Memorial Hermann Health System
Advancing Clinical Integration
Improving quality, safety and patient experience by engaging hospital and physician leaders
Memorial Hermann Physician Network
Formerly known as Memorial Hermann Health Network Providers, MHMD is the Memorial Hermann Physician Network. It is the largest clinically integrated physician organization in Texas, comprised of more than 3,500 doctors and serving the greater Houston area.
Challenges & Objectives
MHMD initially tasked WayPoint with implementation of a Patient Centered Medical Home (PCMH). This led to providing solutions in several critical areas:
- Developing innovative population management payer contracting relationships
- Creating patient quality and safety incentive programs
- Start-up of the Memorial Hermann Accountable Care Organization
- Participating in the Medicare Shared Savings Program
- Strengthening health information technology and population management infrastructure
“WayPoint accelerates our programs. Our PCMH was up and running in a year. An ACO application could take 3 years, yet MHMD and WayPoint did it in three months. Readiness assessment is vital. We couldn’t have done it without WayPoint.”
Keith Fernandez, MD, MHMD President & Physician in Chief
Assessment and Design
WayPoint assessed Memorial Hermann’s existing clinical integration resources, evaluated existing incentive structures, and refined objectives to reflect market-specific priorities in order to develop the following implementation recommendations:
- Enterprise scope
- Structure, governance and leadership
- Provider network composition and development
- Care coordination/patient engagement resources
- Reporting tools and processes
- Care team incentives
- Health information technology resource plans
- Staffing plans and operating budget estimates
Specialized resources were identified in order to:
- Promote clinical process improvement
- Enhance access and communication
- Evaluate population-specific health needs
- Facilitate patient engagement
- Identify high-risk patients
- Deliver disease management programs
- Coordinate care
- Report quality and cost metrics
- Provide feedback and evaluate performance
- Apply data to improve care
- Incentivize and support provider adoption
“WayPoint’s leadership reflects that rare breed of well-rounded individuals who can execute. They aren’t afraid to put their fingers on the keyboard. They don’t just describe the work, they break it down into logical steps and do it. Together we produce outcomes.”
David Bradshaw, Memorial Hermann Hospital System Chief Information, Planning and Marketing Officer
- PCMH implementation completed in a year
- ACO Application completed in three months
- In the 24 months after successful submission of the ACO application, the Memorial Hermann Accountable Care Organization became the fourth largest ACO in the country
“WayPoint has become a part of our team. They understand the people on our team and the functions they provide. No matter what the issue is, they help us articulate a better vision and execute it into action.”
Chris Lloyd, MHMD CEO
Payer Contracting Strategy Development
Maintaining Financial Stability in a Rapidly Changing Industry
Emerging challenges in managed care, clinical integration and healthcare reform have made payer contracting increasingly complex and intertwined with every aspect of organizational strategy. Our client tasked WayPoint with evaluating its current financial and market data against pre-defined performance targets and industry benchmarks in order to compare current operating results to standards achieved in similar care environments.
Strategies were developed to address the following concerns:
- What near-term managed care operational initiatives should be executed?
- What alternative managed care fee arrangements should be considered?
- How might cost, quality and patient experience metrics be used to reward results and adjust current percent of charge-based reimbursement structures?
- How can consistent value-based metrics be best maintained across payers and populations?
- What emerging trends and strategic priorities should be planned for current commercial, Medicare Advantage and Medicaid managed care relationships?
- Should joint contracting with aligned physician practices be pursued?
- Should managed care contracting alignment strategies be pursued with other regional health systems?
Market-based Contract Portfolio Assessment
- Market share, volume, rate structures and net revenue yields per case were compared to internal benchmarks, available market-based benchmarks and Medicare reimbursement levels on a case mix adjusted basis using available financial data
- A competitive profile was developed including key payer, provider and employer group data points
- Priority contracts were identified
- Financial scenarios were projected
- Negotiation scenarios with key internal and external stakeholders were developed
Review of Significant Factors Impacting Payer Relationships
Full consideration was given to various factors that could impact payer contract rates and terms such as:
- Care management and coordination of programs and tools
- Provider network clinical integration tools, processes and incentives
- Cost, quality and patient experience reporting tools and processes
- Financial and utilization reporting tools and processes
- Enterprise information technology platform
Contracting Guidelines Development
Managed care contracting guidelines were developed that included:
- Rate levels and structures matched to payer volume, population, service type and market position
- Alternative quality, safety, efficiency and patient experience incentive models matched to payer volume, population, service type and market position
- Payer population attributes signaling positive or negative implications
- Business terms/contract objectives matched to business, technology, quality reporting and clinical management capabilities
- People, process and technology resources necessary to support contract objectives
- Provider network composition and clinical integration strengths and weaknesses relative to payer contract objectives
“We value WayPoint’s frank assessments and one-on-one approach. They haven’t been a single engagement for us but a valued on-going partnership.”
Chief Financial Officer, 325-bed, Level II Trauma Center, and a Truven Health 100 Top Hospital
Triad HealthCare Network (THN)
Engaging a Physician-Led Collaboration in the Establishment of an Accountable Care Organization
Improving quality, safety and patient experience by aligning physician, hospital and payer leadership
Triad HealthCare Network (THN)
With a membership exceeding 750 employed and independent physicians, THN has grown from its beginnings in mid-2011 as a clinically integrated network for Cone Health System to a Medicare-certified Accountable Care Organization. THN provides patient-centered care for approximately 60,000 covered lives, including 34,000 Medicare lives, in Greensboro, North Carolina and the greater Piedmont Triad area.
Challenges & Objectives
WayPoint was initially tasked with gaining CMS approval to participate in the Medicare Shared Savings Program. This led to providing solutions in seven critical areas:
- Start-up activities for the Triad HealthCare Network ACO
- Implementation of population health management technology to support the ACO
- – Analytics to identify, stratify and assess the patient’s risk
- – Analytics to improve provider performance and measure quality
- – Health Information Exchange
- Care management advisory services
- Clinical process improvement and organizational structure
More than half of Triad HealthCare Network’s members are independent physicians, making it a unique physician-led organization. WayPoint provided strategic, operational and project management expertise by working directly with the Triad ACO Enterprise Steering Committee.
Organizational Assessment, Operations Improvement and Technology Implementation
Clinical integration assessment occurred across THN and Cone Health System while drafting the ACO application. Upon receiving approval as a Medicare Shared Savings Program, WayPoint continued to assist THN in designing and implementing organizational structure and process improvements as well as contracting and implementing a number of support technologies in the areas of care management, performance analytics and Health Information Exchange.
Clinical process improvement to achieve key quality initiatives was also a focus area in WayPoint’s work with THN physicians. WayPoint’s most recent advisory services entail streamlining the vast physician committee structure and process by which clinical improvements are adopted.
“It has been a very rewarding opportunity to work with WayPoint; one that has been marked with good physician communication, trust, and integrity.”
Tom Wall, MD, Medical Director, Triad HealthCare Network
- ACO application completed and CMS approval gained for the Medicare Shared Savings Program
- THN has grown to be among the largest ACOs nationally and named one of Becker’s “100 ACOs to Know”
“I have seen WayPoint become a trusted member of our THN team. They jump in wherever necessary, whether it is a board discussion with our physician operating committee or facilitating a team meeting between technology vendors and THN team members. They get things done.”
Steve Neorr, Vice President and Executive Director, Triad HealthCare Network
WayPoint Healthcare Advisors Clients Among the Very Top ACO Performers
Last week, the Centers for Medicare & Medicaid Services (CMS) released final first year quality and financial performance results for the Medicare Accountable Care Organizations (ACOs). WayPoint Healthcare Advisors is pleased to announce that two of its clients were among the very top performing ACOs that experienced significant shared savings.
Among 220 eligible ACOs, WayPoint client Memorial Hermann ACO in Houston, Texas was the number one Medicare Shared Savings Program (MSSP) performer, delivering CMS $57.83 million in savings. Generating $21.51 million in shared savings, Triad Healthcare Network, LLC in Greensboro, North Carolina delivered the seventh highest amount of shared savings among the MSSP participants.
“We have worked with both of these clients from the MSSP application process through much of the first two years of ACO operations. We are so pleased their hard work and vision has resulted in such positive outcomes for their patients, physicians and the health systems,” said Brett Kirstein, Managing Director.
Since the Medicare Shared Savings Program’s launch in 2012, more than 360 ACOs have been established, serving over 5.6 million Americans with Medicare. These top-performing ACOs have successfully improved the quality of care for Medicare beneficiaries through greater collaboration between doctors, hospitals and healthcare providers and engaging patients in an active and ongoing relationship to keep them healthy.
“We are very proud of our clients and our partnerships with them. They have demonstrated innovation in their approach to reducing costs while improving patient health,” said Jim McCoy, Managing Director. “They deserve great credit and recognition for their achievements.”
WayPoint Healthcare Advisors is a recognized leader in the healthcare advisory industry. Its advisors have served as consultants and senior executives in large healthcare organizations and top consulting firms, developing significant experience in ACO start-up activities, health information technology implementation and patient engagement resource deployment
For more information regarding the Centers for Medicare & Medicaid Services findings please visit http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-09-16.html