VALUE-BASED CARE AND SURVIVAL OF THE INDEPENDENT PRACTICE

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1 VALUE-BASED CARE AND SURVIVAL OF THE INDEPENDENT PRACTICE SANDY L. CHUNG, MD, FAAP, FACHE VICE-PRESIDENT, VIRGINIA CHAPTER OF THE AAP CEO, TRUSTED DOCTORS

2 DISCLOSURE STATEMENT I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in our presentation.

3 Virginia Chapter of the AAP The leading authority, advocate and voice for the health of Virginia s children and for the profession of pediatrics > 900 pediatricians across Virginia Quality Improvement Initiatives (MOC and CME credit) Healthy Minds, Healthy Children HPV Vaccination Improvement Telemedicine in Primary Care Medical Homes Bright Futures Improve Health for Foster Care Advocacy for Children and Child Health Local, State and Federal Pediatric Legislative Day Legislative Committee Educational Conferences Liaisons to national AAP, state and local government, and other stakeholders Toolkits for Asthma, Obesity, Disaster Preparedness

4 Surviving as an independent practice in this new world of healthcare?

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6 Cascade of Healthcare Challenges for the Near Future Expenses National health expenses will increase to $5.7 trillion by 2026 increasing each year by 5.5% Stressor Percent of millennials who report health insurance costs as a source of stress 72% Financials Hospitals that don t change from current operations will experience a margin loss of 16% Insurance Estimated percent of insurance payments that will be value-based by % Burnout Percentage of physicians reporting burnout symptoms 50% Workforce Percentage of physicians older than 55 years old 43%

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8 Pathways for Change

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11 Which Definition Are We Using?

12 Financial Risk in Value Based Contracts Shared Risk Primary Care Incentives Performance Payments Shared Savings Fee for Service

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14 PHYSICIAN PRACTICE MODELS HOW TO WORK TOGETHER AND STAY INDEPENDENT INDEPENDENT IPA Independent Physician Association CIN Clinically Integrated Network Supergroup Financially Integrated PANELED Groups who are affiliated through insurance company for value payments

15 THE STORY OF FAIRFAX PEDIATRICS o Founded in 1964, FPA is a pediatric independent practice with 13 providers and 2 locations in northern Virginia. o In 2011, we helped to found Health Connect IPA working together with over 150 primary care providers. Health Connect is a CIN for value based care. o In 2016, we joined with multiple pediatric groups in northern VA for Anthem s first pediatric only panel fro value-based care. o In 2018, FPA and The Pediatric Group joined to form Trusted Doctors, a supergroup with now 37 providers and 9 locations in northern Virginia.

16 HOW TO PLAY THE GAME

17 Care Coordination Key to Success for Value-based Care

18 Use in-network radiology sites and in-network labs The Price Difference - An example from an insurance company website Chest Xray Outpatient Radiology Site $40-$189 Hospital A More than $189 Abd and Pelvis CT Outpatient Radiology Site Less than $462 Hospital A $462 - $1,287

19 Patient Engagement and Education What s the difference between the emergency room and urgent care? Higher co-pay, higher co-insurance! $350 to go to the ER versus a $20 copay at urgent care Only life-threatening symptoms need to go to the ER chest pain, shortness of breath, severe pain or injury, seizures, etc. My doctor has 24 hour phone access, extended evening and weekend hours. I should call them first!

20 Innovative Care Delivery Labs at home Consumer Rx Personal wearables Genomics Uber Care Conciergecare TELEMEDICINE PERSONALIZED TRIAGE HOME VISITS SKIP INSURANCE Convenient Low Cost Immediate Similar to other industry disruptions EMS Based Triage ER Based Triage Direct to Employer Direct to Consumer Bundles

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22 Patients want telehealth

23 Questionable Quality?

24 Telemedicine Devices

25 Robots and AI

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27 Sandy Chung, MD, FAAP, FACHE