MMC ADVANTAGE PROVIDER TRANSFORMATION CARE MODEL DEVELOPMENT AND CLINICAL TRANSFORMATION
PATIENT-CENTERED MODELS ARE TRANSFORMATIVE IN THEIR APPROACH TO WHOLE PERSON CARE DELIVERY…
A
F
Patient-centered, caring culture with team-based staffing and patient engagement models
Health, behavioral, and wellbeing program integration
Value optimization through intelligent adaptive workflow
E Predictive modeling, prevention, and early intervention
B
1
Proactive health and wellness management, optimizing the health of the population
2
Care team and patient engagement models are aligned to the patient’s needs
3
Multi-skilled care teams are capable of meeting all the patient’s health related needs
C Patient-Centered Care Core Competencies
Population Health Management – whole-person care across the pyramid
D Web-enabled, personalized, 24-hour clinical model
Marsh & McLennan Companies
1
… AND WILL UNLOCK VALUE THROUGH MASTERY OF THE POPULATION HEALTH PYRAMID
Marsh & McLennan Companies
2
NEXT GENERATION POPULATION HEALTH WILL THRIVE ON COMPLEX ADAPTIVE SYSTEMS TAILORED TO SEGMENTS OF THE POPULATION Severe behavioral • Dedicated psychiatric NPs/MDs • Bio-monitoring of Rx adherence • Dedicated social worker, PCP
Chronic with social needs • Case worker embedded in care team • Dedicated coach for nutrition, mental health
Generally healthy • Affordable acute care options • Rewards and incentives • Social/mobile health tracking tools
POPULATION HEALTH PYRAMID
End of life • Palliative care experts • Support for caregivers Potential Care Model • Hospice centers • Legal/financial advisers Components for family
Poly-chronic/complex • Dedicated “Extensivists” • Remote monitoring • Specialty clinics • Integrated behavioral health
Early chronic/at-risk • Dedicated health coach for fitness, nutrition • Attention to behavioral health • Rewards for meeting goals
Specialized care models will be supported by new population-specific ecosystems Marsh & McLennan Companies
3
PATIENT-CENTERED CARE TEAMS WILL INCLUDE A BROADER ARRAY OF SKILLS TO TREAT THE WHOLE PERSON Patient-centered care introduces new skillsets into the practice…
…and organizes and deploys resources in a new patient-centered model
Traditional
Physician-led model Physician
Non-physician practitioner
Care manager
• Treats most acute patients • Manages complex referrals and care coordination
• Clinical professional (e.g. NP, PA) credentialed by health plan • Handles less acute cases to increase physician flexibility and capacity
+
Care team-led model with coordination across condition and episodic specialist models Condition care models
Physician
• Leads care coordination and patient outreach, follow-up and care plan compliance
Behavioral health
Patient centered
Extenders Behavioral health Social workers/ case managers Nutritionists/ pharmacists
• Manages non-physical wellness, understands whole person • Helps patient manage adjacent social issues • Collaborates with care team on overall disease care and management
Admin support
Marsh & McLennan Companies
Oncology Cardiology Diabetes COPD/Asthma ESRD
Social workers/ case managers
Pharmacists
Care manager
Nutritionists
Admin support • Professionals handling patient admin and practice transformation duties
• • • • •
Episode care models • Orthopedics • CV Surgery
4
ABOUT MMC ADVANTAGE
The MMC Advantage Provider Transformation team draws on the expertise of leading risk experts and specialty consultants from four Marsh & McLennan Companies subsidiaries: Marsh, Mercer, Guy Carpenter, and Oliver Wyman. The team’s collaborative projects have resulted in increased efficiencies and tangible financial gains. By folding in risk financing and human capital perspectives to healthcare strategy discussions, our clients have been able to assess the changing landscape from a broader, more useful perspective.
Marsh & McLennan Companies
5
Marsh & McLennan Companies