Making Changes to Give our Patients the Very Best Care

CHA is adapting to changes in the healthcare environment by developing a high-performing, high-value Accountable Care Organization (ACO). This will allow us to be sustainable and meet the needs of our patients and communities in the years ahead.
 
At the core of this transformation is our ability to integrate our healthcare delivery system, academic programs, and public health functions to improve the health of individual patients and entire populations. This effort - already in progress - will continue to leverage our strengths in primary care, spreading the Patient-Centered Medical Home (PCMH) model and our comprehensive planned care and chronic disease management programs. This will also allow us to adapt to new financial models that use global payment methods.

These changes will have a long-lasting and beneficial impact on our patients and our system, reducing costs while maintaining a focus on our vulnerable patients. Our ultimate goals are to continue providing access to culturally-competent and comprehensive care while furthering our critical community health mission.

Our New Clinical Model

CHA is transforming the way we provide care to leverage our strengths in primary care and behavioral health. This includes further developing our Patient-Centered Medical Homes, based on the TransforMED model and the NCQA guidelines, which we have been actively developing since 2008. In 2010, five CHA primary care sites were selected for Massachusetts’ new PCMH Initiative and two were recognized as Level 3 Medical Homes by the NCQA, the highest designation. Our goal is to have all our general primary care practices to be functioning as Medical Homes by 2013.

This effort is capitalizing on and leveraging the system's key strengths and competencies:

• Information technology – CHA has a system-wide electronic health record, resulting in more integrated patient care, better communication among caregivers, and stronger teams at the bedside, clinic, and across the organization. 
• Clinical Services - With expertise in primary care, secondary hospital care, and behavioral health services, we are seeing patients during more than 650,000 annual visits. We are also one of the state's largest acute mental health providers, and have award-winning planned care programs which improve outcomes for patients with asthma, depression, and diabetes.  
• Employed Physician Model - We have more than 300 employed physicians, representing 30 specialty areas, who provide the majority of care to our patients.  
• Patient and Community Focus – Our strong community linkages are helping us maintain access to care, manage patient care and motivate healthy behaviors.  Additionally, our unique public model allows us to lead efforts to address complex community health issues like senior health, substance abuse, childhood obesity, asthma, and domestic violence.

Accomplishments Towards Our Goals

• Piloted a global payment initiative with Network Health for Medicaid managed care and Commonwealth Care shared members.
• Advanced PCMH development with six primary care practices participating in national/statewide demonstration and learning collaboratives. 
• Fully deployed EPIC EHR across the system. 
• Created a data repository that supports internal software development, quality initiatives, real time reporting, research support, and various scenario analyses.  Clinical and business systems data are now continuously extracted and integrated, providing a single source for reporting, analysis, and facilitating operational improvements. 
• Developed attribution models to improve accuracy of physician panel data. This enables CHA to identify all patients assigned to a CHA PCP, ensures patients are appropriately connected to primary care services, and facilitates improved care management and cost containment strategies.
• Developing a comprehensive care management infrastructure, with a focus on high risk, complex patients. Using the planned care team approach, we are piloting models at our PCMH sites to improve health, managing chronic and intensive conditions, and reduce low-acuity non-emergent emergency visits and readmissions.
• Continued planning for an integrated physical and behavioral health services model including co-locating and integrating behavioral health in the primary care setting and developing a new ‘mental health care home’ model for intensive mental illness with primary care clinicians within a psychiatry site.
• Continued workforce transformation, including new physician compensation models, structured care team development, including new workforce competencies that require staff to work at the top of their licenses, and redesigned clinical workflows/processes.
• Prepared for the start of the Pioneer ACO demonstration project for Medicare members.