Patient Centered Health Care Consortium

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1 Developing Community Based Primary Care Accountability Enhancing Benefits / Lowering Costs Patient Centered Health Care Consortium

2 Primary Care Accountability Confidential 2

3 Primary Care Accountability Confidential 3

4 Primary Care Accountability An Expected Set of Deliverables Confidential Source: Cornell Program for Healthy Living,

5 5 What s Driving the Conversation?

6 The Health Care Landscape Rising Costs & Inefficiency Confidential It s your money, it s your choice, it s your decision 6

7 Typical Health Care Model Lack of Physician Accountability & Commitment Confidential Insurance carriers build provider networks that offer deep discounts but have limited influence over the quality of care provided. Providers are compensated for sick care but are not accountable for quality outcomes. Employees select physicians based on convenience or perceived quality rather than on actual quality. Employers have limited ability to effect change. Wellness programs can increase employee awareness of health status, but rarely drive real behavioral change. Disease management programs often fail to engage patients. When it comes to care management, both fail to get to the core of the problem: physician accountability. 7

8 One Model for Primary Care Accountability The Four Pillars Confidential Employer Advantage is built on four pillars: 8

9 Physician Alignment Building a Featured-and-favored Network Confidential Highly-trained and efficient primary care physicians are recruited in local communities to build a featured-and-favored network that delivers a higher standard of care covered individuals, driving greater efficiency and quality outcomes. This process includes: 9

10 Health Care Alignment A Better Health Care Delivery Model Confidential Aligned Enlightened Self Interests / Balanced Rewards and Value 10

11 Measuring What You Want to Manage Responsible Provider Episod es Variance Total Extrapolated Total Variance CMI Total ER IP AMB FAC Performance Index Florence, David G. 45 $524 $23, Bills, Stephen H. 28 $629 $17, Davis, Glenn A. 17 $809 $13, Tidmore, Karen A. Schweitzer, Meredith Do PRO C MED LAB RAD PAT H 38 $310 $11, $460 $8, OOS RX E&M UD

12 Case Study: Large Automotive Supplier Enhanced Fee Schedule / Suspend NCCI

13 The Challenge Confidential Our client, a large automotive supplier, was looking for new and innovative solutions for lower costs while improving the health of its employee population. The company had implemented, with limited success, the following major strategies for reducing health care costs: 13 [1] Client s total average health care costs per employee per month (PEPM) for 2011 was $ National average of health care costs per employee according to the Mercer National Study of Employer Sponsored Health Plans 2011 was $ (PEPM). Client s average PEPM health care cost per employee is 20.3% lower than the national average for the same time period.

14 The Solution Creating a Customized Strategy Confidential Employer Advantage reviewed the client s existing benefits infrastructure, working with its consultant / broker. We then implemented several solutions that garnered results within 15 months. The customized solution consisted of: 14

15 Claims and Clinic Costs Trend Flat over 5 years 5 year view of Medical & Rx Claims and OnSite Clinic Costs Confidential $ $ $ $ $51.39 $ $ $ $ $ $ $57.22 $ $73.47 $89.44 $91.67 $ $ EAHCS/ OnSite Clinic & Preferred Primary Care $ $ Medical & Rx Claims $ $ $ $ $ $ Total $ $ $ Linear (Total) $ $ $ * $0.00 *Incomplete claims data during carrier transition 15 Confidential information of CalsonicKansei North America, Inc.

16 Tangible Results First-year Improvements Confidential In the first year, our program delivered immediate and tangible results: 16

17 Case Study: Central Virginia Manufacturer Payment in Advance of Care / Encounter Reporting

18 Summary of Results Confidential 18

19 Future Focus Confidential Building an EEOC Compliant Strategy for Adherence Creating a Performance Based System of Reward / Acknowledgement 19

20 Employer Advantage s Patient Commitment Levels Confidential Preferred Primary Care Practices Medical Interventions Lifestyle Interventions Patient is consuming health care without knowledge or utilization of employer or preferred primary care resources Patient has completed a health risk assessment, biometric screening with preferred primary care Patient has entered into a Care Plan Contract with preferred primary care to keep appointment s, be adherent to medications and participate in referrals Patient is completing all steps Care Plan Contract Patient has completed a Life Assessment (Values) and Health Literacy Questionnaire (Knowledge) Patient has met with a Wellness Planner, completed a Life Plan Contract with the Wellness Planner and agreed to use the Wellness Planner as their accountability partner Patient is completing all steps in Life Plan Contract Patient has and maintains normal biometrics and good health habits Employer Advantage s Medical and Lifestyle Programs Employer Wellness Support (Culture and Incentives) 20

21 Employer Advantage Patient Commitment Model Confidential 21

22 Provider Engagement Strategy Confidential Top of License Model Medical Support Services Physician Heart / COPD / High End Rx / Complicated / Recent Non-Surgical Hospitalization Nurse Practitioners Hypertension / Asthma/ Stable Lung Disease Collaborating Specialists Pain Management Musculoskeletal Program Psych PhD / Behavioral Counselor Psychological Issues / Depression Medical Assistant Administer Lab Testing / Immunizations / Rx Fulfillment / Referral Support Referrals (if needed) Sleep Program Diabetes Program Weight Management Health Coach / Wellness Planner Obesity / Smoking / Behavioral Issues 22

23 1550 West McEwen Drive, Suite 60 Franklin, TN 37067