SANDCASTLE FAMILY PRACTICE

1. SANDCASTLE FAMILY PRACTICE TEAM 8 TEXAS GULF COAST MEDICAL MANAGEMENT ASSOCIATION 3RD ANNUAL BUSINESS PLAN COMPETITION NOVEMBER 5, 2016

2. Content • Overview of market • MACRA • Keys to success under MACRA • Proposed solutions • Cost of solutions • Five year outlook • Next steps

3. Corpus ChristiNueces County SeatTexas • ~ 250 providers per 100,000 people (260 providers per 100,000 people nationally) • 20% patients have a challenge of accessing provider due to physician shortage Texas Gulf Coast Corpus Christi Population: Over 350,000

4. Corpus ChristiProviders Three main hospitals owned by With 15 affiliated physician groups

5. Medicare • 80% of traditional insurance • Physician Fee Schedule • 15% of federal spending growing 6% per year • Aging population • Poor financial outlook

6. MACRA: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is bipartisan federal legislation signed into law on April 16, 2015. • Value-based care reimbursements • Value = outcomes / $ spent • Improve patient long-term outcomes

7. Corpus Christi Regional Challenge • Medicare beneficiaries: 12% population • Medicare payments: • 40% healthcare revenue • Chronic diseases: • Most prevalent health condition

8. Keys to Value-Based Reimbursement EHR Monitor and report quality metrics Practice improvement Management of chronic care Partnerships with other providers

9. Existing Operations Family Medicine Practice 20 physicians plus staff Anticipated change to value-based reimbursement • EHR • PQRS • Partnerships

10. Proposed Solution:Education • Why? • 50% of Physicians: • Unaware of MACRA Outcome? Vision Transition: Patients’ long-term health • How? • MACRA physician information sessions: • Goal of value-based reimbursement • Impact on reimbursement • Revisions to current medical practices

11. Proposed Solution: Patient Advocate • Why? • Increase providers’ awareness: • Patients’ health changes • Outcome? • Constant monitoring: • Manage chronic disease • How? • Hire 6 Patient Advocates • Conduct training • Inform patients

12. Proposed Solution: Customized Care Plans • Why? • One size treatment plans: • Not effective • Outcome? • Patient input: • Create care plan for behavioral changes • (diet and exercise) • How? • Patient Advocate • Modify existing care plan instructions • Understand patients’ goals

13. Proposed Solution: Personalized Patient Profile • Why? • Risk assessment: • Patients that need more support during care • Outcome? • Providers Access: • Summary of relevant information • How? • Questionnaire for each visit • Classify patients as High vs. Low attention • Allocate Patient Advocate time

14. Proposed Solution:Alliance with Providers • Why? • Improve communication • PCP &Specialists • Reduce medical waste • Outcome? • Improvement of care • Reduce medical waste • How? • Alliance with local hospital & specialists • Patient Advocate: Manage appointments & records • Inform referred physicians about EHR, personalized care plan, and patient profile

15. Proposed Solution:Home Visits • Why? • Improve access to • healthcare • Chronic patient care • Outcome? • Management of • chronic disease • Combat lack of access • How? • Patient Advocate will notify physicians of changes in patient health • Each physician will make home visits

16. Patient Advocate

17. Finance Changes • Compliance with new care plans 75% • Reduce visits to physician by 1/3 • 6 Patient Advocates • New patients • Participate in Chronic Care Management • Report measures under MIPS

18. $ Cost Break Down $ New Continuing Building and utilities Equipment Variable Costs Staff salaries 58% of Total Revenue • Patient Advocate • Salary: $25/hr • Hours: 8/day • Additional reporting requirements • Physicians see patients 40 hours week • Visit time includes time per patient for reporting data

19. Revenue Generation: Patient Advocate • Improve compliance, decrease visits • Reduce existing patient visits by 280/mo • Generate patient savings

20. Revenue Generation:New Patients • Welcome 6750 new patients • Generate revenue though yearly check ups • Generate revenue though Chronic Care Management Purpose: To meet provider shortage in region Physicians spend same amount of clinic time with patients

21. Revenue Generation: New Reimbursements • 80% Medicare beneficiaries qualify • 80% will participate Chronic Care Management

22. Revenue Generation:Physician Time Physician Reallocation • New patients to physicians with high compliance • Reallocate salary to physicians with improved compliance in patients

23. Revenue Adjusted for MIPS

24. Revenue, Cost, &Profit Breakdown

25. Next Steps • Implement Solutions • Continue to foster relationships with nearby hospitals and specialists • Observe existing and new ACOs

26. Thank you Questions?

27. Supplemental

28. Billing Charges • Medicare initial visit $ 200.00 • Medicare Follow-up $ 70.00 • Initial Chronic Care Management $ 63.68 • Chronic Care Management Monthly $ 42.60

29. Patient Questionnaires Initial Follow-up

30. References American College of Physicians. Chronic Care Management Tool Kit. 2015 Christus Health. Christus Physicians in Corpus Christi Areas. 2016 CMS.gov Centers for Medicare & Medicaid Services. Physician Fee Schedule Overview. 2016 Department of Health and Human Services Centers for Medicare & Medicaid Services. Methodology for Determining Shared Savings and Losses under the Medicare Shared Savings Program. 2014 Department of Health and Human Services Centers for Medicare & Medicaid Services. FY2017 Proposed Rule. 2016 Department of Health and Human Services Centers for Medicare & Medicaid Services. 2016 Physician Quality Reporting System (PQRS): Implementation Guide. 2016 Department of Health and Human Services Centers for Medicare & Medicaid Services. National Health Expenditure Projections 2015-2025. 2015 Department of Health and Human Services Centers for Medicare & Medicaid Services. NHE Fact Sheet. 2016 Department of Health and Human Services Centers for Medicare & Medicaid Services. The Medicare Access & Chip Reauthorization Act of 2015 Quality Payment Program. 2015 Family Practice Management. Patient Surveys/Questionnaires. 2016 Health Catalyst. What is an Accountable Care Organization (ACO)?. 2016 Kaiser Family Foundation. An overview of Medicare. 2016 National Association of Counties. NACo County Explorer: Corpus Christi. 2016 NEHI. Improving Medication Adherence and Reducing Readmissions. 2012 Physicians Practice. Overhead Calculator and Benchmarking Tool. 2016 Texas A&M University- Corpus Christi. 2016 Costal Bend Health Needs Assessment. 2016 United States Census Bureau. Quick Facts Corpus Christi city, Texas. 2015