Memorial Hermann Healthcare System Clinical Integration & Disease Management

1. Memorial Hermann Healthcare SystemClinical Integration & Disease Management Dan Wolterman April 15, 2010

2. Memorial Hermann Overview

3. Memorial HermannHealthcare System • Non-profit healthcare system operating in Houston, Texas • Market share leader • In partnership with University of Texas Health Science Center National Patient Safety Leadership Award 2009 National Quality Healthcare Award (NQF) 2009 HealthGrades 2010

4. Total hospitals: 12 (9 acute, 2 rehab, 1 children’s) Heart & Vascular Institutes: 3 Managed acute care hospitals: 3 Imaging Centers: 29 Sports Medicine & Rehab Centers: 25 Diagnostic laboratories: 25 Ambulatory surgery centers: 17 Retirement/nursing center: 1 Home Health agency: 1 Memorial HermannHealthcare System Woodlands Sugar Land TMC Katy Memorial City Southeast • Annual admissions: 138,351 • Annual emergency visits: 411,591 • Annual deliveries: 26,731 • Employees: 20,840 • Beds (acute licensed): 3,581 • Medical staff members: 4,857 • Physicians in training: 1,821 • Annual payroll: $1.088 billion Northwest Northeast TIRR PaRC Children’s Southwest

5. Clinical Integration & Reduced Costs

6. Clinical Integrationfor Memorial Hermann • Memorial Hermann has over 3,500 physicians within our physician organization - Health Network Providers (HNP) • 2,000 “core” clinically integrated, independent physicians submitting quality data • Combination of UT, Private and Employed physicians • Governed by 20 member, all physician Board of Directors • Focused on collecting, reporting and managing quality outcomes • Joint determination of clinical utilization targets for contracting and performance

7. Clinical IntegrationPhysician Criteria • The criteria that physicians must agree to by participating in Clinical Integration • (1) Participate in evidenced based medicine, protocol development and implementation • (2) Participate in a preferred electronic health record platform • E-Clinical Works is the system supported standard • (3) Submit quality data for both inpatients and outpatients • (4) Agree to transparent use of data to elevate quality and reduce costs

8. Clinical Integrationand Reduced Costs • Clinically integrated physicians have documented better clinical outcomes than other physicians • Lower average lengths of stay (ALOS) • Less complications • Fewer readmissions • Lower charges to patients • HNP has delivered significant costs savings across targeted disease outcomes

9. Clinical Integrationand Reduced Costs 30% 15% 4% 33%

10. Disease Management

11. Disease ManagementSummary • Memorial Hermann remains committed to improving wellness and chronic disease issues within the Houston community • To address these issues, Memorial Hermann has developed multiple programs including the following • C.O.P.E. – Community Outreach for Personal Empowerment • Community Case Management Initiative • Congestive Heart Failure (CHF), Diabetes, etc.

12. C.O.P.E. Program C.O.P.E Community Outreach for Personal Empowerment • Program Goals • Empower participants to take control of their health care • Establish participants with a Primary Medical Health Home • Improve and maintain participants’ general health and well being through the use of available local community resources • Decrease hospital Emergency Center visits, observation stays, and inpatient admissions • Decrease cost per case of Emergency Center visits and inpatient admissions

13. C.O.P.E. Program • Eligibility – Patients Must • Be registered as “Self Pay” or qualified for Charity Care • Have incurred at least 5 emergency center visits or 3 inpatient admissions in the last 12 months • Have no current chemical or alcohol dependency diagnoses • Live in the Houston area (defined geographical boundary) • Have no active psychiatric diagnoses • Only be accepted if they have accessed services at Memorial Hermann • No outside referrals will be accepted into the program • Requirements – Patients Must Agree to • Return staff phone calls within a 1-2 day time frame • Use Primary Medical Health Home or Clinic or Doctor’s office for non-emergent medical care • Follow up with all scheduled appointments • Show an ongoing effort to complete program goals

14. C.O.P.E. Program Overall reduction of 680 visits at a savings of nearly $2.5 million

15. Disease ManagementCommunity Case Management • Program Structure • Referral and enrollment via in person or telephonic introduction to the program by Navigator (social workers) • Telephonic initial assessment and ongoing monitoring calls by RN case manager • Utilization of evidence-based literature, tools and self-management activities • Assist patient population in understanding and managing their disease and maximizing quality of life

16. Disease ManagementCongestive Heart Failure • As one of the nations’ leading diseases, Memorial Hermann initially focused the community case management initiative on Congestive Heart Failure (CHF) • Outcome data supports • Decrease in readmissions and cost for participants • Improved quality of life • Program has been successful in assisting community to achieve appropriate utilization of health care services

17. Disease ManagementCongestive Heart Failure Overall reduction of 439 visits at a savings of over $5 million