Memorial Hermann Healthcare SystemClinical Integration & Disease Management

Dan Wolterman April 15, 2010

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Memorial Hermann Overview

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Memorial HermannHealthcare System

• Non-profit healthcare system operating in Houston, Texas

• Market share leader• In partnership with

University of Texas Health Science Center

HealthGrades 2010

National Quality Healthcare Award

(NQF) 2009

National Patient Safety Leadership Award 2009

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Memorial HermannHealthcare System

• Total hospitals: 12 (9 acute, 2 rehab, 1 children’s)

• Heart & Vascular Institutes: 3 • Managed acute care hospitals: 3 • Imaging Centers: 29• Sports Medicine & Rehab Centers: 25 • Diagnostic laboratories: 25• Ambulatory surgery centers: 17 • Retirement/nursing center: 1 • Home Health agency: 1

• Annual admissions: 138,351• Annual emergency visits: 411,591 • Annual deliveries: 26,731 • Employees: 20,840 • Beds (acute licensed): 3,581 • Medical staff members: 4,857 • Physicians in training: 1,821• Annual payroll: $1.088 billion

Woodlands Sugar Land TMC Katy Memorial City Southeast

Northwest Northeast TIRR PaRC Children’s Southwest

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Clinical Integration & Reduced Costs

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Clinical Integrationfor Memorial Hermann

• Memorial Hermann has over 3,500 physicians within our physician organization - Health Network Providers (HNP)– 2,000 “core” clinically integrated, independent

physicians submitting quality data– Combination of UT, Private and Employed physicians– Governed by 20 member, all physician Board of

Directors– Focused on collecting, reporting and managing

quality outcomes– Joint determination of clinical utilization targets for

contracting and performance

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Clinical IntegrationPhysician Criteria

• The criteria that physicians must agree to by participating in Clinical Integration– (1) Participate in evidenced based medicine,

protocol development and implementation– (2) Participate in a preferred electronic health

record platform• E-Clinical Works is the system supported standard

– (3) Submit quality data for both inpatients and outpatients

– (4) Agree to transparent use of data to elevate quality and reduce costs

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Clinical Integrationand Reduced Costs

• Clinically integrated physicians have documented better clinical outcomes than other physicians– Lower average lengths of stay (ALOS)– Less complications– Fewer readmissions– Lower charges to patients

• HNP has delivered significant costs savings across targeted disease outcomes

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Clinical Integrationand Reduced Costs

ClinicallyIntegrated OtherPhysicians Measurement Physicians Improvement

3.71 Average Length of Stay 5.26

1.51% Complications of Care 1.78%

6.15% 30-Day Readmission Rates 6.40%

$23,430 Average Charges $34,885

30%

15%

4%

33%

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Disease Management

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Disease ManagementSummary

• Memorial Hermann remains committed to improving wellness and chronic disease issues within the Houston community

• To address these issues, Memorial Hermann has developed multiple programs including the following– C.O.P.E. – Community Outreach for Personal

Empowerment– Community Case Management Initiative

• Congestive Heart Failure (CHF), Diabetes, etc.

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C.O.P.E. Program

Community Outreach for Personal Empowerment

C.O.P.EC.O.P.E

Program Goals

1. Empower participants to take control of their health care

2. Establish participants with a Primary Medical Health Home

3. Improve and maintain participants’ general health and well being through the use of available local community resources

4. Decrease hospital Emergency Center visits, observation stays, and inpatient admissions

5. Decrease cost per case of Emergency Center visits and inpatient admissions

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C.O.P.E. Program

Eligibility – Patients Must

1. Be registered as “Self Pay” or qualified for Charity Care

2. Have incurred at least 5 emergency center visits or 3 inpatient admissions in the last 12 months

3. Have no current chemical or alcohol dependency diagnoses

4. Live in the Houston area (defined geographical boundary)

5. Have no active psychiatric diagnoses

6. Only be accepted if they have accessed services at Memorial Hermanna. No outside referrals will be accepted into the program

Requirements – Patients Must Agree to

1. Return staff phone calls within a 1-2 day time frame

2. Use Primary Medical Health Home or Clinic or Doctor’s office for non-emergent medical care

3. Follow up with all scheduled appointments

4. Show an ongoing effort to complete program goals

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C.O.P.E. Program

Visits CostsInpatient 378 $3,580,586Emergency Room 907 $450,741Observation 82 $247,177

Total 1,367 $4,278,504

PRE-ENROLLMENT

Visits CostsInpatient 154 $1,387,605Emergency Room 455 $218,989Observation 78 $208,378

Total 687 $1,814,972

POST-ENROLLMENT

Overall reduction of 680 visits at a savings of nearly $2.5 million

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Disease ManagementCommunity Case Management

Program Structure

• Referral and enrollment via in person or telephonic introduction to the program by Navigator (social workers)

• Telephonic initial assessment and ongoing monitoring calls by RN case manager

• Utilization of evidence-based literature, tools and self-management activities

• Assist patient population in understanding and managing their disease and maximizing quality of life

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Disease ManagementCongestive Heart Failure

• As one of the nations’ leading diseases, Memorial Hermann initially focused the community case management initiative on Congestive Heart Failure (CHF)

• Outcome data supports– Decrease in readmissions and cost for participants– Improved quality of life

• Program has been successful in assisting community to achieve appropriate utilization of health care services

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Disease ManagementCongestive Heart Failure

Visits CostsInpatient 888 $10,685,885Emergency Room 119 $68,223Observation 48 $179,379

Total 1,055 $10,933,487

PRE-ENROLLMENT

Visits CostsInpatient 456 $5,497,842Emergency Room 108 $60,414Observation 52 $256,469

Total 616 $5,814,725

POST-ENROLLMENT

Overall reduction of 439 visits at a savings of over $5 million