transforming health care: better, simpler, more … · goals for blue premier by 2020 by 2024 ... +...
TRANSCRIPT
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Von D. Nguyen, MD, MPHVice President, Clinical Operations and Innovations
Blue Cross and Blue Shield of North Carolina
TRANSFORMING HEALTH CARE:BETTER, SIMPLER, MORE AFFORDABLE
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People who report problems paying medical bills
Uninsured adults who cite cost as the reason for not having insurance
26%
45%
THE AFFORDABILITY CRISIS
PROPRIETARY & CONFIDENTIAL SOURCE: Kaiser Family Foundation, Americans’ Challenges with Health Care Costs, June 2019
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DEMAND GOES DOWN, PRICES GO UP
SOURCE: Health Care Cost Institute, Employer-Sponsored Coverage Study, January 2018
Unit price increases in employer coverage, 2012-2016:
PROPRIETARY & CONFIDENTIAL
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BRINGING VALUE TO HEALTH CARE
+ Give physicians and clinicians flexibility to deliver value
+ Better care coordination
+ Incentives for cost-efficient innovations, prevention
+ Population health
+ Focus on the patient experience
THREE AIMS OF TRANSFORMATION
+ Better care+ Simpler system+ More affordable
PROPRIETARY & CONFIDENTIAL
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SHIFTING OUR PRIORITIES
ABlue Premier: Changing the Way We Pay for Care
B Primary Care
C Behavioral Health
D Population Health
PROPRIETARY & CONFIDENTIAL
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BLUE CROSS NC: LEADING TRANSFORMATION
Blue Cross and Blue Shieldof North Carolina
+ Almost 4 million members
+ Approximately 5,000 employees
+ Over $10 billion revenue
+ Insure majority in NC commercial market, many for most of their lives
PROPRIETARY & CONFIDENTIAL
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BLUE PREMIERFor the first time, true shared risk and savings
+ One of the nation’s first shared savings model with two-sided risk
+ Rapid shift limits fee-for-service increases, builds network of ACOs
+ Makes primary care a priority
PROPRIETARY & CONFIDENTIAL
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CURRENTBLUE PREMIER PARTNERS
PROPRIETARY & CONFIDENTIAL
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Current
GOALS FOR BLUE PREMIER
By 2020 By 2024
25% 50% 100%
Blue Cross NC Medical Spending in Blue Premier Contracts PROPRIETARY & CONFIDENTIAL
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PRIMARY CARE
1 National Ambulatory Medical Care Survey, 20152 Milbank Memorial Fund, 2017 “Standardizing the Measurement of Commercial Health Plan Primary Care Spending”
51%
% of all physician office visits in 2015 were to
primary care1
7.7%
% of medicalspending onprimary care2
10%
% of medicalspending onprimary care
CURRENT GOAL
PROPRIETARY & CONFIDENTIAL
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PROPRIETARY & CONFIDENTIAL
PAYING FOR WHAT MATTERS MOST
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BETTER CARE, BETTER ACCESS
+ Intensive primary care
+ Rural primary care
+ Physician Assistants training
+ Aledade, independent primary care
+ Blue Cross NC Foundation
Photo Credit: UNC School of MedicinePROPRIETARY & CONFIDENTIAL
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WHAT BETTER CARE LOOKS LIKE
+ Greater focus on the patient experience
+ Fewer patients, more time with each
+ Integrating behavioral and mental health
+ Screen for non-medical drivers of health
+ Incentives for patient outcomes and total cost of care
+ Primary care team helps patient navigate system
PROPRIETARY & CONFIDENTIAL
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BEHAVIORAL HEALTH STRATEGY
Integrated behavioral
and physical health
Optimized behavioral
health network
Best-in-class
solutions
PROPRIETARY & CONFIDENTIAL
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PUTTING STRATEGY INTO PRACTICE
Integrated NetworkBlue Cross NC investing in integrating behavioral health into primary care, building a high-performance network
• QuartetIdentify patients with underlying mental health conditions, give physicians data and resources
• Substance use disorder Investing in nonprofits and health systems for prevention, treatment, recovery
PROPRIETARY & CONFIDENTIAL
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INVESTMENTS IN DRIVERS OF HEALTHTo build healthier communities
+ Food insecurity
+ Early childhood development
+ Housing
+ Transportation
PROPRIETARY & CONFIDENTIAL
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MOVING BEYOND INCREMENTAL CHANGE
+ Diabetes
+ Smoking
+ Healthy births
+ Health and well-being
PROPRIETARY & CONFIDENTIAL
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THE I.T.
BEHIND BLUE
PREMIER
PROPRIETARY & CONFIDENTIAL
02 attribution
05 financial
01 digital tools
04 provider reporting
03 data exchange
06 providerpartnerships
01 02 03
060605050404
0101 0202 0303
060504
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OUR “DnA” TEAM
Consolidation and scalability
Accessibility Governance
PROPRIETARY & CONFIDENTIAL
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DnA AND IT: MAKING HISTORY TOGETHER
+ Successful exchange in real-time
+ Right information to the right place at the right time
+ Playbook for data exchange capabilities with other Blue Premier partners
+ Foundation for future program design
PROPRIETARY & CONFIDENTIAL
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HOLDING OURSELVES ACCOUNTABLE
Delivering an Exceptional
Experience for Consumers
+ Changing the way we do business
+ Established Customer Experience team
to capture the voice of the consumer+ Best Net Promoter Score in the history of the
company – but we are driven to do better
Improving the Provider Experience
+ Assess provider touchpoints,measure satisfaction
+ Reimagining our relationshipswith providers for easier, moreeffective collaborationPROPRIETARY &
CONFIDENTIAL
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MAKINGHEALTH CARE MORE AFFORDABLE
Lower Premiums
+ Over 4% reduction for 2019 ACA rates
+ Over 5% reduction for 2020 ACA rates+ 3.3% reduction for 2020 small group rates + Average rate decrease in all 100 counties for the
first time
Affordability Index
+ Developing metrics to hold our company accountable to our customers
Managed Care + Serving North Carolina’s Medicaid population
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CALL TO ACTION
Health Insurers+ Pay based on value
+ Support physicians with data and resources
+ Provide members with cost and quality transparency tools
Individuals/Consumers+ Shop for health care based on value
+ Engage on improving personal health
Employers+ Demand value, help employees navigate the system
Providers+ No going back to fee-for-service
+ Use data to improve care, lower costs
Policymakers and Regulators+ Support broad definition of health (drivers of health)
+ Allow competition to flourishPROPRIETARY & CONFIDENTIAL
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VON D. NGUYEN, MD, MPHVice President, Clinical Operations and Innovations
Blue Cross and Blue Shield of North Carolina
PROPRIETARY & CONFIDENTIAL