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Population Health Overview
2015
2
Macro View of Population Health
3David A. Kindig, MD, PhD
4PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC.
Tied to the National Quality Strategy
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Vidant Health System of Care
• 12,000+ employees• 8 hospitals• 80 physician practices• Outpatient, home health
and hospice services• Critical care transport• Serving 1.4 million
people in 29 counties, 1/3 of NC
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Definitions
7
Definitions continued
80% of patient encounters are in a physician’s office
A Shifting Landscape
9 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC.
Volume driven fee-for-service
Across the board FFS cuts
Fragmentation of delivery
Variance in use/cost/quality
Hospital as healthcare hub
Immature use of information technology
High cost
Focus on sickness care
Specialty/procedure driven
Payer driven
Passive consumer
Current state of health care in America
Intensivecare
Non-Acute/specialty care
Primary & preventative care
TODAY
1766
10 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC.
Winners and losers
Greater accountability/transparency
People-centered primary care
E-health and other innovations
New focus on population health and social determinants
Risk-based, value-driven reimbursement (P4P)
Cost reductions
Quality across the continuum and focus on transitions
Smaller hospitals with more intensive care
New public and private partnerships
Future State
Intensive care
Non-Acute/specialty care
Primary & preventive care
TOMORROW
11 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC.
Track one: Push
Legislative “push/pull” to accountable care
Cuts to Medicare FFS System
Readmissions penalty
HACs penalty
Partnership for Patients
Value-based purchasing
Meaningful use penalties
Private payors and Medicaid
Bundled payment: 2016?
Track two: Pull
Disrupt existing system
Medicare Shared Savings Program(MSSP)
Pioneer
State/Federal duals demo
Medical home demo; new InnovationCenter Primary Care Initiative
Reducing readmissions from nursing homes demo
Bundled payment demos
We are changing the way we do business
Cost Restructuring
Coordinated CareFragmented Care
Patient CenteredProvider Centered
Payment for ValuePayment for Volume
Care Systems FocusedFacilities Focused
Care Team AccountabilityPhysician Accountability
Longitudinal, Multi-Site Care ModelsEpisodic, Hospital-Based Care Models
Efficient, Evidence Based CareInconsistent, Variable Methods
ElectronicPaper
FUTURETODAY
Cost Reduction
Clinically Integrated Network:Coastal Plains Network
14 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC.
Separate legal entity• Physician and health system participation
• Will “make” and/or “buy” functions and services
• Many strategic and business decisions will need to be made in the next several months before the entity can be legally formed.
Purpose – to be the entity that organizes and administers all regional provider population health efforts in eastern North Carolina.
Coordination and Timing – building a CIN requires assembling components from finance, IT, independent physicians and health systems.
The CIN will NOT be monolithic in it’s approach to the healthcare needs of eastern North Carolina
• Employers• Medicare population• Medicaid population• Commercial• Self insured employers• Uninsured
A CIN Vehicle to Pursue Population Health Initiatives
Clinically Integrated Network and Population Health
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MSSP (Medicare Shared Savings Program)Our current “ACO” contract with CMSInvolves VMG physicians onlyOver 17,000 fee for service Medicare patientsThree year contractOnly upside potential
Medicaid Provider led ACOWill involve many partnersCan be run through CP Network
Employee Health PlanCP Network can be the vehicle to provide the Provider network and share quality/cost data
Other Population Health InitiativesBundled payment programsRisk contracting with private insurance
A group of providers willing and capable of accepting accountability for the total quality and cost of care for a defined population.
Coastal Plains Network (CP):Our Clinically Integrated Network (CIN). VH as the current sole Member (can expand). Allows sharing of data without competitive concerns. Goal to improve the quality and cost for patients. Other members can be added via contract. Many other programs can exist within this CIN
16 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC.
Benefits of Clinical Integration
Benefits to the Patient
•Better value for their health care dollar•More effective care management and outreach from a trusted source, their physician•More reliable information to support their choice of health plans, physicians and hospitals•More accurate and meaningful provider ratings•Greater stability in their relationship with their doctor and hospital and less likelihood that they will need to choose new health care providers every year
Benefits to the Physician
•Demonstrate clinical quality to current and future patients•Participate in the decision of clinical initiatives for evaluation•Enhance revenue through better management of chronic patients•Benefit through the use of available network infrastructure•Engage in group contracting
Benefits to the Hospital
•Demonstrate clinical quality to current and future patients•Enlist physician support for hospital initiatives including development of clinical pathways, standardized order sets, and cost saving initiatives•Improve performance on hospital pay-for-performance measures•Position themselves at an advantage in the market on the basis of quality
Benefits to the Employer
•More effectively manage the health care costs of employees and their dependents through the purchase of better, more efficient health care services•Increased employee productivity and reduced absenteeism, through the better management of chronic disease•More reliable information to support conversion to consumer-driven health insurance products•Opportunities for direct contracting
Source: INTEGRIS Health Partners
17 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC.
Clinical infrastructure requirements to successfully practice population health management:
• Comprehensive delivery platform» Integrated Primary Care Base» Strategically aligned and integrated Specialty Care Physicians» Broad geographic presence» Clinical Integration across the network» Hospitals and other facilities
• Patient Centered Medical Home (PCMH)• Team-based care models• Comprehensive Care Management Capability
» Systems &Technology, Clinical Protocols, Human Resources (including embedded case managers)
» IT Platform to facilitate clinical aggregation and integration
• Quality and Outcome monitoring, reporting and improvement competencies
• Performance Transparency
Provider role and involvement
18 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
1. Identify/communicate/engage beneficiaries
2. Select and implement data analytics platform
3. Establish a public and physician communications plan and office
4. Identify your highest risk population (2-3% of patients that are currently or are predicted to be the highest utilizers)
5. Establish a process to capture and report 33 measures (GPRO)
6. Develop a plan to grow market share by using data analytics to identify leakage and develop action plan
7. Establish robust team based patient centered medical homes (PCMH) across the participating MSSP provider network
8. Establish and implement a care management plan for high risk patients
9. Define and finalize a shared savings distribution methodology
10. Assess post-acute care processes and local market providers
Premier’s Top Ten Key Steps Taken by Successful ACOs
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Caring for a Population
At-Risk
60-80 % population
15-35% population
3-5% population
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Caring for a Population
At-Risk
Top 5% = 47-50% Expenditure
Top 5 % rising to High Risk
60-80 % population
Trade high cost service for low cost management
Navigate and coordinate care
Reduce high cost utilization, slow progression to high risk
Keep healthy
Keep loyal
15-35% population
3-5% population
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Caring for a Population
At-Risk
60-80 % population
Keep healthy and loyal
Keep loyal
15-35% population
3-5% population
Changes we are making
Care Management
Annual Wellness VisitsHealthy lifestyle goalsMyChart engagement
Preventive and Community OutreachPreventive services outreachAdvance Care PlanningCommunity & Faith PartnershipsWellness Services
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Caring for a Population
At-Risk
Top 5 % rising to High Risk
60-80 % population
Reduce high cost utilization, slow progression to
high risk 15-35% population
3-5% population
Changes we are makingAccess and Patient Centered Medical Home
• Access to care• Real time clinical decision making• Chronic disease standards of care• ED avoidance; Care plans• Coaching/goal setting for life style and
risk behaviors• Team based care• End of Life planning
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Caring for a Population
At-Risk
Top 5% = 47-50% Expenditure
Top 5 % rising to High Risk
60-80 % population
Trade high cost service for low cost management
Navigate and coordinate care
15-35% population
3-5% population
Changes we are making
Transitional care and Care coordination
• Transitions of care protocols• Remote home monitoring• Telephonic case management• Post acute visit with PCP < 7 days• End of life conversations early and
often• Collaboration with SNFs
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Outcomes
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Oct Nov Dec Jan Feb Mar Apr May
Enrolled 83% 78% 93% 78% 78% 80% 80% 82%
Readmission Rate 2 4 8 8 9 6 7 7
83%78%
93%
78% 78% 80% 80% 82%
2
4
8 89
67 7
0
2
4
6
8
10
0%10%20%30%40%50%60%70%80%90%
100%
Read
mis
sion
Rat
e
Enro
llmen
t Per
cent
age
Transitions of Care
• Over 6300 enrolled in TOC program (Oct to May)• N=613/month enrolled in Remote Home Monitoring• N=636/month enrolled in Home Health & Hospice
2016 Work Plan Highlights
Access and PCMH• Map core services by practice type• Ambulatory evidence based protocols and order
sets for most common encounter types• Shared decision making protocols• Continue roll out of PCMH principles in Primary
Care practices• Optimize EHR work flows
Care Coordination• Implement ambulatory risk tool concept in EDs• Assure complete and accurate flow of info between
CC staff and Providers• Plan to leverage SNF based medical directors• Hardwire handover across all systems of care• Explore utilization of paramedics for CC
Care Management• Complete phase 1 patient engagement training for
providers and staff, begin phase 2 – health literacy, behavior mod, coaching for activation
• Use technology to provide individual health management information, tracking tools and integration with available locations – My Chart and Mobile app
• Explore virtual care options
Preventive and Community Outreach• Implement plans for faith-health partnerships• Integrate community resources, services, programs
into care delivery model• Expand programs that bring care closer to where
people live, learn, earn, pray and play• Establish formal training and certification program
for lay health advocates• Address barriers to health – transportation &
health literacy – thru partnerships w/community agencies
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Measures of Population Health
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Care Coordination & Patient Safety (10)
Preventive Health (8)
Clinical Quality at Risk Populations (7)
Cost of Care
Patient Experience (8)
Key Steps
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Communicate and engage with people
Identify high risk population
Ensure care coordination
Develop robust analytics
Survive financially while operating intwo different worlds
We are changing the way we care for people
Cost Restructuring
Coordinated CareFragmented Care
Patient CenteredProvider Centered
Payment for ValuePayment for Volume
Care Systems FocusedFacilities Focused
Care Team AccountabilityPhysician Accountability
Longitudinal, Multi-Site Care ModelsEpisodic, Hospital-Based Care Models
Efficient, Evidence Based CareInconsistent, Variable Methods
ElectronicPaper
THE FUTURE IS NOWTODAY
Cost Reduction
Questions? Thank you!
Population Health Overview
2015
