View as Webpage

Primary Care Practice Redesign Newsletter Cohort 1 | Issue 3 December 12, 2018

This newsletter is a biweekly forum to keep practices connected and informed on the Cohort 1 Redesign efforts. For previous newsletters you may have missed, please visit MSHP's News and Media page .

Update on Redesign Initiatives

We have five project areas that we will roll out in this phase of our Redesign efforts. We've completed the pre-Redesign care survey — thank you for your participation. Your practice facilitators will guide the five project areas below.

Five Projects Green Belt Lean Care Wellness Survey Same Day Access Daily Huddles Transitions of Care We are continuing our focus on huddles. For practices that have daily huddle practices in place, we are deepening this work by adding pre-visit planning and population health management. For practices new to the huddle process, we are clarifying roles, timing, and structure of huddles. As always, the best teachers for this work are other practices, so please feel free to reach out to your other Cohort 1 members. For email details, see Issue 1 of our newsletter. For any questions about the projects, please reach out to your practice facilitators: Matt Miesle & Chris Scalamandre: 85th Street and Brooklyn Heights George Lourentzatos: 23rd Street, Ansonia, Sam Friedman, Williamsburg

Population Health Management

Leveraging Available Resources: MSHP's Partnership with Lumeris Mount Sinai Health Partners has engaged Lumeris, a population health management partner, to help us optimize our performance in value-based contracts. Lumeris provides tools and resources to our practices to help them better navigate the ever-changing health care environment.   Cohort 1 practices will have an assigned Population Health Manager , who will help support practices’ utilization of technology and population health initiatives designed to optimize efficiencies, quality, and utilization related to value-based contract performance. Practices will also have access to comprehensive patient-specific information via Lumeris’ Accountable Delivery System Platform ( ADSP ) that helps providers gain perspective on each attributed patient’s utilization of the health care system.    Niyum Gandhi, Executive Vice President and Chief Population Health Officer for Mount Sinai Health System, shared, “As we rapidly embrace value-based care as a system, continuously improving our efficiency and quality to improve the overall health of our community is a critical priority. Mount Sinai has identified innovative collaborators to help support us in this journey, and we believe Lumeris can accelerate our ability to effectively and responsibly manage large populations in risk-based models.”   For more information please reach out to your Practice Facilitator .

Talking to Your Team and Patients about Population Health Learn more about population health by following our patient, Joe, on his health care journey in Mount Sinai's "What is Population Health?" video . It may be helpful to screen this brief video with your practice staff and review the discussion guide and FAQs about population health management afterward.

In Your Words: Why Healthcare?

At our kickoff meeting, we asked you, the participants in this cohort, why you got into health care — a question you’ve probably been asked and answered hundreds of times. Its purpose at this meeting was to be more than a mere icebreaker, however. As key figures in MSHP’s first cohort of the Primary Care Practice Redesign initiative, your challenges are a high priority, but so too are your visions of what health care can look like in its ideal form. And that’s exactly what drove many of you to the roles you’re in today, whether you’re a provider or an administrator.

In your own words:

As we progress toward our practice redesign goals both as individual practices and a larger cohort, let’s not lose sight of what drove us to this field in the first place. Those reasons are as crucial to our efforts as the problems we look to solve.

And the Winner Is...

Congratulations to Lisa Renaud, Practice Manager, Mount Sinai Doctors and Dr. Stephanie Wang, Medical Director, Mount Sinai Doctors (both from 1090) for winning Mount Sinai St. Luke’s “Special Recognition Team Certificate,” which was awarded to them at Mount Sinai St. Luke’s President’s Recognition Award meeting hosted by Mount Sinai St. Luke’s President, Art Gianelli, on December 4, 2018. Well done to the 1090 team!

Lisa Renaud Dr. Stephanie Wang

National Transformation News Are Screens Coming Between Doctors and Patients?

Read Dr. Atul Gawande’s New Yorker article on digitization and its effect on doctors and patients : “ The volume of knowledge and capability increases faster than any individual can manage—and faster than our technologies can make manageable for us. We ultimately need systems that make the right care simpler for both patients and professionals, not more complicated. And they must do so in ways that strengthen our human connections, instead of weakening them.”

Missed an issue? If you'd like to view back issues of the Primary Care Practice Redesign newsletter, please visit the MSHP website's News & Media page.

If you have any questions please contact Stella Safo, MD, MPH at stella.safo@mssm.edu . Is there a topic you'd like to see covered in a future issue? Reach out to Lisa Bloch at lisa.bloch@mountsinai.org .