Memorial Hermann ACO Creation


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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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  • Homerun page 8
  • Patient Retention
  • Home Run
  • Questions
  • Home run balanced score card
  • Memorial Hermann ACO Creation

    1. 1. TEAM 29James Cervantes Anthony Hopper Jessica Jacobs
    2. 2. 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
    3. 3. Why we have to change STRENGTHS WEAKNESSES • Positive Margin • Variable financial performance • Full Range of Facilities • Numerous, Small IPAs • High Level of Health IT adoption • Nascent Health IT in provider offices • Nationally Recognized QI • Undefined HIE OPPORTUNITIES THREATS • Large Medicare/Medicaid Population • Ambiguous ACO requirements • Choice Primary Care Physician Lock-In • Start Up Costs/Reimbursement • Recruiting Advantages • Texas Physician Employment Law Supplement: 8-15
    4. 4. Competitor Profile Supplement: 8
    5. 5. Memorial Hermann Why we have to change Where we are going How we will get there How we will know we are there
    6. 6. Culture & Core Values BREAKTHROUGHS EVERY DAY 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 Supplement: 18-20
    7. 7. Patient Support Access Information Eligibility Patient Clinical Billing Care Home Care Supplement: 29-32
    8. 8. Memorial Hermann Why we have to change Where we are going How we will get there How we will know we are there
    9. 9. Critical Issues & Areas Operational Quality• Strategy and • Financial Direction Considerations • Provider Support • Health• Organization and • Risk Management Governance • Patient Advocacy Information Technology • Quality Improvement Organizational Financial Supplement: 16-17
    10. 10. Organizational Design Supplement: 22-29
    11. 11. Provider Support Supplement: 22-24, 33-34
    12. 12. Financial ManagementPatient Budget Performance PaymentAttribution Development Monitoring Plan Incentive Plan • Provider • Baseline • Reporting • One-Sided Enrollment Historical plan which Shared • Patient Risk Data compares Savings Plan Management • Trend actual costs Estimates to the budget • Adjustments Supplement: 36-41, 61-85
    13. 13. Legal Risks 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 Supplement: 39-40
    14. 14. The CQI System• Triple Aim • High-quality Patient Identification • Cost-effective • Southeast Texas Performance Concurrent Oversight and Review Accountablity population• Patient Advocacy Quality Tools for Improvement Frontline Staff Teams Supplement: 45-49
    15. 15. Quality Dashboard Supplement: 49
    16. 16. The Health IT System Acute EMR mHealth GIS Mapping PHR HIE Amb. EMRSupports: Quality Improvement, Patient Throughput, and Revenue Cycle Management Supplement: 42-44
    17. 17. Memorial Hermann Why we have to change Where we are going How we will get there How we will know we are there
    18. 18. Implementation Plan Implementation Issue Start Date End Date Responsible Entity O1. Define Mission Vision and Values for the CCO/Provider Support Whole Organization Jun-10 Feb-11 Services O2. Develop Program that helps members CCO/Provider Support achieve the MVV Mar-11 Apr-11 Services Organizational Design O3. Develop Human Resources Evaluation tool CCO/Risk Management for all staff members to encourage ACHIEVE Apr-11 May-11 O4. Get stakeholder buy in to reorganize the CCO/CEO board of directors. Feb-11 Mar-11 O5. Facilitate discussion between “primary CMO care” and “specialist” based physicians. Jan-10 Jun-10 O6. Engage community stakeholders to gain an CSO understanding of actual community need. Jan-10 Jul-10 O7. Query Faculty governance members CSO regarding their organizational structure. Jun-10 Aug-10 Supplement: 50-51
    19. 19. Implementation Plan C3. Continual Monitoring Plan F3. Physician Reimb. F6. Facilities & Providers OM 3. Provider Undestanding C4. EHR Adoption Tool OM 10. Patient Advocacy Training OM 7. Provider Enrollment OM 8. Staff Enrollment OM 9. Quality/IT Training O4. Board of Directors O3. HR Eval Tool C2. Educate QI Plan C7. HIE Records O2. MVV Program C 10. PHR C1. QI Plan Design C5. MPI Assignment C6. Provider IDS C8. mHealth C9. RCM F 1. Patient Assignment F2. PMPM Review F4. Third Party Payers F5. Claims Processing F7. Incentive Possiblities F8. Contracting Law F9. Org. Legal Issues OM 5. Care Coordination O1. Define MVV O6. Engage Community Stakeholders O7. Faculty Engagement OM 6. RCM Training O5. MHMD Communications OM 1. Recruitment and Staffing OM 2. Preferred Products 2010 2011 2012 2013 2014 2015 Supplement: 52
    20. 20. Critical Areas Dashboard Supplement: 47- 53
    21. 21. The Model Supplement: 18-21
    22. 22. Memorial Hermann We Welcome Your Questions