Introducing HealthSpan• Founded in 1991

• Partner organization to Catholic Health Partners (CHP)

• HealthSpan Partners:• HealthSpan Integrated Care

• HealthSpan Physicians

• HealthSpan, Inc.

• 30% interest in Summa Health System

HealthSpan Integrated Care (HMO)

HealthSpan Inc. (HMO)

HealthSpan Inc. (Indemnity/PPO)

ToledoCleveland

Lima

Springfield

Cincinnati

Youngstown

The Changing Healthcare LandscapePresented by:

Dr. Nick Dreher, Medical Director

Payment ReformAverage US Salary vs. Health Insurance Premium

• From 1999 – 2009, salaries have increased 38% while premiums have increased 131%

If other prices grew as quickly as healthcare costs since 1945

• Dozen eggs would cost $55• Gallon of milk would cost $48• Dozen oranges would cost $134

Institute of Medicine, 20113

Affordable Care Act and Healthcare Reform

Current: Fee For Service

New Model: Reward Quality Outcomes

and Stewardship of Resources

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Extreme Makeover Home Edition

• Team-based approach• Open access • Patient engagement and

empowerment• Data-directed quality

improvement• Engaged leadership

• Uncoordinated care• Over-loaded schedule• Physician and practice-centric• Arbitrary quality improvement

projects• Lack of clear leadership and

support

What is Population Health Management?

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What Is the Solution?

TRANSFORMATION• beyond transaction• through technology• to manage shared risk• by connecting• for our patients

VALUE DRIVEN CARE

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How Do We Improve Care and Manage Costs? Patient-Centered Medical Home (PCMH) is one way

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Care Coordination: What Is It? The goals of coordinated care

o Ensure that patients, especially the chronically ill, get the right care at the right time

o While avoiding unnecessary duplication of services AND preventing medical errors

VALUE for the Patient = QUALITY/COST

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Care Coordination AIM o Effectively identify, manage and track results of

PCMH’s high risk patient population through care coordination, patient coaching and education, application of Evidence Based Medicine, and population data analysis and reporting

Interventionso Embed Care Coordination Teams in Primary Care

offices, identify high-risk patients and provide high touch to these patients

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What Is the Goal of the ACO?

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What Are the Cornerstones of the ACO?

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What Are the Components of the ACO?

Payer Partners

Insurers

Employers

States

CMS

Core Components:•People Centered Foundation•Health Home•High-Value Network•Population Health Data Mgmt•ACO Leadership•Payer Partnerships

A group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population.

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Tying It All TogetherIntegrated elements of a successful ACO

• Improved clinical outcomes and patient satisfaction linked to

• Care Coordination embedded in• Patient Centered Medical Homes practicing• Improvement Science Methodologies that support• Population Health Management using• Data Analytics across a Clinically Integrated

Organization

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Where Does Wellness Fit In?(To Date, Wellness has not Proven Sustainable Outcome Improvements for Large Populations.) Interlinking Electronic Medical Record with Wellness Platform.

Physician participation in Wellness goals and monitoring.

Physician based treatment protocol for behaviors related to morbidity, (addiction, obesity, etc…)

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Comments and Questions

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