Williamson-Chatman 3.23 Symposium

Clinical Integration and
Quality Improvement
Jay C. Williamson, M.D.
CMO, Summa Physicians Inc.

Robin Chatman, MD
Trinity Family Medicine

Copyright 2012Ohio State Medical Association 1

The Integrated Healthcare Delivery System
Hospitals Physicians Health Plan Foundation
Inpatient Facilities Multiple Geographic Reach System Foundation
• Tertiary/Academic Campus Alignment Options • 19 Counties for Commercial Focused On:
• 3 Community Hospitals • Employment • 18 Counties for Medicare • Development
• 1 Affiliate Community Hospital • Joint Ventures • 60-hospital Commercial • Education
• 2 JV Hospitals with Physicians • EMR provider network • Research
• Clinical Integration • 41-hospital Medicare • Innovation
Outpatient Facilities • Health Plan provider network • Community Benefit
• Multiple ambulatory sites • National accounts in • Diversity
• Locations in 3 Counties Summa Physicians, Inc. multiple states • Government Relations
• 260+ Employed Physician • Advocacy
Service Lines Multi-Specialty Group 191,000
• Cardiac, Oncology, Neurology, O Total Members
rthopaedics, Surgery, Seniors, B Summa Health Network • Commercial Self Insured
ehavioral • PHO with over 1,000 • Commercial Fully Insured
Health, Women’s, Emergency, R physician members • Group Process Outsourcing
espiratory • EMR/Clinical Integration • Medicare Advantage
Program • Individual PPO
Key Statistics
• 2,000+ Licensed Beds
• 62,000 Inpatient Admissions
• 47,000+ Surgeries
• 660,000+ Outpatient Visits
Net Revenues: Over $1.5 Billion
• 226,000+ ED Visits Total Employees: Nearly 11,000
• 4,300+ Births
• Over 220 Residents


The Next Evolution of the Integrated Delivery System

Summa fundamentally believes that accountability in healthcare
is a moral imperative with Integration being a means to that end

• We believe that the current healthcare payment system is unsustainable and that payment
mechanisms will have to change to better align incentives toward reducing total healthcare
costs while continuing to provide high-quality care

• Summa will use its Integrated Delivery System to provide continually improving, value-
based, high-quality, transparently accountable care to patients, populations and payers it
serves

• Summa will build upon its relationships to continually advance accountability by partnering in a
deeper way with patients, populations, and payers toward improving the health of our
communities while reducing costs


Community Collaborations: Physician Joint Ventures
• Summa Health Center at Lake Medina
– Joint venture outpatient surgery center with 2 ORs and 1
procedure room opening in conjunction with the new Summa
Health Center at Lake Medina development
– Includes physicians from the following specialties:
OB/Gyn, General Surgery, Pain, Podiatry, Ophthalmology, Hand

• Summa Western Reserve Hospital
– Joint venture started in June 2009 between Summa Health System
and Western Reserve Hospital Partners
– Began the for-profit Summa Western Reserve Hospital at the
current Summa Cuyahoga Falls General Hospital location

• Crystal Clinic Orthopaedic Center (CCOC)
– Orthopaedic Hospital Joint venture between Summa Health
System and Crystal Clinic (a local group of approximately 30
orthopedic surgeons)
– Began operations in May 2009 on the Summa St. Thomas Hospital
Campus


Critical Issues
Three critical issues threatening the stability of today’s
healthcare system:

1. Uninsured and underinsured populations are increasing.

2. Healthcare costs are escalating.

3. Government regulations are expanding and government
reimbursement is not keeping the pace with the cost of
providing care.


Summa Physicians Inc. Governance
• 501(c) 3 organization
• Independent Board of Directors which include
physicians and senior management appointed by
system governance committee
• Oversee all aspects of SPI operations and finance
except compensation
• Physician Advisory Council to CMO
• Both fully employed and leased models


SPI Overview
• 270 Physicians
• 59 Advanced Practice Nurses and Physician
Assistants
• 671 non-Provider Employees
• Summit, Medina, Portage, Wayne, and Stark
• Physicians hired based on Community Need, Mission
and preventing physician “leakage” from Summa
• New planned growth to be based on System needs
and focused strategic growth


Satisfied, Engaged, and Aligned Physicians
SPI Growth as of December 2011
• Summa Physicians, Inc. continues to have success with its model for physician employment

Number of Employed Physicians
300
255266
220
200 187

100 81
41
7 8 14 17
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011


SPI – Business Model
• Physician Compensation is Productivity Based
• Will soon be implementing a model looking at quality
metrics, patient satisfaction and issues such as community
service and System performance
• Ancillary Services have transferred to Provider Based Billing
under the Hospitals
• Mission focus helps eliminate unnecessary System costs
• All physicians are employed under a Hospital or System
approved business plan
• Reviewing Leased vs. Employed Model


2011 SPI ACCOMPLISHMENTS
• Outstanding Budget
– Performance through December $3.9 million better than budget.
• Vast Improvement in health risk assessment
– Over 1000 this year have been completed leading to better
documentation of care provided to Medicare patients and enhanced
reimbursement.
• Our newly added 24 physicians
• Outstanding performance in light of a year of transition featuring three
different presidents in 2011.
• EMR implementation with 113 providers and 37 doctors attested for
Meaningful Use at $18,000 each and 15 more by year end which aids in
care coordination and integration.


The Future - SPI
• Implement Strategic Plan
– Enhance Physician Engagement and System
Integration
– Expand Market Penetration (selectively and
strategically) and Increase our Patient
Population
– Achieve superior Operative and Clinical
Performance
– Improve Population Health through ACO and
Medical Homes


Patient Center Medical Home (PCMH)
The Affordable Care Act Main Objectives
Focus on Measurably Improving Population Health Meaningful Measures of System Performance
Organizational Accountability for Capacity, Cost and Quality Right Workforce
Payment for Value, Not Volume

Healthy
Consumer
Overall Goal is to move healthcare cost
from downstream to upstream
Continued Preventable
Health Condition
ACO
PCMH No Hospitalization Acute Care
Episodes

Successful High Cost Complications, Re
Outcome Outcome admissions

In order to achieve the objectives of reform, we need to transform our current delivery system from high cost, low
value to low cost, high value through a strong primary care foundation


PCMH Impact on Stakeholders Across Continuum Care

Better, safer, less costly, more Improved member and employer
convenient care satisfaction
Better overall health Lower costs
Productive long-term relationship Opportunity for new business
Payer models
with a PCP

Patient Specialists
Increased focus on the
patient and their health Better referrals
Greater access to health Whole patient care integration
information Better follow up
Higher reimbursement PCMH
More PCPs
PCP Government

Lower healthcare costs
Healthier population
Hospital Employer

Lower number of chronic care
admissions and readmissions
Lower healthcare costs
Increased focus on procedures.
More productive workforce
Improved employee satisfaction


What is PCMH?
A PCMH puts patients at the center of the health care system, and provides
primary care that is “accessible, continuous, comprehensive, family-
centered, coordinated, compassionate, and culturally effective.”
Features of PCMH
A personal physician who coordinates all care for patients and leads the team.
Physician-directed medical practice – a coordinated team of professionals who work together
to care for patients.
Whole person orientation – this approach is key to providing comprehensive care.
Coordinated care that incorporates all components of the complex health care system.
Quality and safety – medical practices voluntarily engage in quality improvement activities to
ensure patient safety is always being met.
Enhanced access to care – such as through open-access scheduling and communication
mechanisms.
Payment – a system of reimbursement reflective of the true value of coordinated care and
innovation.


How Features of PCMH are Implemented?
Enhanced Access Physician Directed Medical Practice Team
Extended Hours, Open Schedule
Team approach
Internet, e-mail
Low complexity tasks handled by other
Increased same day access avoids ER and
increase continuity members of the team
Team members can be internal/external
Collaborative relationship between physician and
Quality and Safety
non-physician practitioners
Evidence Based Medical care
QI projects at the practice level
Personal Physician & Whole Person Orientation
First contact, continuous and comprehensive care
Coordinated/Integrated Care
Contextual Care
Registries
Proactive care Having a usual source of care is associated with a greater
likelihood that people receive appropriate care, preventive
Information Technology care, better outcomes, lower cost
Health Information Exchange
Chronic care coordination
Internal/external care coordination
Part of a patient’s health plan Reduced duplication and improved
coordination across the spectrum of care


Summa PCMH Pilot Project Roadmap
Highlights of Project
6 practices involved
IT and Policy Subcommittees
PCMH Performance Metric Team
SUMMA
NCQA Recognition
PCMH
Transformation Transformation
Cultural Change
Redefining staffing roles
Improve Outcomes

NCQA Recognition Program
Offered at three level–basic, intermediate and advanced Measure improvements
Goal is to obtain Level 3 Support ACO Initiatives
Publically report
Gap Analysis achievements
Identification of PCMH Metrics
EHR Upgrades
Policy Creation and Standardization


PCMH
• ACO paying for part-time physician leader, full-
time analyst, and project director.

• PHO will pay for NCQA Certification Fees.


Accountable Care Organization
Our ACO is a clinician-led care collaborative
that partners with communities
to compassionately care for and serve our populations
in an accountable, value- and evidence-based manner.

Organizational Facts
• Start Date – Began operations January 1, 2011
• Initial Pilot Population – 11,000 SummaCare Medicare Advantage members that
currently see a participating primary care physician
• Legal Entity – Non-profit taxable structure allows for physician majority on the Board
• Board Composition – 4 community primary care physicians, 1 medical specialist, 1
surgical specialist, 3 Summa representatives


PCMH

Primary Specialty Patients
Hospital Skilled Nursing Home
Ambulatory Home
Care Care and ED Nursing Health


Financials:
PMPM Target and Results - 2011
Medical Spend Shared Savings
PMPM Annualized
Breakeven $793.62 $0
SC Medicare NHC ACO $733.79 $7,400,000
2010 Milliman Benchmarks
Loosely Managed $752.45 $5,089,600
Competitively Managed $639.56 $19,045,513
Well Managed $522.36 $33,534,246


Progress Milestones: 2011
• Began Operations

• Heart Failure Readmission Initiative

• Heart Failure Education

• Discharge-to-Home Care Transition


Progress Milestones
• Population-based Actuarial Analysis

• ACO Finance Committee

• ACO Clinical Value Committee

• ACO Medical Home Initiative

• Call Center Plan

• Harmony Plan


PHYSICIAN COMPENSATION PLAN

Summa Physicians, Inc. (SPI)


• High Performance Team appointed in late 2011 by new SPI President to
outline a new compensation model by early 2012.
• Multispecialty group including representatives from the following areas:
– Family Medicine
– Psychiatry
– Surgery (Colorectal)
– Gastroenterology
– Hematology / Oncology
– Cardiology
– General Internal Medicine
– Geriatrics


• Began with weekly meetings with a goal for the
new model to be part of new and updated
contracts
• Agreement for a one year “shadow” program to
see how the model works
• Outlined a set of Guiding Principles and an
Incentive Plan Proposal was developed


GUIDING PRINCIPLES
SPI CMO COMPENSATION COMMITTEE

GENERAL CONTRACTING PRINCIPLES

1. All should share in the success of the organization.

2. Incentive plan is calculated on 20% of base compensation. Base compensation is not reduced to
fund incentive plan.

3. A shadowing program will be used the first six months, the new system will start in 2013.
Standardized contract language will be used with an agreed upon compensation plan.

4. Incentive Dimensions required for all. Metrics include Success of SPI/Summa Health System,
Citizenship, Information Management, Quality/Service. (Incentive Plan Proposal attached)

5. Quality metrics for primary care and specialties are different and subgroups may be needed to
work out details.

6. Annual performance review required and passing review will be required to qualify for bonus
distribution.

7. Patient satisfaction review will be part of all metrics. One standardized survey will be used.

8. Changes in base compensation are being considered.

9. Incentives obtained from some bonus dollars and possibly ACO shared savings dollars.

10. MGMA should remain the salary benchmark of choice.

11. Blends of education, teaching, and work productivity will remain part of the contracts.


INCENTIVE PLAN PROPOSAL
TARGET: TOP QUARTILE TOTAL POINTS = 20
Incentive Dimensions: 2/6/12
Success of SPI / Summa Citizenship Information Management Quality / Service
(Individual & Group)

Growth of Established and Loyal Attendance @ SPI meetings Measures of Integration Access to Care – Same Day
Patients - SPI ≥ 75% of meeting  Keep the patient @ home  Established Patient and
 Information Management New Patient
Major Conditional Incentive within Network
Source: eCW counted charts, billings  In Network Use of Lab/ (1% Group)
of unique patients during the prior ½ point Radiology/PT-Rehab
year vs. next year Source: Referral Tracking in eCW, Source: Phone survey for
Source: Attendance sign in and lab/imagining/pt by ordering established and new patients
2 points sign out sheets monitored by physician
SPI ops. 3points 2 points
Profitability of Summa Hospital Completion of Records on a Measures of Coordination Inpatient SCIP & Core Measures at
Operations / Meet or Exceed Budget timely basis  Hand off Measures 98% attainment
Expectations - Summa Hospital  Two-way Communication
Major Conditional Incentive  Satisfaction with
Source: Summa Financials, booked ½ point Referring Physicians Info Source: CMS/JCHAO List of Top
year end hospitals only  Collegiality / Stellar APR performers
Source: eCW “closed files Source: Referral Sender/Receiver
2points report”, Med Records survey 3 points
Procedures 3 points
Patient Satisfaction > 75th percentile Inpatient patient satisfaction with
Source: Press Ganey OP, C. Natale physicians above 50th percentile
2points Source: HCAHPS
2points
6 Dimensions of Quality (IOM)
Safe Pt. Centered
Effective Timely
Efficient Equitable



• Further discussion by specialty of quality metrics


Example of Quality Metrics for Diabetic Care in
Primary Care Practices
B D E F G H I J K L M N O
Eye Exam
1 Insurer DOS HbA1c Date LDL Date Urine date Result BP Sys BP Dias Foot Exam CPT/ICD
Date
2 MC 7/9/11 6.4 7/19/11 59 3/22/11 N N 112 62 N N 250.00/214
3 SC SEC 6/30/11 9.4 6/27/11 110 6/27/11 N N 150 67 5/5/11 N 250.00/214
4 MC 3/22/11 7.3 3/16/11 94 6/16/11 1/21/10 Neg 115 49 9/2/01 N 250.00/214
5 SC SEC 5/19/11 7.2 5/19/11 92 4/21/11 N N 149 75 N 8/16/10 250.00/214
6 MC 3/30/11 10.9 8/15/11 73 8/3/11 N N 156 12 N 5/3/10 250.00/214
7 MC 2/3/11 6.2 2/17/11 61 5/20/11 12/30/10 POS 153 74 N 12/20/10 250.41/214
8 MC 7/22/11 6 7/15/11 High Trig 7/1/11 N N 146 63 11/10/11 N 250.00/214
9 MC 7/11/11 7.5 6/9/11 67 6/9/11 N N 113 67 4/8/11 N 250.00/214
10 MC 7/13/11 5.6 7/7/11 43 7/6/11 N N 129 61 N N 250.00/215
11 MC 6/15/11 6.4 6/9/11 69 6/8/11 N N 117 62 8/2/11 N 250.00/214
12 MC 4/19/11 8.4 4/19/11 74 1/11/11 4/19/11 Neg 140 102 N 5/11/11 250.02/205
13 SC SEC 8/22/11 6.4 8/8/11 51 1/3/11 N N 150 85 8/1/11 N 250.00/214
14 MC 8/18/11 6.6 10/18/10 83 1/10/11 1/10/11 Neg 133 61 4/11/11 N 250.00/214
15 MC 8/17/11 7.3 8/10/11 160 8/10/11 N N 141 61 3/17/11 N 250.00/214
16 MC 8/9/11 8.9 8/2/11 78 8/2/11 N N 144 68 11/18/10 N 250.02/214
17 MC 2/1/11 6.5 1/26/11 78 1/26/11 N N 123 62 N N 250.00/214
18 MC 3/25/11 6.8 3/9/11 59 6/15/11 N N 128 66 2/24/11 N 250.02/214
19 MC 3/25/11 6.9 3/9/11 3/9/1900 3/9/11 9/15/10 Neg 126 73 N N 250.00/214
20 MC 6/16/11 5.5 6/9/2011 42 1/25/2011 10/10/2011 Neg 124 3/3/1900 8/18/11 12/23/10 250.00/214
21 MC 7/14/11 6.6 2/3/11 57 11/23/10 N N 128 65 4/27/11 N 250.00/214


Eye Exam
Date
22 MC 3/28/11 7.3 3/21/11 34 3/21/11 N N 140 85 N N 250.00/215
23 MC 6/29/11 6.2 6/22/11 71 6/22/11 N N 138 80 3/4/11 N 250.00/214
24 MC 7/11/11 6.9 7/5/11 51 3/2/11 N N 122 64 N N 250.00/214
25 MC 5/4/11 6.2 4/13/11 89 4/13/11 N N 95 60 N N 250.00/214
26 MC 7/27/11 5 7/20/11 126 7/13/11 7/13/11 POS 144 88 7/11/11 N 250.00/214
27 MC 8/23/11 6.4 5/13/11 102 5/13/11 9/17/10 NEG 126 68 10/2/11 N 250.00/214
28 MC 7/13/11 6.4 7/1/11 38 7/1/11 N N 123 66 9/8/10 2/11/11 250.00/214
29 MC 6/22/11 5.9 6/15/11 83 6/15/11 3/7/11 POS 138 80 N N 250.00/214
30 MC 8/23/11 7.1 8/16/11 76 6/14/11 N N 130 74 N N 250.00/214
31 MMO MC 8/25/11 7.3 6/17/11 63 8/18/11 N N 138 78 1/11/11 N 250.00/214
32 MC 2/1/11 5.8 1/4/11 55 1/4/11 N N 111 52 10/19/10 1/19/10 250.00/214
33 MC 2/1/11 6.9 6/7/11 89 1/4/11 5/21/10 POS 134 64 2/3/11 1/19/10 250.00/214
34 MC 1/5/11 6.5 3/2/11 87 12/30/10 N N 166 77 10/12/10 N 250.00/214
35 MC 9/6/11 7.5 9/1/11 52 5/10/11 N N 120 79 8/11/11 N 250.00/214
36 Anthem SR 6/15/11 6.5 6/7/11 56 6/8/11 N N 133 70 N N 250.00/214
37 MC 5/11/11 7.8 5/4/11 104 8/4/11 N N 137 75 4/-/11 N 250.02/214
38 MC 8/3/11 6.2 7/20/11 57 7/20/11 7/20/11 Neg 114 63 9/13/10 N 250.00/214
39 MC 8/1/11 7.3 7/6/10 N N N N 150 96 1/20/11 N 250.00/203
40 MC 6/29/11 6.1 7/2/10 67 7/2/10 N N 144 82 4/9/11 N 250.00/214
41 SC SEC 7/20/11 7.4 7/6/11 97 3/8/11 3/8/11 Neg 160 70 6/22/11 N 250.00/214
42 MC 6/30/11 8.4 6/23/11 47 6/23/11 N N 151 81 5/12/10 N 250.02/214
43 MC 6/17/11 6.1 6/10/11 63 6/10/11 N N 126 77 5/11/11 N 250.00/214


Eye Exam
Date
44 MC 5/12/11 6 4/5/11 56 4/5/11 N N 122 66 N N 250.00/214
45 MC 4/28/11 6.4 4/25/11 77 4/25/11 N N 134 71 10/10/11 N 250.00/214
46 MC 6/16/11 7.3 3/9/11 59 6/8/11 12/9/10 POS 122 64 4/7/11 N 250.00/214

SPI Dr.
Total # of
Patients
Studied 903 45
Average
HbA1C 7.1 7.0
Average
LDL 91 73
Percentage
of Urine
Samples
collected 43% 29%
Average BP
Systolic 133 133
Average BP
Diastolic 75 70
Percentage
of Eye
Exams
Performed 35% 67%
Percentage
of Foot
Exams
Performed 21% 18%


COMPENSATION GUIDELINES
A. Base Compensation
– Uses 85% of MGMA Median by Specialty to determine base.
– Will be reset each year (WRVU target) based on prior year
WRVU production and market adjustments.
– Adjusted upward if WRVU exceeds base target. Based on
tiered compensation formula.
– Adjusted downward if WRVU is below base target.
– Maximum amount of base compensation to be paid through
bi-weekly payroll = 80% of MGMA national 90% compensation.


B. Excess WRVU Above Base Compensation Targets
– Tiered structure adds a portion of excess WRVU to base
compensation (not extra bonus) and a portion to incentive pool
Base & Performance Bonus WRVU Tier descriptions
Tier 1 = Nat Med to Avg Nat Med / Nat 75th The level of Physician production utilized in the Tiers =
Tier 2 = Avg Nat Med / Nat 75th to national 75th higher of 2 yr avg production or the prior yr production
Tier 3 = all WRVUs over the Nat 75th

1.0 FTE New Base = 85% Nat Median + Tier 1 + Tier 2 + Tier 3 % to payroll
85% of Nat Median + For that Physician's specialty
Tier 1 - Base @ 50% of SPI rate +
Tier 2 - Base 45% of SPI rate + This component added to Base and paid through bi-
Tier 3 - Base 40% of SPI rate + weekly payroll
Total New Base

1.0 FTE Performance Bonus Funding = Tier 1 + Tier 2 + Tier 3 + SPI % Perf Bonus Fund
Tier 1 -Bonus 50% of SPI rate +
This component held until contract year end and
Tier 2 - Bonus 55% of SPI rate +
amount to be awarded determined thorough annual
Tier 3 - Bonus 60% of SPI rate +
performance review - pre-defined performance
SPI added Perf $ (% PCP or % other) +
metrics.
Total Performance Bonus Funding


C. WRVU Production Below WRVU Target
– At a certain level may not be eligible for a bonus
D. Incentive Plan Pool
– Using tiered approach amount not added to base is
placed in incentive pool.
– Physician has ability to add back a comparable amount
using different incentives.
– 15% Primary Care addition for recognition of primary
care.
– 5% Specialist addition to pool


• There will always need to be market
considerations.
• Outliers will have to be looked at on an individual
basis.


Questions and Discussion


Williamson-Chatman 3.23 Symposium

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Destacado

Destacado (6)

Similar a Williamson-Chatman 3.23 Symposium

Similar a Williamson-Chatman 3.23 Symposium (20)

Último

Último (20)

Williamson-Chatman 3.23 Symposium