washington presentation abrev 1 12

8/3/2019 Washington Presentation Abrev 1 12

1/21

George Mayzell, MDCEO

Health Choice, LLC

Accountability in Health Care


2/21


3/21


4/21

4

Background on the players

Methodist LeBonheur Healthcare (MLH) operates in Memphis Tennessee and is a $1.3 billionhealth system with 4 adult facilities and 1 pediatric hospital in the metropolitan area. MLH isthe academic partner of University of Tennessee School of Medicine.

HealthChoice, our Physician Hospital Organization(PHO), was formed in 1985 and is a true joint venture between MLH and MetroCare, which is a group of about 1,500 physicians thatpractice at MLH.

As of today, most physicians in Memphis are not employed by a hospital system.

Our system has achieved commercial market share success over the last ten years...asignificant change since 1995. We have strong payer partnerships and even stronger ties tothe employer community.

Health ChoiceNAVIGATING HEALTHCARE. DELIVERING SOLUTIONS.


5/21

M emphis Accountable Care Home(M ACH1)

y MACH1 is a collaborative with CIGNA, HealthChoice, and 26 primarycare physicians.

y CIGNA patients that see those physicians are attributed to them andtotal approximately 20,000 patients.

y Attribution formula based on prior two years utilization.y Only upside risk for physicians.y Physician Practices signed contracts with HealthChoicey Mach1 staff has been hired


6/21

M ACH1: How does it work?y HealthChoice holds MACH1 contract with CIGNA. HealthChoice

holds MACH1 contract with physician groups.y CIGNA-employed nurse sits at HealthChoice with full access to CIGNA

systems.y Physician groups commits to become a Patient Centered Medical Home.y Patients are attributed to PCPs. Bi-annual check for PMPM is paid to

group.y Group commits to practice transformation.y

HealthChoice completes comprehensive survey of office practices,attaching a score to each. Re-assessments quarterly with new scorestabulated. Projected timeline of practice transformation in Agreementwith group.


7/21

M ACH1: How does it work?y Group hires (or shares) care coordinator. Care coordinator manages defined

population.y HealthChoice works with group to focus on attributed patients, become NCQA

PCMH recognized, and shares data on performance of group.y Data is diseminated through HealthChoice to groups. Action taken by group is

then reported back to HealthChoice.y When gaps are identified, HealthChoice resources are used to educate and

create and processes for practice.y Total cost of patient episode is shared with PCPs downstream specialty cost is

attributed to overall PCP cost.y

Savings created from year over year trend for these patients and physicians. Apositive savings is shared between the physicians and employers.y PMPM payment to MDs to cover transformation costs


8/21

Clinical Data Flow

Cigna Claims

Care Coordinators at Health Choice

Designated PracticeCoordinators at PCPs EMRS

Patients

Cigna Case Manager (at Health Choice)


9/21


10/21

M ACH1: Whos in Charge?y Overseen within the network by

the Accountability SteeringCommittee and local oversight bythe Community AdvocacyCommittee.

y Committees will assesseffectiveness, cost trends, andcriteria for new physicianparticipation.

y Quarterly review with CIGNA.y Monthly review by the

HealthChoice Board.


11/21

11

Superb Accessto Care

Patients can easily make appointments and select theday and time.Waiting times are short.eMail and telephone consultations are offered.Off-hour service is available.

PatientEngagement

in Care

Patients have the option of being informed andengaged partners in their care.Practices provide information on treatment plans,preventative and follow-up care reminders, access tomedical records, assistance with self-care, andcounseling .

ClinicalInformation

Systems

These systems support high-quality care, practice-based learning, and quality improvement.Practices maintain patient registries; monitoradherence to treatment; have easy access to lab andtest results; and receive reminders, decision support,and information on recommended treatments .

CareCoordination

Specialis t care is coordinated, andsystems are in place to prevent errorsthat occur when multiple physicians areinvolved.Follow-up and support is provided.

Team Care

Integrated and coordinated team caredepends on a free flow of communicationamong physicians, nurses, case managers and

other health professionals (including BHspecialists).Duplication of tests and procedures isavoided.

Patient Feedback

Patients routinely provide feedback todoctors; practices take advantage of low-cost, internet-based patient surveys to learnfrom patients and inform treatment plans.

Publically availableinformation

Patients have accurate, standardizedinformation on physicians to help themchoose a practice that will meet theirneeds.

8Source: Health2 Resources 9.30.08

Defining the Medical Home

1

1


12/21

12


13/21

M ACH1 Datay Reports include:

y Inpatienty ED Utilizationy

Advanced Imagingy Predictive Modelingy Quality Scoring for PCPy Cost and quality data for network specialistsy Rx Utilizationy Disease Management program adherence


14/21

M ACH1 Data

y Ultimate goal is tocombine claims data with

EMR data to create fullpicture of care.y HealthChoice is working

on how best to facilitate

not only EMR adoption butinformation exchange anddata registries.


15/21

M ACH1 M etricsy Quality Scores (gaps in care)y Cost of Carey Utilizationy Elimination of duplicative testingy Movement toward PCMHy

EMR adoption and usage (to include population health)y E-prescribingy Patient Satisfaction


16/21


17/21


18/21

P artnersCongregational

HealthNetwork : UsingCHN liaisons as lifecoaches.


19/21


20/21

Accountable Care Organizations A COs are defined as a group of providers that has the legal structureto receive and distribute incentive payments to participating providers.

Patient Centered Medical Home


21/21

F uture Plansy PCP are the base of the pyramidy Add subspecialist to modely Integrated hospital and post acute to programy Bundling pilots?y Consider modified risk contracts

washington presentation abrev 1 12

Documents