Implementing a Patient Centered Medical Home and ACO to Improve Health Outcomes and Reduce Medicare
Costs
Medicare Market Innovations Forum July 14, 2014
Donna Zimmerman Senior Vice President,
Government & Community Relations
Health Plan
• 1.5 million members
Medical Clinics
• 1,700 physicians
• 50 primary care locations
• 55+ medical specialties
Dental Clinics
• 60 dentists across 22 clinics
• 6 dental specialties
Hospitals
• 6 hospitals
• Level 1 trauma and tertiary center
• Acute care hospitals
• Critical access hospitals
Consumer-governed, non-profit Integrated health and financing 22,500 team members
2
Accountable Care Building Blocks
Lessons Learned New Payment
Models Transforming Care
• Culture
• Care Design Minnesota Market
Health Care Homes and Accountable Care Organization Journey
State –Certified Health Care Home
(2011)
NCQA Certified ACO (2013-2014)
Health Plan Products & Support Health Care Home
Value Payments Integrated Organization
Pioneer ACO (2012)
Transforming Care:
Culture
Care Design
MINNESOTA:
COME FOR THE CULTURE
STAY BECAUSE YOUR CAR WON’T START
6
Minnesota Market
• Large integrated medical groups
– Agree on best evidence - Institute for Clinical Systems Improvement
– Public reporting of clinic results - MN Community Measurement
• Health plan products
– Value-based contracting – Consumer directed plans
• “Leaner” and very high quality Medicare products dominate – high managed care penetration
• Lowest premiums on insurance exchange for ACA
www.icsi.org www.mncm.org
Measure HealthPartner s Clinics 12 out of 18
Entira Family Clinics 10 out of 18
Fairview Health Services 12 out of 18
Park Nicollet Health Services 10 out of 18
Quello Clinic 10 out of 18
ADHD
Adolescent Immunizations Breast Cancer Screening Bronchitis
Cervical Cancer Screening Childhood Immunization Status (Combo 3)
Chlamydia Screening
Colorectal Cancer Screening Controlling High Blood Pressure
COPD
Depression Remission at 6 months
Depression Remission at 12 months
Pharyngitis
Optimal Asthma Care- Children
Optimal Asthma Care- Adults Optimal Diabetes Care Optimal Vascular Care URI
Minnesota Community Measures High Performing Medical Groups in 2013 (Primary Care)
=Medical Group rate and CI fully above average Blank=
measure reported but rate was average or below average
8
The Triple Aim
Improve the experience
of the individual
Improve the health of the population
served
Improve affordability for the
population
We strive to simultaneously accomplish these three critical objectives
Patient Centered
Reliable Systems Involved &
Engaged Care Team
Data
Transparency Leadership
& Goals
Pieces of the Culture Puzzle
Health Care Home Evolution
Health Care Home 1.0
• Patient initiates care
• Individual
• Clinic Care team
• Treatment-based
Health Care Home 2.0
• Care team initiates care
• Population
• Community care team
• Prevention-based
• Stratification
We use the following design principles to ensure our care achieves Triple Aim results:
Four Care Design Principles
Reliable processes to systematically
deliver the best care
Reliability
Care is customized to individual
needs and values
Customization
Easy, convenient and affordable access to care and
information
Access
Coordinated care across sites,
specialties, conditions and
time
Coordination
New Payment Models
Changing the way we pay for health care
FROM TO
Pay for 30,000+ codes Pay for total costs
Pay for sickness only Pay for chronic illness
management and coordination Pay for Procedures Pay for quality and results
Pay for in-person, exam room care
Also pay for online, technology support care
Evolving
Complementary new payment
models remove barriers to enable Triple Aim improvement:
• Bundled Payments
• Primary Care Patient Management
• Shared Savings/Total Cost of Care
• Grants for Health Care Homes
Change Payment
Change Experience
Change Care
Measuring Total Cost of Care
PRICE RESOURCE
USE TOTAL
COST OF CARE
WHAT IS TOTAL COST OF CARE?
• Population-based model
• Attributable to medical groups for accountability
• Includes all care, treatment costs, places of service, and provider types
• Measures overall performance relative to other groups
• Illness-burden adjusted
• Drillable to condition, procedure and service level
• Identifies price differences and utilization drivers
• National Quality Forum-endorsed
• 90 licensees in 29 states
UPTAKE ACROSS THE COUNTRY
www.healthpartners.com/costandquality
Results
Care Improvements
Healthy lifestyles Coordinated care
Appropriate use of services Patient engagement
Evidence-based care
Inpatient admissions ER visits Unnecessary labs Hi-tech diagnostics
High Performance Quality Results for Medicare
Highest Performing Minnesota MSHO Plan Top 8% of all MA plans in the country
20
Year 2011 2012 2013 2014
Results 4.5 4.0 4.5 4.5
CMS Star Rating for Dual Eligible Special Needs Plan
Reducing the Gap: Breast Cancer Screening
•Pre-visit planning/decision aid
•Same Day mammogram
• Registry
• Culturally-specific mammogram days
Reducing Readmissions
7%
8%
9%
10%
11%
12%
13%
RH Readmissions - Excl OB, Newborn, Neonatal
Inpatient Admissions
25 30 35 40 45 50
2009 2010 2011 2012 2013
Acute Inpatient Admissions/1000
Average cost of admission per day: $2,000
5%
15%
25%
35%
45%
0.870 0.890 0.910 0.930 0.950 0.970 0.990 1.010
Total Cost Index
90%
95%
9.0% 0.89
97.1%
97%
% patients with Optimal Diabetes Control*
* controlled blood sugar, BP and cholesterol (per ICSI guideline A1c changed from < 7 to < 8 in 1Q09 and BP control changed from <130/80 to <140/90 in 3Q10), AND daily aspirin use, AND non-tobacco user
% patients “Would Recommend”
HealthPartners Clinics Total Cost Index
(compared to statewide average)
< 1 is better than network average
TRIPLE AIM: Health-Experience-Affordability HealthPartners Clinics
47%
24
Better Health for Patients with Diabetes
Saves 417 Hearts, 72 Legs & 745 Pairs of Eyes Each Year
17.8 17.5
10.1 10.1 10.0 8.8
6.5 7.4 7.6 6.3 5.8 5.9 5.1
4.8 4.9 4.6 4.0 4.3 3.3 3.9 3.6 3.3 2.6 2.6 2.6 2.6
68.0
57.4 59.8
56.1 54.5 56.4
53.1
46.9 47.9 48.2
41.0 43.3
41.8
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Events/1000
AMI/1000 AMPUTATIONS/1000 NEW RETINOPATHY CASES/1000
HealthPartners Health Driver Diagram
26
Improved Health
Key Outcome
Health Determinant
Primary Drivers
Health Care (20%)
Health Behaviors (30%)
Socio-economic factors (40%)
Environmental Factors (10%)
Preventive Services Acute Care
Chronic Disease End of Life
Patient Engagement Cross Cutting Issues
Tobacco Non-use Activity
Diet/Nutrition Alcohol Use
Education (ex. Early childhood) Economic Development Other Community Identified
Safe, walkable streets
Access to grocery stores and fresh foods
Modified from David Kindig, MD, PHD. University of Wisconsin
Key Learnings and Implications for Medicare
• Health Care Homes are the building blocks, not the end point
• Terms HCH/ACO mean little to consumers; message is on quality, simplicity, choice, cost
• Payment models continue to evolve based on total cost of care and quality
• Great potential for Triple Aim improvements, especially coupled with community initiatives to support health
• Medicare payment and health plan models should evolve to reward the “Triple Aim” across the country