February 21, 2013 Oregon Health Leadership Council: High Value Patient Centered Care Model Mini Summit VII: Intensive Outpatient Care Programs Denise L. Honzel Executive Director
Oregon Health Leadership Council Purpose Develop actions to keep health care costs and premium increases closer to the CPI Commissioned by the business community in 2008 Incorporated as a 501(c) 6, statewide membership organization in 2010 30 Member Multi-stakeholder Health Industry Group Medical groups, hospitals/health systems, local/national health plans; Oregon Assoc. of Hospitals and Health System, Director of Oregon Health Authority (ex-officio) Initial work in 4 areas: payment reform, value-based benefits, evidence-based best practices, administrative simplification 2
Payment Reform: Moving Forward In 2009, the Payment Reform group recommends a multi-payer medical home initiative for high risk adults Focus on the commercial market, one health plan and Medicaid included Medicare Hypothesis: Focused efforts on highest risk patients will result in lower costs; fewer emergency room visits, fewer inpatient visits and better quality Goal: Launch quickly, learn and adapt along the way 3
Program Design Built on the Boeing Model ; hired Renaissance Health Health plans identify patients using predictive risk models Top 10-15% highest risk adult patients Exclude patients with ESRD, transplants, OB, Trauma with no other co-morbidity Medical Groups hire RN Care Managers embedded in primary care offices 2 year demonstration, with a control group, evaluated by OSHU 4
Demonstration Requirements Multiple payers to achieve scale Common payment model and standard contract Common model of care Common set of health plan policies and practices Common administrative reporting Collective funding to support infrastructure Scientific approach to the evaluation 5
High Value Patient Centered Care Demonstration--Timeline Early 2010, sent RFP to 25 medical groups By July 2010, selected 14 medical groups Contracts with 5 health plans and 4 state purchasers completed in 45 days Oct. 2010, 23 RN Care managers hired and participate in 4 days of training March 2011, initial patient enrollment completed July 2011, began quarterly reporting to medical groups on all patients, claims-based utilization data and measures; joint plan/medical group and individual RN meetings March 2012, second patient enrollment completed May 2012, weekly Office Hours for the RN s 6
Common Care Model Components Access Dedicated care manager for each patient 24/7 access for urgent care Access to care team via email/phone Facilitate access for non-md services, integrated w/pcp Care Delivery Elements Rules-based, care planning and management Intentional, integrated care coordination Recognition of social and behavioral health needs Information Infrastructure EHR, registries, quarterly feedback for the team Movement towards broader data transparency 7
Common Care Model Components Care Coordination Care transition management (post ED, hospital) Medical neighborhood of specialists, service agreements Care giver and social support systems Intensive Care Management Motivational interviewing, readiness assessment Team based pre-visit planning, systematic Rx review Team huddles, group visits Advanced directives, end-of-life care programs Staffing RN as a team lead with support from the care team; one RN for 200 patients enrolled 8
Common Payment Approach for All Payers 1. PMPM for participating patients to fund RN care coordinator 2. Standard fee-for-service for medical services 3. Shared savings between the medical groups and payers for achieving savings and quality metrics, paid at the end of the demonstration, on medical group performance Quality measures maintain or improve to Quality Compass 50 th percentile for select chronic care measures plus Patient Satisfaction Cost savings 50% share up to specified limit; based on difference over difference of intervention group vs. tightly matched control group 9
Health Plans and State Payers Health Net PacificSource ODS Providence Regence Blue Cross OEBB (School employees) DMAP (Medicaid FFS) PEBB (State employees) OMIP (State High Risk Pool) 10
The Journey Over the 2 year period up to 3,600 patients voluntarily enrolled Extended the demo 2 months, better timing to recruit for patients lost through attrition Second enrollment allowed for more refined selection process Quarterly utilization reports to medical groups and health plans; aggregate utilization reports including comparison data between medical groups 11
Results to date While promising, too early to make conclusions; no control group to compare, some enrollment data needs reconciliation Looking at utilization data through June 2012, compared to the pre-intervention time period, we are seeing Downward trends in emergency room visits, inpatient admits and inpatient days/1000 Office visits for primary and specialty care initially stayed flat; then decreased over time (phone/email not included) Slight downward trends in pharmacy and imaging Final cost savings won t be available until the end of the demonstration and analysis fall 2013 12
Next Steps Demonstration ends February 28 Plans and medical groups have agreed to a Bridge Period to keep program elements in place until results are known During the Bridge Plans agree to pay for set volume; no shared savings Medical groups can graduate patients-criteria based New patients will be enrolled identified by the Plans Cleaning up the data for the Evaluation Evaluation completed Nov. 2013 Start now on the future state 13
For More information Denise Honzel, Oregon Health Leadership Council Denise@orhealthleadershipcouncil.org Dr. Pranav Kothari, Renaissance Health pk@renhealth.net 14