Payors

Pareto was born out of my experience and love for Value Based Care as a business model that has been proven to improve outcomes for patients, decrease cost for payors, improve engagement and decrease burnout for providers. Pareto is designed to engage in Value Based Care contracting by providing rigorous medical management support to all patients including the most complicated 20% of patients that incur 80% of the morbidity and mortality and drive 80% of the cost-hence Pareto-or the 80/20 rule. Pareto is unique among primary care practices as it is intentionally designed to increase value as measured by improved STARS, CG-CAHPS, HOS and Utilization metrics.

How would Pareto benefit you?

EXPERIENCE | BENEFITS TO PATIENTS | BENEFITS TO YOUR NETWORK

EXPERIENCE | BENEFITS TO PATIENTS | BENEFITS TO YOUR NETWORK

EXPERIENCE

What experiences have we had that we believe align well and position Pareto to meet and exceed the needs of your patients?

  • Pareto is a practice intentionally built and uniquely designed to provide rigorous medical management support to all patients including the most complicated 20% of patients that incur 80% of the morbidity and mortality and drive 80% of the cost-hence the name Pareto also known as the 80/20 rule .
  • Pareto Population Health Management Practice is owned and operated by Kenyatta Lee MD, MHS-CL.
    • American Board of Family Medicine Certified
    • Masters trained clinician exposed to organizational behavior and basic business principles (Thesis-Developing Medicare Compliant Transitional Care Program-included with supplemental material).
    • 10-year history of developing innovative, effective evidence based practices in the Urban Core of Jacksonville. (DRAP powerpoint provides an excellent summary of programs and outcomes. )
  • Developed the first academic practice plan to receive Level 3 Patient Centered Medical Home recognition.
  • Published research that demonstrated the role of PCMH in reducing disparities.
  • Practices were selected by CDC for rigorous study that concluded that the practice systems were effective in improving outcomes at reduced costs. The model and results were shared nationally.
  • Deeply familiar with the Schell-Sweet Community Resource Center and the New Town community as this practice was included in the portfolio of practices that I managed for 8 years. (Known at the time as College Park and operated by Dr. Registre. )
  • Spent an additional 2 years working as the Senior Medical Director in the Full Risk DaVita Medical Group in Tampa, FL, which was recently purchased by Optum.
    • Served as the Chief Quality officer for a 1200 physician practice at the University of Texas Health System in San Antonio, TX for 3.5 years.
  • Built and managed a team of 40+, that included Case Managers, Data Analysts, Community Health Workers and HEDIS Quality improvement Specialists.
  • Worked closely with the various products and plans in the market to drive improvement in Patient Experience, HEDIS metrics and Utilization Metrics- Hospital and ER utilization.
  • Medicare:
    • Positive Payment adjustments for MIPS each year.
    • Developed second University of Texas owned ACO and recruited over 20 participants
  • Medicare Advantage:
    • Improved CG-CHAPS or PE experience metrics through development of education programs and dashboards.
    • Improved STARs or HEDIS performance (maintained 4.7 STAR score for DaVita and improved UT STAR performance.
    • Decreased Hospitalization and ER Utilization metric through the deployment of case managers.
    • Increased panel sizes and retention.
    • Worked with my team to develop a Hierarchical Condition Category ( HCC) program designed to improve appropriate documentation of key HCC codes.
  • Medicaid:
    • Developed and implemented strategy to secure Full Valuation for the Delivery System Improvement Program (DSRIP).
    • Improved performance for targeted populations that resulted in significant distribution of shared savings resources.
  • Commercial
    • Worked with the UT Self-insured team to provide improved access.
    • Work with the UT system team to improve the reporting platform for key utilization metrics.
    • Worked with the team to develop language and content to build Clinically Integrated Network (CIN).
  • Pareto PHMP is located in the Schell-Sweet Community Resources Center located on the Campus of Edwards Waters College in the New Town community.
    • Schell-Sweet is committed to decreasing the burden of suffering and mortality in one of the most underserved areas in the Jacksonville community.
    • Patients that are attributed to our practice will not only have same day access to high quality, low cost primary care but an interdisciplinary team (true medical home) of committed and compassionate health care professionals. Schell-Sweet provides :
    • Veteran services
    • Programs for at risk families
    • Department of Children and Families- food stamps/Medicaid
    • Food distribution
    • DAD Network
    • Health screenings
    • Mental health counseling
    • Pregnancy support and counseling
    • Utility assistance
    • Exercise classes for elders
    • E-Health and basic computer training
    • Employment referrals
    • Community activities.
  • The Schell-Sweet center has been a viable and vibrant resource for the New Town community for over 20 years with demonstrated evidence of its ability to mitigate the impact of the rampant disparities that affect patients in the community.
  • The center and its mission have been supported by the college as well as political leadership at the local, state and federal level.

Call Us For More Information at (904)478-5483 or Email us at info@paretoclinic.com

BENEFITS TO PATIENTS

What are the benefits to the Patients of including Pareto Population Health Management Practice (PPHMP) in your network?

  • Same day access to a Board Certified Primary Care Practitioner servicing 5 days/week.
  • Access to the Schell-Sweet community center team that provides social services support in addition to wellness resources.
  • Culturally congruent care with a provider who has a 10+ year history of providing care in the urban community.
  • Reduce unnecessary hospitalizations as patients will have access to Case Managers that will target and work closely with patients to ensure that chronic and acute conditions are managed effectively.
  • The Practice location is within walking distance for many patients. In fact over 80% of Schell-Sweet visitations occur from residents from the New Town community.
  • Decreased out of pocket health care costs. Pareto will reduce unnecessary hospitalizations, ER spend and use medications that are evidence based, effective and affordable.
  • While providing patients with excellent access to specialists when needed, we will be selective in our referral partners choosing only to work with specialists who share our philosophy regarding patient care. This will ensure that patients have access to high quality care and will minimize cost and adverse morbidity that comes from overutilization.

Call Us For More Information at (904)478-5483 or Email us at info@paretoclinic.com

BENEFITS TO YOUR NETWORK

What are the Strategic benefits to your network of including Pareto Population Health Management Practice(PPHMP) in your Network?

  • Ensure that your network will retain and grow its panels in target communities by providing access to:
    1. Board Certified Family Practice
    2. State of the art practice
    3. Electronic Health Record
    4. Patient Health Portal
    5. TeleMedicine (video and email communication)
  • Ensure network adequacy in both letter and spirit of the concept. Pareto’s location in the New Town community (documented Primary Care shortage area) will Ensure that your network meets and exceeds the expectations as outlined by State, Federal and Commercial contracts:
    1. We share your network’s passion for providing value and high quality care. It is said that “the best predictor of future behavior is relevant past behavior.” The Pareto Team has over 16 years of demonstrating a high level of performance in all areas central to success in Value Based Care and Population Health .
    2. Prior to our reopening, the clinical practice in Schell-Sweet was closed for over three years forcing many families to go without care or to travel far outside of the community to seek quality care.
    3. New Town has the lowest concentration of primary care practices in the city, by some estimates, the country. It has been listed by the federal government as a primary care shortage area, has the highest mortality rates from chronic disease and highest poverty levels.
    4. From a strategic standpoint, the high concentration of enrollees and the low concentration of primary care providers in the New Town area represents a threat to the success (growth, retention and health of its enrollees) of all products (Commercial, Medicaid HMO and Medicare Advantage).
    5. This low concentration of primary care in the New Town community is strategically a threat because patients are more likely to go to the ER, be admitted to the hospital and experience catastrophically high levels of inappropriate and unnecessary utilization as they will not have access to regular primary care.
  • Pareto is unique amongst primary care practices as it is intentionally designed to increase value not volume or downstream referrals to specialists or imaging centers.
  • Improve and maintain STARS scores which will ensure that your plan will be able to recruit patients into its Medicare Advantage programs all year.
  • The urban core has the highest concentration of Dual eligible patients. Pareto will provide excellent access and support to ensure decreased morbidity/mortality and decreased inappropriate/unnecessary utilization.
  • Pareto is close to both the I-95 and I-10 corridors, logistic hubs and industrial parks in the west of the city. Many of the patients in commercial products will benefit from this close proximity.

Call Us For More Information at (904)478-5483 or Email us at info@paretoclinic.com

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