REWRITING PAYER/PROVIDER COLLABORATION July 24, MIKE FAY Vice President, Health Networks

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1 REWRITING PAYER/PROVIDER COLLABORATION July 24, 2015 MIKE FAY Vice President, Health Networks

2 AGENDA ACO Overview ACO Financial Performance ACO Quality Performance Observations 2

3 AGENDA ACO OVERVIEW ACO OVERVIEW FINANCIAL PERFORMANCE QUALITY PERFORMANCE OBSERVATIONS 3

4 THREE COMPONENTS OF WELLMARK ACOs 1. QUALITY TRIGGER ON 2. SHARED SAVINGS Consumer price index (CPI) target Wellmark trend target 3. QUALITY INCENTIVE PAYMENT ACO compared to network, ACO and best practice 4

5 VALUE INDEX SCORE (VIS) SM Developed for Wellmark by 3M Health Information Systems, the VIS is a single score that quantifies the quality of care like a Consumer Reports for health care value. Applies to all patients, regardless of health status Measures Domains of quality Quality Score 5

6 VIS DOMAINS AND MEASURES Primary and Secondary Prevention Chronic and Follow-up Care Population Health Status* Continuity of Care Tertiary Prevention Member Experience* Breast cancer screening Colorectal screening Percent of attributed members birth to 15 months who had the recommended number of wellchild visits with a PCP Risk-adjusted percent difference in potentially preventable readmissions Percent of attributed members with hospital discharge with provider office visit equal to or less than 30 days postdischarge Percent of attributed members with chronic disease (clinical risk categories 50, 60, 70) with 3 or more provider visits Percent difference of attributed members who acquire chronic conditions, riskadjusted Percent difference of attributed members with chronic conditions that increase in severity, risk-adjusted *To be added at a future date. Percent of attributed members who are non-users, not riskadjusted Percent of attributed members with PCP visit, not risk-adjusted Percent of attributed members with continuity of care, riskadjusted Risk-adjusted percent difference in potentially preventable admissions Risk-adjusted percent difference in potentially preventable emergency department visits Patient confidence in managing health problems Identification of one person as patient s personal doctor or nurse Efficiency and organization of provider office 6

7 AGENDA ACO OVERVIEW FINANCIAL PERFORMANCE QUALITY PERFORMANCE OBSERVATIONS ACO FINANCIAL PERFORMANCE 7

8 2012 WELLMARK ACO COVERAGE 3 ACOs 734 Personal Doctors 75,006 Cost/Quality Members $277.5 M Total Cost of Care 8

9 2012 ACO RESULTS ACO 1 ACO 2 ACO 3 Trigger Off/On On Off On Savings/(Losses) CPI $8.75 $17.49 $12.05 Savings/(Losses) Trend

10 2013 WELLMARK ACO COVERAGE 5 ACOs 1,143 Personal Doctors 109,416 Cost/Quality Members $430.4 M Total Cost of Care 10

11 2013 ACO RESULTS ACO 1 ACO 2 ACO 3 ACO 4 ACO 5 Trigger Off/On On On On Off On Savings/(Losses) CPI - $7.99 $8.58 $0.10 $12.02 Savings/(Losses) Trend $

12 2014 WELLMARK ACO COVERAGE 9 ACOs 1,584 Personal Doctors 254,407 Cost/Quality Members $614.9 M Total Cost of Care 12

13 2014 ACO RESULTS Trigger Off/On ACO 1 ACO 2 ACO 3 ACO 4 ACO 5 ACO 6 ACO 7 ACO 8 On Off On On On On On On Savings/ (Losses) CPI - $ $ $8.33 Savings/ (Losses) Trend ($3.05) $29.35 $4.62 $1.97 ($12.53) $32.49 ($2.76) $

14 2015 WELLMARK ACO COVERAGE 13 ACOs 2,067 Personal Doctors 525,433 Quality Members 195,848 Cost Members $2.3B Total Cost of Care $843M Total Cost of Care 14

15 AGENDA ACO OVERVIEW FINANCIAL PERFORMANCE QUALITY PERFORMANCE OBSERVATIONS QUALITY PERFORMANCE 15

16 Percentile VIS SHARED SAVINGS SCORE- ACO LEVEL 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% Target Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Rolling 12 months ending date 16

17 BREAST CANCER SCREENING 17

18 COLORECTAL CANCER SCREENING 18

19 WELL-CARE VISITS FOR INFANTS 19

20 POTENTIALLY PREVENTABLE ADMISSIONS 20

21 POTENTIALLY PREVENTABLE VISITS 21

22 CHRONIC CARE VISITS 22

23 AGENDA ACO OVERVIEW OBSERVATIONS FINANCIAL PERFORMANCE QUALITY PERFORMANCE OBSERVATIONS 23

24 OBSERVATIONS Standard payment rates reduces payment variation, thus removes savings opportunities available in other markets Effective ACO combinations include a culture of change, physician leadership, analytics and transparency Measuring quality is a natural fit, saving money is not Additional work is needed to provide actionable data to produce savings Expect to be challenged by the employer community 24

25 THANK YOU! Mike Fay, Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association. Confidential and Proprietary Wellmark Blue Cross and Blue Shield.