Building a New Partnership for Value

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Building a New Partnership for Value

Event Title: Innovative Care Delivery Models: Payor Provider Partnerships toImprove Health & Lower Costs

Location: Washington, DC

Date: Wednesday, April 17, 2013

Mike EnglehartPresidentAdvocate Physician Partners


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Advocate Health Care Overview

Why we Entered into this Arrangement

Key Drivers

New Competencies

Results

Challenges

Discussion Topics

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$4.7 Billion Annual Revenue

AA Rated

12 Acute Care Hospitals

1 Childrens Hospitals

5 Level 1 Trauma Centers

4 Major Teaching Hospitals

4 Magnet Designations

Over 250 Sites of Care

Advocate Medical Group

Dreyer Medical Clinic

Occupational Health Imaging Centers

Immediate Care Centers

Surgery Centers

Home Health / Hospice

Physician Membership

1,200 Primary Care Physicians

2,800 Specialist Physicians

Total membership includes 1100

Advocate-employed Physicians

Central verification office certified by NCQA

9 Physician Hospital Organizations ( PHOs)

230,000 Capitated Lives / 700,000 PPO Lives /

245,000 Attributable Lives

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Total physicians on medical staffs = 6,500

Total APP Physicians = 4,100

Independent non-APP

= 2,400

Employed/affiliated =

1,100

Affiliated (Dreyer) =

200AMG (employed) = 900

Independent APP = 3,000

Advocates Physician Platform

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Blue Cross Blue Shield of Illinois (BCBSIL) &Advocate/APP faced 2 choices:

Lower unit cost now

Partner together/reduce inefficiencies

Employers demanding change

Prepares for Medicare value basedpurchasing

Prepares for Medicare Shared SavingsProgram - MSSP (ACO)

Prepares for Exchange price point in 2014

Two Years Ago

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Blue Advantage (BA) small network HMO

added APP to network Feb. 2011

HMOI Risk adjusted global cost of care

PPO - Shared Savings Model

Measured on attributable patients

Focus on trend in the total cost of care

Need to attain outcomes, safety, andservice targets

BCBSIL Contract Highlights

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Contract Lives Total Spend

BCBSIL 380,000 $1.8 B

Medicare

Advantage 32,000 $0.3 B

Advocate

Employee 22,000 $0.1 B

Medicare ACO 115,000 $1.2 B

Total 549,000 $3.4 B

Value Based Agreements

ACO=Accountable Care Organization

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From TO

Silo Care Management Enterprise Care Management

Episodes of Care Coordination of Care

Discharges Transitions

Utilization

Management

Right care, at the right place, at the right

timeCaring for the sick Keeping people well

Production (volume) Performance (value)

Changing Paradigms

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Key Drivers

Culture

Governance

Infrastructure

Incentives

Transparency of

Results

Feedback

Loop

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Strategy Tactic

Outpatient

Enterprise

Care Manager

(ECM)

Dedicated/embedded caremanagers in physician practices for

high-risk patients (2%-5%

commercial population)

Care Manager (CM) workload andpredictive modeling system to target

actionable patients

Inpatient ECM Enhanced inpatient and ED care

manager role Readmission risk tool

Follow-up appt. with PCP office

Medication reconciliation

Physician-partnered CM model

AdvocateCare Strategies & Tactics

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Bent the cost curve in 2011 and 2012 while

maintaining or improving outcomes and

satisfaction

2% HMO membership growth; marketdropped >10%

11% PPO attributed patient growth

PPO In-network use up 3.4% points

APP physician membership growth

What Results Have We Seen?

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Outpatient Care Management

- Early results for managed vs. control

group showing reduction in ED and Inpatient use

SNF Readmissions: 13.6% compared to

national average of 20.3%

SNF LOS: 19.2 days compared to national

average of 27 days

Transition Coach: 26% reduction in

readmissions

What Results Have We Seen?(continued)

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Redesigning Primary Care-AdvancedMedical Practice

IT Connectivity

In Network Care Coordination

Discipline to create a standard approach

Management / Governance Succession

Planning

Patient Experience

Biggest Challenges Moving Forward

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C Suite Leadership Engaged

Transparency

Regular, frequent meetings at various levels

Full Data set exchange

Multi Year Commitment

Financial arrangement has to be win-win

Grows market share

Ideal ACO Partnership

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Tighter attribution models

Benefit plan design to support in network

care coordination

Narrow Networks - EPOs

2014 Exchanges Private and Public

Looking Ahead

EPO = Exclusive Provider Organization

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Questions?

Questions?

Building a New Partnership for Value

Documents

Transcript of Building a New Partnership for Value