Health system priorities for medical

innovation under new payment models

John Birkmeyer, MD

October 30, 2015

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IMPROVE POPULATION VALUE-BASED NEW PAYMENT HEALTH CARE MODELS

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Enterprise Strategy Design

Population Health Integrated Delivery Enterprise Support Management System Services

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ERA

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< < Integrated Research and Education > >

DH Path to New Payment Models

FFS

CMS Demo Project

Elevate Health (NH)

Pioneer (CMS)

Benevera Health

One Care VT

Commercial Risk

Contracts

Apr ’05 Jun ‘08 Jan ‘12 Jan ’13 Dec ’13 Jan ‘16

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Risk

ACOs with two-sided risk (250K lives)

Capitation

FFS with shared savings

$9,300

$10,000

$12,750

$11,500

Keys to success under global payment

• Serve the largest population we can (spread risk)

• Keep people healthy and out of the hospital

• Relentlessly drive down delivery costs

• Leveraging scale on purchasing, non-clinical

services, IT, etc.

• Care integration, driving care to low cost settings

• Outsourcing where advantageous

Net cost

Patient outcomes

Higher

Lower

Better Worse

Decisions to adopt

new devices and

innovations

What’s different under new payment

models

• Less blasé about device / implant costs passed

onto payers

• Concern about overall utilization as well as cost

per service

• Focus on reducing variation in clinical practice

VT

NH

“One D-H”

model for

clinical

practice

Approach to industry partnerships

• Alignment with faculty scientific interests

• Areas of strategic importance to D-H

• Leverage our primary assets

• Dartmouth brand / strengths in population & health

delivery science

• Real world, regional clinical laboratory

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Dynamic Evidence Pathways

Machine-learning / big data analytics to individualize care protocols and algorithms

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DH Center for Telehealth