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

2

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

5

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

6

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)

7

CPC delegated authority from the System Quality Committee

8

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

10

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

12

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

14

Y1 Quality in MSSP among the best in the country

15

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

16

Panel Questions

Discussion Themes

• Physician Behavior

• Analytics and Data

• Care Coordination

Discussion Themes

What else is on your mind?