Mi Mid-Sou South M MGM GMA Febru ruary 28, y 28, 2019 2019 - - PowerPoint PPT Presentation

Mi Mid-Sou South M MGM GMA Febru ruary 28, y 28, 2019 2019

Age genda

• Value Based Care Overview
• Local Efforts
• Key Elements to Success

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Val alue Base Based Car Care O Overview

He Healthcare e Envi viron

• nmen

ent T Today

• Health care economics have changed – shifting from volume to value
• Market-driven accountability for quality, cost and value of healthcare
• Physicians lead the change emphasize value
• Employers want proof they are receiving quality care for the money are

spending

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• Delegates Credentialing for

UHC and CIGNA

• 366 Practices
• 2,085 Providers
• CIGNA and UHC Contracts
• 175 Practices
• 1,531 Providers
• MSSP Track 1
• Methodist Hospitals
• 14 Practices
• 402 Providers

MetroCare Physicians Trilogy CIN MSSP

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Key y Features s of Trilogy

• Physician-led and governed
• Independent, employed and university physicians working together
• Staff with years of local market experience
• Evidence-based guidelines to improve patient care, decrease cost,

and demonstrate value

• Improve Quality with Data Analytics
• $3 Million Investment in Optum Analytics
• Timely performance feedback to physicians

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Quality

Fee for Service Pay for Performance Shared Savings and Bundled Payments Affiliated Engaged Coordinated

Risk

Aggregation and Measurement

Shared Risk and Capitation High-Preforming

Performance and Improvement

Evolution of Value Based Care

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Improve Quality Identify High Risk Patients Care Coordination Cost Reduction Collaborate & Improve

Shared Savings and Bundled Payments Coordinated

Quality Report Distribution Cost Transparency and Utilization Analysis Integrate with Payer/Employer Programs

Evolution of Value Based Care

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Loc

• cal E

Efforts rts an and Su Succe ccess

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He HealthCh Choi

• ice T

e Trilogy gy C Com

• mmer

ercial A ACO Contracts

United HealthCare

Year 1 May 1 2016- April 30 2017 Year 2 May 1 2017- April 30 2018

Year 3 May 1 2018- April 30 2019

CIGNA

Year 1 October 1 2016- September 30 2017 Year 2 October 1 2017- September 30 2018

Year 3 October 1 2018- September 30 2019

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Un United ed He HealthCa Care

• 20,000 covered lives
• Shared savings, upside only (No Risk)
• Providers paid current fee for service
• Shared savings are created by efficient cost control
• Shared savings pool is retained by quality metrics

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• 70,000 covered lives
• Shared savings, upside only (No Risk)
• Providers paid current fee for service
• Shared savings are created by efficient cost control
• Shared savings pool is retained by quality metrics

Cigna Ac Accountable Care (CAC)

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Shared S Savi vings D Distri ributi tion

United HealthCare Year 2 CIGNA Year 1

• $1 million distributed to Trilogy

Clinically Integrated Network

• $1.8 million distributed to Trilogy

Clinically Integrated Network

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Measurem emen ents f from

• m Payer

ers

Outpatient Clinical Measures

• Screenings
• Breast Cancer
• Cervical Cancer
• Colorectal Cancer
• Appropriate Care
• Diabetes Care
• Low Back Pain
• Statin Use in CAD Patients

Hospital Based Clinical Measures

• Inpatient Focus
• Length of Stay
• All Cause Readmissions
• Escalation Rate
• Emergency Department Focus
• Visits per Thousand
• High Utilizer Visits per Thousand
• Avoidable Visits per Thousand

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Medicar are S Shared S Savings gs Program am ( (MSSP SSP)

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Shift of Medicare Reimbursements from Volume to Value-based*

2014 2016 2018 2011 $289.6 Billion $253.4 Billion $181 Billion $362 Billion $72.4 Billion $181 Billion $108.6 Billion 100% Volume Based 20% Value Based 80% Volume Based 30% Value Based 70% Volume Based 50% Volume Based 50% Value Based

Governmental

*All Financial figures based on 2014 Medicare Payments

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• $1.1 Billion in savings for 2017
• $780 Million in bonuses
• $313.7 million in net savings
• Saving generated by 60% of the participating ACOs
• 561 ACOS in MSSP
• 82% are Track 1

MSSP on a National S Scale

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Health Choice MSSP-De Demographics

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Category 3rd Q 2018 # 3rd Q 2018 % MSSP ACO Average % 3rd Q Total Bene from Distribution by Eligibility*

19,702 11,404

# Deaths 484 # Survived 19,218 % Distribution by Eligibility # Assigned Bene. % Aged Non-Dual 16,466 85.4% 81.24% % Aged Dual 769 3.99% 6.07% % Disabled 1,650 8.55% 11.50% % ESRD 403 2.09% 0.69% % Distribution by Age

19,702

% 0-64 2,436 12.4% 14.53% % 65-74 9,818 49.83% 45.51% % 75-84 5,579 28.32% 27.38% % 85+ 1,869 9.49% 11.40% % Distribution by Gender % Male 8,262 41.9% 0.43% % Female 11,440 58.1% 57.01%

Health Choice MSSP-Uti tilizati tion Metr trics

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HealthChoice 1st Q 2018 HealthChoice 2nd Q 2018 HealthChoice 3rd Q 2018 All MSSP 3rd Q 2018 2017 19,462 19,703 19,702 11,404 Utilization By Care Setting IP discharges per 1,000 285 290 282 282 306 Short-term discharges per 1,000 256 261 254 253 282 LTCH discharges per 1,000 1 1 1 1 2 IRF discharges per 1,000 22 22 21 22 11 IP Psych discharges per 1,000 6 6 6 6 7 SNF discharges per 1,000 22 20 20 20 53 OP ED visits per 1,000 643 633 621 607 686 IP ED visits (EDV that are admitted) 196 202 198 197 206 CT visits per 1,000 854 662 662 672 624 MRI visits per 1,000 277 191 190 193 225 Primary care visits per 1,000 (> = better) 8,804 8,678 8,722 8,838 9,752

• w. a PCP (> = better)

3,266 3,240 3,299 3,389 3,782

• w. a specialist

4,481 4,376 4,347 4,355 4,365

• w. a NP/PA/CNS

1,043 1,050 1,062 1,081 1,188

• w. a FQHC/RHC

14 11 12 14 34 Other Utilization Metrics Readmissions per 1,000* (30 day all cause) 161 166 not provided not provided not provided 30 day post discharge provider vists per 1,000 739 735 737 736 804 COPD discharges per 1,000 (add asthma 2nd Q) 6.67 6.98 6.63 6.53 8.76 CHF discharges per 1,000 16.38 17.73 17.10 18.09 16.09 Category (Per 1,000 Person Years)

Health Choice MSSP- Measurem emen ents

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Key y El Elements t ts to

• Su

Succ ccess ss

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Physician E Educati tion-Pharm rmacy

• Since 2017, Trilogy has been working with an Academic Detailing

Pharmacist through a relationship with the PBM, Express Scripts

• Initiatives Include
• Trilogy RX Report Newsletter
• Creation of clinical drug-information reference documents
• Actionable drug cost-savings opportunities for expensive meds
• Peer-Benchmarking reports for the prescribers
• Drug and Therapy Class Evaluations/ Clinical Reviews

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Physician E Educati tion-Pharm rmacy

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2019 T 2019 Tac actics

• HCC Coding
• Educational opportunities at

MetroCare

• Night program with Coding

Educator Steve Adams, University

• f Memphis, April 3rd
• Care Pathways for Following
• Diabetes Intensive Management
• CHF
• COPD
• Annual Wellness Visits
• Data reporting process beginning
• Initial roll out with MSSP
• Annual Preventive Visit
• Practice visits and data review

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Upcoming Edu ducationa nal O Opp pportunities

• Reporting Pediatric Services with

Attention to Value-Based Measures

• Basic Chart Auditing
• HCC Coding and Risk Adjustment
• Self- Auditing for HCC and Risk

Adjustment For Physicians

• Coding Bootcamp
• Modifiers for Physicians
• Getting It Right with Modifiers, &

Place of Service in 2019

• Dissecting & Coding OP Notes

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