beyond the horizon: what’s next?
TRANSCRIPT
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Beyond the Horizon: What’s Next?Session PH6, March 5, 2018
Don Calcagno, President, Advocate Physician Partners
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Learning Objectives
• Describe the sustainability of a changing business model to accelerate the population health movement
• Explore advanced and disruptive technologies and their role in enabling innovative care delivery models
• Illustrate that population health will require understanding and optimization of a personalized longitudinal plan inclusive of clinical, behavioral, socioeconomic, and other factors
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Advocate Health Care$6.4 billion of revenue1.6 million unique patients1,007,000 value based lives35,000 associates
Physicians/Ambulatory1,400 employed + 400 APCsOver 6,000 physicians in 450+ sites of care
Hospitals (11)4 teaching |5 level 1 trauma centers1 children's |1 critical access | 2 LTACH
Post-acuteHome health, hospice, SNF and palliative care
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Post AcuteAcute CareOutpatient
ED Hospital HH SNF LTACHUC Hosp Phy
3,500 APP Independent | 1,500 AMG | 1,600 independent
PLURALISTIC PHYSICIAN PLATFORM
> 1M Lives: 666K shared savings | 344K
capitated
$1.3B Funds Flow: Capitated, CI and Shared Savings
Quality: Top Decile/Top Quartile NCQA physician measures
MSSP: Largest MSSP ACO (saved > $134M last 2 years)
MANAGED CARE
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Performance Highlights
• TOP DECILE level based on available NCQA benchmarks on 28 CI MEASURES
• TOP QUARTILE on 7 CI MEASURES
http://www.advocatehealth.com/ValueReport
1010
-0.6%
1.5%
1.1%
3.1%
2.4% 2.4%
3.5%
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
2013 2014 2015 2016
AdvocateCare® PerformanceNational Medical
Services Inflation*
%Change RBC
Medical Expense
1111
MSSP SavingsTop 3 2015Top 2 2016
2015 2016
Beneficiaries 145,365 139,617
Expenditure $11,229 $10,995
Quality Score 94.2% 97.28%
Total Savings $73 M $61 M
Earned Savings $34 M $29 M
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Payor-Provider Relationships
Operational
Excellence
Partnership
Transactional
Provider
Payer &
ProductDistributor
Employer
Consumer
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Who bears
financial risk?
Who’s capable of
bearing risk?
Provider
Payer &
ProductDistributor
Employer
Consumer
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Changing Paradigms
FROM... TO...
Silo care management Enterprise care management
Episodes of care Coordination of care
Discharges Transitions
Utilization managementRight care at the right place at the
right time
Caring for the sick Keeping people well
Production (volume) Performance (value)
Provider
Payer &
ProductDistributor
Employer
Consumer
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EmployersPromotion of high-performing
providers
Offer clinically integrated delivery
models (ACOs, PMCHs)
Centers of excellence for
certain non-transplant
procedures
Direct contract with hospitals/health
providers in specific locations
Narrow network offered through
independent entity
Narrow network offered through
health plan
9%32%
1%29%
15% 47%
15%
54%
11%
51%29%49%
Current FutureSource: 2017 Aon Health Survey, 560 employer respondents
Provider
Payer &
ProductDistributor
Employer
Consumer
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Triple Aim1. Improving the patient experience
2. Improving health outcomes
3.Reducing the total cost of care
4. Improving clinician experience*
*Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Ann Fam Med 2014; 12:573-576. doi: 10.1370/afm.1713.
Provider
Payer &
ProductDistributor
Employer
Consumer
23AHA 2016 Full TrendWatch Chartbook
Patient out of
pocket costs are
up 63%
High deductible
plans & premium
increases
ConsumerProvider
Payer &
ProductDistributor
Employer
Consumer
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Health care spend is
crowding out discretionary
spending
Provider
Payer &
ProductDistributor
Employer
Consumer
25Copyright 2017 American Medical Association.
All Rights Reserved.JAMA. Published online November 02, 2017. doi:10.1001/jama.2017.15686
Affordability IndexProvider
Payer &
ProductDistributor
Employer
Consumer
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Prisoner’s Dilemma
The prisoner's dilemma is a standard example
of two completely "rational" individuals might not
cooperate, even if it appears that it is in their
best interests to do so.
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2 streams1 Rewarded income when we provide services 2 Rewarded when we do not provide inappropriate services
IF….Non-negotiable Quality and Safety most importantManagement is given tools to actively managePhysicians are given tools to actively managePayors partner with providers to structure
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2 DRG/Case Rate
1
3 Shared Savings
4 Fee for Service
Global
Capitation
Lot’s of forms of Financial Risk
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True North
Leading Indicators Drivers
ACI Total Expense PMPM
$x
$x PMPM
ED Expense
$x
$x PMPM
ED Visits/ 1,000
$x
$x PMPM
Low Acuity ED Visits
$x
$x PMPM
Hospitalizations Expense
$x
$x PMPM
Hospitalizations/ 1,000
$x
$x PMPM
Chronic Disease Hospitalizations
$x
$x PMPM
SNF Expense
$x
$x PMPM
Discharge to SNF/ 1,000
Discharge to PAN SNF
Program %
Access
Acute Care
Post Acute
Analysis Framework
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Interdisciplinary Delivery Team (IDT)
• Multidisciplinary team that reviews polychronic individuals
pre- and post- discharge to ensure needs are metWhat is it?
Findings • Strengthened cross continuum collaboration
• Enhanced use of disease management resources, (eg
chronic care clinics)
• Multidisciplinary support for difficult outpatient cases = more
effective care plans
• Group problem-solving for more appropriate setting
• Create culture for effective financial risk management
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Integrated Care Management
Care Management, unified and coordinated
across the continuum
What is it?
Findings
In design phase, pilot in ED starting.
Clear from design work, operations were
independent
From To
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Where does technology disruption occur?
Payor Provider Distributor Employer Consumer
Personal Technology
Benefit Design
Data & Analytics
Transparency
Policy
Medical Technology
Process Improvement
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Connected Data Sources
Immunizations MasterPerson Indexes
Pharmacy Benefit
Management
ElectronicHealth Records
Registrationand Billing
Labs
Claimsand Payers
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850,000+
5,000+
11
14,670
+
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Physician’s office
Provider
Home care
Patient
Patient Centered Care
HospitalEnabling
Hospital
Physician’s office
Provider
Scorecard
Home care
Integrated View of Care
The goal
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Works in progress• Patient Engagement phone app
• Payor analytics systems
• Asthma phone app
• Network utilization
• Tele-medicine
• Population Health platform
• Mobile eye exams
Lessons• Members/Patients
– Engage how they want to
– Bandwidth for apps/videos
– Follow-through
• Some technology disrupts care continuum
• Administrative burden
• Systematic vs individual solutions
What’s Next for APP?