Clinical Integration Update: APP Embeds Case Managers in Select Practices

Wednesday, November 16th, 2011
This post was written by Patricia Donovan

In an expansion of its highly regarded clinical integration program, Advocate Physician Partners (APP) has embedded 60 outpatient case managers in select physician practices.

“The case managers are focused on the sickest 2 to 3 percent of our population,” explained Mark Shields, MD, MBA, APP senior medical director and VP of medical management for Advocate Health Care, in a recent interview. “There is active discourse between the physicians and RNs about which patients should participate in the case management program.”

APP placed the case managers in the practices in early 2011, after studying the success enjoyed by Geisinger Health Plan’s embedded case managers.

The newly embedded case managers are accessing tools like “Active Advice,” which prompts the care managers with further data analytics, as well as a home-grown statistical tool employed to determine those patients at highest risk of readmission to the hospital as part of APP’s “Transitions” program.

Reducing avoidable ER visits is another mission for both outpatient and ER case managers, Dr. Shields notes. There are related incentives and training for providers, including the use of group visits, telephone visits and enhanced scheduling to impact this metric.

APP defines clinical integration as “physicians across specialties working together with hospitals to drive quality, patient safety and cost-effectiveness.” APP’s clinical integration has expanded in 2011 to include 3,800 physicians and 10 hospitals, who are subject to 147 individual performance measures. New measures added this year were chiefly in the areas of global cost of care, ambulatory conditions and readmissions, said Dr. Shields.

Looking ahead to future improvements, APP expects to roll out a fully operational patient portal in early 2012 to support meaningful use imperatives. Some APP sites are already trialing patient e-visits modeled after those in use by Group Health Cooperative, he said.

Keeping pace with other federal initiatives, Dr. Shields is leading the group analyzing CMS’s recently issued ruling on the Medicare Shared Savings program, which create accountable care organizations (ACOs) for Medicare beneficiaries.

“It’s a significant step,” said Dr. Shields of the revised rule. “It makes Shared Savings more approachable while still maintaining the rigor across many domains.

“It is the start of a universal set of metrics.”

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