henry ford health system approach to macra ford health system approach to macra gary e. loyd, ......
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Henry Ford Health System
Approach to MACRA
Gary E. Loyd, MD, MMM
Ann Marie Creed, MSA, CMPE
Conflicts and Notice
No Conflicts of Interest
Please note that the views expressed are those of the
conference speakers and do not necessarily reflect
the views of the American Hospital Association and
Health Forum.
Opting for NextGen APM
Henry Ford ACO
– 27,900 CMS lives
– > 1,000 Physicians
– > 800 mid-level providers
– 5 Hospitals
– 142 SNFs
• 34 Inpt Stay Waiver Benefit Enhancement 3 day
– 10 Home Health Agencies
Components of NextGen at HFHS
Primary Care Initiative
– Managing High Risk/High Cost Populations
– Reducing Variation in Medical Decision Making
– Managing Transitions of Care
Surgical Specialty Care Initiative
– System Service Line Councils
– CQI Initiatives
– Perioperative Surgical Home (PSH)
Components of NextGen at HFHS
Primary Care Initiative
– Managing High Risk/High Cost Populations
– Reducing Variation in Medical Decision Making
– Managing Transitions of Care
Surgical Specialty Care Initiative
– System Service Line Councils
– CQI Initiatives
– Perioperative Surgical Home (PSH)
Goals of the PSH
OutcomesQuicker Recovery
ComplicationsConfounding Factors
Efficiency Efficacy
Cost Waste
Pt and Provider Satisfaction
Frustration Barriers
PSH Interplay Matrix
PSH Interplay Matrix
PSH Strategic Plan AchievementsPatient Centered
CommunicationClinical Pathways
Financial Mgmt
Payment SystemsMetrics and Measurements Auxiliary Projects
PSH Patient HUB (PERC)6 Service Lines & 9
Comorbidity Teams
Business Development
Planning
Lead and Lag Metrics for all service
lines & comorbidity teams
PMI Research/ Public
Health- PSH Integration
SMSF Grant Funding
IT/Helios support-
1. Procedure Pass
2. PSH Patient Flag
3. Clinical Pathways
Multi-disciplinary
Decision Support
Finance Mgmt
Spine (MISSIC), Hip & Knee
(MARQI0, etc integration
Perioperartive Medicine
Inpatient Consult Service
IT support/ Creative
ServicesPSH Team eRoom
Data Collection and
Analysis Improvement
System Councils: Anesthesia,
Bariatrics, Joint, Spine
Periop Med Non-
Accredited Fellowship
Patient/Care Giver-
Educational Materials
OneHenry website for
PSH Protocols and PlansActuarial Services PSH Datamart and EDW
Periop Med Informatics
Accredited Fellowship
Patient Surveys and Follow-
up Assessments
Optimization Clinic re-
design (PMI Research,
Rad space)
Public & Pop Health
ETG data integrationMPOG/Aspire Benchmarking
Research Coordinator
Care Provider Education
(MA, RN, CRNA, APP,
MD/DO, etc)
Central Authorizations:
Blanket Authorizations
for Service Lines
Patient Education Website -
Educational Materials POC Scanning
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365.0
417.0
334.0
0
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2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-01 2017-02 2017-03 2017-04
# o
f tu
rno
vers
Ave
rage
Month TIme Period
Room Turnover Average (excludes add-ons & ICUs)
Average of room_turnover Goal # of turnovers
Value Stream Mapping and development of strategy and tactics
Full ImplementationRCA nearing completion
Celebration Party
PSH development for Hips/Knees
PSH Cost Accounting – Second Pass
HFH PSH is HERE
Courtesy of Premier, Inc
Components of NextGen at HFHS
Primary Care Initiative
– Managing High Risk/High Cost Populations
– Reducing Variation in Medical Decision Making
– Managing Transitions of Care
Surgical Specialty Care Initiative
– System Service Line Councils
– CQI Initiatives
– Perioperative Surgical Home (PSH)
Pop Health Performance Highlights A1C
– 10% average reduction in HbA1c (blood sugar) ~ 1200 patients (< HEDIS & CMS benchmarks)
Ambulatory Management
– 17% reduction in admits/1000 and 21% reduction in ED visits/1000 for
Concentrated Care Centers
– 26% reduction in admit/1000 and 22% reduction in ED visits/1000
Emergency Department Decision Support
– 7% reduction in admissions
Post Acute Care
– Readmissions from SNFs have dropped more than 11% in past 18 months
– SNF LOS for ACO patients dropped from 28 days to 16 days
– 170 3-day waivers invoked to date, saving $382,000.
Primary Care Referring WiselyReferral Variation/Rates
HFMG Internal Referral Variation
(Standard Deviation)
HFMG Overall Referral Rates
(referrals/1000 visits)
Henry Ford ACO Performance – 20169%
Reduction
10% Reduction
10%
Increase
on Quality
Indicators