Population HealthThe Road to 2020 & The Path to Value

Dr. Matthew WayneChief Medical Officer, New Health Collaborative & Summa Physicians

September 16, 2015

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Who We Are

• NewHealth Collaborative (NHC):• Clinician-led collaborative founded in January 2011.• We partner with communities to compassionately care

for and serve our populations.• We do so in an accountable, value- and evidence-based

manner.• More than 90,000 patients & $700 million in total

annual medical spend. • The only Accountable Care Organization (ACO) in Ohio

to achieved shared savings two years in a row.• 3.8% in savings on total cost of care in FFS

What Our ACO Looks LikeProviders Hospitals/Systems Payers

Mercy Professional Care Corp.

Mercy Medical Center - Canton

MMO

HealthSpan Physicians, LLC Crystal Clinic Orthopedic Center

Medicare

Independent physician practices

Summa Health SummaCare

Summa Physicians, Inc. Humana

HealthSpan

675 providers

Our Success

2013 2014$240,000,000

$250,000,000

$260,000,000

$270,000,000

$280,000,000

$290,000,000

$300,000,000

$310,000,000

$320,000,000

Medicare Shared Savings Program (MSSP)

Benchmark Actual

Measurement Year*

Med

ical Spe

nd

$10,225,342

$11,796,182

$306,829,999

$295,033,817 $275,693,772

$265,468,431

*2013 measurement year ran from 7/1/12 through 12/31/13, and 2014 measurement year ran from 1/1/14 through 12/31/14

2014 Quality Scores by Domain

Pt/Caregiver Experience Care Coordination/Pt Safety Preventive Health At Risk Populations70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

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88.95% NHC Quality Score

33 Quality measures are separated into four key domains that serve as the basis for assessing, benchmarking, rewarding and improving ACO quality performance

How did we do it?

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Risk Stratification

Tools and Strategies

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In-Network Care Coordination

Integrated Care Management

Clinical Communication Center

Primary CareTransformational Goals

Example: Integrated Care Management

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Outcomes

Patient and physician satisfaction, reduced unnecessary hospital admissions and emergency room encounters

Follow Up

CM works the plan of care with patient including: in person & phone encounters, home visits , community referrals, visits w specialists. warm handoffs with other

service providers

CM communicates and documents care updates, clarifications, community linkages in EMR and by phone

Plan of Care

Plan of care problems and and goals are discussed and documented in EMR Pt receives written plan with goals (see form) and patient education as needed

Comprehensive visit

Attended by PCP, CM and patient/family 30 minute visit 3 Patient problems and goals are highlighted

Outreach to Patient

PCP Office phones patient using scripting Introduces CM & Schedules Comprehensive Visit

Validate and Collaborate

Care Manager, Primary Care Physician and Office Champion review high risk list Prioritize patients; CM investigates pertinent history

Identify the High Risk Patient

List generated from payer data and PCP input. High Risk defined by cost, patterns of care, utilization, co-morbidity

Example: Outcomes for Integrated Care Management

• 13 Integrated RN Care Managers supporting all primary care offices within NHC

• Populations currently under focus:– High risk/fragile patients– Diabetics in poor control

• Patients under management as of June: 1,923• Average patients/care manager: 148• Outcomes Jan - June 2015:

– 247 admissions avoided– 227 ED visits avoided– High levels of provider and patient satisfaction

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Why is this important?

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Why Population Health?

• Fee-for-service payment model is unsustainable– Outcomes do not support the cost

• Opportunity to reengineer how healthcare is delivered to drive Triple Aim outcomes…– Cost, Quality and Patient Experience

• And thereby create value

Value Equation in Healthcare: The Triple Aim Restated

Patient Experience

Cost

Quality

Value

Adapted from: Porter ME, Lee TH. "The Strategy That Will Fix Health Care: Providers Must Lead The Way In Making Value The Overarching Goal". Harvard Business Review, October 2013 & Healthcare Financial Management Association “Value in Health Care: Current State and Future Direction” June 2011

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The Road to 2020

Two Provisions in FY 2016-2017 State Budget

Sec. 5167.33. (A) Not later than July 1, 2018, each medicaid managed care organization shall implement strategies that base payments to providers on the value received from the providers' services...

AND

Not later than July 1, 2020, each medicaid managed care organization shall ensure that at least fifty per cent of the aggregate net payments it makes to providers are based on the value received from the providers' services.

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New Health Collaborative Value Proposition

• Provider based organization– Patient centered solutions– EHR and analytics– Clinical standards

• Medicaid solutions– Same principles, different strategies– Women and children– Disabled– Dual eligible

What Does It Look Like?

• Common EHR and analytics• Integrated data for clinicians and patients regardless of site• Agreed upon clinical standards• Teams of clinicians working collaboratively to treat patients• More care delivered outside of hospitals– Hospitals move from revenue generator to cost center

• Financial burden of healthcare decreased– For Summa, employers, government, & patients

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Challenges

• How do you pay for value?• Aligning excellent care with payer approaches that

recognizes value• Developing synergy with managed care organizations

(MCO)– Who leads?– Where is there duplication in services and how do we

reconcile that?– Where are there care gaps and who is responsible for

eliminating the care gap?– Each MCO operates differently

QUESTIONS?

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