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TRICORE’SVALUE-BASEDSTRATEGY&IVDORGANIZATIONS’ROLERickVanNess,MSDirector,ProductManagementTriCoreReferenceLaboratories

InformationcontainedinthismaterialisconfidentialandproprietarytoTRICOREanditsaffiliatesandmaynotbemodified,copied,published,disclosed,distributed,displayedorexhibited,ineitherelectronicorprintedformatswithoutwrittenauthorizationofanofficerofTRICORE.

April30,2019

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•  Grant/ResearchSupport:None•  Salary/ConsultantFees:

–  TriCoreReferenceLaboratories•  Board/Committee/AdvisoryBoardMembership:

–  UNMMainInstitutionalReviewBoard,CommunityScientificReviewer–  NewMexicoBiotechnologyandBiomedicalAssociation,President

•  Stocks/Bonds–  Mozak,LLC(CEOandCo-Founder)

•  HonorariumExpenses:None•  IntellectualProperty/RoyaltyIncome:None

FINANCIALDISCLOSUREINFORMATION

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•  Background–  TriCoreReferenceLab

–  ClinicalLaboratory2.0

–  TriCore’sLaboratory2.0andVBPstrategy

•  Laboratory2.0Study:PrenatalCareinNewMexico

•  IsBeckmanalignedwiththefutureofthelab?

AGENDA

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DEMING

GALLUP

ROSWELL

ARTESIA

TRICOREREFERENCELABORATORIESServices12clinicalspecialties

2,900highlyspecializedtests11,100,00+diagnostictestsperyear

Generate~60%ofNewMexico’sclinicallaboratorydata98.6%ofalltestsareperformedinTriCorefacilities

Footprint1300+employees30courierroutesacrossNewMexico

60+drawsitesthroughoutNewMexico50+pathologistsandscientists99%patientsatisfaction

15hospitallaboratories3cancercenters

LaboratoryNationallyrecognizedHematopathologyconsultservice

Thefirstmulti-siteCAP15189accreditation

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TRICOREREFERENCELABORATORIES

TriCoreVisionTobeanationallyrecognizedlaboratoryfocusedonindividualandpopulationhealth.

PopulationHealthMajorityofmedicaldecisionsarederivedfromlaboratoryresults1ClinicalDataprovidesthebestinsightintohowtoimproveoverallhealthandhealthcare2,3

AnalyticspoweredbyRhodesGrouptechnology

•  Accesstorealtimedata•  Uniquepatientidentifier•  Longitudinaldatarepositoryacrosscarecontinuum

1.  Forsman,R.W.WhyistheLaboratoryanAfterthoughtforManagedCareOrganizations?(1996)ClinChem.42:813-8162.  Adler-Milstein,JandJha,A.K.Healthcare’s“BigData”Challenge.(2013)AmJManagCare.19(7):537-5383.  Hartman,C.Healthcare’sGrowingDataOpportunity.LeveragingClinicalIntelligencetoElevatePopulationHealthManagementStrategies.(2014)HealthManagTechnol.35(5):24v

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BACKGROUND:NATIONALMEDICALSPEND(2017)=$3.5TRILLION1

HospitalCare

PhysicianandClinicalServices

RetailPrescriptionDrugs

OtherHealth,Residential,andPersonalCare

NursingCareandContinuingCare

Dental

HomeHealthCare

OtherProfessionalServices

Othernon-durableMedicalProducts

ProtectingAccesstoMedicareAct

1.  CenterforMedicaidandMedicareServices.NationalHealthExpenditures2017Highlights.https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf(Accessed:March1,2019)

Year CMS2,3 %ofSpend

2017 $9.7B 1.71%2,3

2018 $8.7B 1.54%

2019 $7.9B 1.38%

2020 $7.1B 1.34%

2021 $6.0B 1.06%

2022 $5.1B 0.90%

2023 $4.3B 0.76%

Year TriCore

2017 -

2018 2.9%

2019 1.9%

2020 ?!

2021 ?!!

2022 !!

2023 !!!!!

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STRATEGYSHIFT:LABORATORY2.0Lab1.0–Volume-based•  SamplecentricinaFFSmarket•  Measuredbycostperunit•  Unfulfilledneedforprimarycareproviders•  Limitedcarecoordination•  Complicatedhealthcareenvironmentinsilos

Lab2.0–Value-based•  Patientcentricinabundledmarket•  Costperlife-population•  Increasedaccesstocare/primarycare•  Enhancedfocusedcoordinatedcare•  Actionableinterpretativeresults

Pre-Analytical Result Post-Analytical

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INPATIENT’SSERUMCREATININE(mg/dL)

0.83

0.50mg/dL

1.40mg/dL

June30 July1 July2 July3 July4 July5

0.750.770.90

1.381.48

July6

1.01

July7

0.88

7/5/20184:05AMHospitalreactstokidneyinjury

7/4/20184:37PMLabanalysisobservedAcuteKidneyInjury

IncreaseinSCrby≥0.3mg/dLbaselineto48hours

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•  30-40%increaseinlengthofstay–  $7,933increaseinhospitalizationcosts1

•  40%ofpatientscandevelopsepsis2–  $32,421increaseincosts3

•  40%ofpatientsrequiredialysis4–  ~$42,077increaseincosts1

•  50%increaseinmortalityrate4

ACUTEKIDNEYINJURYPOTENTIALEFFECTSANDCO-MORBIDITIES

1.  SilverSA,LongJ,ZhengY,ChertowGM.CostofAcuteKidneyInjuryinHospitalizedPatients.(2017)JHospMed.12(2):7-762.  MehtaRL,BouchardJ,SorokoSB,etal.SepsisasacauseandaconsequenceofAKI.(2011)IntensiveCareMed.37(2):241-2483.  ArefianH,etal.Hospital-relatedcostofsepsis:Asystematicreview.(2017)JInfect.4(2):107-1174.  LafranceJP,DjurdjevO,LevinA.Incidenceandoutcomesofacutekidneyinjuryinareferredchronickidneydiseasecontext.(2010)NephDialTranspl.25(7):2203-2209

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ProjectSantaFeFoundationacoalitionoflike-mindednationalleadersandinstitutionsinlaboratorydiagnostics,

comingtogethertocreateanewanddisruptivevalueparadigmtopushbackthefrontiersthatwilldefinetheandplacementofdiagnosticservicesinvalue-basedhealthcare

www.cl2lab.org

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TRICORE’SVALUEBASEDSTRATEGY

PopulationSurveillance

Pre-DefinedMeasures

•  DiseaseSurveillance

•  HCCs/RiskAdjustment

•  HEDIS/PQRSFocused

PHASE11A

PAYFORREPORTING1B

BONUSINCENTIVE

•  CMSStarBonuses

•  PerformanceMeasures

•  QualityRatings

PMPMPerReport/Condition

↓PMPM+/-Bonus

MEASURES

BundlePaymentforCondition

•  DiabetesBundle

•  PregnancyBundle

•  HepatitisCBundle

Population+%SharedSavings

PartnershipModelw/ProviderGroup

•  TotalCostofCare

•  SpecificHealthConditions

•  LabTriagestoProvider

PopulationBasedUpside/Downside

OUTCOMES

FFSBASEDUPSIDEWITHSHARESAVINGS

PHASE2CAPITATIONWITHRISKSHARING

PHASE3

TRIAGE/EFFICIENCY

OBJECTIVE

EXAMPLES

PRICING

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TRICORE’SLAB2.0BUSINESSPLAN

DIAGNOSTICOPTIMIZATION

ClinicalAnalytics Biometrics

SurveillanceData Reporting

Division

ProductsorServices

Features

AlertsandInformationPush

Integration(LabData,HRA)

ActionableWorkLists

PatientConsent PatientEngagementCenter

Datause TriageModel

SpecimenBanking ClinicalPharmacists

PatientEngagement

FacilitatedFollow-Up(FF)

AutomatedPatientNotifications

CareGapClosure

PM/PMPrice $/PatientTargeted AddsValuetoResearch ValueBasedCare MoreInsights

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HYPOTHESIS:CANLABORATORYINFORMATIONIMPROVEOUTCOMES?

•  Clinicallabguidesmajorityofmedicaldecisionsandprovidessignificantvalueinpatientevaluation1,2

1.  Forsman,R.W.WhyistheLaboratoryanAfterthoughtforManagedCareOrganizations?(1996)ClinChem.42:813-8162.  LaposataMEetal.PhysicianSurveyofLaboratoryMedicineInterpretiveServiceandEvaluationofInterpretationsonLaboratoryTestOrdering.(2004)ArchPatholLabMed.128:1424-14273.  HoAhnCetal.EvaluationofNon-LaboratoryandLaboratoryPredictionModelsforCurrentandFutureDiabetesMellitus:ACross-SectionalandRetrospectiveCohortStudy.(2016)PLoSOne.11(5):e01561554.  BurtonLC.etal.UsingElectronicHealthRecordstoHelpCoordinateCare.(2004)MilbankQ.82(3):457-481

•  Patientsmayhavemultipleprovidersenablingclinicallaboratoriestoprovidealongitudinalhistory

•  Identifyingriskwithclinicallaboratoriescanoccurnearreal-time3

•  Effectivecarecoordinationreliesonreal-timestandardizationofhealthdata4

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Salud!

StateCoverageInsurance

BehavioralHealthServices

CoLTS

SelfDirection

PersonalCareServices

PresbyterianHealthPlan

TPA/Molina

Molina

AmeriGroup

UnitedHealthcare

OptumHealth

BlueCross&BlueShield

Lovelace

HumanServicesDepartment.CentennialCare2.0:1115WaiverRenewalPublicEngagement.June2017.http://www.hsd.state.nm.us/uploads/files/Public%20Information/Centennial%20Care/CentennialCarePublic%20Meetings_06-20-2017%20FINAL%20V2.pdf.[Accessed:September19,2017]

BACKGROUND:NEWMEXICO’SMEDICAID<2014

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HumanServicesDepartment.CentennialCare2.0:1115WaiverRenewalPublicEngagement.June2017.http://www.hsd.state.nm.us/uploads/files/Public%20Information/Centennial%20Care/CentennialCarePublic%20Meetings_06-20-2017%20FINAL%20V2.pdf.[Accessed:September19,2017]

•  Bendthecostcurveovertime

•  Streamlineandmodernizetheprogram

•  Promoteintegratedcare

•  Carecoordinationforat-riskmembers

•  Payprovidersforvalueandoutcomes

•  Rightcare,righttime,rightsetting

•  Purchasequalitycare

•  InvolveMembersintheirownhealth

•  Educatebeneficiariestobesavvyconsumers

DevelopComprehensiveDeliverySystem

EmphasizePaymentReform

SimplifyProgramAdministration

EncouragePersonal

Responsibility

BACKGROUND:NEWMEXICO’SMEDICAID>2014

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BACKGROUND:IMPLEMENTING&ASSESSINGCARECOORDINATION

•  ~850,000residentsareinsuredbyMedicaid(NMHSD)1

•  NMHSDrequirescarecoordinationforeachmember

•  NMHSDevaluatescarecoordinationthroughPerformanceMeasures(e.g.HEDIS)–  Example:TimelinessPrenatalandPostpartumCare

•  %ofprenatalmembersreceivedOB/GYNvisitin1sttrimester•  %ofprenatalmembersreceivedPCPvisitwithin56daysofbirth

1.  NewMexicoLegislativeFinanceCommittee.2017AccountabilityReport:Medicaid.https://www.nmlegis.gov/Entity/LFC/Documents/Program_Evaluation_Reports/Accountability%20Report%20Medicaid%20-%202017.PDF(Accessed:June21,2018)

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BACKGROUND:NMHSDINCENTIVIZEDPERFORMANCEMEASURES

1.  NMHSDAmendment#8totheMedicaidManagedCareAgreementAmongNMHSDandHCSChttp://www.hsd.state.nm.us/uploads/files/Looking%20For%20Information/General%20Information/Contracts/Medical%20Assistance%20Division/MCOs%20-%20Centennial%20Care/BCBSNM_CONTRACT_AMENDMENT_%238_SIGNED.pdf(Accessed:June7,2018)

2.  MedicaidEnrollmentReportByManagedCareOrganizationFee-for-Servicehttp://www.hsd.state.nm.us/uploads/FileLinks/5bc82a76689a437682dbd68988331f79/March_By_Managed_Care_Organization_Fee_for_Service_2.pdf(Accessed:June7,2018)3.  HealthNotes.ProgramEvaluationUnite.LegislativeFinanceCommittee.January13,2017https://www.nmlegis.gov/Entity/LFC/Documents/Health_Notes/Health%20Notes%20-%20Medicaid%20managed%20care%20rates.pdf

•  PMsrequire2%increaseaboveHEDISRegionalAverage,failureresultsin2%ofcapitationwithhold1

•  EightPMstotaling14points,eachpointisworth7%ofthetotal2%withhold•  Example:AnMCOwith215,827members2has$1,154,366perpoint3

•  PrenatalCareisworth3points•  Example:PrenatalCarePMsareworth$2.4millionfortheMCO

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BACKGROUND:NEWMEXICOPRENATALCAREPROBLEM

•  72%ofNM’sbirthsareMedicaid2-  20%ofNewMexico’sbirthsreceivedprenatalcareinthesecondtrimester3-  8.5%receivednoprenatalcare3

•  30%ofwomenreceivedinadequateprenatalcare4

$13,668$14,175

$815 $827

$-

$4,000

$8,000

$12,000

$16,000

FY10 FY11

AverageCostofNewbornsforNewMexicoMCOs1

CostofNewbornswithComplications CostofNormalNewborns

1.  NewMexicoLegislativeFinanceCommitteeReport.HumanServicesDepartment.September2012.http://www.nmlegis.gov/lcs/lfc/lfcdocs/perfaudit/Human%20Services%20Department%200Improving%20Outcomes%20for%20Pregnant%20Women%20and%20Infants%20Through%20Medicaid.pdf(AccessedOctober7,2015)

2.  MedicaidFunds70%ofNMBirths.AlbuquerqueJournal.January27,2013.Availableat:http://www.abqjournal.com/163829/news/medicaid-funds-70-of-births-in-nm.html[AccessedJuly20,2015]3.  PerinatalCareinMedicaidandCHIP.(February2015)http://www.medicaid.gov/midicaid-chip-program-information/by-topics/quality-of-care/downloads/secretarys-report-perinatal-excerpt.pdf.(AccessedOctober10,2015)4.  InstituteofMedicine(US)CommitteeontheConsequencesofUninsurance.Washington(DC):NationalAcademiesPress(US):2002

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BACKGROUND:NEWMEXICOPRENATALCAREPROBLEM

0

10

20

30

40

50

60

70

80

90

100

%ofP

atientsC

ompliant

PrenatalCarein1stTrimesterbyYear1

NewMexico UnitedStates

•  Receiveda“C”GradebyMarchofDimesdueto10%pretermbirthrate2

•  Ranked43rdstatetohaveababy3

1.  CompleteHealthIndicatorReportofPrenatalCareintheFirstTrimester.NewMexico’sIndicator-BasedInformationSystem(NM-IBIS).NewMexicoDepartmentofHealth.https://ibis.health.state.nm.us/indicator/complete_profile/PrenCare.html(Accessed:October18,2018)

2.  Peristats.MarchofDimes.2018.https://www.marchofdimes.org/peristats/ViewTopic.aspx?reg=35&top=5&lev=0&slev=4(Accessed:October18,2018)3.  McCannA.Best&WorstStatestoHaveaBaby.August13,2018https://wallethub.com/edu/best-and-worst-states-to-have-a-baby/6513/(Accessed:October22,2018)

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BACKGROUND:LABORATORIESROLEINPRENATALCARE

1stTrimester 2ndTrimester 3rdTrimester

Mother&FetusBloodTyping,Rubella,HIV

1stMaternalSerumScreen 2ndMaternalSerumScreen

GestationalDiabetes

GroupBStrep

•  Identifyingandmonitoringpotentialmothers

MaternalBirthScreen

•  Identificationofbirthstoestablishpostpartumcare

Age,Previousdx,Diabetes

•  Identifyingandmonitoringprenatalrisks

UrinaryTractInfection(<3m&after) AbnormalPrenatalScreens

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Measureclosureofcaregaps

Clinical Financial

Createmultifacetedtoolwithactionableinsights

Assessoutcomes

TimelyidentificationofMCOmembersandneeds

Identifyadditionalbenefits

STUDY:LABORATORYDERIVEDINSIGHTSHELPANMCO?

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METHOD:INFRASTRUCTURE

CentralRepositories(Clinical,Financial,Operational)

•  OrderManagement•  SpecimenTracking•  Turn-Around-TimeAnalysis•  EfficiencyImprovement

Operation Analytics

•  Pre-ClaimsScrubbing•  EligibilityChecking•  RejectionAnalysis•  ClientManagement

Revenue Analytics

CentralNormalizedRepositories(Clinical,Financial,Operational)

InvoicesOrders

LIS ResultBillingSystem

•  CareGapAnalysis•  RiskStratification•  InterventionNotifications•  AccessAlerting(ER,etc.)

Clinical Analytics

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METHOD:MEMBERIDENTIFICATION&PRENATALINSIGHTCREATION

EligibilityFile MatchwithinTriCore’sPatientRepositoryFocus:Medicaid

TargetedInterventions

HealthConditionAlgorithms

•  Memberfilesentbycustomer(payer,provider,etc.)viaSFTP•  KeymemberidentifiersmatchedwithTriCorepatientrepository1•  SuccessfulmatchesanalyzedwithTriCore’sPrenatalTargetedInterventionalgorithm•  Resultsdeliveredeveryweekfor~7monthsforMCOcarecoordination

1.  Just,B.H.,Fabian,D.P.,Webb,L.L.,andHjort,B.M.ManagingtheIntegrityofPatientIdentityinHealthInformationExchange.(2009)AHIMA.80(7):62-69

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METHOD:INFORMATIONSENTTOPAYER

•  Excelspreadsheet•  Patientneeds

•  CareGaps•  Risks

•  Updatedcontactinformation

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METHOD:ENHANCEDPRODUCTFORPAYER

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METHOD:RISKSTRATIFICATION

Elevated Patient Risk Factors

Elevated Patient Risk Factors

AND Care Gaps

Optimal Care Gaps

Riskcreated

from

patient

riskfactors

Riskcreatedfromgapsinhealthcare

2016

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METHOD: POPULATION LEVEL ANALYTICS

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METHOD: POPULATION LEVEL ANALYTICS – MEDICAID

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METHOD: POPULATION LEVEL ANALYTICS – MEDICAID & PRENATAL

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METHOD: POPULATION LEVEL ANALYTICS – MEDICAID & PRENATAL W/ ER

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METHOD: PRENATAL ANALYTICS

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METHOD: PRENATAL ANALYTICS AND MEDICAID

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METHOD: PRENATAL ANALYTICS AND MEDICAID W/ ER

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METHOD: INDIVIDUAL PATIENTS

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METHOD:PATIENTTAILOREDINSIGHTS

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METHOD:PATIENTTAILOREDINSIGHTS

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METHOD:PATIENTTAILOREDINSIGHTS

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EXAMPLERESULT#1:MCOPRENATALMEMBERS23year-oldfemaleinruralNM

1/12/17:AccessesAlbuquerqueER;dxpregnant

1/26/2017:ReceivesprenatalworkupwithCNM

3/15/2017:AccessER;UTIdiagnosed

8/27/2017:Babygirlborn,admittedtoNICU

10/2/2017:BabydischargedfromNICU

27year-oldfemaleinurbanNM

7/12/17:AccessesER;dxpregnant

9/5/2017:CareManagercalls,coordinatesOBGYN

2017-2018:Receivesallprenatalscreens

3/18/2018:Boabyboyborn,40weeks

3/19/2018:Momandbabydischargedforpostpartum

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EXAMPLERESULT#2:MCOPRENATALMEMBERS

30year-oldfemale

01/17/2017:Accessesfamilypractice,dxpregnant

Receivesmonthlydrugmonitoring

08/02/2017:Babygirlborn;admittedtoNICU

08/30/2017:BabydischargedfromNICU

27year-oldfemale

09/01/2017:Initialprenatalscreen

09/20/2017:LabinfosenttoCareManager

10/17/2017:OBGYN&Hospitalprovidealltests

04/05/2018:Babyborn,39weeks

04/06/2018:Momandbabydischarged

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RESULTSALIGNEDWITHOBJECTIVESClinical Financial

TimelyidentificationofMCOmembersandneeds

Createmultifacetedtoolwithactionableinsights

CATEGORY FOCUS

Quality Timeliness&frequencyofprenatalandpost-partumcare

Outcome Pretermdelivery,NICUcare

•  >65%ofTriCoreinsightswerenotreflectedinMCO’sclaimsdata

•  77%ofmembersinfirsttrimesterwithadditionalinsightsinnearreal-time(within24hours):

–  Careneeds

–  Births

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RESULTSALIGNEDWITHOBJECTIVESMeasureclosureofcaregaps

•  73%ofalllaboratorycaregapsclosed(645of889);63%withoutGroupBStrep(350of558)•  486birthsidentifiedinnearreal-time(within24hours)

Clinical Financial

FullTerm(≥37wks) Preterm(<37wks) Total

Study 72(89%) 9(11%) 81

Control 55(80%) 14(20%) 69

*Termdeliverycalculationisreliantuponpatientcompletingamaternalserumscreeningtest.p=0.092

Assessoutcomes

TermDelivery

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RESULTSALIGNEDWITHOBJECTIVES

No Yes Total

Study 141(89%) 18(11%) 159

Control 188(81%) 44(19%) 232

NeonatalIntensiveCare

N MeanLoS(days) MedianLoS(days)

Study 18 12.3(0.29–94.34)* 6.66*

Control 44 12.3(0.13–64.30) 6.05

NeonatalIntensiveCare:LengthofStay

*Resultsshowsafterremovalofasingleoutlierof94.34days

*p<0.025

Assessoutcomes

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TIMELINESSOFPRENATALCARE

1.  HealthcareEffectienessDataandInformationSet(HEDIS)Reports.NewMexicoHumanServicesDepartment.http://www.hsd.state.nm.us/LookingForInformation/healthcare-effectiveness-data-and-information-set.aspx(Accessed:November1,2018)

MCO#3

MCO#2

MCO#1

MCO#4

63%

2015 2016 2017

74% 68%

77% 77% 73%

78% 80% 71%

73% 75% 78% $1.4million

-------

-------

($2.4million)

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POSTPARTUMCARE

1.  HealthcareEffectienessDataandInformationSet(HEDIS)Reports.NewMexicoHumanServicesDepartment.http://www.hsd.state.nm.us/LookingForInformation/healthcare-effectiveness-data-and-information-set.aspx(Accessed:November1,2018)

MCO#3

MCO#2

MCO#1

MCO#4

48%

2015 2016 2017

59% 56%

54% 54% 52%

61% 59% 59%

54% 58% 61% $1.4million

($2.4million)

-------

($2.4million)

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TOTALPRENATALCAREPENALTIESFOREACHMCO/YEAR

MCO#3

MCO#2

MCO#1

MCO#4

2016 2017

$940,000 ($940,000)

($2.4million) ($2.4million)

---- ($2.4million)

$1.4million $1.4million $2.8million

($2.4million)

-------

($4.8million)

TOTAL

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CONCLUSION

HealthCondition Measure/Outcome 2016MCOPerformance1

TRLClinicalAnalyticsResult2 ROI

Prenatal

TimelinessofPrenatalCareNMHSDPM#5 75% 77% $1,154,3663,4

Post-PartumCareNMHSDPM#5 58% 60% $1,154,3663,4

FrequencyofPrenatalCareNMHSDPM#6 56% 73% $1,154,3663,4

NICUOccupancy 19% 11% $3,371,8203

PretermDeliveryOutcome 20% 11% $868,5482,5

Diabetes HemoglobinA1cTestingPM#4 82% 92% $1,154,3663,4

NephropathyScreeningPM#4 87% 91% $1,154,3663,4

HepatitisC NMHSDHepatitisCDSIM 350members 1,577members $2,424,1694

TOTAL $11,628,312

1.  BCBSNMAuditReviewTable.http://www.hsd.state.nm.us/uploads/FileLinks/485263ae1ad040ea9d52673aef6109b4/2016_HEDIS_BCBS.pdf(Accessed:March21,2018)2.  ResultsprojectedfrompilotperformedwithBCBSNMSpecialBeginningsSeptember2017throughApril20183.  AssumesBCBSNM’srevenueforCentennialCareisapprox.$536,736,096.HealthNotes.ProgramEvaluationUnite.LegislativeFinanceCommittee.January13,2017https://www.nmlegis.gov/Entity/LFC/Documents/Health_Notes/Health%20Notes%20-

%20Medicaid%20managed%20care%20rates.pdf4.  NewMexicoHumanServicesDepartment.RequestforProposals.RFP#13-630-8000-0001CentennialCarehttp://www.hsd.state.nm.us/uploads/FileLinks/c06b4701fbc84ea3938e646301d8c950/Centennial_Care_RFP_and_Contract__8_28_12__FINAL_.pdf(Accessed:

August11,2017)5.  ThanhNXetal.HealthServiceUseandCostsAssociatedwithLowBirthWeight-APopulationLevelAnalysis.(2015)JPediatr.167(3):551-5566.  CenterforDiseaseControlandPrevention.Health,UnitedStates,2016.https://www.cdc.gov/nchs/data/hus/hus16.pdf#093(Accessed:August29,2017)

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TRICORE’SVALUEBASEDSTRATEGYMAP

PopulationSurveillance

Pre-DefinedMeasures

•  DiseaseSurveillance

•  HCCs/RiskAdjustment

•  HEDIS/PQRSFocused

PHASE11A

PAYFORREPORTING1B

BONUSINCENTIVE

•  CMSStarBonuses

•  PerformanceMeasures

•  QualityRatings

PMPMPerReport/Condition

↓PMPM+/-Bonus

MEASURES

BundlePaymentforCondition

•  DiabetesBundle

•  PregnancyBundle

•  HepatitisCBundle

Population+%SharedSavings

PartnershipModelw/ProviderGroup

•  TotalCostofCare

•  SpecificHealthConditions

•  LabTriagestoProvider

PopulationBasedUpside/Downside

OUTCOMES

FFSBASEDUPSIDEWITHSHARESAVINGS

PHASE2CAPITATIONWITHRISKSHARING

PHASE3

TRIAGE/EFFICIENCY

OBJECTIVE

EXAMPLES

PRICING

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HEPATITISC:LABKNOWSALL

SCREEN DIAGNOSE TREATMENT/MONITORING

HepatitisCAntibody HepatitisCQuantitation

HepatitisCGenotype

HepatitisCQuantitation

Platelets

•  Identifyinglevelofcirrhosis

AST/ALT Albumin

HIV

•  Identifyingriskofcomplications

HBV Diabetes(HA1c,Glucose)

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BACKGROUND:NMHSDINCENTIVIZEDDSIM

1.  NMHSDAmendment#1totheMedicaidManagedCareAgreementAmongNMHSDandHCSChttp://www.hsd.state.nm.us/uploads/files/Looking%20For%20Information/General%20Information/Contracts/Medical%20Assistance%20Division/MCO's%20Centennial%20Care%202.0/BCBS%20Contract%20PSC%2018-630-8000-0033%20A1.pdf(Accessed:March1,2019)

2.  MedicaidEnrollmentReportByManagedCareOrganizationFee-for-Servicehttp://www.hsd.state.nm.us/uploads/FileLinks/5bc82a76689a437682dbd68988331f79/March_By_Managed_Care_Organization_Fee_for_Service_2.pdf(Accessed:June7,2018)3.  HealthNotes.ProgramEvaluationUnite.LegislativeFinanceCommittee.January13,2017https://www.nmlegis.gov/Entity/LFC/Documents/Health_Notes/Health%20Notes%20-%20Medicaid%20managed%20care%20rates.pdf

•  HepatitisC=DeliverySystemImprovementTarget#4

•  MCOmustachieveDeliverySystemImprovementTargetorbeimposed1.5%oftotalcapitation1

•  EachDSIMisworth20%ofthetotal1.5%withhold

•  Example:AnMCOwith215,827members2has$2,424,169perDSIM3

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GAINSHARINGMODELSREQUIRETHELABORATORY

•  HealthPlansareturningtoprovidersforvalue-basedarrangements1

•  Providersreluctanceinvaluemodelsaregravitatingtowardsgainshare2

•  Laboratoriesknowmoreduetolongitudinalperspective3

1.  BeveridgeRA,HappeLE,andFunkM.ThePhysician-InsurerDynamicMustShifttoSuccessfullyImplementValue-BasedPayments.(2016)Healthcare.4(4):282-2842.  LongG,MortimerR,andSanzenbacherG.EvolvingProviderPaymentModelsandPatientAccesstoInnovativeMedicalTechnology.(2014)JMedEcon.17(12):883-8933.  StreetRL,LiuL,FarberNJ,ChenY,CalvittiA,ZuestD,etal.ProviderInteractionwiththeElectronicHealthRecord:TheEffectsonPatient-CenteredCommunicationinMedicalEncounters.(2014)PatientEducCouns96:315–9.

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TRICORE’SIMPACTINGAINSHARE

•  HepatitisC–  442patientsaremissingquantitation–  284patientsareinneedforgenotype1

–  $268,414.36infuturelabcosts2

•  294oftheseweretouchedbyTriCoreinthelast90days(40%)3–  $3,502invenipunctures–  Additionalcostsinanalytes,reagents,

tubes,etc.–  Physicianfees,patientindirectcosts

1.  Pangenotypictreatmentsmayrenderthisadditionaltestingobsolete2.  Calculationsderivedfrom2016CMSCLFS3.  Containsbothinpatientandoutpatientsetting

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TRICORE’SLAB2.0BUSINESSPLAN

DIAGNOSTICOPTIMIZATION

ClinicalAnalytics Biometrics

SurveillanceData Reporting

Division

ProductsorServices

Features

AlertsandInformationPush

Integration(LabData,HRA)

ActionableWorkLists

PatientConsent PatientEngagementCenter

Datause TriageModel

SpecimenBanking ClinicalPharmacists

PatientEngagement

FacilitatedFollow-Up(FF)

AutomatedPatientNotifications

CareGapClosure

PM/PMPrice $/PatientTargeted AddsValuetoResearchInst. ValueBasedCare MoreInsights

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IMPACTISINTHEDRAWSITE?

•  Laboratoriesknowneedsinreal-time

•  Empowerclinicallaboratoryassistantstoimprovethehealthcaresystem

•  Closecaregapsatthepointofcare

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•  Reflextesting–  Importanttoolinprovidingtimely,cost-effectiveand

qualityofcare–  Generallyeachlabmustnegotiatewitheach

providerwhattestscanbereflexed1

•  Labsneedautomationfordiseasemanagementprotocols

•  BeckmanCoulter’svisionalignsperfectlywithourvisionandstrategy

BESTIMPACTISWITHSAMPLEINHAND

1.  HHSOfficeofInspectorGeneral.PublicationofOIGComplianceProgramforClinicalLaboratories.FederalRegisterNotice.Vol.63,No.163,August24,1998,45076-45087

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BECKMAN’SSTRATEGYALIGNSWITH2.0

BeckmanCoulter,thestylizedlogo,andtheBeckmanCoulterproductandservicemarksmentionedhereinaretrademarksorregisteredtrademarksofBeckmanCoulter,Inc.intheUnitedStatesandothercountries.

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POSITIONLABORATORYATFOREFRONTOFCARE

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•  Laboratory2.0isaboutrepositioningthelaboratoryandTriCore’sstrategyis:– Diversify– Changethelabfromancillarytotertiaryinvaluebasedcare

•  BeckmanCoulter’smiddlewarealignswithourneedtoincreasethevalueofeachsample

SUMMARY

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THANKYOU

RickVanNess,MSDirector,ProductManagementTriCoreReferenceLaboratories

Albuquerque,NMRick.vanness@tricore.org

(505)938-8906