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Tom Olenzak
Director, Independence Center for Health Care Innovation
Independence Blue Cross
Payer-Provider Partnership Models for
Health Care Innovation
Independence Blue Cross at a Glance
Medical, service, and ancillary
Medical and ancillary
Service and ancillary
Medical
Service
Ancillary
Potential expansion markets
AmeriHealth Caritas
AmeriHealth
Administrators
AmeriHealth
Administrators
AmeriHealth Caritas
AmeriHealth Caritas and
AmeriHealth Administrators
AmeriHealth Caritas
AmeriHealth
AmeriHealth Caritas
AmeriHealth
Administrators
AmeriHealth Caritas
AmeriHealth CaritasPA & NJ Market
Independence Blue Cross
AmeriHealth
AmeriHealth Administrators
AmeriHealth Casualty
AmeriHealth Caritas
AmeriHealth Caritas
AmeriHealth Caritas
AmeriHealth and
AmeriHealth Administrators
AmeriHealth
Administrators
AmeriHealth Caritas and
AmeriHealth Administrators
AmeriHealth Caritas and
AmeriHealth Administrators
Serving 8.2 million people in 24 states as well as the District of Columbia.
• Once-in-a-generation transformation of our industry
• Convergence of economics, regulatory will, and public opiniono Our core risk-based business is becoming a commodity
o Product migration: fully insured to self insured to defined contribution
o Transformation from payments management to care management
o Our key business model is shifting: BTB to BTC
• Traditional silos are breaking down, new business models are emerging.
o Our core business is evolving at an accelerating rate
o We are now vulnerable to new entrants and disruptive innovators
Why innovation?
4
• Innovation in health care can’t be done alone.
• Identify and align priorities with other entities within the region and nation.
• Focus on targets that eliminate waste, enhance the customer experience,
and/or improve outcomes.
• Work with others to reduce costly fragmentation in the market.
• Seek, evaluate, and monitor new and potentially game-changing
companies, technologies, and business models.
We want to work with partners
IBC Innovation Structure
5
We are building a culture ready and willing to embrace innovation
We scour the
landscape to find and
engage with innovative
companies and
technology to inform
and support our growth
strategy.
We identify and
evaluate new
corporate opportunities
through our Deep Dive
and Tiger Team
processes.
We lead the effort to
accelerate the
development of the
health innovation
community in our
region.
We are creating a partnership with operating units and HR to design
creative methods to incentivize innovative behavior
We are building a network through which we are embedded in the health
care, technology, and innovation communities
We created the Center for Health Care Innovation
6
• Penn Medicine
o Leveraging IBC’s vast databases of claim information and
Penn’s research expertise to identify new ways to keep
people healthy.
o Collaborated on breakthrough Medication Adherence
research program.
• New York University
o Research collaboration between IBC and NYU to use IBC
medical and pharmacy claims data to develop artificial
intelligence methods for predicting members who have
undiagnosed diabetes or who are at risk of developing the
disease.
• Also in the Region
o Leading the creation of HealthShare Exchange of
Southeastern Pennsylvania, the first health information
exchange in our region that went live in 2012.
o Exploring ways to leverage claims, clinical, and other
health data to create a joint regional research asset.
Early partnership effortsEarly Partnership Initiatives
• Team: Volpp/Asch (PIs), Troxel, Terwiesch, Mehta
• Objective: Prevent vascular events or rehospitalization in the 12 months
following heart attack
Medication Adherence - $5mm CMMI Grant
• Design:
o 2 arm RCT of 1500 patients
o 1 in 5 chance of $5, 1 in 100 for $100
o IF they took their meds (daily)
o Social support…e.g., family gets an
alert
o Low personnel ratio
Demonstrates Enduring Adherence to Medication Following a Heart Attack
Early Detection of Diabetes
• Who will develop diabetes in the
next 12, 18, and 24 months?
• Which diabetics have undiagnosed
comorbid conditions?
Incorporate broad data sources
12
Early Results
Model:
• Current models use over 1,200
features
• Area under ROC Curve = 0.79 across all
ages
Results:
• 590,000 members not diagnosed
with diabetes by 2011 were enrolled
though 2012
• Model produces probability of being
diagnosed with diabetes within 24
months for every member:
• 54,000 with > 0.70 likelihood
• 18,000 with > 0.80 likelihood
• 2,500 with > 0.90 likelihood
13
Early Diabetes Detection: Next Steps
Implementation
• Bring algorithms in-house
• Outreach to providers
• Outreach by case management
• Candidates for peer mentoring
program
Expansion of
Models
• Refine models
• Answer additional research
questions
• Expand outreach capacities
• DreamIt Health Philadelphia
o Powered by Independence Blue Cross and Penn Medicine.
o Four-month startup accelerator.
o $50,000 in seed funding.
o Free work space and legal council
o Access to industry executives and Penn & IBC data
• 2013
o 10 out of 10 companies still active.
o Pilots with both Penn and IBC.
o 8 companies remain in the Philadelphia region.
• 2014
o Currently accepting applications for the DreamIt’s 2014
class of companies.
DreamIt Health
15
STAT Medical Transport Pilot
Challenge
• IBC generates LOH lists
• Care Management works with the
Member to manage conditions
• Transport to providers can be a
significant barrier
Pilot
• Utilize STAT, a Dreamit Health
2013 Company, to manage
transport options
• Utilizing CMS grant to pay for
transport
• Success measured [tbd]
16
Other Joint Initiatives
Medical Transport
• IBC generates LOH lists
• Care Management works with the
Member to manage conditions
• Transport to providers can be a
significant barrier
• Utilize STAT, a DreamIt Company
• CMS grant pays for transport
Tele-Dermatology
• Discontinuity in specialist referral
process allows preventable conditions
to worsen
• Provides immediate access to
dermatologists from PCP location
• Tele-derm not reimbursed today
• IBC provides payment structure
Next Step: Expand the network to other providers and partners
17
Tandigm Health
IBC and DaVita Healthcare Partners have formed a new company,
Tandigm Health, that will work in tandem with primary care physicians
to deliver high-quality, affordable care
• Combines traditional doctor-patient relationships with innovative tools and support
• Focuses on enabling, not acquiring, primary care physicians
• Provides PCPs with enabling technology including access to real time data and
services such as community health workers and home care