Benevera Health, the Population Health Organization: A New Prototype for Alternative Payment Model Success. Janice Baker VP of Strategy & Operations

Transcription

1 Benevera Health, the Population Health Organization: A New Prototype for Alternative Payment Model Success Janice Baker VP of Strategy & Operations

2 Agenda 1 An Introduction to Benevera Health 2 Population Health: A patient-centered approach 3 Meet Our Patients 4 Setting Our Team Up for Success 5 Measurable Impact 2

3 Benevera Health A population health management company created in 2015 through a joint venture between Harvard Pilgrim (payer) and several leading New Hampshire health systems All partners are closely aligned to reduce costs and improve the health of our fully insured and Medicare Advantage members in NH 3

4 Our evolution INSURANCE PRODUCT INSURANCE AND POPULATION HEALTH COMPANY POPULATION HEALTH FOR PARTNERS AND BEYOND Initial joint venture Launch jointly owned insurance products Narrow network products, risk sharing Provider-driven care management model Data sharing Grow jointly owned products Design broader JV including more partners, and risk sharing Include all of Harvard Pilgrim New Hampshire business in JV Launch new JV and population health company with shared risk and assets Provider inclusion in all HPHC insurance decisions in New Hampshire Build and prove population health organization capabilities Expand services offered by Benevera to JV partners Offer services to providers and organizations outside JV

5 Population The five Benevera Health partners are financially responsible for the 110,000 patients with Harvard Pilgrim insurance in New Hampshire. 105,000 commercially insured, 11,000 of whom are Medicaid Expansion 5,000 Medicare Advantage About one-third receive their primary care from the four provider partners within Benevera; two-thirds acquire primary care from other providers. 5

6 Key components of our joint venture Capitation Full upside/downside risk on patients attributed to health system owners Insurance/risk PAYMENT MODEL shared financial accountability for ALL of Harvard Pilgrim s business in NH POPULATION HEALTH Technology and data shared technology platform to integrate data, develop analytics, and engage patients Resources and model Hiring and deploying new resources and development of a population health model 6

7 Why a joint venture PROVIDER Risk strategy: Benefit from efficient care of patients, gain access to diversified revenue Insurance market: Have a say in products, pricing, and strategy without up-front investment in creating a new insurance company PAYER Market strategy: Partner with providers in a strategy that can t be duplicated Provider value: Learn from provider perspectives in their communities, value in provider commitment to insurance goals Population health: Develop a jointly invested population health approach that leverages the best of payer and provider models, efficiency, data, and technology 7

8 POPULATION HEALTH A patient-centered approach 8

9 Population health focus areas We focus on the two people at the root of health care: patients and their providers: Patients: Our Care Management and Patient Engagement program identifies and engages high need patients Providers: Through Care Delivery, we work with doctors, nurses, and other members of a patient s care team to improve how they provide care. Data and analytics: Powering these two focus areas is a best-in-class analytics system that combines claims, EMR, and publicly available data to form a single patient record. 9

10 Determinants of health: County health rankings model HEALTH OUTCOMES Length of life (50%) Quality of life (50%) Tobacco use Health behaviors 30% Diet and exercise Alcohol and drug use Sexual activity Clinical care 20% Access to care Quality of care HEALTH FACTORS Education Social and economic factors 40% Employment Income Family and social support Community safety POLICIES & PROGRAMS Physical environment 10% Air and water quality Housing and transit 10

11 Whole person, in person care management Whole Person Socioeconomic needs Health and wellness Medical needs Behavioral health needs Pharmacy medication needs Working with people, not just their diseases Engaging patients as their single point of contact Assessing allpatients needs and creating a plan to address them Providing support through a multidisciplinary team comprised of patient engagement specialists, nurses, social workers, community health workers, and a pharmacist Addressing the barriers to care that most organizations acknowledge but consider outside the scope of their work 11

12 Whole person, in person care management, cont. In person Our team is in NH and lives where patients live. Building lasting relationships by meeting patients in person wherever it s most convenient for them Coos Understanding the available community resources and clinical services, and helping to make appropriate connections Communicating with patients the way they prefer by phone, in person or electronically Grafton Carroll Belknap Sullivan Merrimack Strafford Cheshire Hillsborough Rockingham 12

13 Building trusted relationships We are a concierge service and help patients with: Assistance with applications Chronic disease state management Community resources Comprehensive medication management Discharge planning and post-hospital discharge follow-up Family and caregiver support Health education Help navigating HPHC insurance plans Lifestyle modification guidance and support Mental and behavioral health Social needs (transportation, financial assistance, etc.) Understanding medications Whatever needs the patient has, we aim to provide education, advocacy, clinical and social support as the single point of contact. 13

14 Identifying and engaging high need patients Patient has needs Patient can be reached Patient willing to engage Engagement begins We identify patients for our Care Management program who have: Emerging medical/behavioral health needs Existing high medical/behavioral health needs Recently experienced a significant medical event We look for evidence of how the patient has communicated with health systems in the past: Portals (health provider or payer) Phone: home, cell We use various techniques to get patients to work with us: Leveraging physician relationship Leveraging recent medical event Someone like you Motivational interviewing/ behavioral science techniques Connecting with family member 14

15 MEET OUR PATIENTS 15

16 Patient Richard and spouse, Elizabeth SITUATION APPROACH OUTCOME Patient profile Richard is a 63 year old male with a PMH of DM type II, HTN, hyperlipidemia, chronic back pain, depression, s/p TKA x2, cognitive decline and urinary incontinence. Patient history Between January and June 2017, Richard had five inpatient and/or rehab stays and two ER visits, primarily due to falls resulting from unsteady gait. Wife Elizabeth is primary caregiver and is becomingly increasingly stressed with husband s medical needs and his angry, aggressive outbursts. Full court press Benevera nurse, social worker, and pharmacist visited Richard and Elizabeth at their home. Followed by constant coordination Continuing work with Richard and Elizabeth 10 months later, focusing on DME needs, VNA services, transportation for appointments, counseling for both of them. Closely collaborating with Richard s PCP. No hospitalizations or ER visits since enrolling in CM Increase in medication adherence and safety Able to stay in his home Greater awareness, understanding, and management of stressors 16

17 Patient Ginger SITUATION APPROACH OUTCOME Patient profile Ginger is a 20 year old female with Type I diabetes, Hepatitis C, depression and anxiety. She s 4ʹ10ʺ and weighs 86 pounds. Patient history Over the course of six months, Ginger was an inpatient for ketoacidosis and went to the ER eight times for various reasons. She does not monitor her blood sugar, misses many appointments, is difficult to reach, and is planning a one-month trip to Mexico. Find a way to connect Our pharmacist got involved in her case and established a good relationship. She took lead over our nurse and social worker. Maximize engagement windows When we got Ginger on the phone or were with her during an appointment, we did all we could. We had her PCP order all her specialty tests. We got her into a week Hep C treatment regimen and kept close tabs on her. Keep her safe We planned her trip to Mexico insulin orders, insulin transport (cooler, ice), TSA guidelines, physicians/hospitals in Mexico. Ginger had a safe trip to Mexico she managed her diabetes and stayed on her Hep C regimen Unfortunately, she stopped those good practices when she returned to the U.S. Was inpatient and at the ER again, although not as frequently. 17

18 Patients Tom and Susan SITUATION APPROACH OUTCOME Patient profile Tom is a 61 year old male who owned his own construction business until a TBI sidelined him 13 years ago. He also has HTN and depression. Patient history Since TBI, depression and his lack of self care have worsened. Tom recently fell off a porch and broke his arm in three places. He was hospitalized for two weeks and the family received $19,000 in bills. Approach stressors first Tom didn t want to talk with a Benevera nurse. His wife Susan was also reluctant but said she was worried about the bills. We addressed that first. Listen and adjust We thought Tom needed OT and cognitive therapy and realized depression was the root cause. Tom took a lot of pride in his profession and continued to get licensed each year, even if he couldn t physically work. We set out to help Tom find a new purpose via new job. Listen more & adjust again We realized Tom s wife had neglected her medical needs. We enrolled her in our program and arranged for a PCP visit which uncovered high BP and depression. Tom began working again getting up in the mornings, taking care of himself, guiding younger construction staff. The construction job eventually came to a close, but the experience prompted Tom to continue his good habits. He s now helping around the house, taking on home improvement projects, etc. Susan s BP and depression are being actively treated. Tom s improved health is allowing her to focus on her own. 18

19 POSITIONING STAFF FOR SUCCESS Tools & Technology 19

20 It all starts with data Claims data More complete picture of the patient EMR data Other types of data: Public data: census, public records Patient reported: depression screenings, HRA, social determinants Care management: care plans, engagement, preferred outreach More complete view of the patient, real-time, actionable analytics, improved outcomes Enables proactive engagement of more patients, identifying issues earlier 20

21 And using that data to predict and prescribe Business Impact Algorithms & machine learning to create solutions: What should we do? Advanced analytics to forecast the future: What could happen? Aggregate & mine data to define historical insights: What has happened? DESCRIPTIVE PREDICTIVE PRESCRIPTIVE Analytics Approach 21

22 MEASURABLE IMPACT Clinical & Financial 22

23 What does success look like? A proven model with results better than what providers or payers can do alone: Patient engagement Engaging patients in meaningful, trusted relationships. Higher levels of engagement with us than with other health engagement programs (payer, provider, third party) Patient satisfaction High satisfaction and net promoter scores with patients we engage in our program Costs Reduced costs for those members who we engage in our program vs. without our program or with other programs Outcome/quality Improved health outcomes and quality scores for our partners, patients, and other providers we work with Provider enablement Improving care delivery by engaging physicians and systems in the levers that affect the quadruple aim 23

24 Care management results RESULTS 35% DECREASE in medical costs for the patients we engage Our patients give us a >95% satisfaction rate and a >75% Net Promoter score, both incredibly high for the health care industry. 24

25 What our patients are saying I like that I have someone who can coordinate my care with all the providers that I have to see. She is someone who I can discuss issues with and get resolutions to problems I am facing. I feel that I am getting a personalized service with her. JACK PATIENT I love this program that Harvard Pilgrim has and told my provider that they need to get this as well. Because of the program I am going to always make sure that I keep my healthcare with Harvard Pilgrim. BOB PATIENT Elliot and I work well together and he understands my needs. I like that I can get information from him that I would not have thought of before. I hate to take pain medication all the time and Elliot helped me come up with alternative to taking pain medication. JAMES PATIENT I know that if I am having a problem that I can give Sara a call. She first listens to me and then tries to help me find a solution to my problems. She is a mediator for me when I am having trouble getting my son s meds or referrals.i love having an advocate to help me manage my son s health. MOTHER OF PATIENT 25

26 Thank You Contact details: Janice Baker Vice President of Strategy and Operations