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In the spring of 2011 I was on a team that designed an accountable care organization for Memorial Hermann Health Systems.
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TEAM 29 James Cervantes Anthony Hopper Jessica Jacobs
Memorial Hermann
Why we have to change
Where we are going
How we will get there
How we will know we are there
Executive Summary
STRENGTHS WEAKNESSES• Positive Margin• Full Range of Facilities• High Level of Health IT adoption• Nationally Recognized QI
• Variable financial performance• Numerous, Small IPAs• Nascent Health IT in provider
offices• Undefined HIE
OPPORTUNITIES THREATS• Large Medicare/Medicaid
Population• Choice Primary Care Physician
Lock-In• Recruiting Advantages
• Ambiguous ACO requirements• Start Up Costs/Reimbursement• Texas Physician Employment
Law
Why we have to change
Supplement: 8-15
Competitor Profile
Supplement: 8
Memorial Hermann
Why we have to change
Where we are going
How we will get there
How we will know we are there
Mission: Memorial Hermann Accountable Care Collaborative is dedicated to improving the health of the people in Southeast
Texas by providing a continuum of high quality health services
Culture & Core Values
BREAKTHROUGHS EVERY DAY
Supplement: 18-20
Patient
Access
Eligibility
Billing
Home Care
Clinical Care
Information
Patient Support
Supplement: 29-32
Memorial Hermann
Why we have to change
Where we are going
How we will get there
How we will know we are there
• Strategy and Direction
• Organization and Governance
Organizational
• Provider Support• Patient
Advocacy
Operational • Financial Considerations
• Risk Management
Financial
• Health Information Technology
• Quality Improvement
Quality
Critical Issues & Areas
Supplement: 16-17
Organizational Design
Supplement: 22-29
Provider Support
Supplement: 22-24, 33-34
Patient Attribution
• Provider Enrollment
• Patient Risk Management
Budget Development
• Baseline Historical Data
• Trend Estimates
• Adjustments
Performance Monitoring Plan
• Reporting plan which compares actual costs to the budget
Payment Incentive Plan
• One-Sided Shared Savings Plan
Financial Management
Supplement: 36-41, 61-85
Legal Risks
Supplement: 39-40
Potential Legal Issue How to Avoid It
Antitrust 30% / 20% Rule
Stark Law Waiver from HHS
Texas Physician Risk Physician led board of director
No physician employment
• Triple Aim• High-quality • Cost-effective• Southeast Texas
population
• Patient Advocacy
Patient Identification
Concurrent Review
Tools for Frontline Staff
Quality Improvement
Teams
Performance Oversight and Accountablity
The CQI System
Supplement: 45-49
Quality Dashboard
Supplement: 49
PHR
Acute EMR
HIE
Amb. EMR
mHealthGIS
Mapping
The Health IT System
Supports: Quality Improvement, Patient Throughput, and Revenue Cycle Management
Supplement: 42-44
Memorial Hermann
Why we have to change
Where we are going
How we will get there
How we will know we are there
Implementation PlanImplementation Issue Start Date End Date Responsible Entity
Organizational Design
O1. Define Mission Vision and Values for the Whole Organization Jun-10 Feb-11
CCO/Provider Support Services
O2. Develop Program that helps members achieve the MVV Mar-11 Apr-11
CCO/Provider Support Services
O3. Develop Human Resources Evaluation tool for all staff members to encourage ACHIEVE Apr-11 May-11
CCO/Risk Management
O4. Get stakeholder buy in to reorganize the board of directors. Feb-11 Mar-11
CCO/CEO
O5. Facilitate discussion between “primary care” and “specialist” based physicians. Jan-10 Jun-10
CMO
O6. Engage community stakeholders to gain an understanding of actual community need. Jan-10 Jul-10
CSO
O7. Query Faculty governance members regarding their organizational structure. Jun-10 Aug-10
CSO
Supplement: 50-51
Implementation Plan
OM 2. Preferred ProductsOM 1. Recruitment and Staffing
O5. MHMD CommunicationsOM 6. RCM Training
O7. Faculty EngagementO6. Engage Community Stakeholders
O1. Define MVVOM 5. Care Coordination
F9. Org. Legal IssuesF8. Contracting Law
F7. Incentive PossiblitiesF5. Claims ProcessingF4. Third Party Payers
F2. PMPM ReviewF 1. Patient Assignment
C9. RCMC8. mHealth
C6. Provider IDSC5. MPI Assignment
C1. QI Plan DesignC 10. PHR
O2. MVV ProgramC7. HIE Records
C2. Educate QI PlanO3. HR Eval Tool
O4. Board of DirectorsOM 9. Quality/IT Training
OM 8. Staff EnrollmentOM 7. Provider Enrollment
OM 10. Patient Advocacy TrainingC4. EHR Adoption Tool
OM 3. Provider UndestandingF6. Facilities & Providers
F3. Physician Reimb. C3. Continual Monitoring Plan
2010 2011 2012 2013 2014 2015
Supplement: 52
Critical Areas Dashboard
Supplement: 47- 53
The Model
Supplement: 18-21
Memorial Hermann
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