At a time when leaders of patient care organizations across the U.S. are looking for pathways forward into accountable care and population health management, a cadre of innovative integrated health systems is showing the way forward on a number of fronts. Among those is the Memorial Hermann Accountable Care Organization (MHACO), created and operated by leaders of the Memorial Hermann Health System, a 16-hospital integrated health system based in Houston, Texas.
According to a spokesperson for the Memorial Hermann Accountable Care Organization, the MHACO has been the country’s number-one Centers for Medicare & Medicaid Services Shared Savings Program (MSSP) ACO in the country for three years running, generating nearly $200 million in savings across three years of participation in the program. The MHACO, which cares for 50,000 lives (up from 22,000 when it started operations three years ago), encompasses a clinically integrated network of 2,500 physicians, which includes the University of Texas academic faculty, employed physicians, and independent physicians. That 2,500 total includes 700 academic faculty practice physicians, of them 200 employed, and 1,800 independent physicians.
Recently, Memorial Hermann senior executives—Chris Lloyd, CEO of the Memorial Hermann ACO and of the Memorial Hermann Physician Organization; Nishant "Shaun" Anand, M.D., physician-in-chief of those two organizations; and Shawn Griffin, M.D., CMIO of both organizations—spoke with Healthcare Informatics Editor-in-Chief Mark Hagland, to discuss the advances that their ACO has been making in its three years of operations. Below are excerpts from that interview.
Tell me a bit about the physicians involved with the ACO. How many of them are primary care physicians?
Chris Lloyd: We have about 500 primary care physicians. What we really bring to the table is a clinically integrated network of 2,600 physicians, which includes the University of Texas academic faculty practice, employed physicians, and independent physicians. That distinction is important, because we’ve brought together the physicians in the community, in an employment-agnostic model, and gathered them around the ACO and the care delivery network, around some of these principles associated with total cost of care. Some ACOs have primarily employed or physician organizations; we’re an employment-agnostic physician organization that’s partnered with our health system, and we think that that’s particularly strong.
Can you share about your ACO’s cost savings and clinical outcomes?
Lloyd: Our most recent savings were approximately $90 million across those lives. And our aggregate quality score was at the 96th percentile, in terms of member outcomes. Shaun?
Nishant (Shaun) Anand, M.D.: I can give you a three-year trend: in terms of cost savings, we’ve documented $58 million, $53 million, and $89 million, in our three years of operation. In terms of clinical outcomes within the Medicare Shard Savings Program, we’ve been at 83 percent, 88 percent, and 96 percent, respectively.
To what do you attribute your success so far?
Anand: The first success factor is that we have a philosophically aligned group of providers who are very talented at providing holistically aligned care for their patients. They’ve been willing to go the extra mile in addressing quality gaps upfront; and have agreed to improve access to care in their clinics, so we can provide that holistic care. The second success factor is that we’ve built a care management structure to take care of patients with multiple chronic conditions—heart failure, those on dialysis, those with COPD [chronic obstructive pulmonary disease], etc. And when they’re admitted to the hospital, they’re able to make sure they’re care-managed in the hospital. The third success factor involves the fact that we’ve built a data reporting analytics capability that allows us to track and trend our data and identify hot spots. So we can look at claims information and the EHR [electronic health record] and lab data, and we combine those to determine the hot spots [in terms of care gaps]. And finally, around our IT infrastructure, we’ve deployed registries and have worked on interoperability, with data flowing through it, with support tools.
Nishant (Shaun) Anand, M.D.
Can you speak to the human infrastructure and to the processes for care management, that are facilitating your success, and the physician culture changes that have occurred?
Anand: Chris and my team, before I arrived, were already building a culture focusing on partnering and clinical integration. That culture is really there. There’s also a willingness to partner as care teams; that’s a culture change, that healthcare now is a team sport. It’s something where physicians are often the quarterbacks, but you have to rely on your care management teams, and on your hospital teams as well.
Lloyd: We’ve been at this for about 10 years in terms of building a clinically integrated network. When the ACOs came along to stress care management and improved quality outcomes, those elements were already a part of the culture of this organization anyway, so ACOs became an extension of that. And without a culture that invites measurement and focuses on doing the right thing for the patient and absorbing new ways of doing things for the patient—that’s all a part of success.
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