Learn how to solicit your patients and community members in your accountable care organization.

1. Accountable Care Implementation
Collaborative
People Centered Foundation Workgroup
November 18, 2010

2. WorkgroupMembers
1
Name Title Participating Organization
Carl Rosenbaum, DO Family Medicine Aria Health
Terri Schieder VP Clinical Development & Integration AtlantiCare
Suzanne Hendery VP, Marketing & Communications Baystate Health, Inc.
Lu Byrd Vice President Hospital Operations/CNO Billings Clinic
Peggy Wharton Vice President Clinic Operations Billings Clinic
Johnna Reed VP Ancillary & Ambulatory Services Bon Secours
Teri Ficicchy EVP/CNO Bon Secours
Andrea Serra VP, Research & Wellness Development CaroMont Health
Terry Martinson Executive Medical Director Fairview Medical Group Fairview Health Services
Heather Taylor RN FirstHealth of the Carolinas
Bev Blaisure, M.D. GHP Regional Med Director Geisinger
James Lehman, MD VP, Quality Genesis Health System
Lisa Michaelis Administrator /CNO Heartland Health
Marcy Brown Hoag - Director Imaging Services Hoag Memorial Hospital
Jessica Lerner Exec. Director of Integrated Health Memorial Healthcare System
Keith Knepp MMG Methodist Medical Center
James Crawford, MD PhD
SVP, Laboratory Services, Chairman, Laboratory & Pathology
Medicine North Shore – Long Island Jewish
Pranav Mehta, MD, MBA VP, Ambulatory Performance Improvement North Shore – Long Island Jewish
J.J. Parsons Vice President - Performance Excellence Presbyterian Healthcare System
Peter Aran Senior Vice President/Chief Medical Officer Saint Francis Health System
Carol Conley Chief Nursing Officer Southcoast Hospitals Group
Lynn Lenker, M.D. Regional VP/Chief Nursing Office SSM Health Care - St. Louis
Carolyn Holder Manager Transitional Care Summa Health System
Annette Ruby VP Health Services Manager Summa Health System
Dr. Michael Deegan Exec VP Chief Clinical and Quality Officer Texas Health Resources
Sherpri Small Strategic Revenue Services Texas Health Resources
Elliott Kellman Chief HR Officer University Hospitals
Marcia Delk Sr. VP Medical Affairs & Chief Quality Officer WellStar Health System

3. Agenda
2
5:00 p.m. – 5:05 p.m. Welcome and Roll Call
Roll Call
Parker Marsh
5:05 p.m. – 5:10 p.m. Level Set of Priorities
Clinical Workgroup Priorities
Lynne Rothney-Kozlak
5:10 p.m. – 5:35 p.m. Member Presentation
Engaging Your Patients & Community in Healthcare
Reform Efforts
Suzanne Hendery
VP Marketing &
Communications
Baystate Health
5:35 p.m. – 5:45 p.m. Joint WG Meeting with ACO Leadership, People
Centered Foundation and Payor Partnerships
Dr. Peter Aran
5:45 p.m. – 5:55 p.m. Other Updates
Medical Home Training
Patient Centered Primary Care Collaborative Discussion
Care Management Presentation
QUEST/ACO External Advisory Panel
Lynne Rothney-Kozlak
5:55 p.m. – 6:00 p.m. Care Management Sub-group Development Lynne Rothney-Kozlak
6:00 p.m. Next Steps and Closing Lynne Rothney-Kozlak

4. PCFCapabilitiesOverview
Priority 1 (CMS Application)
3
Out of 18 responses as of 10/1/10
Priority 1=CMS Application Priority
Operating Activity Scoring
Priority 1 Capabilities Operating Activity "0" "1" "2" "3" "4" Approach Timeline
Other Work
Group
Dependence
A. Involve People in Decisions
that Affect their Health Care
Defined Pathway for Individuals
from the ACO Community to
Provide Input to Health System
Changes
7 4 4 1 2
Individualized Care Plans 0 6 6 0 6
B. Provide People with Easy
Access to Health Care
Direct Care Management Support
System
2 3 4 2 7
System for Providing People
24X7 Access to Services
4 4 2 4 4
C. Activate Individuals to Take
Responsibility for their Own
Health
Systems that Give People Access
to Health Information
4 1 3 8 2
D. Regularly Assess and
Address Individuals' and
Population's Needs
Needs Assessment System
5 3 6 0 4
Care Disparities Program
1 2 3 7 5

5. PCFCapabilitiesOverview
Priority 2 (CMS Contract 01/2012)
4
Out of 18 responses as of 10/1/10
Priority 2=CMS Contracting Priority
Operating Activity Scoring
Priority 2 Capabilities Operating Activity "0" "1" "2" "3" "4" Approach Timeline
Other Work
Group
Dependence
B. Provide People with Easy
Access to Health Care
Open Access Scheduling
System
8 5 2 2 0
C. Activate Individuals to Take
Responsibility for their Own
Health
Patient Remote Monitoring
System
5 7 2 2 2
D. Regularly Assess and
Address Individuals' and
Population's Needs
Population is Segmented by
Health Care Needs
4 4 4 3 3
E. Measure and Improve the
Experience of People within
the ACO Population
Patient Experience Monitoring
System
0 1 3 6 8

6. ACOClinicalWorkgroups – PriorityItems
Priority Item
High Value
Network
Health
Home
People Centered
Foundation Others Lead WG
Defined Pathway for Individuals from the ACO
Community to Provide Input to Health System Changes a PCF
Open Access Scheduling System a a HH
Needs Assessment System a a a - PHDM PCF
Patient Experience Monitoring System a a- Measures and PHDM PCF
Patient Experience Improvement System a PCF
Team Based Care System
a a HH
Care Management / Predictive Modeling
(encompasses several operating activities) a a a a - PHDM HH
Individualized Care Plans a a a PCF
Patient Remote Monitoring System a a a a - PHDM PCF
Health Home Transitions of Care Program a a a HH
Evidence - Based Design of Care Models a a a HVN
Physician Evaluation & Selection System a a a a- ACOL and PHDM HVN
Health Home Training Program
(encompasses several operating activities) a a a HH
5

7. Presentation to Premier ACO Collaborative, People-Centered Foundation Workgroup
November 18, 2010
Suzanne Hendery, Vice President, Marketing & Communications
Baystate Health, Springfield, MA
suzanne.hendery@baystatehealth.org
Baystatehealth.org
Engaging Your
Patients & Community
in Healthcare Reform Efforts
The importance of Asking, Listening and Delivering a consistently excellent experience

8. Today’s Objective
Update members of the People-Centered Workgroup on:
 Importance of engaging patients
 Changing expectations
 Listening posts
 The Listen, Learn & Loyalty model
 Some of the ways we engage:
 Patient & Family Advisory Councils
 Employee Advisory Council
 Loyalty Clubs: Seniors, Women, MDs
 Mini-Medical School
 Patient Experience design
 Message testing
 Measurement, results and benchmarks
 Considerations for the future
7

9. ● “One of the great ironies in medicine is that
the system often excludes the very person for
whom it exists. It treats patients but doesn‟t
empower them. It talks more than it listens.”
● IOM: Quality care is Safe, Timely, Effective,
Efficient, Equitable and Patient-centered.
(STEEEP)
• continuous healing relationships
• customized to a patient‟s needs and values
• the patient is the source of control
• knowledge is shared, information flows freely
• transparency is necessary
• patient‟s needs are anticipated.
Engaged Patients Achieve the Best Outcomes:
2001, 2004
Patient‟s opinion is the best measure
of the quality of care they receive
8

10. We ask ourselves…
What business would design its products and
systems without asking its customers what is
important to them?
Patients need to be told they are in an ACO!
9

11. Engaged Patients Have Better Outcomes
and become your raving fans!
“Patients are more likely to
make good decisions and do
positive things on behalf of
their health if they are more
engaged, better informed and
feel confident that they can
take care of themselves
well.”
“Conversely, the uninformed,
unassertive, unengaged patient
who lacks confidence in his
ability to influence his health is
less likely to fare well with his
illness.”
Institute for Patient & Family Centered Care
10

12. Why Patient Perceptions are Important
• High patient-satisfaction scores = improved organizational
performance, improved quality, brand reputation and improved
financial performance.
• A strategic tool in a competitive market and negotiations with
managed care organizations, payers. A marketing and recruitment tool
for those with high scores; a challenge for those without.
• A patient relationship tool. Patients who are satisfied:
• Comply and follow treatment protocols more completely. Get well faster.
Are less likely to need follow up visits.
• Litigate less.
• Even if the medical outcome is not positive, tend to view the healthcare
provided as a quality experience.
• A new government, insurance mandate for reimbursement.
“Baystate Health’s vision is to be
one of the leading healthcare systems in the nation.”
An excellent healthcare organization produces an excellent
healthcare experience.
11

13. The New Healthcare Consumer
• Want to understand their
medical care and make
decisions regarding their care
• Question credentials, staffing,
processes, testing, medications
• Better informed, tech savvy;
immediate feedback through
social media.
• Due to media attention on
healthcare quality, safety and
errors, patients and families are
less trusting and have higher
expectations.
12

14. Satisfying & Engaging Patients:
Now a Quality Imperative
• Patients are now active consumers-
review “report cards” to make choices;
comment on social media
• Hospital and Doctor “grades” are widely
posted on the Internet and in media
• Patients participate in national CAPHS
surveys tied to reimbursement rates;
and local surveys and focus groups
• Consumers expect more than just
“satisfaction.” Patients are increasingly
more demanding of the experience they
expect and more difficult to attract and
retain.
So many choices!
All things equal,
individuals make
choices based on their
past experience and
level of satisfaction.
13

16. The Ways We Ask & Listen
Listening&LearningTools/Posts(Frequency)
Customer:CurrentBHPatients/Members&Families
Satisfaction&loyaltysurveys(Continuous) Focusgroup,feedbacksessions(PRN)
In-person,e-mail,mail,meetings,letters,interviews (Continuous) QIteams(Continuous)
Customercallcenter&salesreps:Bi-lingualreps (Continuous) Customeradvisoryboards(PRN)
Primary/secondarymarketresearch,focusgroups(Annually/PRN) Greeterconcierges&escorts(Continuous)
Complaintsystem,ComplaintLog&informalfeedback(Continuous) Leader,MD,RN,chaplain,volunteerrounds(Continuous)
Selectedpatientfollow-upcalls(Continuous) Internet-webresponsesystem(Continuous)
”AdministratorOn-Call”&log(Continuous) PatientRelationsoffice-in-person,phone,email(Continuous)
Customers:MDs&EntireProviderNetwork,InsuranceBrokers
Casemanagementmodel(Continuous) Managedcareuniversity(Continuous)
Satisfactionsurveys(Continuous) Remote-accessinternetportals(Continuous)
In-person,calls,letters,e-mail,meetings,interviews(Continuous) Customercallcenter(Continuous)
Newproduct/servicesurveys,feedbacksessions(PRN) “What’sonYourMind”feedbacksessions(Continuous)
Mysteryshopping,competitorintelligence(Continuous) Salesrepresentatives/visits/directmarketing(Continuous)
Primary/secondarymarketresearch,focusgroups(PRN) Committeesandtaskforces(Continuous)
Community,PotentialPatientsandFutureMarkets
Consumerstudy,interviewsw/communityleaders (Annually/PRN) BaystateBestnotecards(Continuous)
Primary/secondarymarketresearch,focusgroups(PRN) Complaintsystem&informalfeedback(Continuous)
Mysteryshopping,competitorintelligence(Continuous) Internet-webresponsesystem(Continuous)
Volunteersandvendors(Continuous) Healthmagazines/annualreports,newsletters(Continuous)
Customercallcenter:MDreferralservice(Continuous) Fairs,speakers,screenings,openhouses(Continuous)
Loyaltyprograms(Continuous) Organizationinvolvement/sponsorships(Continuous)
Formalparticipationinbusiness,community,civicgroups/boards(Continuous) Researchpublications,professionalassociations,courses,journals,ande-mailnewsletters,
subscriptions,newsabstracts,consultantvisits,In-serviceed(Continuous)
15

17. The Baystate Health
Listen, Learn & Loyalty Model
#3 ESCALATE#4 ACT#5 EVALUATE
#6 HARDWIRE #1 GATHER #2 FILTER
The L3 Model
Uses customer focused data to make
decisions and provide continuous
feedback. The voice of the customer
is the single most important piece of
market intelligence.
16

18. Some of the Ways We Engage
1. Patient & Family Advisory Councils
2. Loyalty Clubs: Seniors, Women, Parents, MDs
3. Mini-Medical School
4. Patient Experience design
5. Message testing
17

19. Patient & Family Advisory Councils
Proactively offers advice, information and recommendations on planning, policies, and
procedures.
This group provides leadership with an enhanced understanding of how to improve quality,
program development, service excellence, communications, patient safety, facility design,
patient and family education, staff orientation and education and patient/family satisfaction
and loyalty.
Mass DPH Amendment to 105CMR 130.000 Hospital Licensure, 3/30/2009
18

20. Patient & Family Advisory Council
Goals & Roles
Goal
• Strengthen decision-making “live focus group”
• Offer insights, recommendations for improvement
• Enhance relationships; direct link to community
• Reflect unique culture of hospital, patient base, community
• Spurs quality improvement in the area of patient and family-centered care.
Role
The role of the PFAC is solely consultative. Members serve as “the voice of the customer—Baystate Health’s
patients and families.”
Members may:
• Present how patients and families might feel and think about issues concerning quality, program
development, service excellence, communications, patient safety, facility design, patient and family
education, staff orientation and education and patient/family satisfaction and loyalty;
• Assist in developing a better understanding of patient and family needs and expectations;
• Recommend refinements to BH operations, policies and/or procedures;
• Reviews selected communication materials to help rewrite them from the patient and family perspective
making them more understandable and user friendly;
• Review patient satisfaction survey results and makes recommendations for addressing concerns identified;
• Identify structural and cultural barriers to patients obtaining health care services and recommends strategies
to overcome these;
• Act as a sounding board for new (existing) services, policies, health related programs, communications, and
business strategies; and
• Identify issues and opportunities for BH consideration;
• Consider matters referred to them by the Hospital Quality Council.
19

21. Organizational Structure
The PFAC serves in an advice-giving capacity and reports to the Hospital Quality
Council/Patient Care Improvement Council* at each BH hospital.
Twice annually, the PFAC coordinator will attend the BH Board Performance
Improvement Council to provide an update on issues addressed and any
outstanding issues needing resolution. An annual report is written documenting
ideas suggested, implemented and results.
Each hospital has a Hospital Quality Council/Patient Care Improvement
Committee which meets monthly. The group is comprised of operational vice
presidents/directors, physician leaders and senior leadership. Members receive:
•Updates and recommendations from the PFAC (at least quarterly);
•Meeting minutes of the PFAC.
•Members will provide:
•Written and/or oral reports of PFAC recommendations undertaken, findings, recommendation(s), and results of
actions taken. PFAC recommendations may be transmitted to pertinent committees and/or individuals as
appropriate.
20

22. Loyalty Clubs; Women, Seniors
Senior Class began: 1990
Members: 23k, 55+ men and women, region-wide, hospital based
Staff: 1 FTE & volunteers
Spirit of Women began: 2000
Members: 15k, women of all ages, region-wide, hospital based.
Goal: Inform, engage and enroll important market segment with programs, services, staff, and
provide social opportunities.
Costs: $5-$7 per member, total budget for each program: approx. $120,000 includes staff.
Programs are “self supporting” with sponsorships.
Benefits to members: newsletter (print and email) with programs with MDs, RNs at each
location, social events, relationship with 1 person who cares, a community, discounts.
Major benefit to Medicaid Managed Care program, Marketing, Development, Legislative
Affairs, Volunteers, Community Relations
21

23. The Emeritus Club; Retired MDs
“The Emeritus Club is a wonderful idea.
I wonder why no one thought of it before.
I miss the place, I miss my patients, my friends and colleagues.
Eckart Sachsse, MD; Former chairman of Radiology, Baystate Medical Center
Began: 2001
Members: 90 MDs; spouses; 5-10 new per year
Goal: Inform and engage retired medical staff about activities, programs and staff while
retaining some medical staff privileges.
Costs: Under $10,000 yr; Medical Staff Office
Benefits:
•Invitations w/ guest to luncheon meetings (4x) from the CMO; and hospital events.
•Emeritus Club Gold ID badge (Café discounts). “We remember who you are.”
•Continuing Education offerings; discounted fees; one class at no charge.
•Library privileges w/ Internet access and email accounts.
•Senior Class,
•Baystate Employee Discount Program with discounted rates at retail merchants.
Spin offs: Resident & Family Association; MD “Thank You” Program
22

24. Other Ways We Engage
1. Mini-Medical School, Teen Mini Medical School
2. Patient Experience design for programs, service lines,
facilities
3. Message testing
23

25. What Patients Want
Lane & Lindquist
In the hospital
 Personal, compassionate treatment
 Availability of nurse when needed
 Friendly and courteous staff (medical/admin)
 Willingness to listen
 Understandable explanations of treatment
 Availability of latest technology/equipment
 Availability of specialists, regional/national reputation
 Comfort, cleanliness and appearance of room
Outpatient; Doctor’s Office
• Access to care; wait times
• Personal, compassionate treatment
• Location of facility to office
• Convenient, well lit, safe parking
• Services on weekends/evenings
• Reputation and recommendations
24

26. Overall PRC Results
• Overall, BH compares favorably to our benchmark target, the PRC top quartile (75%) for
patients responding “Excellent” nationally. Outpatient scores higher than inpatient.
• The 75th percentile increases yearly, as organizations improve service. There has been a
gain for 3-5 points each year, over the last 5 years, except for this year.
2009 was our highest scoring year. 2010 saw a 15% drop in scores. Units now showing some
increases.
25

27. Results reported quarterly
via electronic dashboard

28. Communication
 The key is to collect the data and know
what to do with it to obtain meaningful and
lasting results.
Results reported BH-wide
Quarterly; against targets, over time

29. Specific results for units, showing
Key Drivers
28

30. ACO Considerations
 Levels of satisfaction across the ACO continuum assume critical importance.
How can we follow patient rather than the unit? How do we measure their
experience over time instead of per episode.
 How do we maintain our brand and ensure that across the continuum everyone
understands customer service standards, behaviors, and organizational focus on
the patient.
 How can we survey patients via the patient portal? and maintain response rates,
„mediocre middle?”
 Do we need a separate measurement for the family/friend?
 Can we make every staff member aware and accountable, via their performance
review, for the team‟s quality and service measures?
 Can we account via LEAN financial reporting, the amount of $$ lost to poor
quality and service? Value Based Purchasing as flaming platform for change.
29

31. JointPayorPartnership,PatientCenteredFoundation&
ACOLeadershipWorkgroupCallUpdate
Value Based Benefit Design- presented by
UnitedHealthcare
November 11, 2010

32. JointPP/PCF/ACOLWorkgroupCallUpdate
 UnitedHealthcare (UHC) presented on the topic of Value Based Benefit
Design at the request of CaroMont Health
 There was excellent dialogue between members and with UHC presenter
 All slides and a recording from the November 11th joint Payor Partnership,
People Centered Foundation & ACO Leadership call will be available on the
PIP portal
 The purpose of the update is to provide the workgroup with a brief
overview of the call and to encourage review of the materials on the PIP
portal
31

33. JointPP/PCF/ACOLWorkgroupCallUpdate
 David Sturkey provided an overview of UHC‟s approach to Value Based Benefit
Design using an example of their „Diabetes Health Plan‟
 UHC‟s Diabetes Health Plan Overview:
•Based on 2 Triple Aim objectives (reduce costs, improve quality)
•Targets pre-diabetic population, as well as diagnosed diabetics
•Utilizes predictive modeling and use of Health Risk Assessments (HRA)
•Supports biometric screenings
•Augments medical management- doesn‟t replace it
•Created „Top Tier‟ or „Premium Plan‟ for patients who choose to participate
•Participation requires patient compliance (to receive rewards)
•Rewards include reduced pt. OOP expenses/co-pays, family included in plan, better pt.
outcomes
•Compliance requires completing a HRA, participating in the „Diabetes Management
Program‟, biometric screening and cancer screening, etc.
•Patient‟s have access to electronic personalized care plan tracker, tracker can be viewed
by family member if designation provided or tracker can be sent to patient
32

34. JointPP/PCF/ACOLWorkgroupCallUpdate(cont.)
 UHC‟s Challenges and Recommendations:
•Lab turnaround is lengthy, ~ 3 weeks, and creates challenge for the patient‟s
care plan tracker information
•Demonstrating a return on investment in year 1 or 2 can be difficult- employer
must be committed for long term outcomes
•Communication is critical to ensure appropriate participation regarding service
offering and should occur pre-enrollment process
•UHC accomplishes this by using a multi media approach and bases on the
employers unique setting and infrastructure, i.e., some require on-site meetings
at various locations
•When asked how UHC would advise a provider in moving forward with a payor,
UHC responded to ensure that the vendor not only has the critical data
elements, but more importantly the informatics to analyze the data accurately
•If an employer has a low employee retention rate, employer will not likely see
long term benefits of value based benefit plan, including ROI
33

35. 34
• Drive consumer behavior by incorporating
self-management into a benefit design
• Improve health outcomes and cost with
compliance requirements
• Provide meaningful ROI
Personalized Health Plans can offer an
important VBID opportunity that may help:
• Targeted financial incentives
• Clinical sophistication into benefit design
• Technology support
Value Based Plan Plans are designed
to influence consumer behavior
Current "VBID-lite" approaches including communication
strategies and
indiscriminant co-pay reductions hold limited clinical or
economic value
Value-Based Design ContinuumValue-Based Plan Design“VBID – lite” approaches
Personalized Health Plan:
- Significant benefit design
enhancements linked to targeted
evidence-based behaviors
Communication efforts:
- Target mailings to promote
services
Unilateral Service Reduction
- Isolated specific service
co-pay Reduction
(i.e., anti-hypertensives)
Marketplace Demand:
Influence consumer behavior to help improve health and reduce costs

36. 35
Current Diabetic Health Plan
In-network Out-of-network
In-network Out-of-network
Premium Other
Basic Provisions
Deductible $500/$1500 $1000/$3000 $500/$1500 $500/$1500 $1000/$3000
Coinsurance 90% 70% 90% 90% 70%
Out-of-Pocket $2500/$7500 $3000/$9000 $2500/$7500 $2500/$7500 $3000/$9000
Office Visit Co-pays
$25 PCP/$50
Specialist
70% after
deductible
Waive co-pay on
first evaluation
visit
$25 PCP/$50
Specialist
70% after
deductible
Rx Co-pays--Retail
Retail $5 / 30%(Min:$30, Max:$50) /
30%(Min:$50, Max $75)
No co-pay for specific Rx, meters, supplies related to
diabetic condition; other wise, Retail $5 / 30%(Min:$30,
Max:$50) / 30%(Min:$50, Max:$75)
Rx Co-pays--Mail Order
Mail Order $10 / 30%(Min:$75,
Max:$125) / 30%(Min:$125, Max:$180)
No co-pay for specific Rx, meters, supplies related to
diabetic condition; other wise, Mail Order $10 /
30%(Min:$75, Max:$125) / 30%(Min:$125, Max:$180)
Medical Management Features
- Health Risk Assessment N/A N/A Required
- Diabetes DM/Weight Mgmt (if offered) N/A N/A Required
- Online Tracking and Compliance N/A N/A Required
Screening
- Diabetes (biometric screening) Optional
Required
- Cancer Optional
Diabetes Health Plan: The Difference Illustrated

37. CollaborativeUpdates
• Medical Home Training
– Link to survey of preference for timing, location and content of Geisinger training
• Patient Centered Primary Care Collaborative (PCPCC) Discussion
– Follow this link for rich information with built in web-links
– Premier is a member and Kathy Bradshaw will represent us on future meetings
• Care Management Presentation by Dr. Allan Goldstein
– Choice: receive link to taped presentation to HH WG or have him present a future meeting
• Care Management Sub-group development
– Proposal: joint sub-group of PCF, HH, HVN, chaired by Dr. Goldstein and a member (see next slide
for composition recommendation)
• QUEST/ACO External Advisory Panel Meeting
– See upcoming slide on key takeaways from the discussion on ACO measures
36

38. QUEST/ACOExternalAdvisoryPanelMeeting
• The first ACO/QUEST External Advisory Panel (EAP) meeting occurred on
October 28. Wes Champion and Dr. Bankowitz provided an overview of the
ACO Collaboratives and the Phase I measures.
• Dr. Bankowitz led the EAP through a working session around Phase 2
measures to look at understanding the gaps in the Phase I measures, and
how to address these gaps in the next phase of measurement
development.
• Feedback on the ACO Collaboratives was positive. Comments include:
– The EAP encouraged the collaboratives to more fully integrate the
community and people the ACOs will serve into the Phase II
Measurement strategy.
– The Collaboratives need to be able to demonstrate value to the
consumer of the ACO.
– The Collaboratives should consider articulating more clearly the
learning that is taking place in the Collaborative by the membership.
37

39. ProposedJointCareManagementSub-group(HH, HVN, & PCF)
– Premier Lead – Dr. Allan Goldstein
– Composition –
• This group can be comprised of other delegates from your
organizations
• Multi-disciplinary representation
– MDs
– EHR/informatics
– Administration / Operations staff
– Health educators
– Nutritionists
– Mental health providers
– Volunteers
• Workgroup members
• Co-Leader
38

40. NextSteps
• Two Liaison Volunteers Needed: One liaison to attend the Health Home workgroup
call and one liaison to attend the High Value Network workgroup calls
– Liaisons would attend the other workgroups monthly calls
– Provide a monthly report out to the People Centered Foundation workgroup
• Next People Centered Foundation Workgroup Meeting
– Thursday, December 16th 5:00 – 6:00p.m. EST (Dr. Aran to lead)
39

41. Closing Discussion