1. 1 Miami Experience Dr Liz Siddons NHS Leicester City

2. 2 Presentation structure Purpose of visit Overview of US healthcare MCCI Company Overview What impressed us? Clinical Outcomes What we could try in Leicester City?

3. 3 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

4. 4 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

5. 5 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

6. 6 Headquartered in Miami, Florida Operating since 1988 67 state-of-the-art medical centers in Florida 5,000 to 30,000 square feet Medical Resources 173 physicians Over 250 specialists Partnerships with Humana, Coventry, and WellCare Provides 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 Overview

7. 7  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 Overview

8. 8 MCCI Patients Revenue ($ in millions) Total Membership

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12. 12 MCCI Approach

13. 13 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

14. 14 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

15. 15 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)

16. 16 Clinical Outcomes

17. 17 Clinical Outcomes

18. 18 Clinical Outcomes

19. 19 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?)

20. 20 Liz Siddons Assistant Medical Director Elizabeth.Siddons@LeicesterCity.nhs.uk