Physician Governance
Memorial Hermann
and its
Physician Network
D. Keith Fernandez MD
President and Physician in Chief MHMD
CMO Memorial Hermann ACO
Agenda
 Overview of Memorial Hermann Health System and MHMD
 Building Physician Governance
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Establishing a common understanding of current issues
Establishing a common, believable vision for the future
Education
The Compact
The Physician Board
The Hospital System Board
Role of the Medical Executive Committee
Governance of Quality, Safety and Cost
 Results
2
Memorial Hermann Health System
MHMD

 3500 practicing physicians
 2000 Clinically Integrated
 1850 CI physicians in MHACO
 300 Advanced Primary Care
Practices (PCMH)
 250 additional PCPs
 Evolving High Performance
Specialty Physicians (250500)
 150 of the 2000 are
employed (MHMG)
University of Texas Physicians
 800 physicians
 CI and ACO affiliates
Memorial Hermann

Second Largest Non-Profit in Texas
 6,000 practicing physicians
 10 Acute Hospitals, 3 Heart &
Vascular Institutes
 Children’s & Rehabilitation
Hospitals
 100 Outpatient Sites: Ambulatory
Surgery, Imaging
 Sports Medicine, Neuroscience,
Transplant COE’s
 The nation’s busiest Trauma
program
3
MHHS National Safety and
Quality Leadership
15 Top Health Systems;
Top 5 Large Health
Systems (2012,2013)
Healthcare’s “100
Most Wired” 7th
consecutive year
National Patient Safety
Texas Hospital Association
Leadership Award,
Joint Commission-NQF
Bill Aston Quality Award
Sponsored by VHA National Quality Forum
John M. Eisenberg
(2011)
Foundation & the
National Quality
National Patient Safety
National Business Healthcare Award (2009) & Quality Award (2012)
Group on Health (2009)
America‘s #1 Quality Hospital
for Overall Care
(2011 & 2012)
HealthGrades®
 America’s 50 Best Hospitals
(2010, 2011 & 2012)
 Distinguished
Hospital for Clinical
Excellence (2011)
2011 Texas Healthcare
Foundation Quality
Improvement Awards
(9 Memorial Hermann
Campuses)
Strategic Vision
transformation of medical practice
collaboration with patients, payors
and caregivers
use of evidence-based medicine
culture of physician accountability
quality, safety and cost efficiency
populations
5
Clinical Integration
Establishing a foundation to work together:
Clinical Integration is…
Integration of Physicians with each other (and often
with a hospital or hospital system) on a clinical basis
to
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
Determine the right and best ways to practice medicine
Commit to practice that way
Commit to mutual accountability
Develop active performance improvement programs to enhance
healthcare quality and efficiency
6
MHMD UNIVERSITY at Rice
20 Physicians
10 Administrators
10 Days over 5 months
Team project
Certificate Program
Rice, National and Local Leaders
Establishing Infrastructure
MHMD Board
CPC
Pathology
Radiology
Evidence
Based Med
Medicine
Critical Care
MIC
Nephrology
AMIC
Heme/Onc
Editorial
Allergy
EQC
Hospital
Documentation
Gastro
Infectious
Disease
System
Quality
Board
Membership
Physicians
Pediatrics
Primary Care
Trauma
Emergency
PM&R
Peer Review
(APPs)
(APCPs)
2 per campus
Selected, not voted
CardioWomen and
Surgery
Vascular
Reviewed CEPC
yearly Orthopedics
Children
services
GeneralNurses
Bariatrics
Supportive
Cardiology
Neonatology
Surgery
Vendor TF
Methods
Executives
ENT
NSQIP
CV Surgery
Ob/Gyn
Care Givers
Outsiders
Robotics
Anesthesia
VotingPSH
Pain
All members
VTE
Not all Clinic
attendees
Diabetes
Trauma
8
MHMD Physician Governance
System
Quality
Board
MHMD Board
CPC
Hospital
Medicine
Clinics
Hospital 1
Hospital 2
Hospital 3
Hospital 4
Palliative
Care
Advanced
Primary Care
Region 1
Region 4
Region 2
Region 5
Region 3
Region 6
Hospital
Peer
Review
Credential
Advisory
Aging
Hospital 5
Hospital 6
Hospital 7
9
Connecting the Board
“Up and Over”
BOARD SYSTEM
QUALITY COMMITTEE
MHMD Board of Directors
Clinical Programs Committee
Critical Care
Surgery
Med Staff
Hospital MECs (10)
Medicine
10
11
The Advanced Primary Care Practice:
Quality and Contracting Engine
Claims
Files/Data
Advanced Primary Care
Practice
Single
Case
Signature
Management
Contracting
Access
Marketing
HCC
Training
Document
Training
Quality
Metrics
Patient
Education
Schedule
NOW
Patient
Portal
e
Notify
NCQA
Level 3
Practice
Assessment
Electronic
Medical
Record
Point
Of
Care Tool
Health
Information
Exchange
Quality
Technology
Accountable Care
Clinical Integration
12
MHMD High Performance
Network
GNE Project
Memorial Hermann
Physician Partners
DocBook
Concierge
Doc to Doc
Text
Access
Embedded
CM
Symptom
Control
MU
University
MHMD
University
Reputation
Control
Online
CME
Patients
Group
Purchasing
Liability
Insurance
Innovation
Practice
“Transform”
Report
Cards
NEXT?
Quality
Technology
Accountable Care
Clinical Integration
13
Right Care Right Time
Healthy
Sick
Wellness and Prevention
Life in Balance
•
•
•
•
•
•
Telemedicine
Digital Apps
E Medicine
Virtual Medicine
Fitness
Retail Partner(s)
Chronic Disease Mgmt
Palliative Care
Hospice
Amb ICU
Patient Centered Medical Home
Community
Health
Telephonic Care Management
Integrated Care Management
14
APCP Membership Requirements
• Participants agree to report
metrics, work gap reports,
work collaboratively with
care managers
• In network utilization when
it advances accountable
care in improving quality
and cost
• Agree to report and share
data
• Agree to be held
accountable for quality and
cost of patient care
• Must progress to NCQA
recognition within one year
of joining APCP
• Must be on a preferred EMR
• Participate in coding
training within 3 months of
joining
• Sign agreements for CM
access and MHiE
• Connect to MHiE within
year of joining
• Attend regional meetings
(75%)
15
Information and Trust
16
Specialists
18
19
Certified Zero Awards
20
Early Success
Edge
Clinically Integrated, Proven Results
$12,000
$10,770
$11,000
$9,910
$10,000
$9,190
$9,000
$8,444
Actual/Projected
PEPY Claims Cost
$9,328
$8,869
MHHS Trended
PEPY Claims Cost
52 million in savings over 4 years
$8,000
$7,000
$7,747
$8,569
$8,008
$7,664
$7,162
$7,725
$7,162
$7,162
$7,076
$7,408
$7,672
$8,071
$6,000
FY 2010
21
FY 2011
FY 2012
FY 2013
Projected FY Projected FY
2014
2015
National Trended
PEPY Total Claims
Cost
Efficiency and continuous improvement are critical to long
term ACO success
Memorial Hermann is more efficient than the market
Inpatient
Days/
1000
208
Average
length of
stay
3.5
Readmission
rates
236
13%
better
3.9
11%
better
10.5%
Less in Cost
ER visits /
1000
Memorial Hermann
5.1%
6.0%
164
180
Memorial Hermann’s continuous improvement efforts
are significantly reducing common complications
Diabetes Measures
Diabetics with
Hemoglobin A1c
Control (<8 percent)
2013
2014
60.20% 72.38%
11.3%61.40% 70.76%
TobaccoLess
Non-Use in Cost
68.30% 77.62%
Blood Pressure (BP) <
140/90
18%
better
8%
better
Houston market
22
Aspirin Use
49.40% 86.90%
Diabetics with HbA1c
in poor control (>9
percent)
32.60%
7.22%
MHACO and the MSSP
Domain: At Risk Population - 25%
2013 Collection 2014 Collection
Projected
Percentile
Subdomain: Ischemic Vascular Disease
% beneficiaries w/ IVD w/ complete lipid profile &
LDL control < 100mg/dl (ACO-29)
27.60%
50.2%
40+
Percent of beneficiaries who use Aspirin or other
antithrombotic (ACO-30)
63.00%
76.48%
50+
91.00%
88.89%
80+
Percent of beneficiaries with CAD who met all of the
following criteria:
52.50%
65.15%
80+
Drug Therapy for Lowering LDL-Cholesterol (ACO-32)
65.00%
76.73%
80+
ACE Inhibitor or ARB Therapy for Patients w/ CAD &
Diabetes &/or LVSD (ACO-33)
54.00%
70.24%
50+
Subdomain: Heart Failure
Beta-Blocker Therapy for LVSD (ACO-31)
Subdomain: Coronary Artery Disease
Top MSSP ACO Savings
ACO
States
Total Savings
ACO Share
TX
$57.83 M
$28.34 M
FL
$39.57 M
$19.34 M
NY
$27.92 M
$13.68 M
MI
$24.68 M
$12.09 M
RGV ACO Health Providers, LLC
TX
$20.24 M
$11.90 M
ProHEALTH Accountable Care
Medical Group, PLLC
NY
$21.91 M
$10.74 M
Triad Healthcare Network, LLC
NC
$21.51 M
$10.54 M
WellStar Health Network, LLC
GA
$19.88 M
$9.74 M
Accountable Care Coalition of
Texas, Inc.
TX
$19.10 M
$9.36 M
Memorial Hermann Accountable
Care Organization
Palm Beach Accountable Care
Organization, LLC
Catholic Medical PartnersAccountable Care IPA, Inc.
Southeast Michigan Accountable
Care, Inc.
MHACO and the MSSP
Performance
Year 1
Performance
Year 2 *
Performance
Year 2*
Final
Results
Scenario 1:
100% Quality
Senario 2:
Using 2013 Quality Results
Assigned Beneficiaries
34,430
38,834
38,834
Historical Benchmark
11,742
12,246**
12,246**
Total Expenditures per Assigned
Beneficiary
12,907
10,737
10,737
100% Reporting
100%
82.8%***
Total Savings Generated
$57,834,092
$58,600,506
$48,521,219
MHACO Potion of Savings
$28,338,705
$29, 300,253
$24,260,609
Quality Score
Final Results will be Impacted by:
-4Q2014 lives attributed
-Quality scoring
-Risk adjustment to baseline
*Source: Medicare Shared Savings Program Performance Year 2, 3Q2014 Report.
**May be risk adjusted in future in final results.
***Based on 2013 Quality outcomes with PY2 quality parameters applied.
25
Top MSSP ACO Savings
ACO
States
Total Savings
ACO Share
TX
$57.83 M
$28.34 M
FL
$39.57 M
$19.34 M
NY
$27.92 M
$13.68 M
MI
$24.68 M
$12.09 M
RGV ACO Health Providers, LLC
TX
$20.24 M
$11.90 M
ProHEALTH Accountable Care
Medical Group, PLLC
NY
$21.91 M
$10.74 M
Triad Healthcare Network, LLC
NC
$21.51 M
$10.54 M
WellStar Health Network, LLC
GA
$19.88 M
$9.74 M
Accountable Care Coalition of
Texas, Inc.
TX
$19.10 M
$9.36 M
Memorial Hermann Accountable
Care Organization
Palm Beach Accountable Care
Organization, LLC
Catholic Medical PartnersAccountable Care IPA, Inc.
Southeast Michigan Accountable
Care, Inc.
26
2013 National MSSP
Performance
MHACO –
82.8%
Aggregate Increased Utilization
Increase in
In-Network Utilization
Estimated Financial Impact
Aggregate Increase in
In-Network Utilization
2.3%
$ 6,500,000
Facility Inpatient
1.7%
$ 4,870,000
Facility Outpatient
0.5%
$ 1,450,000
Physicians
0.1%
$150,000
Home Health
0.0%
$ 30,000
28