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 as a Visual
An Engineered Approach
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
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?
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
The Five Pillars and New Approach
Assessing the Community and the Patient Population
Size, Scope, and Scale of Your PCCN
Proximity of Space and Resources
Patient Population Chosen
Barriers to Assimilation
Care Strategies and Task Analysis
Establishing BDPs and Patient Involvement
Task and Resource Considerations
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
Data and Analysis of Current and Future States
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
Creating a Care Circle Team
Personalizing the Resource Pool
Resources for the Resources
Setting up Educational Programs
Leadership and Core Values
Group Dynamics™ for Resources
Challenges and Obstacles
Too Many Cooks?
Build It and They May Not Come
Protecting the Herd
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
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
Infrastructure Options: Overview
Using the SCN
PCCN Management: Resource–Patient Connectivity
Example of a SCN Use Case
Another SCN Use Case: Discharge and Care Transitions
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
Epilogue–The Latent Community
Each chapter includes a Summary and Endnotes
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".