The Evolution of Physician Group from Patient Centric Medical Homes

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Evolution of MCNT from Physician Group to
Accountable Health
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The Evolution of Physician Group from
Patient-Centric Medical Home to Accountable
Health to Serve the Changing Needs of
Self-Insured Employers
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• A Quest to Achieve Higher Quality and Bend the
  Employers Healthcare Cost Curves

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• Medical Clinic of North Texas a USMD affiliate
  is a physicians' group located in Dallas. MCNT
  experienced a stellar FY 2010 performance with
  Total Medical Cost trend.
• Their managed population of 2.4 percent
  better-than-market performance was the
  culmination of various quality-of-care drivers

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The Early Years Physician Group

• In 1995 Medical Clinic of North Texas (MCNT)
  opened its doors in Tarrant County, Texas as an
  office-based  physician group practice. Today,
  the MCNT family has more than 142 primary care
  and specialists practicing in 43 clinics
  throughout North Central Texas.

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Growing Up Medical Home

• Todays concept of Medical Home began to take
  shape in the 1980s when a Honolulu-based
  pediatrician pursued new approaches to improve
  early childhood development.
• Contemporary understanding emerged in 2005, when
  the American College of Physicians developed an
  advanced model prescribing evidence-based
  medicine, clinical decision support tools,
  quality indicators, health IT, performance
  feedback, and other elements that together
  characterize the modern Medical Home.

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• Centers for Medicare Medicaid Services (CMS)
  funded the first of the Medicare Medical Home
  pilots through the Tax Relief and Health Care Act
  of 2006. 
• In 2009, MCNT piloted medical home projects with
  BCBS and CIGNA when they replaced episodic care
  with coordinated care and long-term healing
  relationships.

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• By December 2010, 29 of the MCNT clinics and
  every one of their primary care physicians had
  been awarded Level 3 Recognition by the National
  Committee for Quality Assurance (NCQA) Physician
  Practice Connections - Patient Centered Medical
  Home (PPC-PCMH). MCNT was  the first
  multispecialty group practice in the Dallas-Fort
  Worth Metroplex to receive such distinction.

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• The new PCMO processes which took over 18 months
  to develop and implement in the EHR.
• The new system sports a fully interoperable EHR,
  allowing MCNT to connect with other physicians
  and hospitals throughout North Central Texas
  through a Fort Worth-based Health Information
  Exchange (HIE).
• The result of the massive overhaul?Much better
  care at a significantly lower cost.

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A New Chapter

• While MCNT has earned wide recognition and
  numerous awards, the organization is poised to
  continue their momentum in quality of care and
  cost of care leadership.
• They want to use a lets work together and WIN
  together approach with large self-insured
  businesses.
• By focusing on the goal high quality, low cost
  health care, they can help employers lower
  healthcare costs. They do it by reducing acute
  care admissions and preventable costs.

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• Self-insured employers (also known as
  self-funded healthcare) provide health
  insurance benefits to employees, and pay for
  claims from their own coffers instead of paying
  premiums to a traditional insurance provider.
• Major employers that self-insure report 
• Less employer and employee contribution
• Lower major medical premiums
• Greater plan flexibility with less risk
• Better employee benefits
• Higher employee satisfaction  

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• MCNT intends to drive down health care costs and
  improve quality of care for self-funded employers
  so they achieve even greater value from their own
  programs 
• Improve the healthcare delivery process
• Experience higher patient satisfaction
• See measurable improvements in provider
  care and performance
  visibility
• Lower chronic and in-patient costs
• Experience higher employee productivity
• Improve working capital and operating margins

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The New Evolution

• Its a new approach for employers, but one that
  creates a sustainable cycle to expand quality,
  drive down cost, and build value. 
• The cycle begins with population health
  stratification, and continues with chronic care
  management, and care coordination. Incentive
  management closes the loop and launches a new
  cycle.

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POPULATION STRATIFICATION

• MCNT realized that actuarial, claims-based
  analysis of patient risk simply doesnt help the
  provider.
• To eliminate discord and create risk model
  consensus, MCNT developed a new way to measure
  State-of-Health using clinical data from their
  EHR system.
• For each individual, MCNTs State-of-Health
  analyzer calculates the risk or likelihood that
  the patient will be admitted to an acute care
  facility (IP, ER) in the near future due to a
  complication from chronic conditions.

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• According to Ms. Kennedy, MCNT wants to help
  individuals and employers bend the healthcare
  cost curves. The only way to do that is to help
  prevent patients with moderate risk evolving into
  high risk chronic conditions, and help chronic
  patients manage conditions so that they dont
  experience crisis.

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• MCNTs State-of-Health (SOH) analyzer
• Calculates a State-of-Health score for each risk
  chronic condition for each patient based on
  clinical EHR data
• Enables physicians to understand causal clinical
  factors for each incident of a high risk score,
  in order to diagnose and manage clinical
  parameters, and lower risk scores by chronic
  condition

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• Gives clinical teams and care coordinators the
  right information to design and execute
  patient-specific care plans
• Allows MCNT and employer management teams to
  understand trends over time, and measure the
  effectiveness of care management programs and
  evidence-based best practices.
• Allows employer and MCNT to develop health
  prevention/maintenance programs for their
  specific populations.

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• MCNT developed its new patient risk scoring
  system in partnership with VitreosHealth, a
  healthcare population analytics company based in
  Allen, Texas.
• Over a 18-month period, MCNT clinical teams,
  physicians, and administrative leadership worked
  with VitreosHealth to develop State-of-Health
  (SOH) risk models for the major chronic
  conditions that comprise 90 of employers costs
  diabetes, CHF, CHD, COPD, asthma, osteoporosis
  and hypertension.

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TRANSPARENCY

• Employers that work with MCNT will discover that
  cost transparency, clinically-based risk models,
  and predictive modeling combined with
  evidenced-based care helps them control and
  minimize health care costs to unprecedented
  levels.
• By analyzing risk groups, MCNT can monitor how
  much employers spend on in-patient and outpatient
  care, understands the quality of care in relation
  to the cost, and identifies program needs based
  on population clinical profiles.

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CARE COORDINATION

• Using their 24X7, Medical Home model, MCNT has
  created care teams comprising of care
  coordinators and physicians.
• These teams use the state-of-health scores to
  identify highest risk employees, and they create
  a customized plan for each high risk individual.
• MCNTs care coordination approach helps employers
  reduce avoidable hospital admissions and
  readmissions, and contribute to even greater
  bottom line savings for self-insurers.

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INCENTIVE MANAGEMENT

• The ability to accurately calculate, quantify,
  and report program results is unique to MCNT.
• Their approach to performing what-if analysis
  for evidence-based care and wellness programs
  ensures that employers focus on and solve the
  right health care problems, and create the right
  wellness programs for their unique population
  mix. 

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• MCNT is passionate about their unique gain-share
  model for self-insured employers that
• Enables employers to thoroughly analyze and use
  historical claims data to establish baseline
  costs
• Delivers employee health risk assessments and an
  accurate state-of-health model
• Provides employee-centric healthcare management
  programs
• Reports monthly and/or quarterly healthcare cost
  and quality metrics 

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A NEW APPROACH

• MCNT helps employers take a more active role in
  their employees health with population health
  performance mapping and establishing optimal
  preventive care levels.
• MCNT also improves access to care to employees
  through
• Electronic patient portal
• Extended clinic hours
• Follow ups
• On site clinics
• Same day appointments  

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• Using State-of-Health scores to understand
  population risk for major chronic conditions like
  hypertension and diabetes, MCNT can design
  specific programs with a focus on prevention and
  helping employees with health goals.
• As preventable hospitalizations and frequent
  unnecessary ER visits decline, employee
  productivity goes up. In addition, as
  interventions are timely Length of Stay (LOS) per
  acute care admission is significantly lower.

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Evolution or Revolution? 

• In many industries, the cost of healthcare has
  surpassed the cost of producing the goods and
  services companies sell.
• This phase in MCNTs evolution has become
  revolutionary for those employers that wanted to
  lower healthcare costs.
• MCNT intends to do their part to help self-
  insured companies in North Central Texas and
  their employees keep healthcare costs down and
  quality of care high.