16 th Annual IHA Stakeholders Meeting Session 1B

Transcription

1 16 th Annual IHA Stakeholders Meeting Session 1B September 19, 2017 Hilton Los Angeles Airport Thank you to our Content Partner:

2 Exploring Standardization Opportunities in Medi-Cal IHA Stakeholders Meeting September 19, 2017 Sarah Lally, Project Manager

3 Agenda Welcome / Introduction Sarah Lally, Project Manager, Medi-Cal initiatives, IHA Core Measure Set: Health Plan Perspective Vanessa Pratt, Manager of Population Health, San Francisco Health Plan Value Based P4P in Medi-Cal: Health Plan Perspective Greg Buchert, MD, CEO, Care1st Health Plan Medi-Cal Provider Perspective Q & A Hector Flores, MD, Medical Director, Family Care Specialist Medical Group Integrated Healthcare Association. All All rights rights reserved. reserved. 3 3.

4 Medi-Cal Core Measure Set Integrated Healthcare Association. All All rights rights reserved. reserved. 4 4.

5 Medi-Cal P4P Core Measure Set Starting in 2015, IHA has led an effort among Medi-Cal plans and provider organizations to create a standardized performance measure set for all Medi-Cal P4P programs. IHA recruited an Advisory Committee of representatives from Medi-Cal managed care plans, providers serving Medi-Cal patients, DHCS, and other stakeholders to support this work. Through a voluntary, collaborative process, the Committee reached consensus on a core measure set that all Medi-Cal managed care plans could incorporate into their existing P4P programs. Domain Measures NQF # Cardiovascular Annual Monitoring for Patients on Persistent Medications: ACE or ARB indicators 0021 Annual Monitoring for Patients on Persistent Medications: Diuretics indicator 0021 HbA1c Testing 0057 Diabetes Care HbA1c Control 0575 Eye Exam 0055 Maternity Timeliness of Prenatal Care 1517 Childhood Immunizations, Combo Prevention Well-Child Visits in 3 rd, 4 th, 5 th, and 6 th Years of Life 1516 Cervical Cancer Screening 0032 Respiratory Asthma Medication Ratio Integrated Healthcare Association. All All rights rights reserved. reserved. 5 5.

6 IHA s Medi-Cal Core Measure Set Project membership Health Plans Provider Representatives Collaborators Associations 2017 Integrated Healthcare Association. All All rights reserved Integrated Healthcare Association. rights reserved.. 6 6

7 Core Measure Set Adoption Full Adoption Partial Adoption Developing P4P Program Alameda Alliance Anthem Care1st Central CA Alliance California Health & Wellness CenCal Inland Empire Health Plan CalOptima Gold Coast Kern Family Health Health Net UnitedHealthcare San Francisco Health Plan HP of San Joaquin HP of San Mateo LA Care Molina Partnership Health Plan Integrated Healthcare Association. All All rights rights reserved. reserved. 7 7.

8 Value Based P4P in Medi-Cal Integrated Healthcare Association. All All rights rights reserved. reserved. 8 8.

9 Value Based Pay for Performance Program 200+ Medical Groups & IPAs 9 Health Plans Common Measurement Public Report Card PARTICIPATING IN Public Recognition Value-Based Incentives Common quality, patient experience, & cost measures One of the nation s first & largest <20% of medical groups achieve Triple Aim IMPACTING 9.6 Million Californians Over $550 paid to date Integrated Healthcare Association. All rights reserved. 9 Copyright 2015 Integrated Healthcare Association. All rights reserved. 9

10 Value Based P4P in Medi-Cal As Medi-Cal expands, more medical groups/ipas serving both commercial and Medi-Cal enrollees Opportunity for greater alignment of performance measurement across sectors To support any expansion, IHA could leverage existing VBP4P data flows and program infrastructure, similar to the current Medicare Advantage effort Focus: Medi-Cal Managed Care Plans in Los Angeles County When is a 2 plan model actually a 6 plan model Potential Impact: If implemented by all Medi-Cal managed care plans in LA County, the program would cover nearly 30% of total Medi-Cal enrollment Integrated Healthcare Association. All rights reserved. 10

11 Value Based P4P in Medi-Cal Crosswalks of provider organizations contracted with Medi-Cal managed care plans in LA County found between 30-60% already participating in VBP4P Overlap of provider networks across LA County Medi-Cal MC plans 130 total provider organizations identified 17% contract with all 5 health plans (LA Care, Care1st, Anthem, Health Net, Molina) 37% contract with at least 2-4 plans Care1st Health Plan plans to participate in VBP4P in upcoming cycle Integrated Healthcare Association. All rights reserved. 11

12 PLAN PERSPECTIVE: SAN FRANCISCO HEALTH PLAN Vanessa Pratt 2017 IHA Stakeholders Meeting September 19, 2017

13 About SFHP Licensed community health plan Primary line of business: Medi-Cal Cover over 145,000 Medi-Cal beneficiaries (SF residents with low- and moderate-income)

14 Pay-for-Performance Program: Large Buy-In Incentivizing Comprehensive

15 Pay-for-Performance Program: Large Buy-In Founded 2011 Collaborative Rewarding Non-competitive 20% of capitation at stake Comprehensive Measurement across clinical, access, utilization, data domains

16 Pay-for-Performance Program: Large Buy-In Founded 2011 Collaborative Incentivizing Non-competitive Significant resources at stake Comprehensive Measurement across clinical, access, utilization, data domains

17 Pay-for-Performance Program: Large Buy-In Founded 2011 Collaborative Rewarding Non-competitive 20% of capitation at stake Comprehensive Measurement across clinical, access, utilization, data domains Dynamic

18 Core Set Implementation 2015: PIP contains 80% Core Set measures 2016: PIP adds remaining measures 2017: 1 st year of new measures, pay-for-reporting

19 Core Set Process Advisory Committee Opportunities Benefits

20 Questions? Vanessa Pratt Manager, Population Health (415)

21 Exploring Standardization Opportunities in Medi-Cal Integrated Healthcare Association 2017 Stakeholders Meeting September 19, 2017 Greg Buchert, MD, MPH President and CEO Care1st Health Plan, an affiliate of Blue Shield of California

22 About Blue Shield s Care1st Health Plan Founded in 1994 by a group comprised of providers, organized medical groups, and hospitals In 2015, acquired by Blue Shield of California, a not-for-profit health plan Serves approximately 480,000 members in California 410,000 Medi-Cal members in two counties 60,000 Medicare members in 12 counties 6,300 dual eligible members in the Cal Medi-Connect program Opportunity to leverage Blue Shield s processes, statewide provider network and decades of service to vulnerable populations through the Blue Shield Foundation 22

23 2 3 Rebranding Blue Shield s Medi-Cal Plan New plan name!

24 Our mission Ensure all Californians have access to high-quality health care at an affordable price

25 Care1st is evolving to a non-profit Blue Shield company Moving to the Blue Shield operating environment Operational Improvements Leadership Integration/Transformation 25

26 Pay for Performance (P4P) Has Challenges in a Medi-Cal Program Members more likely to have social, economic, educational, behavioral, communication and cultural challenges Member ability to switch health plans monthly Member familiarity or necessity using Emergency Room vs. primary care provider High dependence on Federally Qualified Health Centers (FQHCs) 26

27 P4P Has Challenges in a Medi-Cal Program Multiple HEDIS monitoring entities/multiple priorities DHCS, NCQA, LA Care, Individual plan priorities Low Medi-Cal revenue compared with Commercial and Medicare lines of business 53 separate reporting Medi-Cal entities in California Quality performance impacts default assignments 27

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29 Member Opportunities for Improvement Member engagement and education Increased partnerships with Community Based Organizations Touch our members where they live Care1st Resource Center 29

30 Provider Opportunities for Improvement Increase timeliness and accuracy of claims payment and encounter collection Timely posting of Care Gaps on provider portal and communication with providers/provider organizations Care1st contracting and member assignment favoring highest performing groups P4P program for both Provider Organizations AND rendering provider when possible Collaborate with other Medi-Cal plans through IHA s Medi-Cal Value Based P4P program 30

31 What s Next... Care1st embraces P4P strategies and supports IHA standardization efforts Open to feedback on how to better partner with members, community based organizations and providers to ensure that all Medi-Cal members receive the care they deserve 31

32 Our Vision Create a healthcare system worthy of our family and friends and sustainably affordable 32

33 Thank you

34 Blue Shield of California and Care1st are independent licensees of the Blue Shield Association.

35 Standardization in Medi-Cal VBP4P Hector Flores, MD Medical Director September 19, 2017 (c) Family Care Specialists

36 Our Goals Boutique-type practice and serve our fair share of the uninsured and Medi-Cal Compete on value P4P, Savings Sharing 2011 Received Most Improved IPA Award, IHA 2012 Achieved Honorable Mention in Elite 25, IHA 2014 Achieved Recognition status Medicare Stars, IHA 2017 Achieved OPA 4.0 Medicare Stars; 3 of 4 Stars Commercial/Medi-Cal Access the opportunities in health care reform ARRA HIT funding, MACRA, Prop. 56 Medi-Cal bump, All Payer VBP4P (c) Family Care Specialists

37 Family Care Specialists (FCS) Medical Group and IPA FCS IPA MSO Beverly Hospital Glendale Memorial Glendale Adventist WMMC FCS Medical Group Senior Care Clinic Multiple Smaller Practices (c) Family Care Specialists

38 Family Care Specialists Medical Group 18 Family Physicians, 6 PA/4 NP, 2 Behavioral Scientists, 2 Navigators, one case manager, 3 Community Health Workers (Promotores) EMR = emds, Analytics i2i Solutions 4 offices in Greater East Los Angeles PCMH Level 3 Extended Office Hours: Monday Saturday: 8:00am 6:00 pm Telephonic Coverage 24/7 physicians and remote access to EMR (c) Family Care Specialists

39 FCS Medical Group Practice Affiliations 40% Medi-Cal 20% Medicare 20% Commercial 10% Covered CA 8% Uninsured 2% Other and Payer Mix FCS IPA Commercial Medicare HMO Medi-Cal HMO FFS Medi-Medi PPO & Uninsured Medicare HMO HCP IPA CareMore Medi-Cal HMO HCLA IPA (Care 1 st ) 25,000 Patients (c) Family Care Specialists

40 The Quality Menagerie: (Payer Type X Health Plan Idiosyncracies)³ = La Vida Loca 1. JCAHO Teaching Clinic and Hospital 2. NCQA/ PBGH/LeapfrogGroup.org Hospital, Health Plan and Medical Practice 3. Health Plans a. PPO PQIP b. IHA VBP4P Commercial, Covered CA c. MIPS ffs, Medicare Stars d. Medi-Cal Plans (EAS + Plan-specific) 4. DHHS Office of the Patient Advocate 5. State DHCS Medi-Cal ffs (EAS, special populations) 6. County DHS Clinic Certification and CHDP (c) Family Care Specialists

41 (c) Family Care Specialists LA County

42 (c) Family Care Specialists

43 And oh, yeah Encounter Data Meaningful Use/Advancing Care Information Typical Specialist in LA County contracts with eight different IPAs and 14 PPOs Typical PCP contracts with three IPAs and six PPOs (c) Family Care Specialists

44 OK, I m ready to practice (c) Family Care Specialists

45 FCS IPA Utilization VBP4P Hospitalists Extensivists Preferred SNF and LTC network Home Health network Urgent Care Network ER Diversion Program Formulary Management Free-standing Imaging Centers ASC Hospital ASC Diversion Program (c) Family Care Specialists

46 Performance Quality HEDIS Medicare Stars PQRS MIPS ACO readiness PPO PQIP DMHC OPA Composite Utilization Medicare 800 Bed- Days/1000 Commercial & Medi-Cal 100 Bed-Days/1000 All-payer LOS 1.5 day lower Readmission Medicare 9%, Adult Commercial & Medi-Cal 6% ER reduced 50% Formulary/Generic 90% (c) Family Care Specialists

47 Opportunities Seamless system of care focused on families regardless of coverage differences Seamless population health strategy capable of leveraging local, state, and federal investments (e.g., State Innovation Model) Demonstrable continuous improvement in quality as individuals navigate a lifetime across different payer systems Readiness for ACOs and Alternative Payment Models Agile delivery system adaptable to market changes (c) Family Care Specialists

48 Thank You! (c) Family Care Specialists

49 16 th Annual IHA Stakeholders Meeting Lunch September 19, 2017 Hilton Los Angeles Airport Thank you to our Content Partner:

50 16 th Annual IHA Stakeholders Meeting Session 2C September 19, 2017 Hilton Los Angeles Airport Thank you to our Content Partner:

51 Medication Adherence AppleCare Pharmacy Programs Confidential and proprietary. Do not distribute.

52 AppleCare Medical Group Medical Group and IPA servicing Los Angeles and Orange County 100,000 members Senior, Dual, Commercial, Medi-Cal Commercial HMO ACO 900 Primary Care Physicians and Specialists Clinical infrastructure Hospitalist Program Pharmacists, Social Workers, Nurse Case Managers Disease Management and Preventative Care Programs High Risk and Post-Discharge Clinic Remote Monitoring Confidential and proprietary. Do not distribute.

53 Our Service Area Landmark Cities Downey Lynwood Long Beach Lakewood Anaheim Whittier Confidential and proprietary. Do not distribute. 53

54 Our Health Plan Partners Confidential and proprietary. Do not distribute. 54

55 Confidential and proprietary. Do not distribute. 55

56 Medication Adherence Program Confidential and proprietary. Do not distribute. 56

57 Pharmacy Processes 1. Annual Preparation Internal 2. Monthly 90-day Supply Provider Outreach 3. Weekly Adherence Member and Pharmacy Outreach Confidential and proprietary. Do not distribute. 57

58 Beginning of the Year Preparation Focus on 90-Day Supply Eligibility Review Provider Templates Pharmacy Outreach Internal Education Reduce adherence calls Patient savings on medications Answer questions about the communication Develop staff relationships Work closely with pharmacy partners to address any concerns and answer questions about working with AppleCare Educate member and provider facing teams about processes and objectives Source/Footnotes Confidential and proprietary. Do not distribute. 58

59 Monthly 90-Day Supply Provider Outreach Continuous follow-up (return rate: 75 %) Pull Adherence Reports by Health Plan Organize by 90-day supply eligibility Monthly fax outreach to provider offices Fax provider approval to pharmacy and follow-up with member Confidential and proprietary. Do not distribute. 59

60 90-Day Supply Provider Communication Confidential and proprietary. Do not distribute. 60

61 AppleCare 90-Day Supply Improvement SCAN Results 90 day-supply rates up 14.3% YOY Received award for most improved group on adherence rates Confidential and proprietary. Do not distribute.

62 Weekly Adherence Member Outreach Telephonic outreach reminders to members Pull Adherence Reports by Health Plan Organize by: 1. % Adherence determine likelihood of meeting quality criteria 2. Refill Due Date Telephonic/fax outreach to pharmacy to initiate refill Confidential and proprietary. Do not distribute. 62

63 Questions? Mary Tadros, PharmD Confidential and proprietary. Do not distribute. 63

64 Welcome to DESERT OASIS HEALTHCARE As a member of the desert community for over 35 years, Desert Oasis Healthcare is dedicated to the health and well-being of our neighbors throughout the Coachella Valley.

65 Pharmacists: A Seat at the Table Lindsey Valenzuela, Pharm.D. BCACP Administrator Population Health and Prescription Management (PHARxM) Desert Oasis Healthcare

66 Desert Oasis Healthcare: HPN Affiliate Medical group with a wraparound IPA established ,000 MediCare Advantage 30,000 HMO Commercial 7,000 Nextgen ACO 1 st Pharmacist hired in 2005 Pharmacist managed clinics under established collaborative practice agreements Anticoagulation Diabetes Coronary Artery Disease (CAD) Hepatitis C (Center of Excellence collaboration with FQHC) Heart Failure COPD Antimicrobial Stewardship Primary Care Refill Program Medication Access HEDIS/5 Star Quality Support

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68 Steps to Success Evidence Based Interdisciplinary Protocol Quality Improvement Council Review EHR Documentation Information Shared with PCP Board Certified Pharmacists Residency Trained Specialized Certifications Medical Director Mentor Champion Expert Pilot the Program Build Success then Expand Measure Outcomes Scale Using Technology Pharmacists Patient Care Process

69 COPD Adherence Health Education Anticoagulation Cost Time Complexity Frustration Patient Primary Care Physician Collaboration Medication Reconciliation and Review Population Health & Prescription Management (PHAR x M) Cardiology Hepatitis C Diabetes

70 DIABETES MANAGEMENT Reduction in all cause and diabetes related hospitalizations Compared to baseline, the percentage of patients with HbA1c at or below guidelines (<7%) increased from 1.5% to 19.2% Optimal LDL (<100mg/dL) increased from 62.1% to 80.6%. Sustainability in HbA1c shown with 7.4% before discharge and 7.4% six months after discharge

71 DIABETES MANAGEMENT Mean initial HbA1c 10.6%, HgA1c at 180 days 8.6% Poorly controlled seniors reduced from 21% to <9% (5 STAR rating in achieved) 48% of all patients had an HbA1c <9% after 90 days. Patient Satisfaction: 100% of patients surveyed would recommend this program to friends and family (n = 100)

72 PRIMARY CARE REFILL PROGRAM

73 PRIMARY CARE REFILL PROGRAM 36% 30 Days 98% 30 Days 16% 30 Days 55% 30 Days In order for prescription medications to be effective at treating illnesses, patients must: Fill the prescription given to them by the physician Routinely take the medication as directed by the physician: Quantity of medication to be taken Number of times per day medication is to be taken Time(s) of day medication is to be taken Refill the medication as needed in order to take the medication as long as recommended by the physician. If a patient fails to do any of these medication adherence is less than perfect.

74 PRIMARY CARE REFILL PROGRAM

75 CARDIOLOGY MULTIDISCIPLINARY MANAGEMENT Cardiologist NP RN Technician Support Enrolled in the Refill Program

76 Patients trust their PCP PCP RELATIONSHIP: KEY TO OUR SUCCESS Patients expect that their PCP, specialist, case manager, Pharmacist, etc. communicate on a regular basis Reinforcing treatment plans Direct conversation regarding concerns or discrepancies Document sharing Shared success

77 Virtual Program Concept, Staffing & Results Khanh Nguyen, PharmD Director, Quality Programs & Pharmacy Operations Clinical Support Hill Physicians Medical Group September 2017

78 Hill Physicians Medical Group Organizational Overview Independent Physician Organization (IPA) founded in 1984 Largest IPA in Northern California in Northern California counties Over 4,000 providers 250K Commercial, Medicare Advantage & Medi-cal members 120K Attributed PPO 78

79 Virtual Program Hospital Discharges Health Plan Providers Drug Consult / Dz Management Initial assessment Routine f/u (1-6 weeks) Full med review, prn Interventions Med optimization Lifestyle goal setting Labs/PCP appts Therapeutic Interchange Patient Case Management Patient & Family Reports & Analytics Virtual Pharmacist Interventions Med optimization per protocol Patient consult note PCP appts POS alerts Generic Rx switches Drug consult Labs f/u Providers 79

80 Current Staffing & Documentation Process # of pharmacist FTEs: 4.5 # of Integrated Practices: 108 # of Integrated Physicians: 150 # unique pts outreached/fte/year: 500 # of interventions/fte/year: 2000 Outreach Document Report Patient communication via phone or secure Provider messaging via EHR All interventions documented in Case Management module Interventions documented in a pharmacy assessment template Output reports updated daily & run as needed Updated outcome reports currently underway 80

81 Patient Based Outcomes

82 2014 VRx Program Patient Based Outcomes Medication Adherence n = 712, pre- and post-vrx med management or med rec; meds for chronic conditions Pre-VRx Intervention PDC: 47% (45%, 48%) Post-VRx Intervention PDC: 63% (61%, 65%) IP Readmissions & ED Visits (Med Rec 30 Days After Discharge) n = 133, case-control matching on similar disease burden, demographics Readmission Rate 30 day re-admission odds: 5.4 times as high for patients not receiving Med Rec 90-Day Incidence Rate: those who received Med Rec were re-admitted 30% less often ED Visit Rate: 30 day post-dc ER visit odds: 2.75 times as high for patients not receiving Med Rec 30-Day Incidence Rate: patients who received Med Rec visited the ED 76% less often IP Readmissions & PCP Follow-up (Med Rec 14 Days After Discharge) n = 83, case-control matching on similar disease burden, demographics Trend towards reduced 30-day readmissions: 8.4% vs. 13.3% (p=0.39) Statistically significant shorter time to PCP follow up: 14.1 vs days (p<0.001) 82

83 2016 Quality Measure Compliance 90% Medication Adherence: Proportion of Days Covered by Patient 80% 79% 70% 60% 63% 60% Pre Intervention Post Intervention 50% 47% 40% 30% 2014 Data 2016 Data Cost savings of $500 per compliant patient *Express Scripts, Report: Adherence to Diabetes Rx, Aug 25,

84 Diabetic Dz Management 2016 Results 9.2% 9.0% HbA1c Change 9.1% 70% 65% % of Patients with any HbA1c Reduction 64% 8.8% 8.6% 8.4% 8.5% Control 60% 55% 50% 56% 8.2% 8.2% VRx Cohort 45% 8.0% Pre-enrollment 6 months postenrollment 40% VRx Cohort Control Every 0.1% decrease in A1c results in an average of ~$1,000/year savings* *The Cost and Quality Gap in Diabetes Care: An Actuarial Analysis, Milliman Client Report,

85 2016 Utilization ER & IP Admits Relative Risk of an ER and IP Visit (RR, 95% CI) ER readmit 90-Days Post Outreach IP readmit 90-Days Post Outreach An ED or IP readmission is less likely to happen in the VRx Integrated group if the RR is < 1 85

86 Practice Based Outcomes

87 2014 VRx Program Practice Based Outcomes Quality Measure Compliance Overall compliance rates are significant at the 90% confidence level VRx Practices: 88% (87%, 90%), Control Practices: 83% (81%, 84%) Year Screening VRx (% Compliance) Control (% Compliance) p-value Breast Cancer 83.6% 78.6% < Cervical Cancer 63.2% 57.1% < Colorectal Cancer 78.6% 70.2% < Breast Cancer 86.2% 78.3% < Cervical Cancer 68.0% 59.9% < Colorectal Cancer 80.3% 70.2% < % 85% 80% 75% 76.7% 76.3% Generic Prescribing Rates 82.1% 80.0% 85.2% 83.8% 87.1% 85.7% Every 1% increase is associated with $1-2 reduction in overall Rx PMPM 70% P < for VRx Practices Control Practices 87

88 2014 VRx Program Practice Based Outcomes Impact on Risk Adjusted TCC PMPM Trends % vs. 10.5% increase in VRx vs. Control From 2013 to Results: VRx Practices Control Practices TCC calculation is risk-adjusted & includes: All medical & pharmacy costs (Rx claims, office-based services, injectables, etc.) Facility cost ($750 ED visit & $4,000 IP day) estimate based on proxies from IHA Value-Based P4P program TCC calculation could not account for out of network cost differences 88

89 VRx 2016 Statistics-Engagement Integrated with 108 practices at Hill 68% patient engagement rate 75% provider recommendation acceptance rate* * Acceptance rate is based on a sampling of intervention cases 89

90 2016 Quality Measure Compliance (Hill Network) 100% 90% 2016 Quality Measures Outreach Practices Non-Outreach Practices * 80% * * 70% * * 60% 50% 40% Asthma Med Ratio Diab Management Two HbA1c tests 2016 Breast Cancer Screening Colo Cancer Screening PDC for Oral Diabetes Medications PDC for Renin Angiotensin System (RAS) Antagonists PDC for Statin Medications * Indicates statistical significance MY 2016 No statistical difference for any measure in 2015

91 Quality Measure Compliance Quality Composite Score CMS Star & P4P Measures 76% 74% VRx Cohort 1 72% 70% 71.1% 73.3% 71.1% VRx Cohort % 68% 67.9% 66% 64% 64.3% Case Matched Control 62% 60% VRx SF Community VRx UCSF Case Matched Control 91

92 68% 71% 71% 72% 73% 81% 2016 Quality Measure Compliance Proportion of Days Covered by Practice NETWORK PRACTICES V RX PRACTICES COHORT 1 V RX PRACTICE COHORT 2 Medication Adherence patient outreach (all regions) n = 719, pre- and post-vrx med management adherence consultations Pre-VRx Intervention PDC adherence: 60% Post-VRx Intervention PDC adherence: 69% 92

93 Percent Generic 89% VRx Practices Case Matched Control 88% 88.3% 87% 86% 87.2% 86.4% 86.6% 85% 85.0% 85.5% 84% 83% Aug Onboarding of VRx Cohort 82% 2015 Q Q Q Q Q Q Q Q2 Every 1% increase is associated with $1 - $2 reduction in overall Rx PMPM 93

94 Pharmacy PMPM Trends $ VRx Integrated Case Matched Control $ $99.83 $90.00 $85.93 $80.00 $70.00 $66.97 $60.00 $57.67 $

95 Total Cost of Care Trends $150 VRx Integrated Case Matched Control $145 $ $140 $135 $130 $ $125 $120 $ $ $115 $