Skating to Where the Puck is Going: Living, Thriving and Growing in the World of Value-Based Care

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1 Skating to Where the Puck is Going: Living, Thriving and Growing in the World of Value-Based Care Craig E. Samitt, MD, MBA AMGA Institute for Quality Leadership November 13, 2014

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5 Introduction to Dean and HCP Dean Clinic is one of the largest integrated healthcare systems in the Midwest 500+ physicians providing over 1.5 million ambulatory visits per year in more than 60 locations. Estimated 30% service area market share by physician services Subsidiary of SSM HealthCare, an integrated delivery system inclusive of Dean Clinic, Dean Health Plan and Navitus Health Solutions (a PBM) HealthCare Partners is one of the largest physician-directed delivery systems in the US employed physicians (and another contracted physicians) providing care for nearly 1 million patients Nearly 200 locations in California, Las Vegas, Florida New Mexico, Arizona, Pennsylvania and Colorado Subsidiary of DaVita HealthCare Partners, a Fortune 500 Company Visions to Transform Healthcare

6 Wisconsin Collaborative for Healthcare Quality Ranking Medical Group Composite Ranking Mean Ranking # of Metrics Reported Thedacare Physicians Dean Clinic Aurora Medical Group Marshfield Clinic Mayo Clinic Health System Franciscan Healthcare Bellin Medical Group Gundersen Clinic, Ltf Froedtert Health Medical Group West Bend Clinic UW Health Physicians Mayo Clinic Health System in Eau Claire Monroe Clinic Medical College Physicians ProHealth Care Medical Associates Wheaton Franciscan Medical Group Aurora UW Medical Group Prevea Health Columbia St. Mary's Community Physicians Mercy Health System Froedtert Health Medical Group Menomonee Falls

7 3-Year Trend at 60% of PWC National Trend $ $ $ $ $ $ $ $ DHP Assuming Milliman Nat'l Trend Adj to Madison DHP Assuming PWC Trend with Plan Changes DHP Commercial PMPM $ $ $ YE 2009 YE 2010 YE 2011 YE PMPM is for reference purposes only and is based on Commercial pool

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9 and with a focus on population health and utilization management as a means of reducing the total cost of care (HCP) Admission rate/1,000 pts (2012) 37% Improvement * Medicare National Reference Population as reported in Pioneer ACO Dashboard, April 2013

10 And reducing clinical rework 0 day all cause re admission rate (2012) 25% Improvement * Medicare and Medicaid Research Review 2013: Vol 3 (2)

11 Skating to Where the Puck is Going: (and the top 10 lessons learned along the way)

12 Lesson 1: Bravery

13 The question should no longer be, should we accept risk?, the question is how much? Less Risk Continuum More Medicare Fee for Service Comprehensive Primary Care Bundled Payments X4 ACO Track 1 ACO Track 2 Pioneer ACO Medicare Advantage 13

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15 Somewhat unrelated to the ACA, senior demand for MA is rising

16 And yet many of us are sitting on the sidelines The Value Model: Group s 5% risk-based payments are >= 25% AND Physician s incentives for value are at least 10% of total cash compensation or greater The Charitable Model: Group s 1% risk-based payments are <25% AND Physician s incentives for value are at least 10% of total cash compensation or greater The Funky Model: Group s 3% risk-based payments are >=25% AND Physician s incentives for value are less than 10% of total cash compensation The Volume Model: Group s 90+% risk-based payments are <25% AND Physician s incentives for value are less than 10% of total cash compensation

17 And there are benefits in return for the risk HCP Total Care Dollars Under Management (Billions) $ HCP Adjusted EBITDA (Millions) $414 $527 $278 $ Source:

18 Lesson 2: Synergy

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21 1. Alignment and Engagement Page 21

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25 Lesson 3: Primacy

26 The clinical care model is changing rapidly, with an intensive investment in upstream components of care delivery

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28 Lesson 4: Sorcery

29 Those organizations that align, engage and inspire clinicians and patients will outcompete those who cannot

30 Data Peer Pressure Incentives Clinician-Led Process Improvement Tools and Support Participatory Management Communication Selective Recruitment Leadership Development Vision Guilt

31 Lesson 5: Technologically

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33 Lesson 6: Granularity

34 The data that we analyze and report may become far more important than the vehicles we use to collect the data Page 34

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36 Big Data will be Huge Encounters Claims Hospital A/D/C EMR Labs Predictive Modeling Prescriptions Enterprise Data Warehouse POP (Patient Online Portal) PIP (Patient Information Portal) Images Analytics to improve outcomes

37 Decision Support

38 Public Unblinding of Data

39 Registries

40 Physician Profiling

41 Lesson 7: Synchronicity

42 100% 100% 115% 115% Page 42

43 Dean PCMH Compensation Model Transition 100% 2% 10% 10% 10% 10% 80% 15% 15% Efficiency 60% 40% 98% 95% 20% 20% 20% Quality Service Panel Size 20% 60% 40% RVUs - 5% RVUs 0% Option A 2010 Option B Future? Salary

44 Lesson 8: Thievery

45 We must reengineer our clinical models, both within our throughout the care continuum

46 Lesson 9: Simplicity

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48 Lesson 10: Priority

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50 Hospice/Palliative Care High Risk Interventions Medication Management Monitoring Comprehensive Care Clinics Care Transitions Intensivist and Hospitalist Investments Same Day Access/Urgent Care Rising Risk Interventions Convenience Clinics Home Services Health Advocates Level 3 High Risk Level 2 Rising Risk Low Risk Interventions Lifestyle and Wellness Management Social and Mobile Connectivity Weight Management E-Health/Web-Based Services Level 1 Future Risk

51 Lesson 11: Reproducibility

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55 Lesson 12: Transparency

56 There will be no where to hide, especially in a world of Health Insurance Exchanges.

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58 Lesson 13: Survivability

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62 A look into the future?

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72 Lesson 14: Non-Complacency

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74 Thank You.

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78 Craig E. Samitt, MD, MBA Partner/Global Provider Practice Leader, Oliver Wyman