The Evolution of Physician Group from PCMH to ACO

1. Evolution of MCNT from Physician Group to Accountable Health

2. The Evolution of Physician Group from Patient-Centric Medical Home to Accountable Health to Serve the Changing Needs of Self-Insured Employers

3. A Quest to Achieve Higher Quality and Bend the Employers Healthcare Cost Curves

4. 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

5. 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.

6. Growing Up — Medical Home Today’s concept of “Medical Home” began to take shape in the 1980’s 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”.

7. 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.

8. 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.

9. 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.

10. 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 “let’s 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.

11. 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

12. 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

13. The New Evolution It’s 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.

14. POPULATION STRATIFICATION MCNT realized that actuarial, claims-based analysis of patient risk simply doesn’t 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, MCNT’s 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.

15. 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 don’t experience crisis.”

16. MCNT’s State-of-Health (SOH) analyzer: • Calculates a State-of-Healthscore 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;

17. 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.

18. 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.

19. 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.

20. 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. MCNT’s care coordination approach helps employers reduce avoidable hospital admissions and readmissions, and contribute to even greater bottom line savings for self-insurers.

21. 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. 

22. 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

23. 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  

24. 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.

25. 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 MCNT’s 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.