Matrix Medical Network: Randy Dobbs, Chief Executive Officer

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Randy-Dobbs-thumbWhen it comes to the various strategies healthcare organizations are implementing to curb readmission rates and enhance the continuum of care, partnering with an in-home assessment company may not be at the forefront of consideration.

However, Matrix Medical Network, the country’s largest prospective health assessment company in the Medicare Advantage market, has proven itself effective in confronting some of the core challenges facing healthcare leaders.

Founded in 2001, Matrix’s mission is focused on one overarching goal: improving the health and lives of senior Americans through better management of their care. The company works on behalf of Medicare Advantage (MA) health plans throughout the United States and has seen its market presence escalate over the last three years, with a growth rate of 524 percent.

Building on rapid growth

When Randy Dobbs was hired as Matrix’s chief executive officer a little over a year ago, he brought with him an impressive track record of turning around broken businesses. However, Matrix’s business wasn’t broken. In 2010, the company had conducted 60,000 health assessments; in 2011, it completed 115,000 assessments.

Matrix’s staggering growth was transforming the company quickly and dramatically, and it was overwhelmed, unprepared to handle its new level of marketplace presence. The company needed a stable, more efficient approach based on better operational processes.

In other words, Matrix needed scalability, especially if it was going to  continue its growth trajectory and expand into new markets.

“If a business is not hitting on all cylinders, it’s the result of not having the right people, the right processes, and the right technology,” Dobbs explained. “If you do those three things, they typically will lead you to having a better product, better productivity, and a stronger position in your market.”

Once implemented, Dobbs’ three-pronged approach—people, processes, technology—brought about immediate results. In 2012, Matrix conducted 225,000 prospective health assessments and is on track to do more than 330,000 in 2013.

With Medicare and Medicare Advantage plans also growing (currently over 14 million people have chosen an MA plan) and a national focus on reducing costs while raising quality of care intensifying, Matrix expects prospective health assessments to be an important part of healthcare  growth  over the next few years.

“We’re the largest provider in a growing market,” Dobbs stated. “The only way that you continue to maintain that is if your clients continue to perceive you as delivering volume on a consistent basis, quality without flaws, and a competitive price point.”

Being unique in a crowded marketplace

Dobbs was clear that Matrix and its competitors are using many of the same strategies every day. However, there is one differentiator for Matrix.

The company fully employs over 400 nurse practitioners who are deployed in more than 30 states. The majority of its competition contracts out nurse practitioners for in-home assessments.

In fact, Matrix’s network of nurse practitioners nearly doubled in the last year, mainly because of the demand for its assessments. To improve its processes, the company also went paperless and completely digitized its operations. This allows it to provide better day-to-day support for its NPs, including scheduling and logistical routing.

Furthermore, because the NPs are fully employed, Matrix is able to provide them with benefits that show how highly valued their expertise is. It also gives the NPs opportunities for continuing education.

“If you’re the lead dog in a growing, competitive marketplace, you like that view and you never want it to change,” Dobbs said. “So, we think about our people and how we can support them with great benefits and continuing education and development.”

Broadening services and offerings

Every month, seven to 10 percent of the people its NPs see are in a situation that demands immediate referrals, whether to a primary-care physician or a case worker. Sometimes, the situation demands immediate hospitalization. More often than not, a visit from a Matrix NP changes or saves a life.

A typical in-home assessment, which is completely covered by the member’s MA plan, takes over an hour. The NP provides not just clinical services, but also education on how the member can improve and control their health situation in the future.

The impact this has on their wellbeing is immense. Independent studies have shown that those who are assessed in-home versus those who are not have a notable reduction in medical expenses, hospital admissions, and ER visits.

Matrix is looking to build on this value by introducing two new product lines. First, a Physician Bulletin (PB) program, offered by Ascender Software, a Matrix company, combines analytics (including algorithms and data mining) and clinical-chart reviews to identify Hierarchical Condition Category (HCC) opportunities as well as HEDIS and Stars quality gaps for MA plan patients. Electronically delivered to the physician at the point of care immediately prior to a plan members’ appointment, the concise, timely, and relevant information in the PB can be rapidly reviewed by the physician, helping to improve their diagnosis accuracy.

The second product focuses on reducing today’s nearly 20-percent hospital readmission rate for Medicare patients by helping the patient transition from round-the-clock hospital or other medical-facility care to self-care in the home. The Transition of Care solution integrates analytics that identify high-risk patients with diagnosis and treatment provided by Matrix NPs.

Collaborating with the hospital and health plan, the NPs assess patient needs, develop individualized 60-day care plans, and administer care personally or through the Matrix Care Center staff. Typical care plans can include prescription review and adjustments; coordination with physicians, medical equipment manufacturers, and community services; and education around the condition, medication, and nutrition.

As Matrix continues to build its operational capacity and its clinical-support services and as Americans continue to sign up for Medicare Advantage plans, Dobbs said he expects the company to play an even greater role in helping both patients and organizations coordinate care.

“At the end of the day,” he observed, “it’s going to be about understanding the condition and the risk of a number of people joining these medical plans who have been underinsured or uninsured in the past.”

-by Pete Fernbaugh

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