WHERE THE BRIGHTEST MINDS in health and IT meet.

Care Coordination Transformation: Road to Population Health

February 21, 2017 — 01:00PM - 02:00PM EST
Orange County Convention Center
Session ID: 


John Muir Health identified care coordination as one of the key competencies for success in achieving the “quadruple aim” defined as better outcomes, lower costs and improved patient and provider experience. The care coordination transformation project that will be shared via this session evaluated and redefined workflows, streamlined processes, reduced duplication and variability while increasing efficiencies and ensured patients were appropriately connected to the right care team members and benefiting from evidence-based care programs and services. To support this effort, documentation for all teams were integrated within the EHR, reducing the dependency and cost associated with maintaining separate applications. Actionable data is now available in a consumable format and is reliable, and the ability to evaluate interventions and adherence to evidence-based care models allows the allocation of resources to contribute most efficiently to positive outcomes.

Learning Objectives: 

  • Describe one organization’s approach to addressing its move to full and partial payer risk agreements through care management activities for the most complex disease management
  • Apply lessons learned from one organization’s experiences to create a care transitions hub to centralize work such as discharge placement and authorization processes
  • Detect opportunities for creating a cohesive care management approach in one’s own organization, reducing duplication of activities and encouraging top-of-licensure clinician work
  • Describe best practices for redesigning workflows to identify patients with the most urgent care needs
  • Explain the importance of gathering metrics and throughout the initiative for flexibility and course correction to ensure that goals are achieved


Nurse, CNO, CNIO
Physician, CMO, CMIO




in health and IT meet.