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(1)

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

(2)

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

(3)

Accountable Care Building Blocks

Lessons Learned New Payment

Models Transforming Care

Culture

• Care Design Minnesota Market

(4)

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)

(5)

Transforming Care:

Culture

Care Design

(6)

MINNESOTA:

COME FOR THE CULTURE

STAY BECAUSE YOUR CAR WON’T START

6

(7)

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

(8)

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

(9)

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

(10)

Patient Centered

Reliable Systems Involved &

Engaged Care Team

Data

Transparency Leadership

& Goals

Pieces of the Culture Puzzle

(11)

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

(12)

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

(13)

New Payment Models

(14)

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

(15)

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

(16)

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

(17)

www.healthpartners.com/costandquality

(18)

Results

(19)

Care Improvements

Healthy lifestyles Coordinated care

Appropriate use of services Patient engagement

Evidence-based care

Inpatient admissions ER visits Unnecessary labs Hi-tech diagnostics

(20)

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

(21)

Reducing the Gap: Breast Cancer Screening

•Pre-visit planning/decision aid

•Same Day mammogram

• Registry

• Culturally-specific mammogram days

(22)

Reducing Readmissions

7%

8%

9%

10%

11%

12%

13%

RH Readmissions - Excl OB, Newborn, Neonatal

(23)

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

(24)

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

(25)

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

(26)

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

(27)

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

(28)

Questions?

References

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