Developing a Poly-Chronic Care Network: An Engineered, Community-Wide Approach to Disease Management, 1st Edition (Hardback) book cover

Developing a Poly-Chronic Care Network

An Engineered, Community-Wide Approach to Disease Management, 1st Edition

By Pierce Story, MPHM

Productivity Press

296 pages | 7 B/W Illus.

Purchasing Options:$ = USD
Hardback: 9781466554740
pub: 2012-10-29
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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.

Table of Contents

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


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




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



Care Strategies and Task Analysis

Establishing BDPs and Patient Involvement

Swimlane Mapping

Task Classifications

Task and Resource Considerations



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


Resource and Capacity Variance

Dynamic Demand–Capacity Matching

The Demand–Capacity Continuum and Simulation Capacity Analysis


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


Governance Structures and the Chronicist


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


Infrastructure Options: Overview

Using the SCN



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


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


Closing Comment

Epilogue–The Latent Community

Each chapter includes a Summary and Endnotes

About the Author

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".

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Quality Control
BUSINESS & ECONOMICS / Industries / Service Industries
MEDICAL / Administration