The Evolution of Physician Group from Patient Centric Medical Homes - PowerPoint PPT Presentation

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The Evolution of Physician Group from Patient Centric Medical Homes

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A Quest to Achieve Higher Quality and Bend the Employers Health Care Cost Curves. Medical Clinic of North Texas (MCNT) enjoys a stellar FY 2010 performance with Total Medical Cost trend for their managed population 2.4% better than market. We tried to understand the journey and the drivers behind the success of Medical Clinic of North Texas from its early years and its future direction. – PowerPoint PPT presentation

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Title: The Evolution of Physician Group from Patient Centric Medical Homes


1
Evolution of MCNT from Physician Group to
Accountable Health
2
The Evolution of Physician Group from
Patient-Centric Medical Home to Accountable
Health to Serve the Changing Needs of
Self-Insured Employers
3
  • A Quest to Achieve Higher Quality and Bend the
    Employers Healthcare Cost Curves

4
  • Medical Clinic of North Texas a USMD affiliate
    is a physicians' group located in Dallas. MCNT
    experienced a stellar FY 2010 performance with
    Total Medical Cost trend.
  • Their managed population of 2.4 percent
    better-than-market performance was the
    culmination of various quality-of-care drivers

5
The Early Years Physician Group
  • In 1995 Medical Clinic of North Texas (MCNT)
    opened its doors in Tarrant County, Texas as an
    office-based  physician group practice. Today,
    the MCNT family has more than 142 primary care
    and specialists practicing in 43 clinics
    throughout North Central Texas.

6
Growing Up Medical Home
  • Todays concept of Medical Home began to take
    shape in the 1980s when a Honolulu-based
    pediatrician pursued new approaches to improve
    early childhood development.
  • Contemporary understanding emerged in 2005, when
    the American College of Physicians developed an
    advanced model prescribing evidence-based
    medicine, clinical decision support tools,
    quality indicators, health IT, performance
    feedback, and other elements that together
    characterize the modern Medical Home.

7
  • Centers for Medicare Medicaid Services (CMS)
    funded the first of the Medicare Medical Home
    pilots through the Tax Relief and Health Care Act
    of 2006. 
  • In 2009, MCNT piloted medical home projects with
    BCBS and CIGNA when they replaced episodic care
    with coordinated care and long-term healing
    relationships.

8
  • By December 2010, 29 of the MCNT clinics and
    every one of their primary care physicians had
    been awarded Level 3 Recognition by the National
    Committee for Quality Assurance (NCQA) Physician
    Practice Connections - Patient Centered Medical
    Home (PPC-PCMH). MCNT was  the first
    multispecialty group practice in the Dallas-Fort
    Worth Metroplex to receive such distinction.

9
  • The new PCMO processes which took over 18 months
    to develop and implement in the EHR.
  • The new system sports a fully interoperable EHR,
    allowing MCNT to connect with other physicians
    and hospitals throughout North Central Texas
    through a Fort Worth-based Health Information
    Exchange (HIE).
  • The result of the massive overhaul?Much better
    care at a significantly lower cost.

10
A New Chapter
  • While MCNT has earned wide recognition and
    numerous awards, the organization is poised to
    continue their momentum in quality of care and
    cost of care leadership.
  • They want to use a lets work together and WIN
    together approach with large self-insured
    businesses.
  • By focusing on the goal high quality, low cost
    health care, they can help employers lower
    healthcare costs. They do it by reducing acute
    care admissions and preventable costs.

11
  • Self-insured employers (also known as
    self-funded healthcare) provide health
    insurance benefits to employees, and pay for
    claims from their own coffers instead of paying
    premiums to a traditional insurance provider.
  • Major employers that self-insure report 
  • Less employer and employee contribution
  • Lower major medical premiums
  • Greater plan flexibility with less risk
  • Better employee benefits
  • Higher employee satisfaction  

12
  • MCNT intends to drive down health care costs and
    improve quality of care for self-funded employers
    so they achieve even greater value from their own
    programs 
  • Improve the healthcare delivery process
  • Experience higher patient satisfaction
  • See measurable improvements in provider
    care and performance
    visibility
  • Lower chronic and in-patient costs
  • Experience higher employee productivity
  • Improve working capital and operating margins

13
The New Evolution
  • Its a new approach for employers, but one that
    creates a sustainable cycle to expand quality,
    drive down cost, and build value. 
  • The cycle begins with population health
    stratification, and continues with chronic care
    management, and care coordination. Incentive
    management closes the loop and launches a new
    cycle.

14
POPULATION STRATIFICATION
  • MCNT realized that actuarial, claims-based
    analysis of patient risk simply doesnt help the
    provider.
  • To eliminate discord and create risk model
    consensus, MCNT developed a new way to measure
    State-of-Health using clinical data from their
    EHR system.
  • For each individual, MCNTs State-of-Health
    analyzer calculates the risk or likelihood that
    the patient will be admitted to an acute care
    facility (IP, ER) in the near future due to a
    complication from chronic conditions.

15
  • According to Ms. Kennedy, MCNT wants to help
    individuals and employers bend the healthcare
    cost curves. The only way to do that is to help
    prevent patients with moderate risk evolving into
    high risk chronic conditions, and help chronic
    patients manage conditions so that they dont
    experience crisis.

16
  • MCNTs State-of-Health (SOH) analyzer
  • Calculates a State-of-Health score for each risk
    chronic condition for each patient based on
    clinical EHR data
  • Enables physicians to understand causal clinical
    factors for each incident of a high risk score,
    in order to diagnose and manage clinical
    parameters, and lower risk scores by chronic
    condition

17
  • Gives clinical teams and care coordinators the
    right information to design and execute
    patient-specific care plans
  • Allows MCNT and employer management teams to
    understand trends over time, and measure the
    effectiveness of care management programs and
    evidence-based best practices.
  • Allows employer and MCNT to develop health
    prevention/maintenance programs for their
    specific populations.

18
  • MCNT developed its new patient risk scoring
    system in partnership with VitreosHealth, a
    healthcare population analytics company based in
    Allen, Texas.
  • Over a 18-month period, MCNT clinical teams,
    physicians, and administrative leadership worked
    with VitreosHealth to develop State-of-Health
    (SOH) risk models for the major chronic
    conditions that comprise 90 of employers costs
    diabetes, CHF, CHD, COPD, asthma, osteoporosis
    and hypertension.

19
TRANSPARENCY
  • Employers that work with MCNT will discover that
    cost transparency, clinically-based risk models,
    and predictive modeling combined with
    evidenced-based care helps them control and
    minimize health care costs to unprecedented
    levels.
  • By analyzing risk groups, MCNT can monitor how
    much employers spend on in-patient and outpatient
    care, understands the quality of care in relation
    to the cost, and identifies program needs based
    on population clinical profiles.

20
CARE COORDINATION
  • Using their 24X7, Medical Home model, MCNT has
    created care teams comprising of care
    coordinators and physicians.
  • These teams use the state-of-health scores to
    identify highest risk employees, and they create
    a customized plan for each high risk individual.
  • MCNTs care coordination approach helps employers
    reduce avoidable hospital admissions and
    readmissions, and contribute to even greater
    bottom line savings for self-insurers.

21
INCENTIVE MANAGEMENT
  • The ability to accurately calculate, quantify,
    and report program results is unique to MCNT.
  • Their approach to performing what-if analysis
    for evidence-based care and wellness programs
    ensures that employers focus on and solve the
    right health care problems, and create the right
    wellness programs for their unique population
    mix. 

22
  • MCNT is passionate about their unique gain-share
    model for self-insured employers that
  • Enables employers to thoroughly analyze and use
    historical claims data to establish baseline
    costs
  • Delivers employee health risk assessments and an
    accurate state-of-health model
  • Provides employee-centric healthcare management
    programs
  • Reports monthly and/or quarterly healthcare cost
    and quality metrics 

23
A NEW APPROACH
  • MCNT helps employers take a more active role in
    their employees health with population health
    performance mapping and establishing optimal
    preventive care levels.
  • MCNT also improves access to care to employees
    through
  • Electronic patient portal
  • Extended clinic hours
  • Follow ups
  • On site clinics
  • Same day appointments  

24
  • Using State-of-Health scores to understand
    population risk for major chronic conditions like
    hypertension and diabetes, MCNT can design
    specific programs with a focus on prevention and
    helping employees with health goals.
  • As preventable hospitalizations and frequent
    unnecessary ER visits decline, employee
    productivity goes up. In addition, as
    interventions are timely Length of Stay (LOS) per
    acute care admission is significantly lower.

25
Evolution or Revolution? 
  • In many industries, the cost of healthcare has
    surpassed the cost of producing the goods and
    services companies sell.
  • This phase in MCNTs evolution has become
    revolutionary for those employers that wanted to
    lower healthcare costs.
  • MCNT intends to do their part to help self-
    insured companies in North Central Texas and
    their employees keep healthcare costs down and
    quality of care high. 
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