Partnerships for Population Health 9/23/2013

Transcription

1 Partnerships for Population Health 9/23/2013 Barbara McCann, Chief Industry Officer, Interim HealthCare Brian Silverstein, MD, President, HC Wisdom Amanda Twiss, President, Garnet Advisors 1

2 Continuum of care 2

3 Post Acute Care (PAC) Reform - Now IOM Study: lower Medicare spending eliminate variation in post acute care (Aug ) Senate Finance and House Ways and Means Quality measures used across PAC Use of OASIS, IRF-PAI, MDS and CARE to bundle PAC payment or introduce site neutral payment VBP for all PAC settings, as a whole Focus - reducing hospital readmissions, ED use 3

4 Health Care s Accountable Moment: Right Setting, Right Cost, Right Outcome Hospital LTAC IRF SNF MD Office Home Care Hospice/ Palliation Clinical practice & cost of care goes at financial risk 4

5 We Can t Talk to Each Other No common language of pain, functional status etc. Our clinicians practice at treating sickness not promoting long term physical and mental health of a population Do we know the true cost of care? We need the data to know the relationship of Discipline Timing Intervention Outcomes or Value Cost Setting 5

6 When is This the Right Setting? This is where she wants to be, person-centered choice: together we need to know how to do this and do it better! 6

7 Clinical Needs Have Changed Year Life Expectancy Leading Causes of Death Clinical Need Pneumonia Influenza Tuberculosis Diarrhea GI disease Acute Heart Disease Cancer Cerebrovascular Heart Disease* Cancer* Cerebrovascular Acute Chronic Chronic Acute Prevention 7 * Cancer is currently the leading cause of death for certain age groups

8 The Bridge From Volume To Value 8

9 Population Health is A Different Business 9

10 It Is Different This Time Employers Data 1990s Managed Care Unemployment rate was low and the focus was how to keep and retain employees with little desire to change benefits Most data systems were immature and could not be used to manage populations 2013 Population Health Unemployment high and employers trying to find any way to reduce benefit cost Robust population management systems are available in the market and the beginning of quality management Patients Payment* Key to Success Did not understand what they were buying into and had no financial incentive to decrease or change utilization Deals were done to trade off reduced prices in exchange for more volume Financial leadership. Create roadblocks to keep patients from using healthcare Benefit design gives patients options associated with different costs Most per-unit payments are the same with opportunities for performancebased increased payment Physician leadership. Segment patients and provide the ones with the greatest need enhanced, lowercost services to avoid the need for expensive rescue care * Payment today is dependent upon local supply and demand for services. In markets with excess capacity, there are movements 10 to have reduced payment for increases in volume.

11 Segment and Focus the Effort Where it Is Needed Advanced Illness BAND 1 Multiple Chronic Conditions BAND 2 At Risk BAND 3 % of Population % of Cost Annual Cost 3% 29% $54,444 7% 23% $14,232 10% 19% $7,728 Stable BAND 4 30% 22% $3,168 Healthy BAND 5 50% 7% $ Source: CareFirst Book of Business 2010, CareFirst Health Care Analytics Source: CareFirst Book of Business 2010, CareFirst Health Care Analytics

12 Predicting The Future Is Difficult Source: Milliman ACO White Paper Jan

13 Interventions Work But May Take Time 13 Source: Geisinger

14 Opportunity Outside of Acute Care Geographic Variation in Spending, MS-DRG 291 Heart Failure and Shock with Major Complications Source: CMS Office of Information Products and Data Analysis, Medicare Claims Analysis

15 The Market Is Responding and Moving 15

16 Rebuild Your Core While Reinventing Your Business Model Reposition the Legacy Business Building For the Future Adapt the core business to the realities of the disrupted market Create a new, disruptive business that will become the growth engine 16 Source: HBR Feb 2013 Two Routes To Resilience

17 Optimize organizational success 1. Clear focus 2. Leadership commitment 3. Devotion to data 4. Appropriate cross-continuum technology 5. Aligned incentives 6. Internal education/marketing 17