Managing Populations to Achieve Triple Aim Outcomes

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1 Managing Populations to Achieve Triple Aim Outcomes Pete Knox, Executive Vice-President and Chief Learning & Innovation Officer March 2014

2 Agenda 2 1. Overview of Bellin 2. Strategically Aligning the Work 3. The Triple Aim as a Foundation 4. The Managing Population Platform 5. Population Examples 6. Managing the Work 7. The Future

Mission Statement 3 Bellin Health is a community-owned not-for-profit organization responsible for the physical and emotional health of people living in Northeast Wisconsin and the Upper Peninsula of

3 Mission Statement 3 Bellin Health is a community-owned not-for-profit organization responsible for the physical and emotional health of people living in Northeast Wisconsin and the Upper Peninsula of Michigan. Directly, and in partnership with communities, employers, schools, and government officials, we guide individuals and families in their lifelong journey toward optimal health. We are committed to providing safe, reliable, cost-effective total health solutions with respect and compassion. Our innovative work will impact healthcare delivery in our region, as well as throughout the world.

4 Vision Statement 4 The people in our region will be the healthiest in the nation.

Bellin Health Overview 5 Serving a market of 600,000 people Bellin Hospital, a 220-bed community hospital with proven excellence in heart and vascular care; orthopedics and sports medicine; family

5 Bellin Health Overview 5 Serving a market of 600,000 people Bellin Hospital, a 220-bed community hospital with proven excellence in heart and vascular care; orthopedics and sports medicine; family programs and services; and minimally invasive procedures including robotic surgery Oconto Hospital & Medical Center, a critical-access hospital in Oconto Bellin Medical Group, a 93-member primary care group with 34 clinic sites and proven excellence in disease management and wellness care Physician Partners, Ltd, more than 170 independent specialty physicians NorthReach, a 26-member primary care group managed in partnership with Bay Area Medical Center in Marinette Bellin Orthopedic Surgery Center, an ambulatory orthopedic surgery center merged in partnership with a local orthopedic physician practice Bellin Psychiatric Center, a dominant provider of in- and outpatient behavioral health services Bellin College with baccalaureate and masters degree programs to educate and train nurses and radiologic technologists Unity Hospice, providing hospice and palliative care services 5 5

6 6 Strategically Aligning the Work

7 Forces in the Market 7

Manage the Work 8 Breakthrough Initiative Projects in the next 120 Day Plan

& Variation (Chris) 250,000 Lives Manage Populations For Triple Aim Outcomes

Initiative Projects that are active in the next 120 Day Plan Operational

8 Manage the Work 8 Breakthrough Initiative Projects in the next 120 Day Plan Operational Priorities Projects in the next 120 Day Plan Eliminate Cost, Waste & Variation (Chris) 250,000 Lives Manage Populations For Triple Aim Outcomes (Pete) New Business Development and Growth (Tom) List of Breakthrough Initiative Projects that are active in the next 120 Day Plan Operational Priorities and Owners List of Operational Priority Projects that are active in the next 120 Day Plan

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10 The Triple Aim Foundation 10

11 Background 11 IHI Triple Aim System designs that simultaneously improve three dimensions: Improving the health of the populations Improving the patients experience of care (including quality and satisfaction); and Reducing the per capita cost of health care

12 Getting Started: Building Triple Aim Infrastructure 12 Identify a population Articulate a clear statement purpose, including what the region is trying to accomplish and why. Develop a cogent set of high level measures that operationally define what your organization or community means by health of a population, experience of care, and per capita cost. Identify a portfolio of projects and investments to support the pursuit of the Triple Aim. Establish a means of governing and integrating the initiatives and investments.

13 Determinants of Health Swedish Model 13 13

14 14 The Managing Populations Platform

15 Population Management at Scale Creating Competitive Advantage Commercial Self-funded Fully-funded Individual 2. Medicare Medicare Advantage Fee-for-Service 3. Medicaid 4. Other 44% Bellin Business 12% of Bellin Business 27% of Bellin Business 10% of Bellin Business 7% of Bellin Business

16 Continuum of Relationships/Options Bundles Shared Savings Full Capitation 16 Medical Home P4P Wellness Packages Health Risk Appraisal Scores Onsite Package 12 month ROI: Onsite cost/billable FFS

17 Driver Diagram(s) 17

18 18 Example #1: Pioneer ACO Medicare Fee for Service

PY1 Pioneer ACO Performance Bars represent annualized PY1 PBPY expenditures Green represents gain, red represents loss

6% 0.5% -6.0% -2.8% 3.5% -6.3% -4.4% -0.6% -3.8% -1.9% 2.7% -4.5% -4.6% 0.3% -5.0% -3.6% 0.5% -4.1% -1.0% 2.6% -3.6% -6.

0% 1.9% -0.1% 1.0% 1.0% 0.0% 0.2% 0.0% 0.2% 0.3% 0.0% 0.3% 0.2% -0.3% 0.5% 0.7% 0.0% 0.6% -1.4% -2.0% 0.7% 2.2% 1.0% 1.3% 4.

19 PY1 Pioneer ACO Performance Bars represent annualized PY1 PBPY expenditures Green represents gain, red represents loss when compared to benchmark 19 Baseline to 2012 Trend ACO Ref. Pop. Difference -8.5% -1.7% -6.8% -5.4% 1.1% -6.5% -5.6% 0.5% -6.0% -2.8% 3.5% -6.3% -4.4% -0.6% -3.8% -1.9% 2.7% -4.5% -4.6% 0.3% -5.0% -3.6% 0.5% -4.1% -1.0% 2.6% -3.6% -6.4% -1.7% -4.8% 3.7% 6.7% -3.0% 0.1% 1.4% -1.2% -1.5% -0.5% -1.0% 0.7% 1.5% -0.9% 2.2% 2.5% -0.3% 0.7% 0.8% -0.1% 2.0% 1.9% -0.1% 1.0% 1.0% 0.0% 0.2% 0.0% 0.2% 0.3% 0.0% 0.3% 0.2% -0.3% 0.5% 0.7% 0.0% 0.6% -1.4% -2.0% 0.7% 2.2% 1.0% 1.3% 4.4% 1.8% 2.6% 5.0% 2.6% 2.3% 5.7% 3.6% 2.1% 2.2% 0.0% 2.2% 2.0% -0.6% 2.6% 8.2% 3.7% 4.5% 4.2% -0.2% 4.5% 7.4% 2.1% 5.3%

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22 Pioneer Examining a Subset of the Pioneer Population Defined criteria to subdivide the Pioneer population Broke Pioneer population into 4 subsets based on spend and chronic diseases Purpose To identify how the subsets varied from one another To identify how to best manage the health and experience for each subset To identify the largest areas for opportunity to make improvements for the population

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24 Pioneer Defining Which Projects to Target by Creating 24 a Driver Diagram 24

25 Pioneer Defining Which Projects to Target by Creating a Driver Diagram (closer look) 25 25

26 Pioneer ACO Strategies 26 Strategy #1: Primary Care Strategy This strategy applies to all 100% of our Pioneer population. Strategy #2: Super User Strategy This strategy applies to 3% of our Pioneer population who spend 30% of the costs of Pioneer. Strategy #3: Build Relationship with Members

27 27 Example #2: Employer Populations

28 Strategic Partnerships 28 Definition: a long-term commitment between two parties for the purpose of achieving specific goals. Key elements: Common goals and strategic interests Mutually creating and protecting a competitive advantage Encouraging innovation Spreading risk Creating goodwill Aim: To guide development of our strategic partnerships that produce triple aim results for our customers, while creating growth and prosperity for Bellin Health and affiliated partners. 28

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30 Bellin Data 30

31 Employee Triple Aim Metrics Actual Goal Metric Health: HRA % Taking HRA Work Comp Cost: PEPY (includes EE prem.) $ 9,517 $ 9,707 $ 9,998 $ 10,298 By Percent 2% 3% (ACA) 3% (ACA) Total Spend (Millions) % Health Cost to Net Rev 3.7% 3.7% 3.5% 3.4% Experience: % Wellness Cert. Completed 67% 71% 76% 80% % Lg. Claims (>$50K) 19% 20% 20% 20% 3% Trend 81% Notes: Mercer 2012 PEPY $ 10,558 Mercer % $ 11,086 ACA is 3% for 2014+

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41 41 A Plan for Achieving The Triple Aim

42 Bellin Health Structure for Overseeing/ Guiding the Employee Work 42 done CEO -HRA Scores -Health Cost Goals Steering Committee -Strategy Development Benefits Culture Resources done done

43 Aligned Incentives 43

44 Bellin Benefits 44 44

45 Specialist with Referral from Bellin Primary Care In-Network Deductible, then 85% Physician Specialist without Referral from Bellin Primary Care In-Network without a Referral Deductible, then 60% Physician Out-of-Network Deductible, then 50% Physician Fees for Surgical and Medical Procedures With Referral from Bellin Primary Care Physician In-Network Deductible, then 85% Without a Referral from Bellin Primary Care Physician In-Network without a Referral Deductible, then 60% Out-of-Network Deductible, then 50% Specific Disease Conditions (Arthrosclerosis/Cardiovascular Disease, Diabetes, Hyperlipidemia and Hypercholesterolemia, Hypertension, Obesity and Tobacco Use) **See Specific Disease Conditions Coding Reference Sheet for labs paid at 100% Bellin Medical Group Provider Only - Office Visits and Labs Paid at 100% **(Prairie States Program), All Other UHC Providers See In-Network Below; See Office Visits In-Network Outside of Bellin Medical Group (Administered by UHC) Treated as any other illness subject to deductible then Out-of-Network Treated as any other illness subject to deductible then Inpatient Hospital Services (Emergency Admissions Do Not Require a Referral) With Referral from Bellin Primary Care Physician In-Network Deductible, then 85% Without a Referral from Selected Bellin Primary Care In-Network without a Referral Deductible, then 60% Physician Out-of-Network Deductible, then 50% Outpatient Hospital Services - Therapeutic Treatments In-Network Deductible, then 85% Out-of-Network Deductible, then 50% Outpatient Hospital Services - Surgery With Referral from Bellin Primary Care Physician In-Network Deductible, then 85% Without a Referral from Bellin Primary Care Physician In-Network without a Referral Deductible, then 60% Out-of-Network Deductible, then 50% Diagnostic Testing In-Network Deductible, then 85% Out-of-Network Deductible, then 50% Outpatient Gastric Scopies (Colonoscopy, Sigmoidoscopy, Endodoscopy, etc.) Includes Scopes with Polyp Removal With Referral from Bellin Primary Care Physician In-Network Covered at 100% Without a Referral from Bellin Primary Care Physician In-Network without a Referral Deductible, then 60% Out-of-Network Deductible, then 50% Bellin FastCare Clinic 100% coverage Other FastCare Clinics Deductible, then 85% 67% reduction in ER

46 Results 46

47 Improved Health: HRA Results 47 47

48 Improved Experience 48 Prevention: 71% compliance with age and gender screenings 4 years ago: only 20% of $50,000+ claims Large Cases ($50,000+): 24% reduction in cases, 34% reduction in spend Percent Large Case Spend: 27% to 19% of total spend Removing Barriers: Value-based primary care with 1,473 individuals in chronic care condition program generating 2,286 annual visits at an average visit cost of $147 48

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50 Improved Cost 50 Bellin's Cost Difference Compared to Average (In Millions) 2001 $ $0.8 -$2.5 -$ OVER AVERAGE -$ $2.0 -$1.7 -$1.1 -$1.2 -$ $17+ Million Saved -$ $ UNDER AVERAGE 50

51 51 Organizing and Structuring the Work

52 Team Structure 52

53 2014 Roadmap 53

54 The Future Transition resources 2. Build a team that focuses on populations at risk every day 3. Continue to build the platform and expand populations 4. Fast with commercial 5. Transition core primary care design 6. Pay attention and manage all elements of the corridor

55 Thank you! QUESTIONS AND DISCUSSION

Creating the New Care Design L2. George Kerwin, CEO Patient of Bellin Health Bellin Health Team. Objectives

Creating the New Care Design L2 George Kerwin, CEO Patient of Bellin Health Bellin Health Team Objectives Identify the five views of the Production System necessary to Create a Connected Personal Experience