2010 03-02 shared savings model - marillac and st. mary's hospital

A SHARED SAVINGS MODEL: Marillac Clinic and St. Mary’s Hospital March 2, 2010 Steve Hurd - [email_address] David West - [email_address]

Alignment
Identical Mission and Values
Same Sponsor - Sisters of Charity Leavenworth Health Systems
Independent Boards of Directors
Independent Audits

LOCATION, LOCATION, LOCATION Marillac Clinic St. Mary’s ER

Marillac Clinic: A Medical Home for the Uninsured
C ommunity-funded S afety N et C linic
(A CSNC not a FQHC or Free Clinic)
Mesa County residents
At or Below 250% of FPL

Marillac Revenue Sources

St. Mary’s Contribution
Total $1,350,000
Cash $ 375,000
In-Kind* $ 975,000
*Building, Utilities, IT Support, Environmental Services, Security

Marillac Clinic 2009
Annual Budget $7,500,000
Patient Panel 7,650
Visits 29,300
FTE 78
Open Access Appts 25%
CPT Billing 0

The Medical Home Motto: “ The right care, at the right place, at the right time.”

Five Lines of Service - All Under One Roof
Medical
Mental Health
Dental
Optical
Low Cost Medication
Marillac’s Model No Wrong Door

Guiding Principle Meeting several patient needs in one visit results in greater efficiency for both patients and providers .

Corollary Principles
Psychosocial issues patients bring to their medical visit are as essential as their biological concerns.
The Medical Home addresses the psychosocial determinants of health through close collaboration within the human service community.

Inter-agency Referral Agreements for the Uninsured Marillac Clinic Human Service Agencies Lab and Radiology Hospital Based Care Specialty Care

Referral Resources
150 Specialists  Sliding scale
Lab & Radiology  Sliding scale
ER Care  Sliding scale
Inpatient Care  Sliding scale

Hospitalist Relies on:
Predictable response from Marillac triage nurse
Open access for post-hospital appts
Marillac to address psychosocial issues that lengthen inpatient stay

Steps to Medical Efficiency
Not for profit hospitals, home health, hospice, health plans, and physician groups
Working together on community problems
Cooperation for caring for the uninsured via Marillac Clinic
Data – Medical records, communications, and open knowledge concerning costs

Characteristics of Medical Homes that Improve Quality and Reduce Cost
Primary Care –continuing and comprehensive
Hospital, office, nursing home, and emergency room
Hospital care – ER, OR, OB, and medical wards
Availability or after hours care via telephone or clinic
Data Driven
Feedback on patient care and patient costs
Quality Health Network
Observations
Favorable Ratio of Family Physicians: Patient Panels
Comprehensive care allowed by favorable liability climate

Other Considerations to Successful Medical Homes in Grand Junction
Relentless emphasis on quality
End of life care – Hospice
Accessibility of care – high cooperation among hospital, Marillac, residency program, health department, and specialists
Cost awareness
Physician leadership

Physician Competitiveness
Be the best – surgeon, primary care physician, subspecialist – by expense data
Be the best quality
Be the best efficiency
Be the best with measurable parameters – health screenings, vaccinations, length of stay, cost per procedure, and overall care of a panel of patients

Aligning Incentives Produces Savings Marillac Clinic Human Service Agencies Lab and Radiology Hospital Based Care Specialty Care Our Shared Patients

Leadership Alignment
CEOs of St. Mary’s and Marillac Clinic meet monthly
Marillac CEO presents to St. Mary’s Board of Trustees annually
Member of Hospital Senior Leadership Team serves on the Marillac Board of Directors

Clinical What care is called for? Is it high quality? Operational What will it take to accomplish care? Is it well executed? Financial How will care best use resources? Is it a good value? C.J. Peek (2008) . Planning Care in the Clinical, Operational and Financial Worlds. Chapter in Collaborative Medicine Case Studies: Evidence in Practice . R. Kessler & D. Stafford (eds.) Springer

Clinical Alignment
Marillac Medical Director meets regularly with Medical Leadership of SMH Emergency Dept
Marillac Medical Director meets regularly with St. Mary’s Hospitalists
Marillac Medical Director follows up with specialists if referral develops a glitch

Operational Alignment
At the conclusion of their ER visit, eligible uninsured patients contact MC for a follow-up appointment
Discharge planning at St. Mary’s Hospital arrange post-hospital follow-up with MC triage staff

Financial Alignment
An identical process is used to determine a patient’s place in the sliding scale
Data scanned between the two organizations eliminates duplication – enhances the patient experience

OUTCOMES

Utilization of ER and Inpatient Services by Marillac’s Integrated Care Patients 2000 - 2004

Financial Outcomes Inpatient Charges for Uninsured Patients Marillac Average 28% Lower Marillac Average 11% Lower $30,596/stay $24,493/stay N - 1029 N - 940 Non-Marillac $27,596/stay $19,078/stay N - 220 N - 209 Marillac 2009 2008

2009 Clinical Utilization of ER
Acute Pharyngitis
Strep Sore Throat
Ankle Sprain
Suture Removal
Pain in Limb
Flu Symptoms
Otitis Media
Seven of the top 20 diagnoses occurring for uninsured non-Marillac patients not present in the Marillac Clinic cohort.

OTHER SUCCESSES
Marillac patients presented at the ER for Dental Disorders NOS at one-third the rate of other uninsured patients
Marillac patients presented at the ER for Alcohol Abuse NOS at one-half the rate of other uninsured patients

CHALLENGES
Some Marillac patients remain high utilizers of the ER:
Chronic Pain
Alcohol Abuse

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2010 03-02 shared savings model - marillac and st. mary's hospital

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