Beyond the Horizon: What s Next? Session PH6, March 5, 2018 Don Calcagno, President, Advocate Physician Partners 1
Conflict of Interest Don Calcagno Has no real or apparent conflicts of interest to report. 2
Agenda Advocate Overview Healthcare Value Chain Understand and Optimize Care Disruption 3
Learning Objectives Describe the sustainability of a changing business model to accelerate the population health movement Explore advanced and disruptive technologies and their role in enabling innovative care delivery models Illustrate that population health will require understanding and optimization of a personalized longitudinal plan inclusive of clinical, behavioral, socioeconomic, and other factors 4
Advocate and APP Overview 5
$6.4 billion of revenue 1.6 million unique patients 1,007,000 value based lives 35,000 associates Advocate Health Care Physicians/Ambulatory 1,400 employed + 400 APCs Over 6,000 physicians in 450+ sites of care Hospitals (11) 4 teaching 5 level 1 trauma centers 1 children's 1 critical access 2 LTACH Post-acute Home health, hospice, SNF and palliative care 6
Outpatient Acute Care Post Acute UC Hosp Phy ED Hospital HH SNF LTACH 3,500 APP Independent 1,500 AMG 1,600 independent PLURALISTIC PHYSICIAN PLATFORM > 1M Lives: 666K shared savings 344K capitated $1.3B Funds Flow: Capitated, CI and Shared Savings Quality: MSSP: Top Decile/Top Quartile NCQA physician measures Largest MSSP ACO (saved > $134M last 2 years) MANAGED CARE 7
Performance Highlights TOP DECILE level based on available NCQA benchmarks on 28 CI MEASURES TOP QUARTILE on 7 CI MEASURES http://www.advocatehealth.com/valuereport 8
Decreasing Variation across Populations %Patients who had a HbA1c Performed Diabetes: HbA1c >=9 9
AdvocateCare Performance 5.0% 4.0% 3.0% 2.0% 1.0% 3.1% 2.4% 2.4% 1.5% 3.5% 1.1% National Medical Services Inflation* %Change RBC Medical Expense 0.0% -1.0% -0.6% 10 2013 2014 2015 2016
2015 2016 Beneficiaries 145,365 139,617 Expenditure $11,229 $10,995 Quality Score 94.2% 97.28% Total Savings $73 M $61 M Earned Savings $34 M $29 M 11 MSSP Savings Top 3 2015 Top 2 2016
Value 12
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Health Care Value Chain Provider Employer Payer & Product Distributor Consumer 14
Payor-Provider Relationships Provider Employer Payer & Product Distributor Consumer Transactional Partnership Operational Excellence 15
Provider Employer Payer & Product Distributor Consumer Who bears financial risk? Who s capable of bearing risk? 16
IDN Financial Forecast Provider Employer Payer & Product Distributor Consumer 17
Changing Paradigms Provider Employer FROM... Silo care management Episodes of care Discharges Utilization management Caring for the sick Production (volume) TO... Enterprise care management Coordination of care Transitions Right care at the right place at the right time Keeping people well Performance (value) 18 Payer & Product Distributor Consumer
Provider Employer Payer & Product Distributor Consumer 19
Employers Payer & Product Provider Distributor Employer Consumer 20
Employers Provider Employer Promotion of high-performing providers Offer clinically integrated delivery models (ACOs, PMCHs) Centers of excellence for certain non-transplant procedures Payer & Product Distributor Consumer 15% 54% 11% 49% 29% 51% Direct contract with hospitals/health providers in specific locations Narrow network offered through independent entity Narrow network offered through health plan 9% 32% 1% 29% 15% 47% Current Future Source: 2017 Aon Health Survey, 560 employer respondents 21
Triple Aim 1. Improving the patient experience Payer & Product Provider Distributor Employer Consumer 2. Improving health outcomes 3.Reducing the total cost of care 4. Improving clinician experience* 22 *Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Ann Fam Med 2014; 12:573-576. doi: 10.1370/afm.1713.
Consumer Provider Employer Patient out of pocket costs are up 63% Payer & Product Distributor Consumer High deductible plans & premium increases AHA 2016 Full TrendWatch Chartbook 23
Provider Employer Payer & Product Distributor Consumer Health care spend is crowding out discretionary spending 24
Affordability Index Provider Employer Payer & Product Distributor Consumer JAMA. Published online November 02, 2017. doi:10.1001/jama.2017.15686 25 Copyright 2017 American Medical Association. All Rights Reserved.
Prisoner s Dilemma The prisoner's dilemma is a standard example of two completely "rational" individuals might not cooperate, even if it appears that it is in their best interests to do so. 26
What is a providers business model? 27
2 streams 1 Rewarded income when we provide services 2 Rewarded when we do not provide inappropriate services IF. Non-negotiable Quality and Safety most important Management is given tools to actively manage Physicians are given tools to actively manage Payors partner with providers to structure 28
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Lot s of forms of Financial Risk 1 Global Capitation 2 DRG/Case Rate 3 Shared Savings 4 Fee for Service 30
Total Provider Financial Value Margin on Services Shared Savings/ Risk Surplus + = Total Margin 31
Understand and Optimize Care 32
Analysis Framework Access Leading Indicators Low Acuity ED Visits $x $x PMPM ED Visits/ 1,000 $x $x PMPM Drivers ED Expense $x $x PMPM True North Acute Care Chronic Disease Hospitalizations $x $x PMPM Hospitalizations / 1,000 $x $x PMPM Hospitalizations Expense $x $x PMPM ACI Total Expense PMPM $x $x PMPM Post Acute Discharge to PAN SNF Program % Discharge to SNF/ 1,000 SNF Expense $x $x PMPM 33
Interdisciplinary Delivery Team (IDT) What is it? Multidisciplinary team that reviews polychronic individuals pre- and post- discharge to ensure needs are met Findings Strengthened cross continuum collaboration Enhanced use of disease management resources, (eg chronic care clinics) Multidisciplinary support for difficult outpatient cases = more effective care plans Group problem-solving for more appropriate setting Create culture for effective financial risk management 34
Integrated Care Management What is it? Care Management, unified and coordinated across the continuum Findings In design phase, pilot in ED starting. Clear from design work, operations were independent 35 From To
Disruption 36
Where does technology disruption occur? Personal Technology Benefit Design Data & Analytics Transparency Policy Medical Technology Process Improvement Payor Provider Distributor Employer Consumer 37
Connected Data Sources Registration and Billing Electronic Health Records Claims and Payers Labs Pharmacy Benefit Management 11 14,670 + 39 850,000+ 5,000+ Immunizations Master Person Indexes 38
Social Determinants of Health 39
The goal Integrated View of Care Patient Centered Care Hospital Provider Enabling Hospital Provider Scorecard Patient Home care Physician s office Home care Physician s office 40
What s Next for APP? Works in progress Patient Engagement phone app Payor analytics systems Asthma phone app Network utilization Tele-medicine Population Health platform Mobile eye exams 41 Lessons Members/Patients Engage how they want to Bandwidth for apps/videos Follow-through Some technology disrupts care continuum Administrative burden Systematic vs individual solutions
Questions? Please complete online session evaluation 42