Patient-Centered ACO WELCOME
Methodist Health System $1.17 Billion in net revenue in 2014. Provided more than $135.8 million in unreimbursed charity care in 2014, 11.6% of net revenue. 471,376 patient visits. 224,464 emergency department visits. 47,514 patient discharges (non-newborn). 8,193 babies delivered. 112 Transplant cases (kidney, pancreas, liver). 28 Family Health Centers 1,128 active physicians. 1,177 licensed beds. Overall quality and clinical outcomes rank in the top quartile in the nation.
Relationship of MPCACO and Other Projects Forward Health Partners Methodist Patient Centered ACO CatalystHealth Network Medicare Shared Savings Project (MSSP) 2011 4 Clinical Integration Projects 2013-2015 Cigna CAC Future projects 15,000 lives 100 physicians 5,000 lives
Our Success The MPCACO is one of the first MSSPs in North Texas, and the only one that has been financially successful under MSSP. 220-262 Providers in the MPCACO 2012- present 15,000/ 22,000 Attributed beneficiaries/total beneficiaries 1 MPCACO received shared savings in the first year $12.7 million METHODIST PATIENT-CENTERED ACO 4
MSSP Financial Performance Savings is split between CMS and MPCACO (less sequestration) MPCACO $12.7 million Top Quartile Quality Performance! 53 MSSPs saved $652 million PY 1 220 MSSPs completed PY 1 5
Core Competency #1=Data Analysis/Spend Identification
Performance Year 1 Financial Results Savings in many areas 12,260 total beneficiaries as of Q3 2013
Utilization Results Oct 2012 Sept 2013 Oct 2013 Sept 2014 Decrease Admissions per 1,000 413 386 (6.5%) ED visits per 1,000 463 456 (1.5%) Avoidable admissions 12% 10% (16.7%) Overall PMPM $1298 $1259 (3.0%) Based upon claims data received as of 1/31/2015
Core Competency #2=Post acute Quality Provider Network
Skilled Nursing Facility and Home Health Initiatives Quarterly meetings Collaborative discussions Data review and discussions Quality measures Lists published 2 x year Measures evaluated annually Distribution to stakeholders Monthly score card survey Post Acute Liaison Transition medication pilot 10
Skilled Nursing Facilities Criteria: Received three, four and five star rating by CMS (CMS star rating verified 2/04/2014) Readmissions <30% for August December 2013 Name Address 1 City Closest Campus The Laurenwood Nursing & Rehabilitation 330 W.Camp Wisdom Rd Duncanville Charlton Windsor Gardens 2535 West Pleasant Run Lancaster Charlton Autumn Leaves on White Rock Lake 1010 Emerald Isle Dr. Dallas Dallas Christian Care Center 1000 Wiggins Pkwy Mesquite Dallas Juliette Fowler Homes Inc. 1260 Abrams Rd. Dallas Dallas The Carlyle at Stonebridge Park 170 Stonebridge Lane Southlake Dallas The Traymore Nursing Center 4315 Hopkins Avenue Dallas Dallas The Villa at Mountain View 2918 Duncanville Road Dallas Dallas Grace Presbyterian Village 550 East Ann Arbor Avenue Dallas Dallas/Charlton Arbrook Plaza 401 W. Arbrook Blvd. Arlington Mansfield Parkwood Healthcare 2600 Parkview Lane Bedford Mansfield The Harrison at Heritage 4600 Heritage Trace Pkwy Fort Worth Mansfield Baybrooke Village 8300 Eldorado Pkwy McKinney Richardson Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie Richardson Plaza at Richardson 1301 Richardson Dr. Richardson Richardson Prairie Estates 1350 Main Street Frisco Richardson Premier Transitional Care Hillcrest 18648 Hillcrest Rd. Dallas Richardson Rockwall Nursing Center 206 Storrs Street Rockwall Richardson San Remo 3550 Shiloh Road Richardson Richardson Settlers Ridge Care Center 1280 Settlers Ridge Road Celina Richardson Signature Pointe on the Lake 14655 Preston Road Dallas Richardson The Belmont at Twin Creeks 999 Raintree Circle Allen Richardson The Legacy at Preston Hollow 11409 Park Central Pl. Dallas Richardson The Legacy at Willow Bend 6101 Ohio Dr. Plano Richardson The Madison on Marsh 2245 Marsh Lane Carrollton Richardson Walnut Place 5515 Glen Lakes Dr. Dallas Richardson/Dallas Renfro Healthcare 1413 W. Main St Waxahachie Charlton Brentwood Place Two 3505 S Buckner Blvd, Bldg 3 Dallas Dallas Brentwood Place Four 3505 S Buckner Blvd, Bldg 5 Dallas Dallas Premier Transitional Care of Dallas 6825 Harry Hines Blvd Dallas Dallas The Manor at Seagoville 2416 Elizabeth Lane Seagoville Dallas Emerald Hills 5600 Davis Blvd North Richland Hills Mansfield Lakewood Village 5100 Randol Mill Rd Fort Worth Mansfield Matlock Place Health Rehab 7100 Matlock RD Arlington Mansfield Senior Care of Green Oaks 3033 W Green Oaks Blvd Arlington Mansfield Kindred Hospital Dallas "Subacute Unit" (Hospital Based SNF) 9525 Greenville Ave.-2nd fl Dallas Richardson/Dallas Lindan Park Care Center 1510 N. Plano Rd. Richardson Richardson Remington Medical Resort of Richardson 1350 E. Lookout Dr. Richardson Richardson The Gardens of Richardson 1111 W. Shore Drive Richardson Richardson Red Oak Health & Rehab 101 Reese Drive Red Oak Charlton Brentwood Place One 3505 S Buckner Blvd, Bldg 2 Dallas Dallas Kindred- Mansfield Plaza 301 N. Miller Mansfield Mansfield Ridgeview Rehab and Skilled Nursing 206 Walls Dr Cleburne Mansfield Senior Care of Crowley 920 East FM 1187 Crowley Mansfield Villages of Lake Highlands 8615 Lullwater Drive Dallas Richardson/Dallas Winters Park Nursing & Rehabilitation 3737 N. Garland Ave. Garland Richardson
Home Health Agencies Criteria all to be within 5% of the National Standard Begin patient care within 24 hours Medication teaching Wound improvement after operation Unplanned return to ER Readmission Home Health Agencies- Meeting Criteria Advocate Home Healthcare Affordable Home Health Aiding Home Health, LLC Amedisys Home Health--Cleburne Attentive Home Health Bethany Healthcare Services Bridgeway C.O.E. Home Health Care South Homecare Encompass Home Health of Greater Dallas Family Care of Texas Girling Health Care Guardian Healthcare Haven Home Health LLC Home Health Services of Dallas Infinite Care Home Health IntegraCare - Bedford Jordan HH (Waxahachie) Methodist HomeCare MultiCare Nurses Noblecare Home Health Services Pinnacle Home Health Rehab at Home Healthcare Services SPIRIT HOMECARE Sunrise Home Health Texas Health Homecare TheraCare of North Texas Trinity Home Health Care
Core Competency #3=Risk Stratification and Navigation Resource Matching
Risk Stratification
Population Health Management: Nurse Navigation More than 50% of the cost Inpatient/ER census Crimson risk scores Physician referrals Case management referrals Individual assessments High Risk Group >400 Level 6-1% to 3% Level 5-5% to 7% The rest of the cost Active Patient Panel 13,400 Level 3 and 4-40% to 50% Levels 1 and 2 -The Rest
Navigator Program Benefits: Coordinated Patient Care A team of RNs and care professionals is available to support physicians in coordinating care across the continuum. CARE CONTINUUM CARE RESOURCES = RN * METHODIST PATIENT-CENTERED ACO 16
Nurse Navigation Risk stratification of entire population Nurse navigation based upon medical complexity Personalized navigation: Work collaboratively and maintain active communication with physicians, nursing, and other members of care team to execute against care plan Ensures that the plan of care and services provided are high quality and cost effective After hours/complications action plan Attend physician visits, communicate between visits Phone and in person following during transitions of locations Medication reconciliation during transitions Advanced directive Social services
Measuring Effects Total Members 17 Source: Crimson Population Risk Management Claims information through November 2013
Patient Benefits: Case Study What the MPCACO beneficiary care navigators did for me was to help me be able to return home confidently by myself after a prolonged hospital stay. I don t think I would have been able to do that without them. JUDITH JORDAN PATIENT METHODIST PATIENT-CENTERED ACO 19