CMO article – Premier Health Group Update

July clark HSBy Jerry Clark, MD, President and Chief Medical Officer, Premier Health Group

Approximately four years ago, Premier Health changed its mission statement reflect our objective of “building healthier communities.” Toward that end, there is a concerted effort across Premier to decrease variation, work as a system, improve quality outcomes, and lower cost of care. Realizing the importance of creating a value proposition to our businesses, as well as to the people living in the communities that we serve, it became even clearer that physicians are critical to that effort. Physicians are taking their place in leadership positions, more than ever before. Medical staff members with leadership potential, and those who are engaged to help Premier Health achieve our mission, have available to them scholarship programs such as the certificate of medical management and MBA program with Boonshoft School of Medicine and Soin School of Business.

Premier has also invested in methods to help transform care delivery in SW Ohio in a medical home-like care delivery model focused on patient –centered population health, which is another approach to improving the health of our community.

Premier Health Group (PHG), a physician-hospital organization, was created and legally organized in March 2013. A provider network of more than 3,000 providers, including approximately 2,200 physicians and mid-levels, was created to provide utilization management, care management, credentialing functions, and robust quality programs. Using technology such as the Identifi™ predictive modeling software, helps providers identify the high-risk people in the populations we serve. These models and rules were developed and are maintained by physicians at the University of Pittsburg Medical Center. Our partner, Evolent Health, assists us in rapidly developing and deploying our case management models. We currently have care models addressing the high-risk, complex care needs in our population, as well as care transitions and unplanned (emergency/urgent) visits. PHG provides the support that most providers can’t afford – with nurse case managers, pharmacists, behavioral health, health coaches, socials workers, and dieticians. We have developed robust reporting systems that will allow us to share real-time utilization information to our providers on both quality outcomes and cost. This assists providers in knowing where the greatest needs are in their patient panels, and also where they can focus their efforts on practice re-design. Creating an idealized office design that is focused on team –based care and organizing so that all team members work to the top level of their license, allows a more rewarding practice experience for the provider, as well as an improved patient experience. New programs in both palliative and catastrophic care, as well as advanced imaging utilization, are currently in development. These value–added services come at no additional cost to the physician or the patient. Our vision is to develop this infrastructure in 2014, as we work with our current customer, the Premier Health Employee Benefit Plan, and then, in 2015, demonstrate and take our successes to more populations of people in our nine-county service area.

“Premier Healthy Living,” a creative wellness program, has been implemented in order to incentivize and engage patients in improving their own health. Using online portals for education and patient engagement and programing, such as weight races, step challenges, etc., has been well-received by Premier employees.

Premier Health Plan is a licensed insurance company that was created, as well. It will serve as a vehicle to spread our population health management to more individuals and business throughout SW Ohio. We have conditional approval to offer a Medicare Advantage product, as well as products that will be available off-exchange. We are also answering requests from local businesses. Integrating our efforts on achieving the “triple aim” (improved care, improved patient experience, and lower total cost of care) with our inpatient teams at all the facilities with the ambulatory networks of providers, allow Premier Health to truly become a clinically-integrated network of providers and hospitals.

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