COORDINATED CARE MANAGEMENT ALIGNMENT WORKGROUP TRANSFORMING OUR BUSINESS MODEL AARON CRANE JUNE 18, 2015
YOUR QUESTIONS 1. How does the Alliance’s work differ from Oregon’s Coordinated Care Model? 2. Going forward, what alignment opportunities do you see between your work and that of the Coordinated Care Model Alignment Workgroup? 3. Who are the member organizations? 4. To what degree have payers (carriers and employers) been engaged in the effort? 5. What is the timeline for the Alliance’s effort? 6. Are there specific goals for increasing value based care? Confidential – For Internal Use Only – Please Do Not Distribute 2
WHO WE ARE Asante – Medford, Grants Pass, Ashland Bay Area Hospital – Coos Bay Mid-Columbia Medical Center – The Dalles Moda Health – Portland OHSU – Portland Salem Health – Salem, Dallas Sky Lakes Medical Center – Klamath Falls St Charles Health System – Bend, Redmond, Madras, Prineville Confidential – For Internal Use Only – Please Do Not Distribute 3
GUIDING PRINCIPLES OF THE ALLIANCE The Population Health Alliance of Oregon will provide the tools, methods and support necessary for optimal health management in the communities we serve. Throughout this endeavor we will: Put patients Demonstrate Collaborate Become the first resilience tirelessly system of choice We will achieve our vision by: • Building solutions with physician leadership • Sustaining performance around meaningful quality targets • Rewarding participants through aligned incentives • Using leading-edge technology to drive robust analytics Confidential – For Internal Use Only – Please Do Not Distribute
KEY MARKET FORCES UNITING THE ALLIANCE 1 Providers who cannot deliver a lower medical trend will likely face a declining share of the market 2 3 To maintain and potentially grow The realization of a share, providers will much lower medical have to deliver a trend is only possible reliable reduction in with greater plan / trend provider alignment and best in class tools for Population health management capabilities are 4 managing utilization expensive, and it makes more sense to invest and cost in this together as opposed to many times separately Confidential – For Internal Use Only – Please Do Not Distribute
ALLIANCE ORGANIZATION CHART Quality & Health Board of Directors Executive Committee Management Committee Chief Executive Officer Director of Technology Chief Medical Officer & Analytics Technology & Quality Clinical Transformation Analytics Identify care management priorities based on Drives quality and Ensure delivery of information analytics process technology and business improvement intelligence enablers Establish guidelines and protocols for member initiatives across Deliver clinical integration onboarding the partnership enablers Provide coordinate care management for Supports the QHM Integrate with the various identified members provider EMR systems Drive use of technology enablers in care to Deliver processes, people, and support model (HIE, EMR, automated care management, registration/referral/ scheduling technology to meet analytics management) needs of the Alliance Manage physician education and change management Coordinate practice improvement initiatives Develop clinical and operational practice models Confidential – For Internal Use Only – Please Do Not Distribute
WHO IS EVOLENT? Founded in 2011, Evolent Health is an independently managed and governed organization backed by capital, asset and intellectual property contributions from UPMC Health Plan, The Advisory Board and TPG Growth + $126M 800 2M 20 million dollars in capital Evolenteers lives impacted by markets served raised in 2015 current model* nationwide • Capital • • National relationships Capital • Infrastructure, intellectual property • • Capital Board guidance, including • 2M lives, $5BN provider-owned Norm Payson (founder of HealthSource), health plan – largest after Kaiser Tom Geiser and Leonard Schafer (co-founders of WellPoint) *includes lives covered under UMPC Source: Evolent Health, 2015
Using Using Tec echn hnolog ology y to to Sup Suppo port rt Value Value- Ba Base sed d Bu Busine siness sses es Arm the enterprise with tools to manage clinical and 4 financial outcomes 3 Optimize EMR use to drive better, more efficient care Provide access to an integrated view of data at a deeper 2 and broader level 1 Foundation as an integration engine Confidential – For Internal Use Only – Please Do Not Distribute Source: Evolent Health, 2015
BRINGING IT ALL TOGETHER Building high performing risk management functions allow providers to aggressively assume risk while clinical transformation efforts gain traction Integrated Risk Management Functions Successful Unlock value by migrating traditional payer-held value-based functions to health systems care Example Drivers Risk Assumption • Care management • Utilization mgmt • RAF Improved Clinical • Quality Decision Making Longer-term change through evolving physician behavior and education Example Drivers • Clinical effectiveness initiatives Current • Clinical decision support State • Physician performance management Time Source: Evolent Health, 2015 Confidential – For Internal Use Only – Please Do Not Distribute
OUR INITIAL CLINICAL FOCUS • Launch Complex Care pilots with by 1/1/16. Complex • Complex Care rollout with by 4/1/16. Care • Launch Transition Care by 4/1/16. Transition • Transition Care rollout by 6/30/16. Care I dentifi • Configuration of technology rules engine by Rules 11/30/15. Source: Evolent Health, 2015 Confidential – For Internal Use Only – Please Do Not Distribute
COMPLEX CARE Overview Complex Care Management is a care advising program for patients with multiple complex chronic conditions, psychosocial needs, and high predicted avoidable medical expense. Objectives Improve patient health and quality of life while lowering medical expense by reducing avoidable ED, specialist, and acute encounters Team Engaged Patient, Physicia RN Pharmac Dietitian Engage Program Social Family n ist ment Coordina Worker Care and care Specialis tor Advisor giver t Confidential – For Internal Use Only – Please Do Not Distribute
IDEAL PROCESS TRANSITION CARE Last 24 – 48 hours First 48 hours Day 7, 14, 21 • Telephonic follow-up • Follow-up appt. scheduled • Home visit if high risk • Medications reconciled • In-home medication • Assess progress toward • Risk reassessed reconciliation personal goals Hospital Home Stable Health 48 – 72 hours 4 hours pre-discharge • Telephonic follow-up • Patient understands red flags (moderate risk patients) and action plan First 24 – 48 hours First 24 hours Day 28 • Confirm receipt of meds • Patient moved to Complex Care • Hospitalist & TCA collaborate • Discharge summary to PCP • Quality and satisfaction of • Transition Care process transition is assessed introduced Source: Evolent Health, 2015 Confidential – For Internal Use Only – Please Do Not Distribute
RULES BY GROUP Group Count Group Count Clinical quality measures 242 Diabetes chronic disease rules 63 HEDIS 190 CAD chronic disease rules 32 Medicare advantage Stars 71 COPD chronic disease rules 19 MSSP Quality measure rules 75 Pediatric care rules 74 Medication safety rules 36 Data QA rules 49 Predictive model support rules 98 Risk adjustment factor 20 Complex care – commercial 19 Palliative care stratification 12 Complex care – Medicare 40 Identifi UI care gap support 21 Medicare part D rules 47 Unplanned care/Stratification 32 Pharmacy custom rules 14 UPMC deployed 39 Pharmacy statin adherence 5 Utilization rules 37 Source: Evolent Health, 2015 Confidential – For Internal Use Only – Please Do Not Distribute
SUCCESS FACTORS AND BENEFITS Success Factors for Alliance Benefits of Alliance Alignment & Commitment Scale • Strong commitment from each • Increased lives under member organization and shared management means faster definition of success break-even and profitability Leadership & Physician Engagement • Physician-led governance structure Risk Pooling and strong executive leadership • Diffusion of risk across a large, • Willingness to delegate authority to diversified entity central entity ```` Detailed Roadmap & Business Case Quality & Value • Defined and quantified opportunity, • Refined best-in class critical milestones, investments, capabilities projected returns • Enhanced care coordination Change Management • Resources/focus to support Network transformational change • Robust and powerful network to management with physicians and manage care within ACO other stakeholders Source: Evolent Health, 2015 Confidential – For Internal Use Only – Please Do Not Distribute
REFERENCE SITE: PREMIER HEALTH Goal from CEO: • 4 hospitals, $1.8B in revenue • 50%+ market share 30% of revenue from value • 250+ owned physicians based care by 2018 • Strong reputation with consumers Medical Reduced ACS ED Utilization High-Technology declined by 26% Admission Rate Admissions Radiology Utilization (H1’14 over declined by 7% (H1’14 declined by 23% drove 14% of the (H1’14 over H1’13) H1’13) over H1’13) reduction in overall admissions Source: Evolent Health, 2015 Confidential – For Internal Use Only – Please Do Not Distribute
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