Technology Driven Strategies for Enhancing Patient Engagement Within an ACO Model ACO Congress November 5, 2013 Charles Kennedy
Aetna s values drive ACS strategy apple 2
Changing the emphasis from volume to value apple 3
Today s realities The worst thing that can happen to industry stakeholders is if there s an outbreak of health. health system executive 4
Leading the way in provider collaborations Aetna cited by KLAS research as transformational by providers Managed Care Magazine: Unexpected Partners: Providers Join Aetna in Private label Plans 5
Accountable Care Solutions from Aetna overview apple 6
Experience with provider collaborations Collaboration Partner Partial List Metrics by Collaboration Type Medicare Advantage Provider Collaborations 100 Multi Line, Multi Payer ACOs 30 Bundled Payment Pilots 165 Medicaid Patient Centered Medical Homes Single Payer Patient Centered Medical Homes Multi Payer Patient Centered Medical Homes 66 31 Collaboration Letters of Intent 37 Providers in Pipeline 200+ 8 7
Value of Collaboration Value based care delivery Improved efficiency Better patient experience PROVIDER BRINGS Community presence Owns the patient experience Clinical expertise Clinical, financial and operational data Collaborative ACO like model that capitalizes on each organization s capabilities Population management tools that support physicians, physicians groups and health systems Focusing on quality and outcomes to manage present and future costs and efficiencies COLLABORATION PAYER BRINGS National presence Population health insight Regulatory expertise Actionable data and insight 8
ACO Supply: Aetna View of ACO Economics Depend on the success of true system wide efficiencies gained through enablement 9
ACO Supply: Provider ACO economics Provider economics depend on ability to gain new membership and increase efficiency 10
Moving from volume to value Transitional Period VALUE MODEL At risk population adoption Fee-for-service adoption $ FEE FOR SERVICE TIME 11
Payer patient provider collaborative dynamic yields significant opportunity Value based care delivery Improved efficiency Better patient experience Patient engagement & interaction 12
Navigating health care is complex for consumers in the current state It s a disjointed, complex experience for most consumers 13
Meaningful use considerations Requires that EPs and hospitals: 14
Providers are faced with multiple factors complicating care delivery Business Model Success Meet quality measures 15
Relationship has changed; patients have to be won and a partnership formed 16
Large opportunity for early adopters to differentiate from competitors 134% 90% 83% 67% 80% 70% Growth in health care s mobile audience in the past year. By far the largest growing sector Want to use self-service features (manage appointments, refill Rx, get reminders) want to access personal medical information online want access to more comprehensive info about docs online of Internet users research health online of all mobile searches result in action within 1 hour Patient demand is outpacing provider supply of convenient, actionable, mhealth information Sources: Adapted from Nielsen, Harris Interactive Poll 2012, Mobile Marketing Association, and 2012 Accenture study: Insight Driven Health. Is healthcare self-service online enough to satisfy patients? 17
Keys to successful patient engagement strategies 18
itriage: Pathway to integrate patients, providers, and payers 19
Decision support and steerage Steers to appropriate level of care Influences to seek lower cost alternatives Engages to connect with care provider 20
Engaged patients cost less Source: Adapted from AARP & You Beyond 50 Patient Survey; Gallup Research, IMI Healthcare 21
Managing a population is complex apple? 22
Technology can provide insight apple Behind on a year s worth of prescription refills At risk for second heart attack Visited the emergency department five times but missed primary care appointments Does not have a PCP Only 17% compliant with prescribed diabetes medications Overdue for a mammogram Visiting 3 specialists for one chronic condition 23
Technology informs and empowers patient centered care COORDINATE CARE Proactively triage and partner Care team collaboration Manage transitions in care Support and communicate ENGAGE Multichannel access Lab results Relevant educational content Secure messaging IDENTIFY Stratify population risk Identify patients in need of intervention 24
Payer Provider collaboration driving efficiencies and improving quality apple Background Since 2008, NovaHealth doctors participating in Aetna s Medicare Provider Collaboration program have provided care to Aetna Medicare Advantage members Collaboration Goal Improve quality of care and lower health care costs Results 50% fewer inpatient hospital days* 45% percent fewer hospital admissions* 56% fewer readmissions* More than 99% of patients visited their doctors in 2011 to receive preventive and follow up care * Compared to unmanaged Medicare populations statewide Payer Provider Collaboration In Accountable Care Reduced Use And Improved Quality In Maine Medicare Advantage Plan HealthAffairs September 2012 25
Patient centric care management Ensure patients with conditions such as hypertension or asthma understand and comply with their care plans, engage in optimal selfcare and receive recommended follow up. Core Care Team Members in Addition to Physicians Requires ongoing complex medical decision making and coordination among multiple providers. Monitor frequency of ED visits, admissions and readmissions and track psychosocial challenges. APs, RNs, pharmacists, care coordinators and MAs APs, pharmacists, care coordinators, behavioral health specialists, social workers and MAs 26
Market changes create opportunities for providers Today Physicians manage a wide variety of illnesses & complaints Future Physicians become extensivists, managing the sickest, most complex patients, resulting in stronger, more personal relationships with patients Physicians & RNs manage in collaboration Physicians manage a virtual team of extenders working at the top of their license, patients, and families Physicians focus on quality metrics Patient engagement limited Focus on a few well known Care Management areas New combinations of data from patient engagement, EMRs, sensors and devices improve predictive modeling Patients encouraged to play a more active role in their care through multi channel touch points New technology and expanded data automate and scale more granular programs across the Care Delivery continuum VALUE READY PROGRAMS: FOR BETTER OUTCOMES AND INCREASED COST SAVINGS 27
Electronic health care data proliferation Value is unlocked with integration The greater the overlap, the higher, deeper the insight Each Data Source Contributes Unique Information Health Plan Claims provides a broad view, insight into cost of care & information such as actual fill (Rx) history Outpatient Chart Information provides rich clinical information and such endpoints as prescribed medications, lab and test results, OTC advice and reported use, family history Inpatient Chart Information provides rich clinical information on procedures, conditions treated, medication use, lab and test results 28
Health plan centric care management TRADITIONAL MODEL The traditional care management model leverages a retroactive approach that is time consuming and cumbersome. Data is 30 60 days old providing a retrospective view into population. CLAIMS DATA Create registry Assignment of high risk patients CM reviews all available patient data CM assigns goals and interventions CM monitors progress 29
Next generation care management NEXT GENERATION MODEL The combination of clinical data, patient supplied data and claims data provides a more accurate, proactive view into the population on a continual basis. Real time quality and efficiency metric can be reported for patient, physician and ACO Monitor progress and alerts to deviations 24/7 CLAIMS DATA PATIENT SUPPLIED DATA Create on demand virtual registries Rules based assignment of at risk patients CLINICAL DATA CM documents against goals and interventions CM reviews patient data at single source with gaps in care considerations 30
The Integrated Health Record (IHR) 31
Technology drives patient engagement Data 32
Thank you. Please visit us at www.aetnaacs.com 33