of 21
8/3/2019 Washington Presentation Abrev 1 12
1/21
George Mayzell, MDCEO
Health Choice, LLC
Accountability in Health Care
8/3/2019 Washington Presentation Abrev 1 12
2/21
8/3/2019 Washington Presentation Abrev 1 12
3/21
8/3/2019 Washington Presentation Abrev 1 12
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.
8/3/2019 Washington Presentation Abrev 1 12
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
8/3/2019 Washington Presentation Abrev 1 12
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.
8/3/2019 Washington Presentation Abrev 1 12
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
8/3/2019 Washington Presentation Abrev 1 12
8/21
Clinical Data Flow
Cigna Claims
Care Coordinators at Health Choice
Designated PracticeCoordinators at PCPs EMRS
Patients
Cigna Case Manager (at Health Choice)
8/3/2019 Washington Presentation Abrev 1 12
9/21
8/3/2019 Washington Presentation Abrev 1 12
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.
8/3/2019 Washington Presentation Abrev 1 12
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
8/3/2019 Washington Presentation Abrev 1 12
12/21
12
8/3/2019 Washington Presentation Abrev 1 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
8/3/2019 Washington Presentation Abrev 1 12
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.
8/3/2019 Washington Presentation Abrev 1 12
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
8/3/2019 Washington Presentation Abrev 1 12
16/21
8/3/2019 Washington Presentation Abrev 1 12
17/21
8/3/2019 Washington Presentation Abrev 1 12
18/21
P artnersCongregational
HealthNetwork : UsingCHN liaisons as lifecoaches.
8/3/2019 Washington Presentation Abrev 1 12
19/21
8/3/2019 Washington Presentation Abrev 1 12
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
8/3/2019 Washington Presentation Abrev 1 12
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