Pineridge Medical Centre PQA

Pineridge Quality Alliance (PQA) focuses on the past work environment of Pineridge medical center to identify the challenges and the opportunities presented in a clinical setup. This aims to assure better clinical environment network with allied institutions to promote accountability with interest in population health. Pineridge Medical Centre was established as a result of the merger of two regional hospitals in Pocatello with larger bed capacity and newly appointed chief executive officer (Darr, Farnsworth & Myrtle, 2017). The new model of health care has a goal of lowering costs and improving the quality of the services patients receive on visiting health care facilities. The management of Pineridge Medical Center believes that a well-organized medical facility will integrate cooperation with partners in its activities. This makes it well prepared for the future challenges and opportunities, hence Pineridge has adopted the ideals in its strategy.

       Several factors came into play creating a need for the facility to launch its own Pineridge quality alliance (PQA). For instance, the passage of patient protection and affordable care act in 2010 made the health care facilities to shift their attention from being volume geared towards value-based institutions. This made the enterprise to consider the payment options, reimbursement systems, capitalization and reorganization of business operations. The act implications varied with individual markets but no customer value addition geared organization could manage to ignore its significance. Therefore, Pineridge was left with three options which were to wait and see the impact of the act exerts pressure on their operational environment, be an early adopter of the act and adopt the requirements of the act in phases. When adopted in phases, it implied initiating the necessary changes initially as the organization moves towards complete implementation of its requirements. The CEO of Pineridge explored the various opportunities the act presented to the institution to ensure it remains an accountable healthcare organization with its teams of doctors, hospitals and third-party health care providers. These are coordinated voluntarily to ensure high-quality services to chronically ill patients at the right time and place without services duplication and medical errors (Darr, Farnsworth & Myrtle, 2017). Through the insight of the CEO, the organization was able to take advantage of the act and participate in accountable care organizations without depending on the centers for Medicare and Medicaid Services. Pineridge was also influenced to launch PQA since it was critical for it to be transparent in its operations, to facilitate contract backed by insurance plans, to allow usage and adherence of clinical benchmark, participation in training programs and ensure efficient and high-quality clinical practices in its environment. Also, it was essential since it ensured entering into an agreement to share information concerning the quality performance standard.

       Pineridge uses various structures and tools of PQA to ensure improved patient quality and increase provider accountability. The health facility has invested in highly skilled and experienced physicians who act as part of its management team and operations. This ensures quality services are assured to the patient. Due to the high caliber of the staff, the medical cost is reduced since they can use accurate and relevant data in their operations. For example, since it was started, six members of the board of directors out of nine are physicians (Darr, Farnsworth & Myrtle, 2017). Also in the governance and operating structures of the organization, the company has hired full-time care managers who facilitate and coordinate provision of medical services to patients who are high risks to help them withstand the pressure of the complex healthcare system. The enterprise has also embarked on contractual arrangements with insurance companies or payer contracts initiatives. For instance, it initially had a contract with Blue Cross of Idaho that was responsible for managing patients who were residing in southeast Idaho. Such contracts made the PQA providers give their patients customized experience in terms of health services. Through such contracts, the primary care providers participated actively in the provision of health care services to the satisfaction of the patients (Berkowitz, et al 2016). Therefore, the patients are assured of well-coordinated care, reduced bureaucracy and improved health outcomes of the served patients.           

       Pineridge has also developed a database with a network of the medical professional who has spread across several provider groups who are derived from the profit and nonprofit making institutions that are spread in both private and public sector within rural and urban areas. These health professionals have a goal of ensuring transformative and collaborative efforts that are in line with the Institute for Healthcare Improvement Triple Aim. Pineridge has also used advanced medical records and practice management systems to facilitate the attainment of quality services and accountability to the patients. The enterprise has purchased a system known as Crimson that will help in data collection and observance of quality standards by all stakeholders in the network of its service providers. Crimson makes it possible for the organization to give the necessary attention to patients’ needs using available data regardless of their location since it analyses data in real-time supporting health teams (Darr, Farnsworth & Myrtle, 2017). The needs of various patients are directed to relevant health experts for action. The organization has made use of agreements signed with the participating provider to ensure the alliance engages in the improvement of performance and data sharing. The data shared is based on medical records, patient bills and claims, management practices and electronic generated systems data which facilitate in data tracking and analyzing. These agreements have facilitated quality reporting and measurement among physicians. Pineridge has integrated continuous learning through collaborative efforts with Optum that are geared towards meeting the requirements of the relevant acts and regulations.

       There is evidence that PQA follows the best practices that assure quality services to the clients and services provider. For instance, through the use of relevant tools and support Optum assists health care providers in early detection, continuous assessment and timely with accuracy reporting of chronic patient condition. It makes use of the best technology that integrates intelligence solutions from relevant data through continuous training and education to achieve the triple aim. The PQA outcome is benchmarked against set standards outlined in the Institute for Healthcare Improvement Triple Aim. Both Crimson and Optum platforms are set in a way that allows for improvements opportunities to integrate the emerging realities in healthcare (Darr Farnsworth & Myrtle, 2017). This makes the two platforms to be the most desired to ensure improved overall cost, quality of service and better utilization of the care services provided to the stakeholders. The PQA System has a direct effect on the health of the community making the health care providers invest more than has been demanded upon its implementation. For instance, about the US $ 2.5 million has been invested in legal and consultancy fees, personnel and information technology. Further, over 20,000 hours being used in planning and implementation to ensure seamless service are provided both in current and future. Opportunities are also being explored to expand the existing network of payer partnership. Also, the PQA system has instituted measures for tracking and analyzing such as the Physician Quality Reporting System. Further provision of aggregate and practice reports that are specific to work is paramount for PQA staffs.

        In marketing PQA will lead to more hospitals, clinicians and stakeholders being brought on board to increase the reach of its services. The enterprise can achieve this by making the necessary changes in its structure to allow accommodation of third party provider and services in its partnership. For instance, the care benefits scheme and fee schedule could be structured to limit those willing to leave the PQA services by requiring them to pay the higher fee making them opt to remain. The reduced turnover can make the management to introduce autonomous department that manages the benefits’ scheme. The spectrum of services being offered under the blue cross of Idaho can be increased to include those that require critical care, those not currently on offer like hypertension and resource-demanding criteria. This will have the potential of attracting other clients in need of the same services. The PQA platform can be structured to optimize the total cost of care programs which will assure stakeholders of better, more and improved services due to controlled cost attracting more clients. The PQA system can also expand its network of partners to include offering services to employees and their dependents, provide support services critical to healthcare and third-party administration of the services (Darr, Farnsworth & Myrtle, 2017). The expanded network will bring onboard clients who will include ordinary citizens, hospitals and physicians who will provide critical expertise when needed. The enterprise can also engage in continuous research and development activities to understand the consumers’ perception of their services. The research will give the company a deeper understanding of the target customers and needs of the market (Berkowitz, et al, 2016). The company can also initiate instant messaging platforms and social media networks to market its services to target clients. This will increase its outreach platforms. Further, the company can engage in publicity exercises like roadshows, promotions and sponsorship services to certain patients who will be able to narrate their success stories after using the services at a later date.

       In operationalizing and prioritizing the goals for 2017-2019, expanding the structure for PQA care management (goal number 4) will create room to implement all the other goals. The expanded structure will focus on horizontal and vertical integration of the services by creation of independent units that manage certain aspects as part of the large portfolio of services on offer. This will have the potential of expanding the provider network with inclusion of supporting departments (Almost, et al, 2018). Also the business model will result in emergence of specialized departments that will address specific challenges, needs and opportunities of the business. For instances the specialized departments may link patients to non-clinical services at real time to ensure prompt outcome to the desired services.

       The specialized departments can also link patients to facilities offering recovery services near their location with much ease unless specialist advice or care is required which may require central attention. The expanded structure will bring on board a network with physicians who are well versed with specific clinical areas (Berkowitz, et al 2016). This will have the potential of offering programs that are customized to help in home care management for conditions like migraine and hypertension. As a result due to home care management the specialist will have more time to devote in more critical cases and evidence based research to improve the quality of health care due to saved time. It will provide the physicians for multi-disciplinary liaison to share their experience through round table conferences and seminars. Due to improved information sharing and usage the management will be better placed in expending the institution resources in priority areas.

       In conclusion, PQA has improved the access to accountable care to the Pineridge Medical Centre clients. The management identification of the key goals to be achieved within 2017/2019 period is an assurance of the commitment to improved services. The adoption of PQA set of tools and techniques by the medical Centre has facilitated smooth work flow in the organization. The goals enshrined within the 2017/2019 planning period will be achieved by integrating the identified weaknesses in the system and taking advantages of the opportunities it creates during the period. Through initiating the required changes in the organization by way of marketing and structural re-organization it will boost the overall reach of Pineridge services in its operational environment.

Appendices

PQA timelines

References

Almost, J. M., VanDenKerkhof, E. G., Strahlendorf, P., Tett, L. C., Noonan, J., Hayes, T., … & Paré, G. C. (2018). A study of leading indicators for occupational health and safety management systems in healthcare. BMC health services research, 18(1), 296.

Berkowitz, S. A., Brown, P., Brotman, D. J., Deutschendorf, A., Dunbar, L., Everett, A., … & Zollinger, R. (2016, December). Case study: Johns Hopkins community health partnership: a model for transformation. In Healthcare (Vol. 4, No. 4, pp. 264-270). Elsevier.

Darr K., Farnsworth, T. J., &  Myrtle, R, C. (2017).Cases in  Health Services Management,6 th edition, Health Professions Press, Inc.