health Record family of applications and support to create a
comprehensive, fast, easy to use, and reliable system that meets the MHS goals of improving
quality, safety, readiness, outcomes and customer satisfaction.
Reducing the research-to-practice divide by focusing the R&D portfolio on the areas that will
have the greatest impact on our strategic imperatives.
Ensuring a thorough understanding of the job families most critical to our strategic initiatives
and then developing/recruiting the right people.
Performance Measures
•Individual Medical Readiness
•Measure of Family Readiness (i.e., PHA for families)
•PTSD Screening, Referral and Engagement (R/T)
•Depression Screening, Referral and Engagement(R/T)
•MHS Cigarette Use Rate (Will transition to: Percent of
Patients Advised to Quit Tobacco Use)
•Body Mass Index
•HEDIS Index – Preventive Screens
•HEDIS Index – Clinical Practice Guidelines
•Overall Hospital Quality Index (ORYX)
•MEBs Completed Within 30 Days
•MEB Experience Rating
•Effectiveness of Care for Complex Medical/Social
Problems
•3rd Available Appointment (Routine / Acute)
•Getting Timely Care Rate
•Potential Recapturable Primary Care Workload
•Percentage of Visits Where MTF Enrollees See Their
PCM
•Satisfaction with Health Care
•Impact of Deployments on MTFs
•Annual Cost Per Equivalent Life (PMPM)
•Enrollee Utilization of Emergency Services
•User Assessment of EHR
•Effectiveness in Going from Product to Practice
(Translational Research)
•Human Capital Readiness
•Staff Satisfaction / Team Function
31
Strategic Imperative Definitions
Mission Outcome Strategic Imperative
Definition
Improved Mission
Readiness
Individual Medical
Readiness
Although we continue our pursuit of all aspects of readiness we will focus
on increasing the proportion of the Total Force (Active and Reserve
Components) that has a known readiness status and on reducing the rate of
deployment limiting conditions.
Increased
Resilience and
Optimized Human
Performance
Psychological Health
Improving health outcomes for the 20-30% of OIF/OEF Service member that
report some form of psychological stress. Continued focus on research into
and adoption of evidence-based care treatments for PTSD and TBI.
Healthy Community Engaging Patients in
/ Healthy Behavior Healthy Behaviors
Encouraging and incentivizing patients and families to take a more active
role in their health. Promoting a shift from “healthcare to health” by
fostering the adoption of healthier lifestyles, particularly the
reduction/elimination of tobacco and alcohol usage, increase in physical
activity, and improvement in nutrition.
Health Care Quality Evidence-Based Care
Transitioning from intuitive medicine to precision medicine through the
development, proliferation, and adherence to evidence-based guidelines.
Achieving lowest decile performance in the Dartmouth Atlas measures by
reducing unwarranted variation.
Effective Medical
Transition
For medically and socially complex patients, establishing partnerships
among individuals, families and caregivers, including identifying a family
member or friend who will be supported and developed to coordinate
services among multiple providers of care.
Coordinated Care for
Complex Cases
Strategic Imperative Definitions (Cont’d)
Mission Outcome
Strategic Imperative
Definition
Access to Care
24/7 Access to Your
Team
Patients are provided information about how to access medical care at any
time, 24 hours per day, every day of the year. Access may be in-person, by
phone or by secure messaging using enhanced technology.
Beneficiary
Satisfaction
Personal Relationship We seek to ensure that all primary care visits are with the same provider or
team which is responsible for providing health care needs or arranging care
with Your Doctor
with other qualified professionals. Care is personal, the PCM and the entire
team listen carefully to the patient and, when appropriate the patient’s
caregivers. Compassionate, individualized and easy-to-understand
education is part of every encounter.
Performance Based
Management
Value-Based
Incentives and
Reimbursement
Shifting from volume-driven to value-driven health care by implementing
performance-based payments focused on improving health outcomes over
time.
Deliver Information
to Enable Better
Decisions
Functional EHR
Improve the Electronic Health Record family of applications to create a
comprehensive, fast, easy to use, and reliable system that supports the
quadruple aim by enabling better decisions, especially at the point of care.
MHS Contribution to Using Research to
Medical Science
Improve Performance
Reducing the research-to-practice divide by focusing the R&D portfolio on
the areas that will have the greatest impact on our strategic imperatives.
Capable Medical
Workforce
Ensuring a thorough understanding of the job families most critical to our
strategic initiatives and then developing/recruiting the right people to be a
part of our team.
Fully Capable MHS
Workforce