Coast to Coast Event San Francisco, CA 27 September 2017 Sam Ho, - - PowerPoint PPT Presentation

Optum Life Sciences Coast to Coast Event

San Francisco, CA 27 September 2017

Sam Ho, MD EVP, Chief Medical Officer

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

A Call to Action—

• Unacceptable Quality Outcomes

– US ranks 38th in national health systems by the WHO – Patients suffer a 6% complication rate for every day of hospitalization – Solutions for eliminating preventable deaths, never events, & HACs aren’t universally adopted

• Unwarranted Variation

– 250% difference in Medicare spending across the US, adjusted for age, sex, race, underlying health, geography and prices—without evidence of better health

• utcomes

– 55% of recommended care is being provided across all geographies, ages, and preventive, acute and chronic care – Case-mix adjusted hospital death rates vary 400%

• Unsustainable costs

– US has the highest per capita health care costs in the world & is 180% > the average of the next 10 countries – Dartmouth Center for Evaluative Clinical Sciences estimates that 30% of Medicare spending is wasted – There is no current positive correlation between quality and spending

Why We Do What We Do—Achieve the Triple Aim Commitment we’ve made to our customers, consumers, and care providers that we call the Triple Aim:

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Reducing the per capita cost of health care Integrity Compassion Relationships Innovation Performance

Better Care Better Health Lower Cost

Value-based Compensation— Foundational to Collaboration

4

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Capitation + PBC Shared risk Shared savings Condition or Service-Line Programs Performance-based contracts Primary care incentives Fee-for-service

Ac Accountable le Ca Care Bu Bundles les & & Epis Episodes Performan mance-based sed Level of financial risk Degree of care provider integration and accountability

$23B $23B

Achieving specific METRICS

$18B $18B

Managing entire POPULATION HEALTH

$6B $6B

Managing a specific CONDITION

• r SERVICE

LINE

Aligning Incentives with Clinical Accountability: Readiness Continuum

5

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

6

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Consumer Engagement and Network Alignment

Evolution of Insurance Products

Gatekeeper

No referral/no coverage

PCP Tiering Specialist Tiering Place of Service Hospital

• Adding gating onto a

tiered benefit plan can save 2.5%-4.5%

4.5%*

• 134,700 physicians are

Premium Tier 1

• 39% of members use

Tier 1 physicians

1.5% - 5.25%

• 16% lower costs

between Premium Tier 1 and a non-Tier 1 physicians

• Ave difference between

freestanding vs. outpt. hospital : MRI $837; Upper GI Endo. $1,354

• Tier 2 hospitals can be

30%+ more expensive

• n a unit-cost basis than

Tier 1 hospitals

Getting to double-digit savings

Using Premium tiering as a foundation, markets can achieve double-digit savings when maximizing differentials and incorporating other levers onto either a gated or open access product

+ 1.5% - 5.25% + 1.5% - 2.5% + .5% - 1% + 2.5% - 4.5%

Medical Savings Realization

4.6% 4.6% 2% .8%

Up to 19% savings achieved

* Plan 240 simulated pricing decrement per lever relative to a standard Choice/Choice Plus product/plan design

Value Continuum – Medical Savings Realization

1% - 3%

Medical Savings Realization

PCCM supports top tier providers via performance data for continued improvements in cost and quality

Patient Centered Care Management (PCCM)

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Better Care, Better Health, Lower Costs

Focusing on Value - Provider Value Pyramid

Better Care, Better Health, Lower Costs

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FINISHING STRONG│ 2017 MBOs

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2017 Weightings: Quality = 35%, Affordability = 25%, Relationships = 30%, Innovation = 10%

Target 1 2 3 4 5 YTD Result HEDIS Measure Improvement - E&I Cohen / Hunt / Nguyen Population Health & Quality Improve at least 50% of HEDIS Accreditation measures to 75th %tile 30% 40% 50% 60% 75% TBD HEDIS Measure Improvement - C&S Fuentevilla / Curtis / Nguyen Population Health & Quality Achieve 70% of state- based quality incentive dollars 49% 50% 60% 70% 75% TBD HEDIS Measure Improvement - M&R Castillo / Hagan / Nguyen Population Health & Quality 80% of members in 4 + star rated plans >70% 70% 75% 80% 85% TBD HEDIS Chase Supplemental Data Sources Auditor Approved - E&I/M&R Nguyen / Allen Population Health & Quality 100% Auditor Approval 92% 94% 96% 98% 100% 100% HEDIS Chase Supplemental Data Sources Auditor Approved - C&S Nguyen / Allen Population Health & Quality 100% Auditor Approval 92% 94% 96% 98% 100% 100% Health Plan Accreditation - E&I Improve Levels Cohen / Hunt Population Health & Quality Improve 25% of plans to Commendable/ Maintain 100% Accreditation

15% 20% 36% 33% 50%

TBD M&R Hospitalization Measures (Plan All-Cause Readmissions, Medication Reconciliation Post- Discharge, and Hospitalization for Potentially Preventable Complications) Castillo/Hagan/ Nichols/Coyle- Ikemoto/Huckaby/ Weiss/Nguyen Population Health & Quality 4+ Star Rating for each measure 3.0 Star Rating 4.0 Star Rating 4+ Star Rating TBD Total Affordability Wilkerson Affordability $1,045M $832 $884 $936 $988 $1,045 $955M Inpatient Management Nichols Affordability $493M $256 $316 $375 $434 $493 $408M Outpatient Management Christian/Shelley Affordability $277M $221 $235 $249 $263 $277 $235M PCCM Savings - ACO Nguyen Affordability $60M <$55M $56 $58 $60 $61 TBD PCCM Savings - CCO Nguyen Affordability $75M <$70M $71 $73 $75 $76 TBD PCCM/ACO Activation % Nguyen Affordability Activate 95% of ACOs that meet contracting guidelines within 30 days

• f contract effective date

<90% 90-94% 95% 96%-99% 100% 96% Analytics Insights Allen Affordability $25M $7.5 $10.0 $12.5 $18.8 $25.0 TBD Peer Comparison Reports Allen Affordability $11M $3 $4 $6 $8 $11 TBD Optum Programs Wilkerson Affordability $400M $320 $340 $360 $380 $400 $196M Emergency Department Transformation Initiative Wilkerson Affordability $39M $31 $33 $35 $37 $39 $19M Operating Cost Reduction Dewey/Foley Affordability $43M $34 $37 $39 $41 $43 On Track Improve Provider Net Promoter Score - All LOB Christian/Shelley Relationships Achieve Provider NPS of 3.0 <-9 1 2 3 8 Audit Compliance – E&I Coyle-Ikemoto Relationships Complete [11-12] market conduct exams at 100% compliance 80% 85% 90% 95% 100% On Track Audit Compliance – M&R Coyle-Ikemoto Relationships 100% compliance to CMS audit requirements 80% 85% 90% 95% 100% 100% Audit Compliance – C&S Coyle-Ikemoto Relationships Complete [11] state HP audits with 100% compliance and no new Clinical CAPS 80% 85% 90% 95% 100% TBD Employee Engagement Harbin Relationships 80% 72% 74% 76% 78% 80% TBD Employee Attrition Harbin Relationships 12% 14% 14% 13% 13% 12% 10.1 Innovation/Health System Transformation (1- M&R Hassle Free Prior Auth Pilot, 2- Tradeables 11 Hospital Pilot, 3- 2nd MD Pilot) Christian/Shelley (Prior Auth Pilot), Weiss/Huckaby (Hospital Tradeables), Christian (2nd MD) Innovation All operational goals met and on-time deployment for key 2017 Clinical pilots. 80% 85% 90% 95% 100% On track 2017 MBO Name MBO Owner Category 3.5 Star Rating

Inspiration

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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

“There are those who look at things the way they are, and ask why…I dream of things that never were, and ask why not?”

• Robert F Kennedy

How to Achieve the Triple Aim— Requires an Integrated Value Strategy

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

High Quality Low Cost

V A L U E

Evidence-Based Medicine Clinically Appropriate Care Cost-Effective Options

Collaboration Amongst Providers, Plans, and Consumers Drives Value

Provider Payment Reform and VBC Delivery System Transformation Population Health Management Data Exchange and Advanced Analytics Consumer Engagement and Value-Based Insurance Design

Value-based Compensation— Foundational to Collaboration

11

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Capitation + PBC Shared risk Shared savings Condition or Service-Line Programs Performance-based contracts Primary care incentives Fee-for-service

Ac Accountable le Ca Care Bu Bundles les & & Epis Episodes Performan mance-based sed Level of financial risk Degree of care provider integration and accountability

$23B $23B

Achieving specific METRICS

$18B $18B

Managing entire POPULATION HEALTH

$6B $6B

Managing a specific CONDITION

• r SERVICE

LINE

Aligning Incentives with Clinical Accountability: Readiness Continuum

12

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

13

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Consumer Engagement and Network Alignment

Evolution of Insurance Products

Gatekeeper

No referral/no coverage

PCP Tiering Specialist Tiering Place of Service Hospital

• Adding gating onto a

tiered benefit plan can save 2.5%-4.5%

4.5%*

• 134,700 physicians are

Premium Tier 1

• 39% of members use

Tier 1 physicians

1.5% - 5.25%

• 16% lower costs

between Premium Tier 1 and a non-Tier 1 physicians

• Ave difference between

freestanding vs. outpt. hospital : MRI $837; Upper GI Endo. $1,354

• Tier 2 hospitals can be

30%+ more expensive

• n a unit-cost basis than

Tier 1 hospitals

Getting to double-digit savings

Using Premium tiering as a foundation, markets can achieve double-digit savings when maximizing differentials and incorporating other levers onto either a gated or open access product

+ 1.5% - 5.25% + 1.5% - 2.5% + .5% - 1% + 2.5% - 4.5%

Medical Savings Realization

4.6% 4.6% 2% .8%

Up to 19% savings achieved

* Plan 240 simulated pricing decrement per lever relative to a standard Choice/Choice Plus product/plan design

Value Continuum – Medical Savings Realization

1% - 3%

Medical Savings Realization

PCCM supports top tier providers via performance data for continued improvements in cost and quality

Patient Centered Care Management (PCCM)

14

Better Care, Better Health, Lower Costs

Focusing on Value - Provider Value Pyramid

Better Care, Better Health, Lower Costs

15

FINISHING STRONG│ 2017 MBOs

15

2017 Weightings: Quality = 35%, Affordability = 25%, Relationships = 30%, Innovation = 10%

Target 1 2 3 4 5 YTD Result HEDIS Measure Improvement - E&I Cohen / Hunt / Nguyen Population Health & Quality Improve at least 50% of HEDIS Accreditation measures to 75th %tile 30% 40% 50% 60% 75% TBD HEDIS Measure Improvement - C&S Fuentevilla / Curtis / Nguyen Population Health & Quality Achieve 70% of state- based quality incentive dollars 49% 50% 60% 70% 75% TBD HEDIS Measure Improvement - M&R Castillo / Hagan / Nguyen Population Health & Quality 80% of members in 4 + star rated plans >70% 70% 75% 80% 85% TBD HEDIS Chase Supplemental Data Sources Auditor Approved - E&I/M&R Nguyen / Allen Population Health & Quality 100% Auditor Approval 92% 94% 96% 98% 100% 100% HEDIS Chase Supplemental Data Sources Auditor Approved - C&S Nguyen / Allen Population Health & Quality 100% Auditor Approval 92% 94% 96% 98% 100% 100% Health Plan Accreditation - E&I Improve Levels Cohen / Hunt Population Health & Quality Improve 25% of plans to Commendable/ Maintain 100% Accreditation

15% 20% 36% 33% 50%

TBD M&R Hospitalization Measures (Plan All-Cause Readmissions, Medication Reconciliation Post- Discharge, and Hospitalization for Potentially Preventable Complications) Castillo/Hagan/ Nichols/Coyle- Ikemoto/Huckaby/ Weiss/Nguyen Population Health & Quality 4+ Star Rating for each measure 3.0 Star Rating 4.0 Star Rating 4+ Star Rating TBD Total Affordability Wilkerson Affordability $1,045M $832 $884 $936 $988 $1,045 $955M Inpatient Management Nichols Affordability $493M $256 $316 $375 $434 $493 $408M Outpatient Management Christian/Shelley Affordability $277M $221 $235 $249 $263 $277 $235M PCCM Savings - ACO Nguyen Affordability $60M <$55M $56 $58 $60 $61 TBD PCCM Savings - CCO Nguyen Affordability $75M <$70M $71 $73 $75 $76 TBD PCCM/ACO Activation % Nguyen Affordability Activate 95% of ACOs that meet contracting guidelines within 30 days

• f contract effective date

<90% 90-94% 95% 96%-99% 100% 96% Analytics Insights Allen Affordability $25M $7.5 $10.0 $12.5 $18.8 $25.0 TBD Peer Comparison Reports Allen Affordability $11M $3 $4 $6 $8 $11 TBD Optum Programs Wilkerson Affordability $400M $320 $340 $360 $380 $400 $196M Emergency Department Transformation Initiative Wilkerson Affordability $39M $31 $33 $35 $37 $39 $19M Operating Cost Reduction Dewey/Foley Affordability $43M $34 $37 $39 $41 $43 On Track Improve Provider Net Promoter Score - All LOB Christian/Shelley Relationships Achieve Provider NPS of 3.0 <-9 1 2 3 8 Audit Compliance – E&I Coyle-Ikemoto Relationships Complete [11-12] market conduct exams at 100% compliance 80% 85% 90% 95% 100% On Track Audit Compliance – M&R Coyle-Ikemoto Relationships 100% compliance to CMS audit requirements 80% 85% 90% 95% 100% 100% Audit Compliance – C&S Coyle-Ikemoto Relationships Complete [11] state HP audits with 100% compliance and no new Clinical CAPS 80% 85% 90% 95% 100% TBD Employee Engagement Harbin Relationships 80% 72% 74% 76% 78% 80% TBD Employee Attrition Harbin Relationships 12% 14% 14% 13% 13% 12% 10.1 Innovation/Health System Transformation (1- M&R Hassle Free Prior Auth Pilot, 2- Tradeables 11 Hospital Pilot, 3- 2nd MD Pilot) Christian/Shelley (Prior Auth Pilot), Weiss/Huckaby (Hospital Tradeables), Christian (2nd MD) Innovation All operational goals met and on-time deployment for key 2017 Clinical pilots. 80% 85% 90% 95% 100% On track 2017 MBO Name MBO Owner Category 3.5 Star Rating

Inspiration

16

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

“There are those who look at things the way they are, and ask why…I dream of things that never were, and ask why not?”

• Robert F Kennedy