Memorial Hermann –
Texas Medical Center
Brian Dean, MPH, MBA
VP, Chief Financial Officer
Interim Chief Executive Officer
Agenda
• System and Hospital Background
• Organizational Alignment
• Value-Based Purchasing Strategies
SYSTEM AND HOSPITAL
BACKGROUND
One Memorial Hermann
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PPO License acquired 2011
HMO License 2014


12 Hospitals
211 locations
Over 320,000 covered lives

4,000 + physician members

Nearly 200 employed physicians
4

Over 1,000 physicians
Pluralistic Approach
11 Independent
Medical Staffs
3 Distinct
Practice Models
Private
Employment
Faculty
5
Clinical Integration
MHMD Physician Governance
MHMD Board
MHMD - One of the nation’s
largest, integrated physician IPA
models
Pathology
Radiology
CPC
Trauma
Evidence
Based Med
Medicine
Emergency
Surgery
MIC
General
Surgery
Bariatrics
Nephrology
AMIC
ENT
NSQIP
Heme/Onc
Editorial
Robotics
Anesthesia
Allergy
EQC
Hospital
Documentation
Infectious
Disease
PM&R
CEPC
Critical Care
Gastro
Clinical Integration=
Protocols, Performance
Tools, Payment, Programs
PSH
Orthopedics
Supportive
Methods
Pediatrics
(APPs)
Peer Review
Vendor TF
CardioVascular
services
Primary Care
(APCPs)
Women and
Children
Cardiology
Neonatology
CV Surgery
Ob/Gyn
Pain
Clinic
VTE
Diabetes
Trauma
6
MHTMC
General Description
• Flagship Academic Campus of the Not for Profit Memorial Hermann
Health System
• Memorial Hermann-Texas Medical Center was the first hospital to open in
the Texas Medical Center - 1925
• Primary teaching hospital for The University of Texas Medical School at
Houston
• Offers comprehensive, specialized care:
–
–
–
–
–
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Children’s Memorial Hermann Hospital
Mischer Neuroscience Institute
Memorial Hermann Heart and Vascular Institute
Memorial Hermann Texas Trauma Institute
Memorial Hermann Ironman Sports Medicine Institute
Memorial Hermann Clinical Innovation and Research Center
MHTMC
By the Numbers…
•
36,000 Admissions
•
4,700 Deliveries
•
67,000 ER Visits
•
32,000 Surgeries
•
3,000 Life Flight® Air Ambulance
Missions
•
1,098 Licensed Beds
•
10 Specialized ICUs
•
Approximately 5,500 Employees
•
1,600 Medical Staff
•
2.0864 Case Mix Index
•
Annual Net Revenue of $1.3B
ORGANIZATIONAL ALIGNMENT
Healthcare as a High
Reliability Organization
Healthcare as a High
Reliability Organization
System Adult ICU CLABSI
Do No Harm
Central Line Associated Blood Stream Infections
12
February CLABSI rates not available due to ISD technical difficulties
10
CLABSI Rate per 1K Line Days
UCL = 9.42
8
6
UCL = 5.79
Mean = 5.53
UCL = 5.13
UCL = 3.86
4
UCL = 2.97
UCL = 2.55
Mean = 3.04
Mean = 2.52
Mean = 2.12
2
LCL = 1.64
Mean = 1.46
Mean = 1.17
LCL = 0.38
LCL = 0.29
2007
2009
2010
3
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3
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2
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1
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4
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3
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2
2008
Q
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1
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4
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3
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2
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3
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2006
Generated: 4/2/2012 7:45:37 AM
Source file date: 3/23/2012
Q
tr
3
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2
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1
0
2011
2012
Reporting Months
produced by S ystem Quality and P atient S afety
MH System Oversight
Leadership Incentive
• Updated monthly
• Basis of incentive compensation
• Template for Executives, Directors,
Managers
• Aligned with MH System performance
expectations
• Aligned with individual employee
performance goals
Peer Group Comparison
Physician Accountability
VALUE-BASED PURCHASING
STRATEGIES
Strategies
• Physician engagement and integration
– Clinic through hospital to post-acute
– Multiple models
– Financial incentive
• Shift to outcome-based metrics
• Transparency of data and results
– Departmental
– Physician-specific
Physician Engagement
FFY
2013
2014
2015
2016
2017
Effective
10/1/12
10/1/13
10/1/14
10/1/15
10/1/16
Risk Pool
1.0%
1.25%
1.5%
1.75%
2.0%
Safety
20%
45%
Clinical
Outcomes
25%
5%
This document is privileged and confidential Quality Committee or Peer Review work product under Hospital Committee Privilege contained in the Texas Health and Safety Code §§ 161.031 & 161.032, or Medical Peer Review
under the Medical Practice Act, Texas Occupations Code, § § 151.001 et. seq & 160.007.; and the Medical Peer Review immunity provided by federal law, the Health Care Quality Improvement Act, 42. U.S.C. 11101, et. seq.
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Shift to Outcomes
FY 13
Core
Measures
FFY14 – FFY17
Core
Outcomes
Measures
Focus was on Processes
Focus is now on Producing Outcomes
Process of Care:
• AMI, HF, Pneumonia
• Surgical Care Improvement (SCIP)
• Preventative Care
• Maternity Care
Patient Outcomes:
• Mortality Rates (AMI, HF, PNEU, COPD,
CABG, Stroke)
• Patient Safety Indicators
• Readmission Rates
• Hospital Acquired Conditions & HAIs
Patient Experience:
• HCAHPS Survey
Efficiency Measures:
• Medicare Spending per Patient
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WHAT’S NEXT?
Accelerate Physician Alignment
 Build upon existing Clinical Integration infrastructure
o Employed, Network/Community, Academic
o ACO, MSSP, 501(a)
 Align AOA Economics around Value Metrics
 Encourage Academic Partners to Leverage Health System resources
 Collaborative Planning for an Environment of Doing Less with Less