Managing your entire population to avoid value-based failure

Transcription

1 Managing your entire population to avoid value-based failure Session ID 22, March 6, 2018 Matt Morrison, Executive Director of Healthcare Operations, MGM Resorts International Mason Beard, Chief Solutions Officer, Philips Wellcentive 1

2 Agenda MGM Resorts Corporate Profile / Overview The Direct Health Care Plan Vision & Tenets Incentives & Requirements Plan Technology Score Card The Path to Transformation Key Results Q&A 2

3 Learning Objectives Review the benefits of a comprehensive, agnostic population health management platform to manage the full range of your populations Identify the benefits of engaging employees as both patients and consumers Discuss ways to overcome roadblocks such as fragmented networks and information systems and outdated mindsets, workflows, and behavior patterns 3

4 Matt Morrison MGM Resorts Direct Care Health Plan 4

5 MGM Resorts 68,000 domestic employees in: Las Vegas, NV National Harbor, MD Detroit, MI Mississippi (Biloxi & Tunica) Atlantic City, NJ 51,000 Las Vegas based employees at 13 hotels, 10 casinos, 3 arenas, and Corporate offices 20,000, primarily non-union, Las Vegas employees enrolled MGM Resorts health plans 5

6 MGM Resorts Las Vegas Locations 6

7 Direct Care Health Plan Vision To improve the quality of health care in Southern Nevada, we focus on two driving factors: Improve the way that quality health care is identified, measured, reported, and compensated; and Restore patient accountability for personal health, while reducing barriers to care 7

8 Direct Care Health Plan Tenets Inspired by the Patient Centered Medical Home model Designated primary care providers directing a team of caregivers Enhanced access to care for patients Integrated technology to facilitate care coordination KPIs for quality, access, and cost that hold both patients and providers accountable Compensation that recognizes the value of primary care 8

9 Plan Member Incentives/Requirements Lowest paycheck contributions of their 3 plan options Lowest cost plan design (no deductible, low copays) PCPs guarantee same or next day appointments for sick visits and less than a 30 minute wait time for all scheduled appointments Given a Direct Care Health Plan Day to be used like a PTO day for annual physicals or other wellness activities Adults must select one primary care provider Employees and spouses receive participation and outcome based paycheck contribution credits related to a Health Score 9

10 Plan PCP Incentives/Requirements Enhanced reimbursement including: Monthly per patient care management fees Global visit fees Annual benchmark bonus Peer comparison bonus Enhanced access for plan members Same or next day sick visits Less than 30 minute wait to see the physician Dedicated phone line for DCHP patients Effectively utilize Population Health Management and referral technology provided by the Plan Access, quality, and cost KPI reporting provided monthly 10

11 Plan Technology Quality improvement initiatives and measurement could not be supported by claims data alone The need for a Population Health Management tool was identified during DCHP design in 2011 Currently 29 PCPs throughout the Las Vegas valley 19 locations under 17 physician organizations 16 instances of 9 different EMRs We selected a common population health management tool and gave to the PCPs based on: EMR Agnostic approach and ability to interface with any willing EMRs PCP and staff feedback on its ease of use Flexibility and willingness to partner on this unique use case 11

12 Monthly Scorecard 12

13 Monthly Scorecard 13

14 Health Score Program Biometric scorecards are provided to members following a physical and lab work with their PCP Scored on a 100 point scale with reductions based on BP, Lipids, Glucose, Waist/Height ratio, and Tobacco use Biometric values are loaded into the PHM application Enrollees and spouses both receive $520 in annual credits towards paycheck deductions for participating and will receive an additional $520 for any one of the following outcomes: Maintaining a score above 70 Improving their score from year to year Meeting with their on-site health coach at least 6 times per year 14

15 Mason Beard The Path to Transformation 15

16 Quality PHM Transformation Aggregation and measurement Performance and improvement Affiliated Engaged Coordinated High-performing Connection and organization Enable episodic care Develop support services Manage payer contracting Coordination and analysis Aggregate and normalize Analyze data and report outcomes Identify opportunities Engage providers Collaboration and improvement Engage patients Close care gaps Identify high-risk patients Implement care management programs Consolidation and optimization Utilize predictive modeling Assess organization s risk Manage utilization Optimize efficiency and costs Improve patient experience Market organization Fee-for-Service Pay-for-performance Shared savings and bundled payments Shared risk and capitation 16 Risk 16

17 Core competencies for delivering population health As defined by industry research leader KLAS Aggregation Analysis Administrative Care Coordination / Patient Clinician / Financial Health Improvement Engagement Engagement Compilation of disparate clinical / administrative data sources to support pop health Segmentation of aggregated data to communicate meaningful innovation Internal and external strategic program analysis Scalable care management support for standardized interventions Patient-centric communication and alignment with health goals and improvement Actionable workflow integration for clinicians 17 17

18 A comprehensive approach to population health management + + Data-driven Business Transformation Monetize your data and uncover potential additional value + Data Insights Data Hub Access, organize and visualize data Turn information into knowledge and knowledge into power Care Management Help turn insights into interventions Reporting & Submission Maximize valuebased returns Data Management Take control of your data with one longitudinal patient record 18

19 Implementation Path Discovery and research Needs assessment Platform implementation Program activation Support and growth plans Initial research to determine your VBC goals, actions to-date and programs in place; understand your organizational structure and populations served Assess where most resources and attention should be focused to arrive at tangible clinical and financial outcomes; align to your goals Implement technology infrastructure to connect disparate systems and begin data aggregation; configure analytics and reporting to your program needs Identify and activate the individual offerings, programs and services that support your strategies Partner with you to continually assess metrics against goals and identify areas for additional care plan opportunities; leverage platform data to adjust and improve 19 19

20 Matt Morrison MGM Resorts Direct Care Health Plan Results 20

21 Key Results Health Score 85% of eligible members earned the Participation Credit 72% also earned the Outcome Credit Health Score incentives helped to increase on-site health coaching utilization by 2.5x among DCHP members Members that utilized coaching had an average increase of 8.2 points in their Health Score 21

22 Key Results (cont d) Cost Allowed PMPM costs are now lower than our PPO plan in all 3 major categories (inpatient, outpatient and pharmacy) 20% fewer ER visits 25% fewer medical and surgical inpatient days 2% greater generic dispensing rate Annual medical and prescription cost inflation has averaged 1.5% over 5 years Access 92% survey satisfaction rate based on wait time guarantee and service 76% report waiting 15 minutes or less 22

23 Key Results (cont d) Cancer Screening rates have improved dramatically since DCHP launch Cancer Screening Rates 100% 80% 60% 40% 83% 82% 82% 63% 62% 39% 20% 0% Mammography Cervical Colorectal Jan-12 Dec-17 23

24 Key Results (cont d) Diabetic Care Of those screened: 78% have HbA1c in good control (<8.0) 81% have blood pressure in good control (<140/90) 100% 80% 60% 40% 20% 0% Diabetic Screening Rates 90% 92% 62% 66% 79% 30% HbA1c LDL Microalbumin Jan Dec-17

25 Key Results (cont d) Enrollment DCHP Membership 1/1/2012 1/1/2013 1/1/2014 1/1/2015 1/1/2016 1/1/2017 1/1/2018 Enrollees 2,379 4,544 7,163 9,641 11,280 11,916 12,576 Dependents (19+) 1,308 2,490 4,123 5,346 6,188 6,357 6,769 Dependents (<19) 1,493 2,813 4,544 5,848 6,638 6,735 6,959 Total Members 5,180 9,847 15,830 20,835 24,106 25,008 26,304 % of All LV Plan Members 11.5% 22.1% 36.3% 46.8% 55.0% 59.9% 63.0% Total Paneled Adult Members 3,687 7,034 11,286 14,987 17,468 18,273 19,345 Primary Care Providers Avg Members per PCP

26 Questions Our speakers Mason Beard, Philips Wellcentive, Matt Morrison, MGM Resorts International, Please complete the online session evaluation Thank you! 26