Implementation issues

1
Implementation issues

• Who
• What
• When
• Where
• How (much)

2
Implementation issues

• Who 4-7 family physicians, 3-10 years into
  practice.
• Challenges
• Respond to work force shortages
• Provide comprehensive scope (basket of
  services)
• Assure commitment to new model
• Possible solutions
• Recruit nationally
• Pay (more than) competitively Bevin (NHS)
• Profile candidates

3
Implementation issues

• Who potential partners health plans,
  self-insureds, govt agencies, entrepreneurs,
  health care systems.
• Challenges
• Sift through market place noise
• Address competing models (multi-specialty,
  retail clinics)
• Address competing demands
• Possible solutions
• Obtain and provide data
• Market and message effectively
• Demonstrate proof of concept

4
Implementation issues

• What - healing and trusted relationship between
  patient and doctor, supported by high functioning
  teams that integrate behavioral health and target
  high-risk patients with intensive care
  management.
• Challenges
• Under serve the well (retail clinics), while
  over serve the ill
• Secure suitable behavioral health professionals
• Manage complex multidisciplinary teams
• Possible solutions
• Provide advanced access (open access, online
  appts, e-access)
• Start as a pilot
• Invest in organizational development

5
Implementation issues

• What national network to support model
  practices.
• Challenges
• Build national capacity for only a few pilot
  sites
• Obtain Initial investment for EHR, organ. dev.,
  care mgt.
• Address shifting marketplace
• Possible solutions
• Learn/borrow from others (Kaiser, PhyCorp,
  TransforMED)
• Identify capital more capital than good ideas
• Target select market(s)

6
Implementation issues

• When
• 6/1/08 national network begins
• 1/1/09 pilot site(s) starts
• 1/1/10 expand site(s)
• Challenges
• Recruit leadership for national network
• Identify suitable sites
• Meet ambitious timeline
• Possible solutions
• Tap cadre of experienced, committed leaders
• Aim at low-hanging fruit
• Use considerable work that has already been done

7
Implementation issues

• Where suburban site(s) in larger metropolitan
  community in southeast U.S. with higher costs,
  lower quality, fewer primary care clinicians.
• Challenges
• Identify best community
• Address local medical culture
• Possible solutions
• Conduct market research
• Establish service agreements with specialists
  and hospitals
• Develop relationships with local champions
  (business, insurers)

8
Implementation issues

• How (much)
• Start up 1-2 million per site
• 20-50 million for network
• Challenges
• Return adequate investment
• Address other ventures competing for capital
• Possible solutions
• Provide outcomes data on both direct and
  indirect savings
• (global cost savings, absenteeism,
  presenteeism, etc)
• Phase-in implementation design for scalability
• Offer to take on (limited) risk, gain sharing