‘We were one of the cat­a­lysts to get Detroit go­ing again’

Modern Healthcare - - Q & A -

Since 2013, Joe Mul­lany has served as CEO of the Detroit Med­i­cal Cen­ter. It’s a nine-hos­pi­tal, $2 bil­lion-a-year sys­tem ac­quired by Tenet Healthcare as part of its merger with Vanguard Health Sys­tems, which had ac­quired DMC in 2010. Dur­ing Mul­lany’s ten­ure, Tenet has in­vested $850 mil­lion at DMC in new fa­cil­i­ties and tech­nol­ogy, ex­panded emer­gency de­part­ments and ICUs, and built the new DMC Heart Hos­pi­tal. Be­fore go­ing to DMC, he served as pres­i­dent of Vanguard’s New Eng­land re­gion, and in ex­ec­u­tive po­si­tions with Essent Healthcare and Health Man­age­ment As­so­ci­ates. Mau­reen McKin­ney, ed­i­to­rial pro­grams man­ager for Mod­ern Healthcare, re­cently spoke with Mul­lany about how his sys­tem’s Medi­care Pi­o­neer ACO has achieved suc­cess­ful re­sults and the chal­lenges and re­wards of op­er­at­ing in eco­nom­i­cally trou­bled Detroit. This is an edited tran­script.

Mod­ern Healthcare: How did your Medi­care Pi­o­neer ACO do in the re­cent CMS re­sults?

Joe Mul­lany: I have been pleas­antly sur­prised. We were one of the orig­i­nal Pi­o­neer ACOs and we’ve stayed in it through three full years. When the re­sults came out this year, we were able to lower our cost curve by $17 mil­lion over a pri­o­ryear spend. The year be­fore was roughly $13 mil­lion. So we have con­sec­u­tive years of chang­ing the way we treat this pop­u­la­tion to the point now where our physi­cians are ex­cited that we have en­rolled an ad­di­tional 12,000 peo­ple for next year. We think the model al­lows us to pro­vide the right type of care and do it at a lower cost.

MH: How are you are tack­ling chronic dis­ease man­age­ment with Detroit’s chal­leng­ing pa­tient pop­u­la­tion?

Mul­lany: Detroit has had high un­em­ploy­ment, so our pop­u­la­tion has a lot of un­served needs. His­tor­i­cally, they have got­ten their treat­ment through emer­gency rooms. We see over 100,000 pa­tients a year in our three emer­gency rooms. Through an in­no­va­tion grant, we are bak­ing into our emer­gency rooms ba­sic pri­mary-care clin­ics, which in­clude so­cial work, be­hav­ioral health, pri­mary-care doc­tors and nurse prac­ti­tion­ers. Once pa­tients come into the ER, they get moved over into a pri­mary-care type set­ting, get worked up, and then all fu­ture care gets re­ferred out to pri­mary care in our com­mu­nity.

MH: What has been the im­pact of Tenet ac­quir­ing DMC?

Mul­lany: Hav­ing the fi­nan­cial back­ing of Tenet and a lot of their best prac­tices has been very good for DMC. The sys­tem had been run very well but had a lot of op­por­tu­nity. Tenet has been able to take the best prac­tices of its 80 hos­pi­tals and bring them to Detroit. That is play­ing out in our pop­u­la­tion-health strat­egy. We are well­po­si­tioned due to the as­sets that we have from the hos­pi­tal side, but more im­por­tantly, on the am­bu­la­tory side. We have over 40 am­bu­la­tory sites in the greater Detroit area, so we are try­ing to take healthcare out to where the pa­tients are.

MH: Are you hop­ing to set up ACO-style agree­ments with pri­vate in­sur­ers as well?

Mul­lany: Yes. I think it’s go­ing to hap­pen at its own pace. We be­lieve due to our learn­ing curve through the Pi­o­neer ACO, we are well­po­si­tioned to take on the risk of treat­ing pa­tients in their to­tal­ity and have bet­ter out­comes. Our read­mis­sion rates are down con­sid­er­ably. Our qual­ity scores have im­proved ev­ery year. And we have done that at a lower cost to the sys­tem. We would like to ex­pand that as much as we can.

MH: How has your sys­tem iden­ti­fied high-qual­ity, low­er­cost post-acute providers, and how has that con­trib­uted to your ACO’s suc­cess?

Mul­lany: The Michigan Pi­o­neer ACO has rated post-acute providers on a va­ri­ety of fac­tors and tracks spe­cific bench­marks. We give this in­for­ma­tion to our pri­mary-care physi­cians and also share it with the post-acute providers to let them see how they com­pare with the com­pe­ti­tion. The at­ten­tion paid to pa­tients af­ter they leave the hos­pi­tal has im­proved pa­tient health and con­trib­uted sig­nif­i­cantly to our ACO per­for­mance by re­duc­ing read­mis­sions, av­er­age length of stay in skilled nurs­ing, and un­nec­es­sary home health costs.

MH: How has your sys­tem used fi­nan­cial in­cen­tives with

“Hav­ing the fi­nan­cial back­ing of Tenet and a lot of their best prac­tices has been very good for DMC.”

pri­mary-care physi­cians to drive the ACO’s suc­cess?

Mul­lany: We work closely with our pri­mary-care physi­cians to help align goals. In the Pi­o­neer ACO, our in­cen­tives are based on qual­ity scores. The scores set by CMS in­clude achiev­ing both mean­ing­ful use and pa­tient sat­is­fac­tion. We share this in­for­ma­tion with our pri­mary-care physi­cians to fa­cil­i­tate ed­u­ca­tion and per­for­mance among peers.

MH: How has your sys­tem ad­dressed the is­sue of ACO pa­tients roam­ing to other provider sys­tems?

Mul­lany: We con­tinue to work closely with our physi­cians to re­duce roam­ing rates. We’re fo­cused on en­hanc­ing care co­or­di­na­tion and ed­u­cat­ing our pa­tients about how they ben­e­fit from this en­hanced part­ner­ship.

MH: What are your views on high-de­ductible health plans and how they are af­fect­ing pa­tient care?

Mul­lany: I’m not a fan of high-de­ductible plans. The ACO model is geared more to­ward em­pow­er­ing the pa­tient through ed­u­ca­tion, com­mu­ni­ca­tion and preven­tion, all of which im­prove care and help re­duce costs in the long run.

MH: What have been your sys­tem’s most ef­fec­tive strate­gies for re­duc­ing hos­pi­tal read­mis­sion rates?

Mul­lany: Detroit, like a lot of in­ner cities, has a built-in higher read­mis­sion rate. Ours was around 30% when we first started track­ing it, much higher than the na­tional av­er­age. We have found a di­rect cor­re­la­tion if we can get pa­tients into a pri­mary-care provider within the first seven days of dis­charge. Then their like­li­hood of be­ing read­mit­ted is sub­stan­tially lower, to the point that our cur­rent rate for read­mis­sions in 2015 is around 16%.

MH: Do you think Detroit is mak­ing an eco­nomic come­back?

Mul­lany: We be­lieve we were one of the cat­a­lysts to get Detroit go­ing again. We made a com­mit­ment to in­vest over $850 mil­lion in new con­struc­tion in Detroit since 2011. We have built a new heart hos­pi­tal and have put sub­stan­tial ren­o­va­tions in all of our ex­ist­ing as­sets. That has cre­ated a nice hub of ex­cite­ment in the midtown area.

We also of­fer hous­ing sub­si­dies for any of our em­ploy­ees to re­lo­cate into the city. There are over 2,000 units of hous­ing un­der con­struc­tion right around DMC, which will come on board within the next 24 months. Our mar­ket share con­tin­ues to grow in a city that re­ally feels like it is on the cusp of great things.

MH: How ef­fec­tive do you think the pop­u­la­tion health man­age­ment model is?

Mul­lany: It’s mak­ing a big­ger dif­fer­ence for the com­mu­nity than past tech­no­log­i­cal and other in­no­va­tions I’ve seen. All peo­ple want to be healthy. Sup­port­ing the ACO model of pro­vid­ing what is best for the pa­tient through im­proved co­or­di­na­tion, en­gage­ment and ed­u­ca­tion al­lows us to strengthen our scope of ser­vices pro­vided to not just in­clude those with chronic con­di­tions, but to also help im­prove the health sta­tus of the com­mu­nity we serve.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.