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12/10/2013
1
Health Systems as Employers
Molly J. Coye, MD, MPH, Chief Innovation Officer, UCLA Health Bradley Wozney, MD, Family Physician and Medical Director, Ambulatory Quality and Informatics, Bellin Health Peter J. Bernard, CEO, Bon Secours Virginia Health System Samuel A. Skootsky, MD, Chief Medical Officer, UCLA Faculty Practice Group and Medical Group
RFB – Rapid Fire Workshop
December 10, 2013 11:15 a.m. – 12:30 p.m.
Dr. Coye discloses serving as a
board member for Aetna Inc. and
holds stock or stock options from
Prosetta Inc.
Peter Bernard has nothing to
disclose.
Samuel Skootsky, MD has nothing
to disclose.
Session Objectives
Explain how Bellin Health, Bon Secours Health System –
Virginia, and UCLA have framed their risk as employers,
selected innovations to improve employee engagement
and health, and the results they have achieved.
Describe how these systems have engaged employees,
and which platforms and programs have been most
successful
Identify Barriers & Opportunities along the way that
provide Insights into Creating a Healthy Workforce
Point to the ability to Leverage Methodology & Learnings
for other Population Segments
P2
12/10/2013
2
Cumulative Increases in Health Insurance Premiums,
Workers’ Contributions to Premiums, Inflation, and
Workers’ Earnings, 1999-2013
57%
119%
182%
56%
117%
196%
14%
34%
50%
11%
29%
40%
0%
50%
100%
150%
200%
250%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Health Insurance Premiums
Workers' Contribution to Premiums
Workers' Earnings
Overall Inflation
SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2013. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2013; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2013 (April to April).
P3
* Estimate is statistically different from estimate for the previous year shown (p<.05).
SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2013.
Average Annual Premiums for Single and Family Coverage, 1999-2013
$16,351*
$15,745*
$15,073*
$13,770*
$13,375*
$12,680*
$12,106*
$11,480*
$10,880*
$9,950*
$9,068*
$8,003*
$7,061*
$6,438*
$5,791
$5,884*
$5,615*
$5,429*
$5,049*
$4,824
$4,704*
$4,479*
$4,242*
$4,024*
$3,695*
$3,383*
$3,083*
$2,689*
$2,471*
$2,196
$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999Single Coverage
Family Coverage
12/10/2013
3
Context: Transformation
Video
P5
http://www.youtube.com/watch?v=LsJiGF_Groo
A key aspect of Innovation Is Engaging
Stakeholders in the Process of Transformation
Example: • PCMH + population health management components • Five clinics in six months: 33,000 patients • Rapid replication to 14 clinics: 100,000 patients • Completed replication 26 clinics 160,000 patients • Platform for continuous introduction, design, testing and deployment
Planning Phase Design Phase Implementation
Phase Operations Phase
TRANSFORMATION
Define Charter
Innovation Life Cycle
Design Deploy Pilot Evaluate Exchange
P6
12/10/2013
4
The Transformation Process
Design/ Implement/ Operationalize
For Accelerated Replication and Scalability
Leadership Team
Design Team Implementation
Team(s) Evaluation
Team Sustainable Operations
• Establish High Level Project Objectives
• Establish Quick Hits • Define Design Team
Charge • Define metrics for
success
• Apply the specific approach and methodology to accelerate the implementation of and sustainability of the objectives
• Apply the process of rapid cycle scalability and replicability
• Define the application of the implementation and operationalization process
• Implements/operationalizes across the systems
• Innovation Science teams
P7
UCLA Innovation/Transformation Model
Replication and Scalability
Design Processes,
Refine Metrics
Document Processes and Metrics,
Identify Scalable and Replicable Components
Share, Advise Others, Replicate and Scale,
Accelerated Spread
12/10/2013
5
Peter J. Bernard
CEO, Bon Secours Virginia Health System
P9
Bon Secours Virginia P10
12/10/2013
6
Employee Focused Culture P11
Program Design
Sources: Bon Secours Virginia Health System, 2013
P12
12/10/2013
7
Value Based Care Delivery P13
Program Timeline
Sources: Bon Secours Virginia Health System, 2013
P14
BSV Employee
ACO
2010-present
BSV Expansion to Spouses/Significant Others and Children
(4-13)
2013
MSSP 2013
Replication of Employee
ACO by Bon Secours Health System
(BSHSI) in Additional
States
2013
BSV Expansion to
Employee Dependents Ages 14-26
2014
Replication to Spouses/Significant Others and Children with BSHSI in
additional states 2014
Replication to BSHSI
Employee Dependents Ages 14-26
2015
12/10/2013
8
Program Outline
Sources: Bon Secours Virginia Health System, 2013
P15
+ =
or or =
Biometrics Online Profile
50 Challenges Outcomes Coaching
PHA
$300
Routine Physical
$300
Healthy Weight
$300
=
Program Highlights
Sources: Bon Secours Virginia Health System, 2013
P16
12/10/2013
9
2012: Early Signs of Success
Sources: Bon Secours Virginia Health System, 2013
P17
2012 Total Health Insurance Benefit Expense vs. National Trends
2013 -2.2%
2012
2013: Progress to Date
Sources: Bon Secours Virginia Health System, 2013
P18
Decreased admissions per 1,000
Decreased ED Visits per 1,000
Increased in-Network Utilization
Increased Urgent Care & PCP Visits per 1,000
Increased Wellness Exams for the Population
12/10/2013
10
2014: Continuing the Journey
Sources: Bon Secours Virginia Health System, 2013
P19
Beyond Employee Populations
Sources: Bon Secours Virginia Health System, 2013
P20
30,000 Employees & Dependents across all of the in Bon Secours Health System (National)
Good Help ACO: 60,000 Medicare Beneficiaries in 7 states across Bon Secours Health System
Total Revenue Model: Bon Secours Baltimore, 19,000 Lives with the State of Maryland
Commercial ACO’s in South Carolina & Virginia for assigned lives in HIX 2014 & 2015
12/10/2013
11
Beyond Employee Populations
Sources: Bon Secours Virginia Health System, 2013
P21
Samuel A. Skootsky, MD
Chief Medical Officer, UCLA Faculty Practice Group and
Medical Group
Professor of Medicine, David Geffen School of Medicine at
UCLA
P22
12/10/2013
12
UCLA Health
UCLA Faculty Practice Group 1200+ physicians, 250 primary care
Integrated multispecialty faculty practice group
> 400,000 patients in all lines of business
UCLA Medical Group Contracting entity for faculty practice group
Multiple quality awards, >90%tile patient experience scores
PPO + Partial and Global Risk Contracts Commercial HMO and Medicare Advantage (~72,000)
Commercial and MSSP ACO contracts (~24,000)
UCLA Hospital System Acute, Psychiatric, Children
Partner in ACO and Risk Contracts
Highest patient recommends
David Geffen School of Medicine at UCLA
Our Approach Embraces “System” Attributes…
24
UCLA Health System
Primary Care Base
Primary Care Base
12/10/2013
13
UCLA Primary Care
Our vision is a systemic change in UCLA Health
Extends beyond “medical home”
Requires collaboration and support from other components of
UCLA Health
Care coordination a central feature
Innovative care coordinator model & embedded services
IOM 2001 & Triple Aim (better health, better healthcare,
lower or attenuated risk adjusted per capita cost) as
important guides to Value
Maintaining the primary care workforce, returning joy to
practice, making primary care appealing to students
25
I. Implement Practice Re-Design
I. Primary Care Re-design
II. Related “System” Re-design
II. Increase Covered Lives Under UCLA Population Management
I. Seeking collaborations that support payment reform
II. Geographic Expansion
III. Expand Primary Care System Capabilities
I. Pre-primary care & Employer partnerships, Retail Clinics, Telemedicine
IV. Collaboration
I. Internally & Externally
V. Replication
I. Internally & Externally
VI. Evaluation
26 26
Objectives Codified
UCLA Primary Care Innovation Model (PCIM)
12/10/2013
14
UCLA Health
ED Services
Acute Transitions/Hospitalist Programs
In-home services
Access to Secondary Specialists and Ancillaries
Urgent Care Centers, Evaluation & Treatment (ETC), Retail Clinics, Telemedicine
Gaps in Care & Registries Coordination Reports (ED, Hospital Admits)
Community Based Programs
Home palliative care
Primary Care Practice
Existing roles: 1. Physician 2. MA/LVN 3. Front Office 4. Manager
New roles 1. Care Coordinator 2. PharmD
Practice and System Re-design
Clinical Advisors
(RN, LCSW, NP)
27
Behavioral Health Associates
“System” Support: EHR, Data aggregation, Population Registries, Predictive Modeling, Decision Support , Practice Standards,
Quality Measurement and Reporting, Accountability, Tele-Medicine, Tele-Health
Patient- Centered Shared Decision
Making
Traditional Benefit-Based Home Health
Palliative & Hospice Care
Complex Chronic Illness
Home Care & High Risk Clinic
Mild Chronic Illness & Care Support for Self Management
Episodic & Expected Care Preventive Services & Urgent Care
Self-Care & Wellness Programs & Health Education & Self-Serve & Guided Preventive Services
Hospital & Hospitalist-Extensivist Programs
Communication Care Transitions ER interventions
Efficient hospital use
SNFist and SNF
Program
Ensuring Care Implementation in the Community & at Home
•Home Palliative & Hospice •Home Social/Environmental Factors
•Patient Coaching •Transitions of Care
•Use of Community Resources •Comprehensive Care Centers
Optimal
Discharge/ Transitions
28 Updated Mar 2013
Overall UCLA Population Management Plan
12/10/2013
15
PCIM* Effect: UCLA Facility Use
Engaged Cohort* Number of patients in cohort
Trend (mean 7 months observation after intervention)
UCLA Emergency Department Use 1093 -29%
UCLA Acute Care Hospital Use 1093 -19%
*Preliminary observation results as of February 2013, based upon 14 PCMH offices, 1093 patients with 12 months baseline data and at least 6 months (mean 7 months) of observation after care coordinator/PCIM interventions. ** Preliminary results, recent analysis by one contracted health plan
Population Analysis** Number of patients Decline from baseline
All Emergency Department Use 14,000 -15%
All hospital Re-admission Rate 14,000 -30%
P29
*UCLA Primary Care Innovation Model
Clinical Transformation Process to Design/ Implement/ &
Operationalize
Leadership Team
Design Team Implementation
Team(s) Evaluation
Team Sustainable Operations
5.17.2013
30
Articulating the Vision, Agreed upon Goals, Consistency of Effort, Measurement, Local Adaptation
12/10/2013
16
Wellness Programs HRI & Biometric Screen, “person journey”
Engagement Platform
(web, mobile apps, coaching, warm
transfers)
Employee Patient
Emp
loym
en
t R
eal
m
Me
dic
al c
are
Re
alm
Employer-Provider Collaboration
Whole Population Health Management
Total Population
Unknown Risk No Risk Known Risks
March 2013
Absent intervention, a sub-population become “patients” on an ad hoc basis…..those who seek medical care on their own.
UCLA Care: Population Segmentation
12/10/2013
17
UCLA Care: Individual Risk Factor
Reduction
33 Loeppke, R; Edington, D; Beg, S. “Impact of The Prevention Plan on Employee Health Risk Reduction.” Population Health Management. 2010 13 (5): 275-284
UCLA Care: Completed enrollment in our
Employer-Provider Collaboration
Health Coaching/ Concierge/
Care Coordination
HRA, Health & Biometric Screenings & Risk
Assessment
Medical Home/ Establish PCP System/ EHR
Chronic Condition Management
Pharma Utilization &
Formulary Compliance
Choose a Primary Care Provider
Patient Journey
Medical Home
“Triple Aim,” Physician/Clinician/ Staff Satisfaction, &
Team-Based Care
HRAs UCLA Care 94% SW 16%
Labs/ TPP reports 79 %
Coaching UCLA Care 73% SW 20.8%
UCLA Care PCP Visits 63%
UCLA Care n=500 Staywell n=125,796
P34
12/10/2013
18
UCLA Health System
Primary Care
Base/PCIM
1. Ability of provider to focus on risk reduction using HRA data. 2. PCIM is a gateway for care coordination and preventive services, and acute and chronic illness services of high value to patients. 3. Role of the specialist is to provide expert evidence and pathway based clinical care of high value.
Provider-Employer Innovation UCLA Care
End
36
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