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Last Page Introduction to Sequent Partnership Benefits Provider Network Sequent Provider Network Operational Infrastructure Technology and Analytics Care Management

Introduction to Sequent

Sequent Health Physician Partners is a physician-led, professionally managed clinically integrated network. Sequent is the result of a shared vision among physician leaders to bring a more coordinated, comprehensive and competitive health care product to the communities and patients that they serve. Sequent is committed to a physician-led transformation of the health care delivery system that will result in higher quality, more cost-effective care.

The focus of the organization is to effectively improve health care in our community by:

Establishing clinical quality standards and measuring outcomes for patient populations
Improving the coordination of care for patients by creating an infrastructure that enable providers to share actionable clinical data
Reducing health care costs by more effectively managing utilization of resources
Providing an array of business services that support physicians in private practice

It is Sequent's Mission to establish a multispecialty provider network capable of efficiently and effectively managing the vast majority of the health care needs of the community. Sequent has been established with consideration for Federal Trade Commission and U.S. Department of Justice guidance to allow the CIN to achieve a level of clinical integration that will permit Sequent to engage in joint contracting with commercial health plans.

Partnership Benefits

Sequent Health Physician Partners has developed a number of strategic partnerships with health plans to provide higher quality, more cost-effective medical care to their membership.

Payers who partner with Sequent are likely to realize the following benefits:

Increasingly competitive insurance offerings
Continuous improvements in access, quality and clinical outcomes
Continuous oversight and optimization of service utilization
Continuous reduction in health care expenditures
The ability to offer access to a high quality, cost-effective provider network without having to assemble "narrow networks"
Increased customer satisfaction (both beneficiary and employer)
Collaborative provider relationships focused on addressing high priority access, quality, cost or utilization issues
More engaged and informed patients/beneficiaries
Increased support for patients to engage in self-management activities
Single signature contracting with a broad, high quality provider network
The ability to engage in increasing levels of risk-based contracting over time

Provider Network

Sequent has taken an inclusive approach to inviting providers from the medical community to participate in the clinically integrated network. Providers must meet the professional qualifications established by Credentialing Committee to participate in the network. They must subsequently maintain quality performance standards established by the Quality Committee to remain in the network.

Sequent’s physician network is comprised of both primary care and specialty care physicians. It is also comprised of physicians employed by Northside Hospital and physicians in independent, private practice.

Providers agree to actively participate in clinical initiatives to further Sequent Health's value-based mission. This participation includes sharing data and agreeing to work with Sequent staff on practice transformational activities and integrate evidence-based practices.

Operational Infrastructure

Sequent has made the necessary investment in infrastructure and support systems to ensure it can have a meaningful impact on clinical outcomes and the patient experience.

Health care Information Systems and Analytics

Sequent Health Physician Partner’s analytics at the core of its IT investment strategy. To maximize use of Sequent’s care management resources, it must prioritize where to focus within large groups of patients. Sequent must also have the ability to translate data into actionable insight for clinicians and care management staff. Therefore, Sequent has partnered with athenahealth to aggregate data across the large number of practices throughout the network.

Athena’s PMS is a cloud-based solution that helps address a broad spectrum of cost and quality challenges, from population assessment and provider profiling to performance and provider management:

Resource utilization management, including emergency department and hospital admissions
Pharmacy cost management, drug substitution and formulary compliance
Physician efficiency and performance reporting
Patient profiling, risk stratification and predictive modeling that can inform providers of the need for a more intensive care management approach
Population health management and outreach
Point-of-care decision support
HEDIS compliance management
Pay-for-Performance (P4P) program management
Network utilization and leakage

Being a part of Northside Hospital allows Sequent’s Data Analytics team to work closely with the Northside’s Information Technology department. The group works together to ensure the data is protected, the proper data is used for reporting, and to validate all reports via a formal data governance process.

The Data Analytics team is continually mining data in the various reporting systems to find new opportunities for the Clinical team. This includes mapping providers to patients to determine gaps in coverage areas, analyzing monthly claims data to identify differences since the last quarterly reports, and to produce reports that are meaningful and easy to use for the providers in the network.

The Clinical Team

The Sequent Clinical Team is focused on building strong care teams, coordinating care across the continuum and leveraging information systems to ensure patients receive evidence-based care. The team is comprised of two distinct clinical roles: Registered Nurse (RN) Care Managers and Quality Specialists.

RN Care Manager

RN Care Managers have primary responsibility for coordinating the care of patients across the spectrum of medical providers and identifying / supporting patients that are at risk for an adverse event. RN Care Managers oversee two primary functions:

Transitions of care from inpatient or emergency department
Complex care management for patients high-risk conditions
Chronic care management (or disease management) for patients with chronic conditions

RN Care Managers help patients navigate the healthcare system and refer patients to community-based services as needed. These could include hospital care management, nursing facility care management, home health services, post-acute programs, community-based services, and payer-provided disease management/case management programs. This ensures the patient is aware of the resources available and that the resources are coordinated and efficiently deployed.

Quality Specialists

Quality Specialists are focused on identifying patients that have ‘gaps in care’ across the patient population regardless of the patient's level of risk. Quality Specialists contact patients to provide vital information about evidence-based screenings, medical services or reminders that will help them manage their health. Quality Specialists also assist RN Care Managers in coordinating post-acute services, specialty referrals and community-based services where appropriate.

Quality Specialists also play a fundamental role in supporting physician’s journey in value-based care. They work closely with physician offices to develop workflows to identify patients with gaps in care so physicians can address needs at the point-of-care. Quality Specialists often function as a conduit for transferring information and data between Sequent and the physician’s office.

Quality Improvement

The Sequent culture of continuous quality improvement is led by the Sequent Quality Committee, which is comprised of Sequent physician members that represent multiple specialties. The Quality Committee determines the quality improvement practices are performed consistently across the Sequent Network and leverages data on these evidenced-based practice guidelines to identify opportunities for improvement. This committee is also responsible for building care pathways to guide movement between settings and providers. These pathways ensure timely access to high quality specialty medicine where appropriate and map the flow of clinical information for integration.

Care Guidelines and Quality Performance

Individual provider and practice performance on metrics identified by the Quality Committee are shared through performance dashboards. These dashboards include performance on quality and utilization measurers. Along with these dashboards, practices are provided guidance from the Sequent Clinical Team about potential opportunities for improvement given their current performance and patient population. Along with high-level metrics, the clinical team has tools to drill down to the patient-level in order to identify patients driving high and/or inappropriate utilization as well as the patients with identified gaps in care. The team works with the practice to determine appropriate changes to current workflows in order to improve in identified measurers. The overall goal of this process is to determine the system issues leading to gaps in care or barriers to care. Once potential barriers are identified, the team works with in the practice to determine new, evidence-based standard work or system changes that will help provide better care and improve practice efficiency.

Over time, impacts of these changes are measured by monitoring the dashboards to quantify the degree of improvement. The network tracks performance over time to determine if the change had the intended impact. When the expected impact does not occur (or does not occur to the degree to which was expected), the team will work to make small tests of change to the plan to determine which activities produce the largest impact. Thus, tracking quality and utilization metrics gives the practices a new tool to measure the impact of new workflows.

In addition to using metrics for quality improvement, it is also a tool used measure individual provider performance. Providers and practices are held accountable for their performance via oversight by the Quality Committee. The committee reviews performance to determine practices or physicians who are outliers within each measure. When high performers are identified, the team seeks to learn more about the drivers of their strong performance in order to spread their innovative tactics to others within the network. On the other hand, when low performers are identified, resources are provided to assist physicians with activities to improve their performance.

All of this quality improvement activity requires a high degree of engagement from the practices within the network. Engagement with the clinical team and the quality improvement process is paramount to success, thus engagement is tracked very closely. Groups identified as displaying low engagement are discussed at physician leadership meetings. Physician leaders perform peer-to-peer outreach to discuss the current issues and engagement requirements moving forward. This process allows an unengaged group to hear directly from a trusted colleague who is leveraging the data and resources well. Should provider continue to display poor levels of engagement, the provider will potentially be further educated, coached, penalized and/or terminated from the network.