Population Health and Wellness: 2 Stories from Cleveland Clinic - - PowerPoint PPT Presentation

Population Health and Wellness: 2 Stories from Cleveland Clinic

Elizabeth Sump Senior Director, Health Policy Cleveland Clinic

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2 population health stories

• Cleveland Clinic Employee Health Plan
• Cleveland Clinic Medicare Shared

Savings Plan

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“To ensure that our employees receive high quality evidence-driven health care that includes both prevention and treatment at a sustainable cost to the employee and the organization.”

E mploye e He alth Plan & Mission

Self- insured 52,000 employees 98,000+ covered lives $410M Book of Business

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E mploye e He alth Challe nge s

• Build a Culture of Wellness
• Support Healthy Life Style Choices
• Promote Personal Responsibility
• Use Accurate Objective Data
• Control Costs

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Tools

• Active Outreach/Care Coordination
• Care and Support Programs
• Financial Incentives
• Bully Pulpit

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Resources

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Caregiver Wellness EHP Employees (2009-2013) and EHP Employees + Spouses (2014-2016)

9% 27% 34% 50% 52% 51% 53% 51% 0% 10% 20% 30% 40% 50% 60%

Dec 2009 Dec 2010 Dec 2011 Dec 2012 Dec 2013 Dec 2014 Dec 2015 Dec 2016

2016 Goal: 55%

Percent of Unique Employees and Spouses with Diabetes, Hypertension, Asthma, Hyperlipidemia or BMI >27 enrolled in Care Management

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2009 vs. 2015 Change in Utilization, Cost and PMPM (Medical and Pharmacy Claims)

EHP primary members only; claims paid through November, 2016 PMPM normalized for ASC Grouper, PBB and 09/01/2010 rate change Includes pharmacy CMS subsidy, rebates and internal savings PBB = Provider Based Billing ASC = Ambulatory Surgery Center Milliman median commercial benchmark

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• 11.6%

29.3% 14.2% 14.2% 44.5%

• 20%
• 10%

0% 10% 20% 30% 40% 50%

EHP Metrics EHP vs. Milliman Benchmark

Utilization Unit Cost PMPM Median PMPM Milliman

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Pre vs. Post Care Management Enrollment Utilization Trend

1. Number of employees: Diabetes  1,945; HTN  2,510; Asthma  2,260 2. Non-normalized PMPM; claims incurred through 3Q16 and paid through 11/2016

14,603 15,399 16,493 16,422 16,115 4,747 5,931 6,608 7,211 6,699

• 4.5
• 4.0
• 3.5
• 3.0
• 2.5
• 2.0
• 1.5
• 1.0
• 0.5

0.0 2012 2013 2014 2015 2016 Not In Healthy Choice In Healthy Choice

Average Weight Gained or Lost by EHP Population by Healthy Choice Participation

Sources: Wellness database; Weight data from COACH, Epic, Fitness centers Weight data collected and aggregated with Ingenix Reports Number of Members in Yellow

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Estimated Percent of Tobacco Users EHP Employees and Spouses by Year

Sources: Clarity; Optum One CDR “Maximum Percent”: Assumes that members “Not Asked” are smokers

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2,464 2,707 2,908 3,407 3,605 3,309 3,430 3,242 2,900

9.7% 9.5% 8.5% 8.0% 7.5% 6.2% 6.4% 6.0% 5.2% 9.9% 9.6% 8.5% 8.4% 7.8% 6.5% 6.7% 6.3% 5.4%

0% 2% 4% 6% 8% 10% 12%

2008 2009 2010 2011 2012 2013 2014 2015 2016

# of Confirmed Smokers Confirmed Smoking % Max % (if no data = smoker)

Annual Trend 2004 - 2009 = 7.5% Annual Trend 2013 - YTD 2016 = 2.6% 0.5% Annual Trend 2010 - YTD 2016 = $220 $270 $320 $370 $420 $470 $520

Q2 04 Q3 04 Q4 04 Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12 Q1 13 Q2 13 Q3 13 Q4 13 Q1 14 Q2 14 Q3 14 Q4 14 Q1 15 Q2 15 Q3 15 Q4 15 Q1 16 Q2 16 Q3 16

Q1 04 to Q4 09 PMPM Q1 10 to Q3 16 PMPM

• Expon. (Q1 04 to Q4 09 PMPM)
• Expon. (Q1 10 to Q3 16 PMPM)

Trended EHP Paid PMPM by Quarter (Medical and Pharmacy Claims)

EHP primary members only ; claims paid through 11/30/16; Data Sources: EHP Warehouse, HCTA, EHP Financial Summary PMPM normalized for ASC Grouper, PBB , 09/01/2010 rate change and rate exception (April 2012 – March 2013) Includes pharmacy CMS subsidy, rebates, internal savings and error adjustment PBB = Provider Based Billing ASC = Ambulatory Surgery Center

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Estimated Cumulative Savings by “Bending the Trend” Since 2010

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• $50

$0 $50 $100 $150 $200

Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12 Q1 13 Q2 13 Q3 13 Q4 13 Q1 14 Q2 14 Q3 14 Q4 14 Q1 15 Q2 15 Q3 15 Q4 15 Q1 16 Q2 16 Q3 16

Cumulative Savings (in Millions)

$183,000,000

Source: EHP Financial Summary; claims paid through November, 2016

Cleveland Clinic Medicare ACO

• Medicare Shared Savings

Program – Upside only

• 4,000+ Cleveland Clinic

hospitals, employed physicians and select Independent PCPs

• CCMACO is at risk for ~

65,000 beneficiaries– Medicare Fee-For-Service

• Jan 1, 2015 – Dec 31, 2017

2012 2013 2014 2015 2016 2017

Medicare ACO Shared Savings Model

Historic Benchmark Adjusted Benchmark Beneficiary Expenditure Savings

Key Care Model Transformations

• Patient centered medical

home

• Care coordination
• Post-acute network
• Readmissions
• Care paths
• Population health analytics
• Teamwork

Target 2015 Spend

2015 Results

n = 62,600 Beneficiaries $10,110 $9,659

Best performing 1st year MSSP ACO Nationwide 6th best performance of all MSSP ACO’s

Performance Drivers

Inpatient 12% Skilled Nursing 21% 30-day All Cause Readmission

6%

Heart Failure Ischemic Vascular Disease All Cause Readmissions Tobacco Screening Falls Screening

90th

Diabetes Coronary Artery Disease Hypertension Breast Cancer Screening Colorectal Screening Pneumonia Vaccination

80th

Top Quartile Quality Performance

54,431 56,830 60,021 62,582 67,675 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 2012 2013 2014 2015 3Q2016

Total Medicare Shared Savings Program(MSSP) Beneficiaries

Number of 2016 beneficiaries 8.1% higher than 2015.

648 7,956 3,681 42,146 676 8,477 3,813 43,865 627 8,344 3,587 47,463 584 7,867 1,586 52,545 334 7,308 2,614 57,419 10,000 20,000 30,000 40,000 50,000 60,000 70,000 End Stage Renal Disease Disabled Aged/Dual Aged/Non-Dual

MSSP Membership by Enrollment Type

2012 2013 2014 2015 3Q2016

Aged/Dual Declines due to MyCare Ohio program Disabled Declines Likely due to Medicaid Expansion

377 2,580 828 257 841 276 355 2,350 810 244 858 273 304 1,634 739 199 816 251 291 1,558 697 192 807 254 500 1,000 1,500 2,000 2,500 3,000 Short Term Hospital Discharge Skilled Nursing Facility

• r Unit Utilization Days

Emergency Department Visits Emergency Department Visits that Lead to Hospitalizations Computed Tomography (CT) Events Magnetic Resonance Imaging (MRI) Events

Utilization Rates

2013 2014 2015 3Q2016

17.73 17.20 10.78 15.70 15.27 8.99 15.28 16.54 8.26 11.68 14.68 6.97 12.25 14.81 6.25

• 2.00

4.00 6.00 8.00 10.00 12.00 14.00 16.00 18.00 20.00 Chronic Obstructive Pulmonary Disease or Asthma Congestive Heart Failure Bacterial Pneumonia

Ambulatory Care Sensitive Conditions (Discharge Rates Per 1,000

Beneficiaries)

2012 2013 2014 2015 3Q2016

218 782 198 796 198 792 185 777 176 779 100 200 300 400 500 600 700 800 900 30-Day All-Cause Readmissions Per 1,000 Discharges 30-Day Post-Discharge Provider Visits Per 1,000 Discharges

Post Acute Utilization Rates

2012 2013 2014 2015 3Q2016

Lessons Learned

• Communication is Key!
• Employers are extremely effective at

delivering wellness messaging

• Incentives work
• Make it meaningful for the audience
• Cost and quality cannot be considered

independently of each other

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