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

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






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  • Q&A--Larry
  • Mesa County residents with a household income at or below the 200% of FPL Services include: Primary care Mental health care Medication outlet Vision care Dental care
  • Q&A--Larry
  • Steve

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

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