2011 Care Coordination Summit - Now Available On Demand ... And At Your Fingertips

Healthcare in the United States is often fragmented. Clinical services are frequently organized around small groups of providers functioning autonomously and specializing in specific symptoms or organ systems. Therefore, many patients receive attention only for individual health conditions rather than receiving coordinated care for their overall health. Dr. Clancy will focus on the key issues being addressed in the delivery of health care today, including how more focused attention on issues such as implementation, dissemination and patient engagement factors into effective care coordination.

This session will enable you to:

• Describe how the movement of ensuring patient-centered care is a central focus of practice across the care continuum.
• Discuss the three pillars of healthcare – cost, quality and access – and the importance of efficient care coordination in improving access, ensuring quality and contain escalating costs.
• Explain the resources available to the care coordination team in equipping consumers to better manage their health and healthcare.

Faculty: Carolyn M. Clancy, MD; Director, Agency for Healthcare Research and Quality

Donna Shalala, Ph.D, co-chair of IOM’s Initiative on the Future of Nursing, stated in a recent article in Nursing Economics: “I believe that we cannot improve the quality of healthcare in our country without a central role for nursing." This session will reveal the recommendations of the landmark Future of Nursing Report and how nurses and other healthcare professionals can translate the report’s recommendations to enhance personal and professional practice. The panel brings to light current plans to incorporate the recommendations into action and the opportunities it brings to the workforce.

This session will enable you to:

• Identify the initiatives being implemented from the Future of Nursing Report to ensure the care coordination team is meeting the needs of improving quality and containing costs.
• Identify the IOM report's intersections with and implications of care coordination in the Affordable Care Act.
• Explain the importance of continued learning, including new models of care, to enhance clinical practice and improve quality of care.

Faculty: 
Winifred V. Quinn, PhD; Senior Legislative Representative, AARP

David DeBiasi, RN, BSN; Associate State Director, Advocacy, AARP Virginia

Entrepreneurship is not solely for the individual getting ready to launch his own company. It’s an ingrained part of leading organizations, which foster a sense of creativity among their staff to solve problems, cut costs and improve quality. For healthcare organizations and the professionals within them, there has never been a better time to explore new, creative ways to positively influence your bottom line and make sure your quality measures are up to par with forthcoming federal regulations. In addition to hands-on techniques, learn about current booming trends like accountable care models, personalized medicine and patient-centered care from these distinguished panelists.

This session will enable you to:

• Describe how disruptive times enable innovation and creativity in such areas as technology, accountable care organizations and personalized medicine.
• Demonstrate how to effectively promote your ideas to key stakeholders.
• Discuss how individual innovations can reshape the healthcare industry.

Faculty: 
Sukhwant Khanuja, PhD; Carematix Inc. 

Susan Riley, President and CEO, Halare Inc. 

Christobel Selecky, Principal, Population Healthcare Strategies

Racial and ethnic disparities in healthcare are known to reflect problems related to access, adherence and quality of care. They contribute to the persistence of chronic diseases, something that renewed wellness and prevention efforts are striving to eliminate. The panel will share real-life challenges that illustrate the impact of healthcare disparities on specific populations and the steps organizations like the National Hispanic Nurse Association, the National Black Nurses Association and managed care organizations are taking to reduce disparities and improve care for all populations.

This session will enable you to:

• Demonstrate why moving toward patient-centered care has evidenced the impact of healthcare disparities.
• Explain the importance of addressing healthcare disparities as part of healthcare reform efforts.
• Describe best practices taking place in organizations to reduce healthcare disparities. 

Faculty: 
Jose Alejandro, RN-BC, MSN President-Elect, National Association of Hispanic Nurses 

Veronica Medina, MSW, LSW, CCM, Director, Rapid Response and Outreach Team / Business Implementation, Keystone Mercy Health Plan, AmeriHealth Mercy Family of Companies 

Diana Wharton, President, Black Nurses Association of Greater Washington, D.C., Area

Created by the Affordable Care Act, the Center for Medicare and Medicaid Innovation explores new approaches to the way we pay for and deliver care to patients so that we have better results both in terms of the quality of care and the affordability of coverage. New delivery models and initiatives are redefining our everyday care, and these innovative patient-centered movements are at the heart of health reform. Dr. Whelan provides an insider's view of how the Center will improve quality and affordability, what your role is and how your organizations can tap into innovations to address challenges facing your organization.

This session will enable you to:

• Implement the three-part aims of the Innovation Center at CMS – better healthcare, better health and reduced costs through improvement.
• Explain the role of improved communication, patient engagement and creativity among all members of the care coordination team in developing new models of care.
• Identify the efforts that are available through the Innovation Center to highlight care coordination efforts.

Faculty: 
Ellen-Marie Whelan, NP, PhD, Senior Advisor, CMS Innovation Center

More than half of individuals with one or more chronic medical illnesses are also affected by one or more co-morbid behavioral health conditions. This has a significant impact upon these individuals’ clinical course, outcomes and costs. Using actual case studies, the panel will show how they were able to achieve positive results with a population of patients with complex medical conditions and behavioral health co-morbidity through effective identification, outreach, patient engagement and clinical management.

This session will enable you to:

• Describe why patients with chronic medical conditions and concurrent mental health conditions often fall through the cracks of the fragmented healthcare system.
• Explain the effects of unidentified chronic mental and physical illness on clinical outcomes.
• Demonstrate how effective care coordination can alter outcomes and improve outcomes for all stakeholders.
• Take away practical tips on achieving integrated healthcare to reduce costs and improve quality. 

Faculty: 
John Colburn, PhD; Director of Clinical Development, Beacon Health Strategies 

Dr. Dan Rome, MD; Chief Medical Officer, Beacon Health Strategies 

Cynthia Voelker, Vice President of Services, Spectrum Human Services

One of the main pathways by which care transition and disease and case management programs influence health outcomes is through the support of member/patient self-management. Tailoring support to levels of activation, as revealed by the Patient Activation Measure assessment, has proven effective as a way to enhance member/patient engagement and improve health outcomes in commercial, Medicare and Medicaid populations. Knowing an individual's level of activation is an important vital sign that allows for improved resource allocation and the tailoring of support to what is realistic and achievable for an individual. This session, sharing both hospital and health plan experiences, will discuss the design and validation of the Patient Activation Measure, and how the activation model anchored by this assessment is being used in care transition and disease management coaching to provide more personalized support and positively impact healthcare utilization.

This session will enable you to:

• Explain the essential components of patient engagement in ensuring the success of the patient-centered medical home and accountable care organizations.
• Describe the link between the level of patient engagement and resource utilization.
• Discuss the importance of understanding the level of patient activation ensuring safe transitions of care.

Faculty: 
Chris Delaney, Chief Executive Officer, Insignia 

Christina Pavetto Bond, MS, FACHE, Director, Aging and Complex Care Crouse Hospital

Chelsea Anderson, Manager, Health & Wellness Coaching, Medica Health Plans

Helping patients stay out of the hospital once they've been discharged has been a longtime quality-improvement priority for many hospitals and health networks. Now it's become a financial priority, too, thanks to provisions of the Patient Protection and Affordable Care Act that set penalties for hospitals with higher-than-average rates of avoidable readmissions for patients with specified conditions. Hear from the Johns Hopkins Health System Readmission Task Force – a multidisciplinary group working together to develop strategies to reduce preventable readmissions – on ways you can reduce the cost burden in your organization.

This session will enable you to:

• Discuss the regulations the Centers for Medicare and Medicaid have levied on hospitals for avoidable readmissions and the impact in terms of revenue and reputation.
• Reinforce the importance of collaboration and communication between providers to enhance patient-centered care and improve outcomes.
• Describe strategies organizations are working on to improve transitions of care and decrease unnecessary readmissions.

Faculty: 
Michelle R. Hawkins, DNP, MSN, MBA, RN, CCM, Director of Care Management, Johns Hopkins HealthCare LLC 

Dawn Hohl, RN, MS Director of Customer Service, Johns Hopkins Home Care Group 

Mary Myers, RN, MS, CNA, Vice President & COO, Johns Hopkins Home Care Group Inc. 

Amy Deutschendorf, MS, RN, ACNS-BC, Sr. Director Utilization/Clinical Resource Management, Johns Hopkins Health System; Principal, Clinical Resource Consultants, LLC