Infographic "Sustainability Insights: Learning from Business Leaders"
[INFOGRAPHIC] Executive Insights on Health Care Transformation
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Transcript of [INFOGRAPHIC] Executive Insights on Health Care Transformation
Employee Plan Performance Employee Plan Performance
Medicare Advantage Inpatient Admissions
Medicare Advantage Skilled Nursing
Facility Days
Health Plan Revenue Medical Loss Ratio
Year 1* Year 2* Year 1** Year 2**Year 1** Year 2**
The Five Principles of a High Performing Value-Based Care Enterprise
Access to scaled processes and
purchasing power
Ability to engage providers
A strategic roadmap
Proven clinical and administrative
capabilities
THE TASK IS VAST, BUT THERE IS A DEFINED PATH TO SUCCESS
WINNING THE HEARTS AND MINDS OF PHYSICIANS IS CRUCIAL
WE MUST PREPARE FOR INEVITABLE CHALLENGES ALONG THE WAY
WITH CHANGE IN MIND, WE KNOW THE DIRECTION WE MUST GO
C-level commitment to an independent
value-based business
Year 1* Year 2*
Compensation models that reward primary care physicians and
specialists for clinical efficiency
Tangible support in “one way of practicing medicine”
vs. payer-based silos
True workflow integration to drive efficiency and to support decisions at the point of care
“ It’s creating engagement in places we didn’t have engagement before. It’s exciting to see the network come together, the clinical model of care piloted in different plans, and the creation of value contracts with payers to help us financially make this a go.”
— Physician Leader
20% reduction in medical admissions
36% reduction in all-cause readmission rate
5% generic Rx dispensing rate
10% increase in in-system inpatient utilization
27% reduction in medical admissions
24% reduction in avoidable admissions
7% increase to generic dispensing rate
“ We have an opportunity to remove 30% of unnecessary spending and radically change quality of life.”
— Dr. Arnold Milstein, Stanford CERC
CHIEF EXECUTIVE OFFICERS
CHIEF MEDICAL OFFICERS
CHIEF FINANCIAL OFFICERS SENIOR INDUSTRY
LEADERS
FUNCTIONAL AREA VICE PRESIDENTS
ATTENDEES
The route taken is as important as the destination. Along the way there are essential ingredients to maximize value creation and capture.
“ Today the eyes of all people are truly upon us…as a city upon a hill, constructed and inhabited by people aware of their great trust and their great responsibilities.”
— John F. Kennedy
evolenthealth.com©2015 Evolent Health LLC
EH-1410039-0320
With thanks to our partners for joining our 2014 summit, and for leading the way in this new era.
TOTAL COMBINED EXPERIENCE:
1,200 YEARS
If you are interested in Evolent’s premier executive learning forums, let us know at [email protected].
Setting a Bold and Balanced DirectionI N S I G H T S F R O M E V O L E N T H E A LT H ’ S 2 0 1 4 FA L L S U M M I T
Evolent Health gathered 50+ executives from 22 health systems to share insights from their transformation efforts in a dynamic health care era.
“ We face a big technology challenge—it’s a huge problem to connect lots of independent physicians who use different EHR systems. We need a solution that will operate in our closed network, and a revenue stream to make this investment.”
“ When Medicare beneficiaries are discharged from hospitals, 50% are readmitted within one year. The acute care hospital episode is not an episode at all. It’s a unique and seminal predictor of declining clinical condition and increasing cost.”
“ Our price is now given by the market. Our business is changing from cost-based pricing to price-based costing.”
— CFO, Health Plan
— COO, Large Physician Group
— Executive Chairman, Full-Service Health Care Organization
Financial Challenges
Clinical Challenges
Technological Challenges
PARTNER HEALTH SYSTEM A PARTNER HEALTH SYSTEM B
PARTNER HEALTH SYSTEM C
CA
PT
UR
E O
F R
EG
ION
AL
PR
EM
IUM
VALUE CREATIONLOW HIGH
HIGH
EFFICIENT COST STRUCTURE
BROAD NETWORK/ACCESS
HIGHLY ENGAGED PHYSICIANS
INTEGRATED POPULATION HEALTH INFRASTRUCTURE
RADICALLY DIFFERENT INCENTIVES
Year 1*pre-Evolent partnership
projected—without Evolent solution
actual
Year 2*
in PMPM
Year 1pre-Evolent partnership
Year 2
in PMPM
projected—without Evolent solution
actual
*January–September
13 20
*January-September 2013/2014 **As of 2014