Value Based Purchasing & Working with Providers on Risk Based Agreements - A Health Plan's Perspective

A value based payment model will be described that is designed for a provider risk based payment model. This model incorporates both employed and affiliated providers from an integrated health system.

Transcript

1. Value-Based Agreements Russ Kuzel, MD, MMM SelectHealth
3. Shared Accountability is how Intermountain Healthcare is improving people’s health–not just their healthcare–for the lowest sustainable costs in the changing healthcare environment.
4. “The transformation that is desperately needed is a move toward more integration of care delivery, involvement of patients in their care, and alignment of financial incentives. Consolidation may well increase efficiencies, standardization and bargaining leverage, but whether or not it leads to integration, will in the end, determine its contribution to healthcare improvement.” Joe Mott, Vice President, Population Health Intermountain Healthcare
5. “We’re committed to population health. SelectHealth Share offers tangible savings to patients and the community. We believe this approach, which is based on a sustained commitment from all participating parties, is the future of healthcare. This is a sustainable model that drives continued innovation, affordable costs and better health outcomes.” Pat Richards, President and CEO, SelectHealth
6. Why?
7. Intermountain Managing the Trend Line DOLLARS IN MILLIONS $3,000 $4,000 $5,000 $6,000 2011 2012 2013 2014 2015 2016 Lower Revenue Rate Increases Managing Expense Growth $400 $280 million from Utilization $120 million from Efficiency $300
8. Why Move from Fee to Service to Value Based Care The current model of Fee For Service healthcare has room for improvement and is a contributor to the high healthcare cost trends. Fee for Service • Incentive for providers to provide services, regardless of value to the member • Fragmented care • Lack of quality measures • No incentive to improve health Shared Accountability • Aligned incentives for all parties involved in healthcare • Coordinated care • Transparent costs and quality measures • Cost increases at a sustainable level
9. 2017 Shared Accountability • 3 Patient Experience Measures • 44 Quality Measures • SelectHealth Products: • SelectHealth Share (11,000 members) • Medicare Advantage (23,000 members) • Community Care (97,000 members)
10. Shared Accountability Regional Financial Model • Provides Care Process Models • Distributes budgets • Provides Population Health Mgt. Services Payer Intermountain Healthcare “Population Budget” 18 Shared Commitments Provider Shared-risk Payment - Productivity - Quality - Patient Experience - Product Performance Intermountain Hospitals Intermountain employed Physicians Contracted affiliated Physicians Geographic Committee
11. Physician Shared Commitments Intermountain Healthcare initiated a Shared Accountability strategy to provide high-value healthcare. Physicians led this effort by providing evidence-based care and by helping patients become more engaged in their care. The strategy included a payment model rewarding providers for delivering evidence-based care and engaging patients.
12. 2016 Physician Payment Model Note: All performance payments are assessed at the group level Productivity Quality Patient Experience Product Performance Total Payment As quality and patient experience scores increase or product performance improves, total payment will increase 2.5% 2.5% 1/3 of Improvement * Available *capped at 12.5%
13. Physician Payment Governance Committee Chair Chief Medical Officer Affiliate Physician Practice Representatives • 4 total Intermountain Medical Group Representatives • 4 total Intermountain/SelectHealth Representatives • VP Finance • VP Shared Acct • SH CMO • SH CFO • RVP Executive Sponsor Senior VP of Strategy
14. Physician Payment Governance Committee • Recommend the structure and parameters of Intermountain Shared Accountability physician* payment model • Including physician performance metrics and • Working with Intermountain Clinical Programs • Consult with Intermountain Payer Contracting Strategy Group on population health management contracts with payers *Payment model for physicians includes, physicians, podiatrists, dentists (for medical plan services), APRNs and PAs
15. Managing a Population Budget Intermountain Hospitals Intermountain employed Physicians Contracted affiliated Physicians Geographic Committee Engage Physicians Regional Population Health Operations Committee Operationalize Population Health Intermountain Hospitals Intermountain employed Physicians SelectHealth CMO
16. Geographic Committee Roles • Physician Engagement, Education, and Communication • Population Health Management • Utilization Management • Provider Performance Support • Total Cost of Care Management Geographic Committees are primarily focused on engaging physicians in population health management They do not have operational or disciplinary responsibilities.
17. • Clinical leadership strategy team; includes SelectHealth • Integrated data system = coordinated, efficient care • Industry-leading supply chain center • C-section rates: three hospitals under 10% • 2.5% lower per-member-per-month costs • 11% lower rate of hospital admissions • 12% lower rates of radiology testing • 26% increase in five-part diabetes compliance • Changing the payment model • Integration means physicians are aligned • 2,200 physicians strong and expanding SelectHealth® & Intermountain Healthcare® A 30-year History of Lower Trends Cost Savings through Integration Advanced Primary Care Fee for Service Pay for Performance
18. What SelectHealth Share Offers • Predictable rates – A three-year proposal with guaranteed rates in years two and three • Engaged, healthy employees – Our SelectHealth Healthy LivingSM team helps employers create a workplace wellness program designed to promote healthy and productive employees
19. How it works • Aligned financial incentives –All participating parties (SelectHealth, hospitals, doctors, employers, and employees) share financial accountability as part of their commitment to the vision of better health, better care, and affordable costs
20. Four Pillars Employers Employees Providers SelectHealth
21. SelectHealth • Commitment – We share our resources and commit to support employers, employees, and doctors • Reward – Fulfill the SelectHealth not-for- profit mission of helping people live healthy lives and access affordable healthcare
22. SelectHealth • Offer predictable premiums and multi-year rates • Implement and support employer wellness programs • Produce reports that aid employers and physicians in meeting their SelectHealth Share goals • Develop online tools to support cost and quality transparency • Maintain effective, integrated care management
23. Providers • Commitment – Intermountain Healthcare and providers on the SelectHealth Share network are contractually committed to 18 shared commitments of care, designed for better healthcare • Reward – Strong, more stable patient relationships coupled with the long-term resources needed for success
24. • Use data to provide evidence-based care • Adopt a nationally certified Electronic Medical Record (EMR) • Share their performance data with other SelectHealth Share providers, and with patients • Participate in a payment model that rewards them for the health and satisfaction of their patients • Accept accountability for performance on quality, patient engagement, and cost Providers
25. • Commitment – Engage employees in a culture of health and invest financially in their healthcare • Reward – Healthy, engaged employees; predictable rates; and a sustainable, long-term healthcare model Employers
26. • Use SelectHealth as the sole carrier within the service area and meet underwriting guidelines, including contribution • Offer a Qualified High Deductible Health Plan (QHDHP) as an option and meet minimum plan design requirements – Fund an employer-match Health Savings Account (HSA) contribution and contribute a minimum amount to premiums • Initiate or sustain a qualified worksite wellness program and meet the minimum employee engagement requirements Employers
27. • Commitment – Be an active participant in their health, their care, and its cost • Reward – Better health, enhanced engagement with physicians, and lower premiums Employees
28. • Create a My Health account and actively engage in the worksite wellness program • Complete a health assessment (includes health screening within the first 90 days of the plan year) – Participate in disease management for certain conditions – Participate in Digital Health Coaching (if identified as needed) – Engage in corporate activity campaigns (two per year) – Complete a qualified tobacco cessation program and enroll in the SelectHealth Healthy BeginningsSM prenatal program when applicable • Choose a Primary Care Physician (PCP) and work together to coordinate care Employees
29. Employees • Create a My Health account and actively engage in the worksite wellness program • Complete a health assessment (includes health screening within the first 90 days of the plan year) – Participate in disease management for certain conditions – Participate in Digital Health Coaching (if identified as needed) – Engage in corporate activity campaigns (two per year) – Complete a qualified tobacco cessation program and enroll in the SelectHealth Healthy BeginningsSM prenatal program when applicable • Choose a Primary Care Physician (PCP) and work together to coordinate care
30. Questions?