1st Edition

Developing a Poly-Chronic Care Network An Engineered, Community-Wide Approach to Disease Management

By Pierce Story, MPHM Copyright 2013
    296 Pages 7 B/W Illustrations
    by Productivity Press

    Although much has been achieved in care coordination and accountable care, healthcare leaders need additional, game-changing innovations to deal with constraints in clinical resources, care capacity, and cost that have not yet been fully addressed. This need for innovation is especially great in the care of the chronically ill: the most costly, highest-risk segments of our populations.

    Filling this void, Developing a Poly-Chronic Care Network: An Engineered, Community-Wide Approach to Disease Management reconstructs and augments traditional chronic care delivery models. The proposed solution—the Poly-Chronic Care Network© (PCCN)—is a specific iteration of the Care Circle Network© (CCN) concept that creates a sustainable community-engaging response to the complexity, cost, and outcomes of chronic diseases. By dynamically engineering all the elements of a community’s "Capacity to Care" directly into short- and long-term patient care processes, the PCCN expands care capacity and physician "reach", and improves quality and outcomes, without increasing the total cost of care.

    The book describes the fundamental concepts, principles, and requirements for the PCCN and explains how this care model could augment and enhance other new business models, such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs). In addition to a detailed description of implementation steps and organizational structures, the text provides useful insights into technologies that can aid and enhance implementation, including home/virtual monitoring, social networking, and dynamic simulation. Importantly, the book includes both detailed examples and a flexible how-to guide for setting up a PCCN or other CCN, offering readers step-by-step guidelines and options for combining readily-available communal resources with simple technologies in the design of innovative care models for their communities.

    With this book in hand, readers can confidently pick and choose specific components to match their community’s needs and capabilities, "amending the blend" to account for the size, scale, scope, and population of the community and patients they wish to serve.

    The PCCN Concept: An Overview
    PCCN Description
         PCCN as a Visual
    Application Overview
    An Engineered Approach
    PCCN Components
         Resource Pool
              Resource Training
              Technology Infrastructure (TI)
         Palliative and End-of-Life Care
              Assimilation and Passion
    Capacity as Strategy
    Other Important Attributes of the PCCN
    An Additive Solution
    PCCNs and ACOs
    A Caveat to the Contents of This Text
    Two Missing Elements
         Mental Health
         The Bottom 50
    A Word on US Privacy Regulations and the PCCN
    Concept

    A Brief History of Previous and Current Healthcare Reforms
    Been Here, Done This?
    Whence Innovation?
    Accountable Care
    Precursors to ACOs in Europe
    ACOs and HMOs
    Can ACOs Save the System?
    ACOs and PCCNs
    PCCNs and Other Business Models

    The Five Pillars of Healthcare for the PCCN
    Quality and Outcomes
    Access
    Capacity
    Cost
    Participant Gratification
    The Five Pillars and New Approach

    Assessing the Community and the Patient Population
    Selecting Patients
    Size, Scope, and Scale of Your PCCN
         Proximity of Space and Resources
         Physician Participation
         Technology Constraints
         Patient Population Chosen
         Community Acceptance
    Assimilation Propensity
    Cultural Barriers
    Barriers to Assimilation
    Summary
    Endnotes

    Care Strategies and Task Analysis
    Establishing BDPs and Patient Involvement
    Swimlane Mapping
    Task Classifications
    Task and Resource Considerations
         Risk
         Variation
         Process Variance
         Process Time Variance
              Process Time and the Impact of Variability
              Process Time Variance Example
         Interdependencies and Variability
         Process Time and Patient Attributes
         Impact of Variance on Capacity
    Tools for Analyzing Complex Systems
         Dynamic Standardization
         Data and Analysis of Current and Future States
         Process Data
         Demand Data
         Analyzing Community Demand

    Building the Communal Resource Pool
    Overview
    Resource and Capacity Variance
    Dynamic Demand–Capacity Matching
    The Demand–Capacity Continuum and Simulation Capacity Analysis
    Resources
    Using the Care Strategies
    Resource Options
    Resource Selection
    Selecting Physicians
    Creating a Care Circle Team
    Personalizing the Resource Pool
    Resource Assimilation
    Resources for the Resources
    Resource Education
    Setting up Educational Programs
    Leadership and Core Values
    Group Dynamics™ for Resources
    Challenges and Obstacles
         Legal Hurdles
         Too Many Cooks?

    Build It and They May Not Come
    Protecting the Herd
    Physician Participation
    Risk, Payors, and the Government
    Future PCCN Model Alternatives

    PCCN Resources and Governance Structures
    Poly-Chronic Care Network Roles
         PCCN Management Team
              Chronicists
              Governance Structures and the Chronicist
              Specialists
              PCCN Manager
              PCCN Trainer
              Patient’s Primary Communal Resource
    Education of the Community
    Governance as a Practical Matter
         More on Governance Structures
    A Word on Group Dynamics™
    Making Room for Skeptics
    Governance as a Legally Binding Concept

    PCCN Technologies
    Introduction
    Infrastructure Options: Overview
    Using the SCN
    Patient
    Connectivity
    Patient–Resource Connectivity
    Resource–Resource Connectivity
    PCCN Management: Resource–Patient Connectivity
    Resource–Clinician Connectivity
    Example of a SCN Use Case
    Another SCN Use Case: Discharge and Care Transitions
    Using Simulation
    Using the HIE
    Using the Chronic Disease Management System (CDMS)
    Using Virtual Monitoring
    Who Pays for It?
    How to Save on Implementation Costs
    PCCN Resources and the Technology Infrastructure

    Financial Considerations of a PCCN
    Implementation
    Cost Analysis Assumptions
    Creating Your Own Cost Analysis
    Impact of the PCCN on Hospital Financials
    Impacts on Physician Office Costs and Revenues
    PCCN Cost Justifications
    Outcomes and Incentives
    Who Pays for What?

    PCCNs, Palliative Care, and End-of-Life Planning
    Palliative Care: Definition and History
    The Origins of Palliative Care
    Resources for Palliative Care
    End-of-Life Planning and Care
    Example: Gunderson Health System
    Integrating EOL and Palliative Care in the PCCN Model
    PCCN Process Evolution and Palliative and EOL Care
    The Payor Role
    Government and EOL Planning

    Final Thoughts
    Imagine
    Closing Comment
    Epilogue–The Latent Community

    Each chapter includes a Summary and Endnotes

    Biography

    I believe that we can simultaneously impact quality, access, capacity, and cost when the right vision meets the necessary resources assisted by appropriate technologies.
    -Pierce Story, MPHM

    Pierce Story is the co-Founder and Director of Concept Development for Capacity Strategies, Inc., a firm dedicated to the optimization of our nation’s total "Capacity to Care". His unique expertise lies in "Dynamic Care Capacity Management" (a concept he developed in 2007); process, systems, and resource utilization optimization; business/care model development; and the application of systems and process simulation.

    During his 20+-year healthcare career, Pierce has developed innovative care and business models to improve health system operations and promote population health outcomes ("Care Circle Networks"). He has also worked in departmental and hospital-wide performance and capacity optimization as well as new facility construction planning throughout the care continuum, including work in Emergency Departments, Surgical Services, inpatient units, and community-based health clinics.

    Pierce has written and lectured extensively on capacity and system optimization, advocating for dynamic, healthcare-specific analytical and improvement tools and methodologies that go beyond traditional industrial-based methodologies such as Lean. His most recent books, Developing a Poly-Chronic Care Network and Dynamic Capacity Management for Healthcare, detail innovative approaches to the optimization of the "Capacity to Care" throughout both hospitals and communities, and have received wide praise for their freshness. Other publications include numerous articles on simulation in healthcare, Dynamic Capacity Optimization, iterations of Care Circle Networks such as the "Poly-Chronic Care Network", and a co-edited book, Management Engineering for Effective Delivery.Prior to starting Capacity Strategies, Pierce worked both on the supplier and consulting sides of healthcare with companies ranging from Kendall-McGaw Laboratories to GE to his own healthcare consulting and simulation firm. In these roles, Pierce was responsible for strategic planning and new process and operations design, client engagement, and business development.

    Pierce received his Masters Degree in Health Policy and Management at the Muskie School of Public Policy in Portland, Maine, and is trained in both Six Sigma and Lean methodologies. He is the current Secretary of the Leadership Council of the American Society for Quality’s Healthcare Division, and is also a Diplomate, Past President and Board Member of the Society for Health Systems, a volunteer organization of over 900 healthcare performance improvement specialists and management engineers.

    Pierce lives in East Lake-Atlanta, Georgia, where he enjoys landscaping, rides his 1988 Harley-Davidson ElectroGlide, and regularly attends St. Philip AME Church and God’s Rolling Thunder "Biker church".