1 miami experience dr liz siddons nhs leicester city
TRANSCRIPT
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Miami ExperienceDr Liz SiddonsNHS Leicester City
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Presentation structure
• Purpose of visit
• Overview of US healthcare
• MCCI Company Overview
• What impressed us?
• Clinical Outcomes
• What we could try in Leicester City?
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Purpose of visit
• 3 day study tour focused on MCCI approach to clinical leadership and driving management of patient care, provider behaviour and activity from primary care
• Arranged by Humana’s Commissioning Institute and Medical Care Consortium Inc. (MCCI)
• Attended by c.30 people (PBC GPs, CEs/Directors) inc. Newham, NE Essex, and Sutton & Merton, DH
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Overview of US system
•Complex and multiple funding streams:•Medicare – 65+yrs (Fed)•Medicaid – low income children
and adults (Fed and State)•Tricare – military (Fed)•Commercial – employer/personal
•C.300m population, of which c.46m uninsured
•Inequitable and financially unsustainable
•Health system reform is Obama priority
Commercial17%
Medicare46%
Medicaid37%
Patient Type
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Key differences to NHS
• Insurance based - coverage• Patients select insurer (e.g. Humana) and
provider (e.g. MCCI) every 6mths• Buyers market – 27 hospitals in Broward
county• Consultants freelance – setting less of an
issue• Insurance notification/authorisation drives
patient level accounting• No tariff so price negotiation
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Headquartered in Miami, FloridaOperating since 1988
67 state-of-the-art medical centers in Florida
5,000 to 30,000 square feet
Medical Resources173 physicians
Over 250 specialists
Partnerships with Humana, Coventry, and WellCareProvides healthcare services under global risk contracts
Approximately 140,000 patients
In-house urgent care services
Broad range of full scale medical services
on site
Disease management programs
MCCI Company MCCI Company OverviewOverviewMCCI Company MCCI Company OverviewOverview
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Pharmacy In-house Pharmacy Mail order capability Home delivery available
Transportation Fleet of 46 vans Ensures patients meet appointments Free service offered to patients
Non-medical staff per facility: 1 medical director 1 business administrator 1 hospital coordinator 2-3 case managers
Activity Centre
MCCI Company MCCI Company Overview Overview MCCI Company MCCI Company Overview Overview
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MCCI PatientsMCCI PatientsMCCI PatientsMCCI Patients
Revenue ($ in millions)Revenue ($ in millions)Total MembershipTotal Membership
$243.8 $273.4
$311.3
$416.6
$525.0
58,351
79,578 90,298
108,518
140,000
2005 2006 2007 2008 2009P
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Medical StructureMedical StructureMedical Structure
Chief Medical OfficerEduardo Alarcon, MD
Medical DirectorMiami-Dade County
Medical Director Hillsborough County
Utilization Management Director
Chief Executive Officer:Jose Armas, MD
Case Managers
Medical DirectorBroward County
Medical Director Palm Beach County
Medical Director Orange County
Medical Director Duval County
Hospital Coordinator
Miami-Dade County Hillsborough CountyBroward County Palm Beach County Orange County Duval County
Hospital Coordinator Hospital Coordinator Hospital Coordinator Hospital Coordinator Hospital Coordinator
Lead Physicians
Miami-Dade County Hillsborough CountyBroward County Palm Beach County Orange County Duval County
Lead Physicians Lead Physicians Lead Physicians Lead Physicians Lead Physicians
Medical StructureMedical StructureMedical Structure
Chief Medical OfficerEduardo Alarcon, MD
Medical DirectorMiami-Dade County
Medical Director Hillsborough County
Utilization Management Director
Chief Executive Officer:Jose Armas, MD
Case Managers
Medical DirectorBroward County
Medical Director Palm Beach County
Medical Director Orange County
Medical Director Duval County
Hospital Coordinator
Miami-Dade County Hillsborough CountyBroward County Palm Beach County Orange County Duval County
Hospital Coordinator Hospital Coordinator Hospital Coordinator Hospital Coordinator Hospital Coordinator
Lead Physicians
Miami-Dade County Hillsborough CountyBroward County Palm Beach County Orange County Duval County
Lead Physicians Lead Physicians Lead Physicians Lead Physicians Lead Physicians
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MCCI’sBroad Range of ServicesMCCIMCCI’’ssBroad Range of ServicesBroad Range of Services
DiseaseManagement
In House/Delivery Pharmacy
EKGTesting
DentalServices
Diabetes Education/Nutrition
CaseManagement
Direct Access to Physicians
PacemakerCheck
Eye Care
Family Health Education
Hospitalists
Direct Access to Specialist
X-rayServices
InternalMedicine
Activity Centers
Urgent Care
Direct ReferralAccess
Lab DrawingStations
Physical Therapy
Transportation Services
MCCI’sBroad Range of ServicesMCCIMCCI’’ssBroad Range of ServicesBroad Range of Services
DiseaseManagement
In House/Delivery Pharmacy
EKGTesting
DentalServices
Diabetes Education/Nutrition
CaseManagement
Direct Access to Physicians
PacemakerCheck
Eye Care
Family Health Education
Hospitalists
Direct Access to Specialist
X-rayServices
InternalMedicine
Activity Centers
Urgent Care
Direct ReferralAccess
Lab DrawingStations
Physical Therapy
Transportation Services
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Cardiology
Endocrinology
Gynecology
Optometry
Psychiatry
Dermatology
Gastroenterology
Nephrology
Orthopedics
Rheumatology
Dietician
General Surgery
Ophthalmology
Podiatry
Urology
Oncology Physical Therapy Wound Care
Wide Offering of SpecialtiesWide Offering of SpecialtiesWide Offering of Specialties
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MCCI ApproachMCCI ApproachMCCI ApproachMCCI Approach
Patient is seen within 7 days after assigned to physician
High risk patients may be segregated into an inter-disciplinary approach
Disease management
Social services
Increased frequency of physician-patient interaction
Preventive screening (e.g., mammograms)
MCCI coordinates all referral visits for patients
One hospital coordinator at every medical center
Post-hospitalization follow up within 48 hours
In-house pharmacy in all facilities
Transportation provided to patients
Activity centers available
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What impressed? (1)
Hospital Coordinator• Primary link between GP, hospital physician and
specialist• Initiates discharge planning and outpatient
management post discharge
• Receives list of all admitted patients twice daily
• Gathers information from GP to avoid duplication of tests
• Attends hospital rounds with Attending Physician and processes orders
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What impressed? (2)
Discharge planning:• Begins on the 1st day of admission• Coordinated approach to assess needs• Hospice Care• Rehabilitation• Home Care• Equipment• Psychosocial/counselling• Nutrition• Pharmacy• Transportation• Follow-up within 48 hours of discharge• Disease Management- phone based
• Patient and family education
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What impressed? (3)
Utilisation management:• Dedicated Director appointment• Dedicated central support team• Web-based reporting system with costed
activity drill down by county, centre, physician and patient
• Systematic review of variation• Physician led discussions with clinical
teams (wkly/mthly/qtly)
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Clinical Outcomes
Admissions per ThousandsAdmissions per ThousandsAdmissions per Thousands
2005 2006 2007 2008
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Clinical Outcomes
Re-Admission Rate (7 days or less)ReRe--Admission Rate Admission Rate (7 days or less)(7 days or less)
2005 2006 2007 2008 Industry Avg.
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Clinical Outcomes
Re-Admission Rate (30 days or less)ReRe--Admission Rate Admission Rate (30 days or less)(30 days or less)
2005 2006 2007 2008 Industry Avg.
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What could we try in UK?
• Shifting emphasis to “aggressive management” out of hospital (PBC groups?)
• Greater use of patient pathways (map of medicine?)
• Supporting admission/planned discharge (hospitalist role?)
• Resource utilisation monitoring, analysis and reporting (PBC hub and cassius?)
• Global risk contracting (new practice procurements?)
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Liz SiddonsAssistant Medical [email protected]