In the spring of 2011 I was on a team that designed an accountable care organization for Memorial Hermann Health Systems.

1. TEAM 29
James Cervantes Anthony Hopper Jessica Jacobs

2. Memorial Hermann
Why we have to change
Where we are going
How we will get there
How we will know we are there
Executive Summary

3. Why we have to change
STRENGTHS WEAKNESSES
• Positive Margin • Variable financial performance
• Full Range of Facilities • Numerous, Small IPAs
• High Level of Health IT adoption • Nascent Health IT in provider offices
• Nationally Recognized QI • Undefined HIE
OPPORTUNITIES THREATS
• Large Medicare/Medicaid Population • Ambiguous ACO requirements
• Choice Primary Care Physician Lock-In • Start Up Costs/Reimbursement
• Recruiting Advantages • Texas Physician Employment Law
Supplement: 8-15

4. Competitor Profile
Supplement: 8

5. Memorial Hermann
Why we have to change
Where we are going
How we will get there
How we will know we are there

6. Culture & Core Values
BREAKTHROUGHS
EVERY DAY
Mission: Memorial Hermann Accountable Care Collaborative is
dedicated to improving the health of the people in Southeast
Texas by providing a continuum of high quality health
services
Supplement: 18-20

7. Patient Support
Access
Information Eligibility
Patient
Clinical
Billing
Care
Home Care
Supplement: 29-32

8. Memorial Hermann
Why we have to change
Where we are going
How we will get there
How we will know we are there

9. Critical Issues & Areas
Operational Quality
• Strategy and • Financial
Direction Considerations
• Provider Support • Health
• Organization and • Risk Management
Governance • Patient Advocacy Information
Technology
• Quality
Improvement
Organizational Financial
Supplement: 16-17

10. Organizational Design
Supplement: 22-29

11. Provider Support
Supplement: 22-24, 33-34

12. Financial Management
Patient Budget Performance Payment
Attribution Development Monitoring Plan Incentive Plan
• Provider • Baseline • Reporting • One-Sided
Enrollment Historical plan which Shared
• Patient Risk Data compares Savings Plan
Management • Trend actual costs
Estimates to the budget
• Adjustments
Supplement: 36-41, 61-85

13. Legal Risks
Potential Legal Issue How to Avoid It
Antitrust 30% / 20% Rule
Stark Law Waiver from HHS
Texas Physician Risk Physician led board of
director
No physician employment
Supplement: 39-40

14. The CQI System
• Triple Aim
• High-quality
Patient
Identification
• Cost-effective
• Southeast Texas
Performance
Concurrent
Oversight and
Review
Accountablity
population
• Patient Advocacy
Quality
Tools for
Improvement
Frontline Staff
Teams
Supplement: 45-49

15. Quality Dashboard
Supplement: 49

16. The Health IT System
Acute
EMR
mHealth
GIS
Mapping PHR HIE
Amb.
EMR
Supports: Quality Improvement, Patient Throughput, and Revenue Cycle Management
Supplement: 42-44

17. Memorial Hermann
Why we have to change
Where we are going
How we will get there
How we will know we are there

18. Implementation Plan
Implementation Issue Start Date End Date Responsible Entity
O1. Define Mission Vision and Values for the CCO/Provider Support
Whole Organization Jun-10 Feb-11 Services
O2. Develop Program that helps members CCO/Provider Support
achieve the MVV Mar-11 Apr-11 Services
Organizational Design
O3. Develop Human Resources Evaluation tool CCO/Risk Management
for all staff members to encourage ACHIEVE Apr-11 May-11
O4. Get stakeholder buy in to reorganize the CCO/CEO
board of directors. Feb-11 Mar-11
O5. Facilitate discussion between “primary CMO
care” and “specialist” based physicians. Jan-10 Jun-10
O6. Engage community stakeholders to gain an CSO
understanding of actual community need. Jan-10 Jul-10
O7. Query Faculty governance members CSO
regarding their organizational structure. Jun-10 Aug-10
Supplement: 50-51

19. Implementation Plan
C3. Continual Monitoring Plan
F3. Physician Reimb.
F6. Facilities & Providers
OM 3. Provider Undestanding
C4. EHR Adoption Tool
OM 10. Patient Advocacy Training
OM 7. Provider Enrollment
OM 8. Staff Enrollment
OM 9. Quality/IT Training
O4. Board of Directors
O3. HR Eval Tool
C2. Educate QI Plan
C7. HIE Records
O2. MVV Program
C 10. PHR
C1. QI Plan Design
C5. MPI Assignment
C6. Provider IDS
C8. mHealth
C9. RCM
F 1. Patient Assignment
F2. PMPM Review
F4. Third Party Payers
F5. Claims Processing
F7. Incentive Possiblities
F8. Contracting Law
F9. Org. Legal Issues
OM 5. Care Coordination
O1. Define MVV
O6. Engage Community Stakeholders
O7. Faculty Engagement
OM 6. RCM Training
O5. MHMD Communications
OM 1. Recruitment and Staffing
OM 2. Preferred Products
2010 2011 2012 2013 2014 2015
Supplement: 52

20. Critical Areas Dashboard
Supplement: 47- 53

21. The Model
Supplement: 18-21

22. Memorial Hermann
We Welcome Your Questions