Bi-Monthly Update
May 2016
A Message From our Chief Medical Officer 
Dr. Mark Hernandez,
Chief Medical Officer

Hi all,

I am excited about conversations happening about value-based care seemingly in every room I enter these days. I believe people are really beginning to embrace the notion of a different focus in the delivery of health care; namely the focus is on achieving better health outcomes for our patients by including them in the work. This will look different depending on the medical issue, but certain commonalities will exist. We will seek to assess the needs of the patient and meet those needs. We will deliver the care in a collaborative and coordinated environment. There will be a particular emphasis on educating and engaging patients in their care. We in the Community Care Collaborative call this "health management" but it is really a way of ensuring high value being delivered by optimizing outcomes. In the post below, Dr. Freeman, vice dean of Clinical Affairs, discusses how the Dell Medical School is approaching this in their service delivery model. I hope it stimulates lots of thinking about this on your part. Send your questions and comments to .
- Dr. Mark S. Hernandez 

Improving Specialty Care in Travis County

Dr. Richard Freeman, vice dean of Clinical Affairs at the Dell Medical School at The University of Texas at Austin, was recruited to the school's inaugural faculty to help design and implement new models of care. Freeman's initial focus is improving specialty care through a model known as integrated practice units, or IPUs. 

In his experience as a transplant surgeon, Freeman typically practiced medicine as part of a team consisting of a pharmacist, a behavioral health specialist, a nurse coordinator, and other caregivers from different medical and surgical disciplines. This integrated team coordinated efforts to provide the necessary care for a patient. This framework is similar to how care will be delivered in the IPUs the Dell Medical School is launching in November 2017 to deliver value-based care to the community.

Integrated Practice Units and Value Based Care

When care is reorganized through IPUs, the individual members of a multidisciplinary co-located team can step in where they're most needed and treat specific conditions and needs of a patient in a more efficient and successful way.

"The idea of an IPU is to say, 'ok, someone with a specific condition or disease doesn't necessarily need to see the doctor for all of the things that could help improve their health,'" said Freeman. "In fact, there are members of a team that are specifically trained to deliver parts of that care that are better equipped than the physician. For example, the pharmacist when a complicated drug regimen is necessary for a patient's care."

Today most health care is paid for through a fee-for-service model. In this model, doctors are paid to do procedures and see patients in clinics. 

In fee-for-service models, a provider may not bill for a pharmacist to manage medication, drug interactions, and patient compliance. 

"Value-based care is aligning the payment structure with what outcomes patients and the community want to improve health," Freeman explains. "It's changing the payment system to be directly aligned with improving the health of the population."

To deliver value-based care and achieve the best results for a patient and ultimately the community, a wide range of professionals have to combine and focus their efforts. 

In an IPU, the team of physical therapists, doctors, pharmacists, and others are paid to provide physical therapy, manage medications, and treat related conditions. Many patients can be kept out of the hospital and avoid surgery, something patients and providers both want.

Technology, Design, and the Patient Experience

IPUs are also being designed to improve the patient experience. Studies show patient experience influences how well a patient complies with treatment and perceives the effect of a medical intervention. 

"You can take [IPU model] way out to one end of the spectrum and say, 'Well that's what Starbucks does.' They're not developing health care services but they very carefully craft their experience so you comply with them, meaning you'll go back to them as a customer," Freeman said.

To get the best patient interaction with an IPU, these experiences have to be designed so patients are more likely to return and engage with the different components.  It requires designing every step to ensure a patient isn't lost before, during, or after their first visit. 

In the not so distant future, Freeman said, technology will go so far as to replace in-person follow-up appointments with secure video conferencing, allow patients to give video tours of their homes so an IPU can identify health risks (i.e. throw rugs in the homes of the elderly who are prone to falling), and even relay vitals to a doctor through wearable devices.

"In a very low-cost way, we can gather some of these really important determinants of what your health is and then we can synthesize that into a larger data system and begin to understand," Freeman said. "It all goes back to value-based care."

With the help of design and technology, the patient experience will improve, the system will save money, and most importantly, the health of the community will improve.

The Future of Travis County

With IPUs reorganizing care around the patient and incentivizing healthier outcomes and better patient experiences, the future of Travis County health care is looking bright. Design and technology will lend a helping hand gathering patient information, relaying this information across the system efficiently, and develop measurement for population risks.

Through value-based care and IPUs, the focus will become getting the best results for the patient, as well as creating the best results for our community.
Leader Spotlight

Cynthia Gallegos joined the Community Care Collaborative in January as the IDS Program Manager. She leads the implementation and evaluation of complex clinical pilots across various specialties for the Integrated Delivery System (IDS) to help improve demand management, access to care, and coordination of services between specialty and primary care providers.  
Cynthia most recently comes from the Seton Healthcare Family, where she was the clinic operations manager of the palliative care medicine program and gastroenterology service line, in addition to the project manager for Seton's palliative care Delivery System Reform Incentive Payment  ( DSRIP project.  Prior to Seton, Cynthia was the practice administrator of Pain Care Physicians, and a project manager at Capital Cardiovascular Specialists and Med360 Partners.  Cynthia holds a Bachelor of Healthcare Administration from Texas State and is pursuing her Master Business Administration at St. Edward's University.  

Currently, Cynthia is working in collaboration with CommUnityCare (CUC), Seton Healthcare Family, and the Dell Medical School (DMS) on an orthopedics pilot targeting reduced wait times for MAP patients referred from CUC. Devin Williams, FNP will offer non-surgical based orthopedic services through the establishment of a mid-level orthopedic clinic and is also working closely with CUC and DMS to begin provider education. By expanding the number of orthopedic clinics and working with referring providers to improve demand management, the CCC aims for this pilot to support care delivery transformation and improve the patient experience along with our community's health.
Dell Medical School at The University of Texas at Austin


The medical school was featured in a recent  New York Times column  by Dr. Dhruv Khullar   which touted its "focus on helping students understand how health systems,  communities and social issues contribute to individual health through a variety of  innovative methods."

Dr. Bill Tierney , Dell Medical School Chair of  Population Health , met with the community in April  to  share his vision  for the department. Later, Mayor Steve Adler talked with  AustinInno  about  how Dell Medical School fits  with Austin's innovation culture.

Dean Clay Johnston  was featured in the  May 6 edition  of  The Hook , a weekly news show produced  by Texas Exes. Don't miss "Saved by the Dell."

Team news:
Dell Seton Medical Center at The University of Texas
One Year Countdown Begins for Dell Seton Medical Center at UT
This time next year, expect a new buzz of excitement around town. May 17, 2017, is when Dell Seton Medical Center at The University of Texas plans to open its doors to its very first patients. People receiving care at University Medical Center Brackenridge will be transferred to the new 211-bed facility, which will serve as the primary teaching hospital for Dell Medical School at the University of Texas at Austin.


The Future of Care Now Visible in Downtown Austin
You may have already glimpsed a new addition to the downtown Austin skyline while driving on I-35. In March, the main signage for Dell Seton Medical Center at UT went up for all passersby to see. It's the latest milestone marking the medical center's transformation to reality .
During the past year, the structural skeleton of the new hospital was built. The exterior façade of glass, stone, and roofing was placed. Interior walls and mechanical systems were erected. Now, builders are rigorously testing all of the equipment systems needed run the hospital to ensure they work properly before closing up the walls and finishing out the interior.
The new medical center will be built, owned and operated by Seton Healthcare Family, a member of Ascension, the largest non-profit health system in the U.S. and the world's largest Catholic health system. Seton and Ascension are paying for the construction. No taxpayer funds are being used.

A New Home for Adult Level I Trauma
Dell Seton Medical Center at UT, like UMCB before it, will house Central Texas' only Level I trauma center for adults. The trauma center gives patients in 11 counties round-the-clock access to skilled specialists.
Four of UMCB's surgeons rely on their military medical service to stay cool under fire. Watch how one patient at a time or 1000 at once, Seton's trauma teams stand at the ready. 

CCC Organizational 'Shout-Out'

El Buen Samaritano's Care Coordination Center would love to recognize Elena Garcia, RN at Peoples Community Clinic. They say she is "very dedicated in her work with patients and collaboration with community partners." Congratulations Elena and thanks for the work you do!
CCC Board of Directors Meetings:

All CCC Board of Directors meetings are held at 1111 E. Cesar Chavez St., Austin, TX 78702.


        • Next Meeting: July 19, 2016 at 2 p.m.


These dates are subject to change pending board approval.