Population Health Management: Banner Health Network s Perspective. Neta Faynboym, Medical Director Banner Health Network

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1 Population Health Management: Banner Health Network s Perspective Neta Faynboym, Medical Director Banner Health Network

2 29 Acute Care Hospitals BANNER AT A GLANCE Banner Health Network with 400K lives in risk arrangements Banner Medical Group 1400 providers Banner University Medical Group 800 providers Specialty Hospitals Heart, Children s and Behavioral Partnership with University of Texas MD Anderson Cancer Center Outpatient Surgery Medical Education $5.4 billion in revenue, 2014 Acquisition of University of Arizona Health Network in 2015

3 PROVIDERS AND CARE SERVICES Medicare Advantage Pioneer Medicare Commercial AHCCCS Exchange Products Other Banner Health Network (BHN) 18 AZ In-Network Hospitals Approx. 1,100 Physicians Approx. 1,000 Physicians Approx. 1,300 Physicians

4 BANNER HEALTH NETWORK VISION To be the health system of choice in markets we serve for those that entrust their health and wellbeing to us. Arizona Integrated Physicians Banner Physician Hospital Organization Banner Medical Group Banner Health BHN Members Triple Aim Goals: 1. Improving the patient experience of care 2. Improving the health of populations 3. Reducing the per capita cost of healthcare 4

5 VALUE PROPOSITION IN AN ACO -TYPE MODEL Expense reduction Revenue generation Decrease unit cost Decrease utilization Increase new membership Delivery Efficiency (service/care) All care team members practicing at the top of their license Streamlined work flow Process automation Decrease the cost of delivering a service (i.e. hospital bed day) Appropriate Utilization (level/type) Population health risk management strategies Care coordination and navigation Evidence based medicine Fraud and abuse mitigation New Business Revenue Shared Savings, Care Coordination, Risk and Joint Venture arrangements with payers Specialty focus care delivery programs/ models with bundle payments while increasing quality and member experience 5

6 HOW WE APPROACH POPULATION HEALTH Competitive Unit Cost Care Management Programs Unifying Technology Improved Member Experience Guaranteed Trend And Performance

7 FOUR FOUNDATIONAL ELEMENTS THE HOW Banner Health Network Care Management Air Traffic Control Real time monitoring Actionable Data Analytics Seamless transitions of care Banner Health Integrated Care Delivery Model 7

8 FROM RAW DATA TO MEANINGFUL ACTIONS Data Collection & Aggregation Point of Care Clinical & Decision Support Tools Member and Provider Engagement Tools Clinical Quality, Utilization, & Cost Reporting Correlational & Predictive Analytics

9 HEALTH MANAGEMENT MODEL Member enrolls in BHN plan Member Needs Assessed Low Intensity 65-80% Mid Intensity 15-35% High Intensity 5-10% Preventive Health Chronic Condition Management Acute Care Complex Chronic Conditions Care Sub acute Care End of Life Care Appropriate Screenings Team-based Care (eg, PCMH) Unplanned Care Minor Episodic Care Specialty and Behavioral Care Elective Procedures 9

10 CONTINUUM MANAGEMENT Hospital Intensive Ambulatory Care Pharmacy Case Manager Home Health Hospice EMS Specialist SNF/Rehab Labs Payors 10

11 IMPROVING HEALTH AND LOWERING COSTS Focus # 1 Focus on Determinants of Health Focus # 2 Focus # 3 Reduce Admits/1000 Management of the 5% High Intensity Members, Reduce Readmissions Decrease ED Visits/1000 Focus Area Focus # 4 Focus # 5 Focus # 6 Focus # 7 Post-Acute Care Pharmacy Improve Performance on Contract Performance Measures Grow Banner Ambulatory Palliative Care Program Focus # 8 Provide Value to PCPs in BHN Network Focus # 9 Develop High Value Network 11

12 #1 FOCUS UNDERSTAND & PRIORITIZE NEEDS OF THE POPULATION Lifestyle Diet & Nutrition Exercise & Physical Fitness Education/ Measurement/ Tracking Tools Sleep Patterns Medical Care Health Environment Assessment of Environmental Components of Health i.e. Smoking, Poor Nutrition, Lack of Resources Aggressive Chronic Care Management Hereditary Factors Assessment of Health Risk Based on Genetic Factors Screening (Risk Based) Disease Modification Biopsychosocial Model 12

13 MEMBER EXPERIENCE CENTER Medical Advice & Follow Up New Member On-Boarding evisit Care Gap Closure PCP Appointment Connection to Care Management Programs Urgent Care ER BHN Member Member Experience Center Manage Care Transitions 13

14 TARGET HIGH INTENSITY MEMBERS WITH TELEHEALTH 27% reduction in cost of care 32% reduction in acute and long term care costs 45% reduction in hospitalizations Forbes 5/3/2015: 14

15 ICARE HOME BASED TELEHEALTH Enrollment in icare Goal 500 members Member enrollment per month icare Data Overview 15 Medicity Proprietary & Confidential IAC Period

16 16 DE-ESCALATE HIGH COST CARE SETTINGS. BHN member Identified ED CM is notified of every BHN member with ICON on the Tracking Board Member Evaluation ED CM evaluates members needs Consultation ED Provider, Hospitalist and ED CM discussion De-Escalation Lower LOC reduces costs to network and expenses to member Infrastructure supports CM transitions and follow-up with ambulatory care providers

17 ACUTE HOSPITAL SETTING 35 to 40% of Medicare Patients are discharged to PAC National Medicare Data Discharged Readmitted 2% 10% 41% 37% 9% 17% 12% 22% 28% 20% LTACH IRF SNF HHC OP REHAB Source:

18 PAC BY THE NUMBERS PAC costs 20 to 25% of the total medical expense for a Medicare beneficiary. PAC spending, with annual growth in the last decade is outpacing other service categories by 50% or more. It now accounts for a significant portion of overall Medicare expenditures. Up to 40% PERCENT SPENDING BY MEDICARE ON PAC SERVICE LTACH, 8% IRF, 11% HHA, 31% SNF, 50% Medicare PAC spending 2012 Overutilization of SNF days (the largest piece of the pie). 25% of SNF admits could go home $65 Billion Annually! $10 Billion Amount that could be saved by Medicare annually if patients utilized the appropriate PAC setting Over 8% The rate at which Medicare spending for SNF, LTC, and Homecare grew annually from

19 BHN & ACO SKILLED NURSING READMISSION RATES 25% 20% 15% Other 17% 10% 5% 4% Banner Affiliated SNF 8% 0%

20 30 BHN SKILLED NURSING ALOS Other Banner Affiliated SNF 5 0

21 35 TELE-SNF Boswell Rehabilitation Center Utilization Dec Nov Dec 2013 Jan 2014 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 Oct 2014 Nov 2014 ED Transfer Prevention Enhanced ED transfer Non-Acute Clinical Care Staff Support KEEPING HEADS IN BEDS! Ready to be implemented in Affiliated SNF s

22 COMPARISON OF OUR SNF PBPM COST VS ALL OTHER PIONEER ACOS 2014 Q2 Banner is a top performer!

23 QUESTIONS?

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