HEALTHCARE WHAT ? REMEMBER WHEN? REMEMBER WHEN HEALTHCARE WAS - - PowerPoint PPT Presentation

HEALTHCARE WHAT ?

REMEMBER WHEN?

REMEMBER WHEN… HEALTHCARE WAS AFFORDABLE?

REMEMBER WHEN…

GAS WAS .25/GAL RENT WAS $92/MTH ANNUAL WAGES WAS $4,600 AVERAGE HOME COST $12,750 HEALTHCARE PER CAPITA WAS $134

Forbes…

In 1958, per capita health expenditures were $134. This may seem astonishingly small, but it actually includes everything, inclusive of care paid for by government or private health

• insurers. A worker earning the average wage in 1958 ($1.98)

would have had to work 118 hours—nearly 15 days--to cover this expense. By 2012, per capita health spending had climbed to $8,953. At the average wage, a typical worker would have to work 467 hours—about 58 days

Little More History: What we recognize as modern medicine began in the 1920s. That's when doctors and hospitals, having only during the previous decade learned enough about disease that they could be reliably helpful in treating sick people, began charging more than most individuals could easily pay. To close this gap, which worsened with the advent of the Great Depression, the administrator of Baylor Hospital in Dallas created a system that caught on elsewhere and eventually evolved into Blue Cross. The Blues were essentially nonprofit health insurers who served local community

• rganizations like the Elks. In exchange for a tax break, Blue Cross
• rganizations kept premiums reasonably low.

Cohn

As health-insurance costs rose during the 1970s and 1980s—driven both by improving medical technology and by the growing inefficiencies of the health-care system—health maintenance

• rganizations, which had been around since the beginning, began to

proliferate, along with other managed-care schemes. Like the Blues, HMOs became victims of their own success. Initially they were mainly nonprofit, but once again businesses spotted an opportunity and for-profit HMOs displaced nonprofit HMOs. (12 percent of the market was served by for-profits in 1981; by 1997, that was more like 65 percent.) With their bottom-line orientation, the for-profit HMOs were necessarily more aggressive about denying treatments. Cohn

Problem still remains: Not Accessible Not Affordable Solution: Remove the GRIP! Remove Layers Direct Care Direct Processing Technology

Improving Wellness starts with improving access, which stabilizes population health, but not monitoring or limiting access to “death”. By “Directing Care” you limit Fraud and Abuse, the highest category of “Cost”

• n this balance sheet.

Admit it! Medicine is a business, why not treat it like one? Improving access by directing care through technology, of each healthcare episodes need.

We call it, “Patient Care at the Point of Need”. Directing a patient to ‘their point of need’ the first time onset happens, whether chronic or episodic, through technology.

SB 741 Health Pass Plus

OKLAHOMA RURAL HEALTH INITIATIVE

• Directed & Delivered by SPMG – Southern Plains Medical Group
• Serving Oklahomans for over 100 years…

OKLAHOMA RURAL HEALTH INITIATIVE

SOUTHE HERN P PLAIN AINS MEDIC ICAL AL C CENTER D DBA A SMPG

• South Plains Medical Group is a 102-year old multidisciplinary Healthcare System

Primarily serving south west Oklahoma through its 5 locations in Grady and Caddo

• Counties. SPMG has affiliates 24 other counties managing the total of all populations

to include thousands of participants who receive benefits from the OHCA.

SPMG

Established:

• Southern Plains Medical Group was established and has been serving Central and Southwest

Oklahoma since 1915. SPMG is a true Multi Discipline Clinic. Role:

• SPMG is a healthcare organization that provides medical, surgical, diagnostic, therapeutic,

and preventative outpatient and inpatient medical care and services to patients of all ages.

Mission:

• SPMG will fulfill and expand its role, serving residents in Oklahoma, starting with those who reside in

Grady and Caddo counties. Purpose:

• The purpose of SPMG is to achieve consistent and sustainable growth, creating value for our patients,

employees, and shareholders, through the provision of exceptional healthcare services. Specialties:

• Cardiology, Family Practice, General & Vascular Surgery, Gynecology, Internal Medicine, Lab,

Occupational Medicine, Oncology, Ophthalmology, Orthopedics, Pain Management, Pediatrics, Podiatry, Radiology, Quick Care, Vision Center and Urology.

SPMG GOAL

• It is the Goal of SPMG and our affiliates to increase it

service to this population, its purpose to manage the total care of same population and offer a true medical home for this population. SPMG delivers healthcare through a proprietary trans-digital system on a medical software platform that interfaces, provides analytics, report-ability and education of real time patient data with the capacity to manage 822,961 lives (MCD enrollee’s as of 5/17/2017).

PURPOSE OF SPMG & ORHI

• Senate Bill 741 is ‘the’ vehicle allowing OHCA to grant a Pilot
• t Prog
• gram to any entity
• ffering the capability to provide services the total Medicaid population providing

direction and criteria to the Pilot Program assuring that it meets certain criteria and “if the funds are available”.

• As defined - Senate Bill 741 has no life.
• However, ORHI provides the entire network and operations currently existing – ‘the

structure’ which is the heartbeat for Senate Bill 741.

ORHI IS DEFINED AS

• A system that delivers medical services exclusively within a Medical Home/Managed Care

Structure to Medicaid recipients in Grady and Caddo. SPMG currently manages a significant number of these patients and has the capacity to manage all enrollees in these counties and beyond.

• Whe

hen hea ealth car are is prov

• vided an

and coordina nated by by an an integ egrated ed healthcare delivery syst stem it increases access, increa eases es quality of

• f care,

e, red educes es cost st, an and improv

• ves fiscal

acco ccountability.

ORHI’S PILOT PROGRAM INCORPORATES

 Virtual Audio Visits – Phone conference

• (Reducing Emergency Room Visits)

 TeleMedicine – Virtual Face Time Medicine (Reducing Emergency Room Visits)  Routing each patient to the po poin int of

• f thei

eir tr true car are need eed  24/7-Access to medical care  Complete Vision Services  Complete Diagnostics including Imaging and Lab inside of the system  All Medical Specialties (17 Medical Specialties)  Surgical Services (within the counties of service)  Rx Services (to include delivery for home bound)

OKLAHOMA RURAL HEALTH INITIATIVE

• Simply Put …
• A completely Integrated healthcare system optimizing internal resources for the coordination of care

inside 1 entity with 5 locations covering all specialties providing …

• Accessible
• Affordable
• Quality Healthcare
• At the point of need

SENATE BILL 741

• SB 741 clearly outlines a number of requirements that are priorities which ORHI has

built into its infrastructure satisfying ALL requirements of said ‘Bill’, while doing so, for approximately 57% - 60% less than current OHCA budgetary expenditures.

• Further, as a short-term strategy ORHI is prepared to duplicate this system in all other

rural and metro counties over the next 48-months beginning in SW rural Oklahoma and moving forward from there.

SB 741

Platform - to encourage the timely and appropriate use of primary care services in lieu of emergency room utilization. Main goal is to re route ER visits to Primary Care “Appropriate Care”

• We can send them to an OP consult first with a surgeon and so on…again Imaging, CT, and MRI. A regular PCP may not have

digital X-Ray, PCP, and MRI. So again they are sending them out. So not only are we sending to Primary Care instead of ER, we are also checking with Internal Medicine, Surgery, etc. and thus saving more and more visits from the ER.

• Functionally speaking, this is not practical or realistic, not specific, multiple compliance issue, no continuum of care, each entity repeat

functions and a breakdown in duplicity of services as each PCP office is diverse as well as the treatment path.

SB 741 SPECIFIC OBJECTIVES

1) Educational strategies to increase health literacy for participants in the Oklahoma Medicaid Program; Center of Diabetes Excellence, the patients will also get educated by specialty providers instead of ER, by PC instead of ER. Each patient we touch we supply with education on their health, as well we can have handouts and do have handouts regarding diabetes and

• ther illnesses.

SB 741 SPECIFIC OBJECTIVES

• 2. Technology-based monitoring
• Proprietary
• Patient Portal
• Education after every encounter
• Phone
• TeleMedicine
• Rx - onsite

ORHI & SPMG offers state-of-the-art monitoring through our proprietary Medical Software Kareo, real time treatment, real time report ability, as well as trans-digital capabilities, patient portals for education and consultation all as a part of the software design that allows direct interface with the MCD platform.

SB 741 SPECIFIC OBJECTIVES

3. Co-payment structures as provided for in and other payment arrangements; and… ORHI proposes a “Flat Fee” pay model where by the Medicaid recipient simple pays a $0 visit fee to any service related or provided in the treatment process, to include imaging, lab, Rx, OV, etc. Within the pilot Program OHCA simply pays SPMG a flat fee of $100 per Medicaid recipient/month for those in Grady and Caddo County covering the totality of services rendered by and through the “Service Agreement”.

SB 741 SPECIFIC OBJECTIVES

C. The Oklahoma Health Care Authority shall develop and implement a telephone information health line pilot program under which physicians are available by telephone twenty-four (24) hours a day to answer medical questions and provide health information for the Medicaid population.

• If the H

Health C Care Authority d deter ermines that t the p pilot program r reduces

• unneces

essary em emergency r room visits and the p pilot program d demonstrates a a

• net c

cost st-savings, the H Heal alth Care A Authority s shal all e expand the p program am

• into a

a statewide initiative.

• They w

will expand s services if the p program reduces unnecessary ER visi sits, s, a and d demonstrates s cost sa savings. s. OHRI/SPMG – DONE! TeleMed ed/AudioMed 24/ 4/7… 7…

• D. The Oklahoma Health Care Authority and the State Department of Health shall

evaluate and report findings relevant to the provisions of subsection A of this section. to the Governor and the Legislature by January 1, 2019. ORHI & SP SPMG wou

• uld el

elec ect to repor

• rt to the

he Adviso sory Committee on

• n a quarterly ba

basis. ORHI Adviso sory Committee will have two members each of the following:  2 OHCA  2 Legislators  2 SPMG (Functional Medical)  2 ORHI (Administrative/Reporting & Oversight Entity)

HEALTH CARE FACTS

• 4/1,000 will need some type of hospitalization in a year period
• 90% of all care can be cared for inside of our current model
• Avg hospital bill less than $50,000
• First - Vet through MedFlash – SPMG program
• Second - Vet them through TeleMedicine
• Third – go directly to a service site for exactly what’s required
• ER Visits? Why? Statistically required only .004% of the time. Emergent ONLY directed by

a Provider not as a Frist Line Therapy as being currently used to include excessive treating and Dx.

• Oklahoma City Average cost for an MRI based on HealthCare BlueBook is $1100-$1200 with the

Rural Health Markets being around $1400-$1600 average.

• GRADY COUNTY
• Pop. Covered by Medicaid

22.00%

• Expenditures

$44, 4,116, 6,046 46

• Average M

Monthly Per Members $31 310

• ORHI will provide the care for $100 per month per member cutting the current budget

cutting the current budget by a estimated 43% or $18,116,046 to upwards of 63% (more to upwards of 63% (more likely) or $27,793,109 (predictable expenditure reduction of expenditure reduction of $27, 7,793, 793,109. 09.

• CADDO COUNTY
• Pop. Covered by Medicaid

35.00%

• Expenditures

$32, 32,495, 495,353 353

• Average M

Monthly/Members $260 260

• ORHI will provide the care for $100 per month per member cutting the current budget

by a minimum of 47% or $15,852,353 to upwards of 61% (more likely) or $19,822,165 (predictable expenditure reduction of $19, 9,822, 822,165. 65.

Phase I Grady & Caddo Counties Current expenditures $76,611 611,399 Grady County Medicaid Savings est: at 63% 63% o

• r $27,

7,793 793,109 09 Caddo County Medicaid Savings est: at 61% o

• r $19,

9,822, 822,165 Anticipated Expenditure Reduction $47,615,274 How? Increase Access, Increase Quality, Manage how the Care is accessed focused to the point of need not Carte Blanche.

• Phase II
• ORHI will request the incorporation in year 2 of is affiliate operation of 17 additional

Counties SE Oklahoma Current expenditures $1.844 billion Anticipated Expenditure Reduction $1.16 billion How? Increase Access, Increase Quality, Manage how the Care is accessed focused to the point of need not Carte Blanche.

SUMMARY

• When care is coordinated by one entity that control all aspects of the care with real time

report ability, across a totally connected system, cost goes down, and access to care goes

• up. SPMG provides a turn key solution. Processes, software, providers, staff,

communications, and technology are already in place and currently servicing half of the Medicaid population needs, with capacity and affiliations to easily accommodate the remaining members in Grady and Caddo Counties and beyond.

• SPMG is ready to ready to commit to the ORHI Pilot Program and is able to launch this

pilot project in the 3rd and 4th quarter of 2017 to begin treatment and saving January 1, 2018.