a care management aco: a multi-pronged strategy
TRANSCRIPT
Memorial HermannA Care Management ACO: A Multi-Pronged Strategy
Revolutionizing ACOs
Chris Lloyd, FACHE, CEO
J. Kevin Giglio, MD, Region Leader
Nicole Clarke Luck, VP & CFO
Shawn Griffin, MD, VP & CMIO
Tesha Montgomery, RN, FACHE, VP & COO
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Traditional Healthcare –A Flawed Model
How the industry has functioned
Physicians, hospitals, and insurers working in
silos
Lack of data sharing across the functions that
touch the patient
Billboard Medicine - Management of a single
occurrence, not the population
Patient engaged after becoming sick
Inadequate transparency and access to data
Lack of population management tools and
comprehensive data
Misaligned incentives between providers and
insurers
Disease and care management only an
insurer function
Little focus on systemic improvement
How it will have to function
Willingness to depart from old models and
change roles of key players
New technologies enable data flows to all
providers wherever the patient presents
Focus on population health, prevention, and
the patient outside the health care setting
Proactive patient engagement
Transparent sharing of data among providers
and between providers and insurer
Population management tools employed and
informed by data to give 360o view
Aligned incentives reward providers and
hospitals for improved quality and cost
Providers and insurer collaborate on disease
& care management to maximize impact
Investment in continuous improvement
3
maps
4
Our Continued Evolution
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MHMD Board
Primary Care
FP/IM Pediatrics
Allergy Ob/Gyn
Behavioral Medicine
Retail Medicine
Consumer Driven
MSO
Post-Acute
Supportive Medicine
PM&R
SNF/LTACH
Homecare
EMS
Pre-Acute
Hospital-Based
Radiology
Anesthesia
Pathology
Neonatology
Emergency Medicine
Trauma
Vendor / Supply Chain
Orthopedic Hospitalist
Nephrology Neurology
Infectious Disease
GI
Heme/Onc Rheumatology
Hospitalist Program
CV/CVS
Cardiology
CV Surgery
CVCP
Surgery
Peri-op Surgical Home
Bariatrics
ORL
General Surgery
Neurosurgery
Robotics
Critical Care
DVT
Sepsis
Clinical Compliance
MIC
AMIC
Editorial
e-Quality Check
Documentation
Quality
Exec Committee
Credentials
Finance Contracting
CME Innovation
Clinical Program Committees
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System Quality
Committee
Authority of the MHMD CPCsSystem-wide quality engine
Delegation from the health system
Protocols (creating and measuring EBM practices and order set templates)
Performance (setting and monitoring progress against established quality standards and protocols)
Products (drives the standardization of vendors, formularies, supply chain decisions)
Payment (Pay for performance goals, co-management agreements, ACO project metrics, PCMH elements)
Projects (ED to ED transfer policy, CT scanning in pediatric head trauma, standardized order sets in Observation units, service line, credentialing and privileging standards)
Program Rationalization (Consolidation and concentration of clinical service delivery – ie open heart and joint programs)
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CPC delegated authority from the System Quality Committee
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Clinical Programs Committee
Critical Care
Surgery Medicine
MHMD Board of Directors
Hospital MECs (11)
BOARD SYSTEM
QUALITY COMMITTEE
“Up and Over”
Med
Sta
ff
Iatrogenic Pneumothorax
MH Southeast HospitalMH Southeast hospital
20 Months
Zero Iatrogenic Pneumothorax
US Mandatory
514 CPC
Recommendations
in 2014
Primary Care Network>350 Adult & Pedi Medical Home Physicians
West Region70 APCPs
Region Leaders – Dr. Ankur Doshi & Dr. David Reininger
SW Region76 APCPs
Region Leader – Dr. John Vanderzyl
North Region60 APCPs
Region Leader – Dr. John Walker
Northeast Region27 APCPs
Region Leader – Dr. Tejas Mehta
Central Region56 APCPs
Region Leader – Dr. Kevin Giglio
Southeast Region48 APCPs
Region Leaders – Dr. Maqsood Javed & Dr. Adnan Rafiq
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Care Management Infrastructure
Virtual Care
Life in Balance
Transitions of
Care Program
Complex Care ProgramPreventive
Care Gap
Services
Health Coach
Services
Social Services /
Psych Response
Pharmacy Services
Supportive
Medicine/
Hospice
Diabetes
Services
CARE MANAGEMENT
Network Status Dashboard
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Clinical macro economics got better
27.1%lower
26.6%lower
28.3%lower
47.0%lower
5.7%lower
42.4%lower
47.8%lower
Year 1 & Year 2Aggregate MSSP Savings
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Y1 Quality in MSSP among the best in the country
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MHACO –82.8%
But be wary……the industry has been here before
Go slow to go fast
Don’t take too much risk
Continue to align incentives
Build capability!! – in network, insurance
capability, efficiency
Absorb technologies
Know the consumer!!
Manage the strategic impact of our model on the
market
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Panel Questions
Discussion Themes
• Physician Behavior
• Analytics and Data
• Care Coordination
Discussion Themes
What else is on your mind?