Executive Summary Population health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group. (1) The rapid changes of the last five to seven years in policy-level decision making, payment structures, and provider alignment have shifted the focus from care provided and paid for at an individual level, to managing and paying for health care services for a discrete or defined population – an approach known as population health (management). (2) Health systems have taken the lead in offering a number of population health initiatives, including Accountable Care Organizations (ACOs) and Patient Centered Medical Homes, among others. As part of this effort, health systems have developed new strategies, developed new partnerships, redesigned IT systems, in addition to a number of new initiatives. Access Market Intelligence’s new report, Health Systems Population Health, has identified more than 40 leading health systems and their population health strategies and activities. In addition the report includes the health system’s background, CEO, population health contact, address, phone and website. (1) David Kindig, Am J Public Health. 2003 March; 93(3): 380–383 (2) Niñon Lewis, MS, Institute for Healthcare Improvement, Mar 19, 2014 Confidential. All Rights Reserved AMI. March 2015 Health Systems Adventist Health Adventist Health System Advocate Health Care Ascension Health Aurora Health Care Avera Health Banner Health Bassett Healthcare Network BayCare Health System Baylor Scott & White Bon Secours Health System Carilion Clinic Catholic Health Initiatives Christus Health Cleveland Clinic Dignity Health Fairview Health Services Geisinger Health System Genesis Health System Gundersen Health System Henry Ford Health System Inova Health System Intermountain Healthcare Mayo Clinic Memorial Hermann Health System MemorialCare Health System Mercy Health MultiCare Health System NewYork-Presbyterian Healthcare Novant Health Ochsner Health System OSF HealthCare Partners HealthCare ProMedica Health System Sentara Healthcare Steward Health Care System Sutter Health Trinity Health UC Davis Health System University of Michigan Health System WellSpan Health Confidential. All Rights Reserved AMI. March 2015 Partners HealthCare Prudential Center, 800 Boylston Street, 11th Floor Boston, MA 02199 617-278-1000 https://www.partners.org Gary L. Gottlieb, M.D., M.B.A. - President and Chief Executive Officer Timothy Ferris, MD, MPH, Medical Director and VP for Population Health Management Background Partners HealthCare is a not-for-profit, integrated health care system in Boston, Massachusetts. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital – two of the nation’s leading academic medical centers – Partners HealthCare includes community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health related services. Partners is committed to the community, and dedicated to enhancing patient care, teaching, and research in service to its patients and their families. Partners is the largest private employer in Massachusetts, with approximately 60,000 employees, including physicians, nurses, scientists, and caregivers. Partners’ institutions maintain a total research budget of more than $1.4 billion, and Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital (BWH) are the largest private hospital recipients of National Institutes of Health funding in the nation. Population Health Partners HealthCare is committed to providing the highest quality, coordinated health care that is affordable and accessible. Population Health Management (PHM) represents Partners latest and most far-reaching strategy for fulfilling its commitment. It comes at the right time, too. Partners defines population health management as a collection of best practices for improving health care delivery. These best practices touch all phases of care and focus on improving the efficiency and effectiveness of each episode of care as well as care delivery over the long term. From the patient’s perspective, the nucleus of care is the primary care office where care is coordinated throughout the Partners system. Behind that patient experience are large-scale improvements in processes and technology to ensure efficient coordination so that patients can stay healthy. Currently, Partners is caring for approximately 500,000 patients through its PHM program. Partners is rolling out PHM in three phases. The first focuses on primary care delivery, Confidential. All Rights Reserved AMI. March 2015 the second on specialty care delivery and engaging patients in their own health care, and the third on programs that promote wellness. Phase One best practices include: - Patient-Centered Medical Home (PCMH) - Partners HealthCare’s primary care practices are undergoing a transformation to a more advanced model of care, the patient-centered medical home, aimed at coordinating care and proactively keeping patients healthy. - Integrated Care Management Program (iCMP) - The Integrated Care Management Program matches high-risk patients with a nurse care manager who works closely with them and their loved ones to develop a customized health care plan to address their specific health care needs. Recent Activities Partners HealthCare was selected to participate in the Pioneer Accountable Care Organization (ACO) model in December of 2011. The initiative, sponsored by the Centers for Medicare & Medicaid Services (CMS) Innovation Center, aims to transform the way that health care is delivered by providing Medicare patients with higher quality, while slowing cost growth through enhanced care coordination. The Pioneer ACO Model is designed to encourage the development of accountable care organizations, which are groups of doctors and other health care providers who work together to provide high quality care for their patients. Partners was chosen specifically as one in a diverse group of leading-edge health care organizations from around the country to test the effectiveness of several new models of payment. Confidential. All Rights Reserved AMI. March 2015
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