2019 Acclaim Award Honoree

Advancing the Triple Aim Through Shared Provider, Patient, and Employer Risk

Lexington Clinic is the largest multispecialty medical group in Central Kentucky. It employs more than 200 providers, representing 30 specialties, and 1,000 support staff, who provide care for more than 600,000 patient visits per year. Like UW Medicine, Lexington Clinic’s application highlighted strategies it took to improve care quality and lower costs. It was especially lauded for its “Direct-to-Employer” partnership program.

Lexington Clinic has incorporated AMGA’s High-Performing Health System Attributes into their multispecialty practice in the following ways:

Efficient Provision of Services

• To reduce overall spend for employers and expand their patient population, Lexington Clinic offers regional and national employers the option to contract directly with their clinic. This direct-to-employer (DTE) model emphasizes population health management and health plan design, as they create customized premier network options for their ­clients. These direct partnerships create a healthcare environment focused on prevention for all and health maintenance for chronic patients.

Organized System of Care

• Lexington Clinic developed a Member Navigator program specifically for their DTE arrangements. Member navigators promote member engagement by removing the hurdles to access that typify health care.
• Care managers are assigned clinical cohorts and are highly proactive. They often work with member navigators to share information with the providers of care. By increasing the touchpoints between members and clinic staff—whether in-person, telephonically, or electronically—they are working to make access and compliance as simple and swift as possible.

Quality Measurement and Improvement Activities

• Quality reporting in their DTE arrangements center around specific population needs. Lexington Clinic drills down to how these populations need to be managed, then develops reports around those management objectives. Reporting is based around a risk-adjusted per-member-per-month (PMPM) metric. When they identify an opportunity for better management, decreasing PMPM costs are an indication that quality care is being achieved.
• They have participated in several quality programs outside of their DTE program, including: Diabetes: Together 2 Goal®, A4 in Focus, and Measure Up/Pressure Down®. They also participate in Medicare’s Bundled Payments for Care Initiative (BPCI), as well as the Merit-based Incentive Payment System (MIPS).

Care Coordination

• Lexington Clinic’s physicians and care managers work closely with high-risk and rising-risk patients to proactively manage their care. For example, their diabetes education program includes clinical pathways and deliverables and is staffed by nurse managers and supported by other professional staff, who help members with a critical aspect of their self-care program: nutrition. In addition, dietitians and care managers have direct access to the electronic health record (EHR), enabling them to update patient records with the most current status and give the physician the most relevant information available.
• In order to assist their members in navigating the complex healthcare system, they first focus on guiding the patient through the system and helping them understand cost elements of care specific to the management of their care. Then, their physicians navigate that member through risks and benefits associated with treatment options, managing the clinical risk elements for the patient.

Use of Information Technology and Evidence-Based Medicine

• Lexington Clinic uses analytics to support their “No Patient Left Behind” program. In this program, they scour data using specific criteria to find individuals who have not had certain types of primary care visits and meet certain age criteria. Using that process, they cast a wide net to try to identify people who have chronic diseases that are not specifically recorded in the patient’s record.

Accountability

• They have developed shared savings arrangements where Lexington Clinic looks at analytical indicators that predict the health performance of a population, identifies areas of improvement, and predicts savings. If those savings are realized, the clinic shares those savings with the employer.

Compensation Practices

• Lexington Clinic uses prevention, patient engagement, and benefit design to incentivize careful utilization of their clinic’s providers and services. The arrangements are not only profitable, but also save their clients money.