Sutter Health Plus Joint Labor Management County of Sacramento - - PowerPoint PPT Presentation

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Sutter Health Plus Joint Labor Management County of Sacramento Calendar Year 2016 Presented by Alicia Aguilera Account Manager Jennifer Nuovo, M.D. Chief Medical Officer Patrick Robinson, RPh Pharmacy Director

Agenda

 Introduction to Sutter Health Plus  Group Demographics  Medical Utilization  Pharmacy Utilization  Sutter Health Plus Member Services  Health and Wellness

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Grow With Us

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Sutter Health Plus Service Area

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Sutter Health’s Medical Network - History

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CPMC Davies Campus, formerly German Hospital,1878 Sutter Medical Center, Sacramento, formerly Sutter Hospital, 1923 Alta Bates, formerly Alta Bates Sanitarium, 1905 Mills-Peninsula Medical Center, formerly Church of

• St. Matthew Red Cross

Guild, 1908 Sutter Santa Rosa Regional Hospital, formerly a small community hospital, 1937 (founded 1867)

By the Numbers

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5,000+

Physicians

60,000

Members

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Urgent Care

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Walk-In Care

El Dorado Hills, Elk Grove, Roseville

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Northern California Counties

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Hospitals and Campuses

Group Demographics

County of Sacramento All Sutter Health Plus Municipalities Comparison Subscribers 2,047

• Members

4,463

• Average Age

33.2 32.6 .6 Years older Gender (% Female) 53.3% 52.2 1.2% Higher Active Employee % Retention 2016 - 2017 92.1%

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Group Demographics

8 1,919 795 188 2,091 976 190 2,266 1,334 211 2,508 1,947 244 500 1000 1500 2000 2500 3000 Active HMO Active HDHP Early Retiree Members

Membership by Medical Benefit Plan Choice

Jan 2014 (2902 Members) Jan 2015 (3257 Members) Jan 2016 (3811 Members) Jan 2017 (4699 Members)

Group Demographics

9 1,919 795 188 2,091 976 190 2,266 1,334 211 2,508 1,947 244 9.0% 22.8% 1.1% 8.4% 36.7% 11.1% 10.7% 46.0% 15.6%

• 500

1,000 1,500 2,000 2,500 3,000 HMO HDHP HMO Active Active Early Retiree Members

Growth by Plan Type

Jan 2014 (2902 Members) Jan 2015 (3257 Members) Jan 2016 (3811 Members) Jan 2017 (4699 Members)

Group Demographics

10 1,054 865 400 395 112 76 1,149 942 494 482 105 85 1,252 1,014 660 674 117 94 1,364 1,144 987 960 136 108

• 200

400 600 800 1,000 1,200 1,400 1,600 F M F M F M Active HMO Active HMO Active HDHP Active HDHP Early Retiree Early Retiree Members

Membership by Gender

Jan 2014 (2902 Members) Jan 2015 (3257 Members) Jan 2016 (3811 Members) Jan 2017 (4699 Members)

Member Retention

11 90.9% 88.0% 80.6% 91.3% 90.1% 79.4% 91.9% 92.4% 81.5% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Active HMO Active HDHP Early Retiree Retention Percentage

Year over year Retention Percentage

Retention Percentage Jan 2014 - Jan 2015 Retention Percentage Jan 2015 - Jan 2016 Retention Percentage Jan 2016 - Jan 2017

Medical Utilization Percentage by Gender

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90% 80% 83% 69% 89% 80% 82% 71% 0% 20% 40% 60% 80% 100% HMO HDHP HMO HDHP Female Male

Percentage Utilization

2015 2016

Medical Utilization Percentage by Plan Type

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86% 74% 93% 89% 85% 75% 93% 80% 0% 20% 40% 60% 80% 100% HMO HDHP HMO HDHP Active Early Retiree

Percentage Utilization

2015 2016

Hospital Inpatient Services: Admits PTMPY

14 52.5 54.8 56.2 50.1 55.4 59.6 53.6 48.2 10 20 30 40 50 60 70 Q1 Q2 Q3 Q4 Admits PTMPY 2015 2016 Milliman Moderatly Managed Benchmark = 47.85 Milliman Well Managed Benchmark = 41.32

Hospital Inpatient Services: Admits PTMPY*

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*Excludes Maternity, Newborn, Psych, Detox and Skilled Nursing

36.6 31.0 40.1 31.2 31.4 45.2 27.8 39.5 10 20 30 40 50 60 Q1 Q2 Q3 Q4 Admits PTMPY 2015 2016 Milliman Moderatly Managed Benchmark = 47.85 Milliman Well Managed Benchmark = 41.32 Comparable Groups

Hospital Inpatient Services: Average Length of Stay

16 3.7 2.7 3.4 3.7 2.4 3.4 4.0 4.5 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Q1 Q2 Q3 Q4 Average Length of Stay 2015 2016 Milliman Moderatly Managed Benchmark = 4.23 Milliman Well Managed Benchmark = 3.72

Hospital Inpatient Services: Average Length of Stay

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*Excludes Maternity, Newborn, Psych, Detox and Skilled Nursing

3.3 2.3 3.2 2.5 2.3 3.4 3.2 3.0 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 Q1 Q2 Q3 Q4 Average Length of Stay 2015 2016 Milliman Moderatly Managed Benchmark = 4.23 Milliman Well Managed Benchmark = 3.72 Comparable Groups

Urgent Care Visits PTMPY

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87.9 83.4 74.5 56.8 85.8 66.8 52.6 53.0 20 40 60 80 100 120 Q1 Q2 Q3 Q4 Urgent Care Visits PTMPY 2015 2016 Milliman P25 = 84.7 Milliman P50 = 114.0 Comparative Groups

ER Visits PTMPY

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164.8 194.1 183.5 188.3 191.4 190.1 164.8 175.4 50 100 150 200 250 Q1 Q2 Q3 Q4 ER Visits PTMPY 2015 2016 Milliman P25 = 175.1 Milliman P50 = 211.0 Comparative Groups

Walk-In Care

Roseville, Elk Grove and El Dorado Hills

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HEDIS: Breast Cancer Screening

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2016 Measurement Year

78.3% 79.0% 70% 72% 74% 76% 78% 80% % of Population Screened

HEDIS Breast Cancer Screening

County of Sacramento All SHP 2015 HEDIS 95% Percentile = 77.5%

HEDIS: Statin Therapy for Patients with Diabetes*

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New HEDIS measurement for 2016

47.8% 50.7% 0% 10% 20% 30% 40% 50% 60% % of Population That Received Statin Therapy

% of Population That Received Statin Therapy

County of Sacramento All SHP

HEDIS: Statin Therapy for Patients with Cardiovascular Disease

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New HEDIS measurement for 2016

50.0% 60.8% 0% 10% 20% 30% 40% 50% 60% 70% % of Population That Received Statin Therapy

% of Population That Received Statin Therapy

County of Sacramento All SHP

Well-child preventive Care

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Asthma Medication Ratio

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2016 Measurement Year

77.9% 77.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% % of Population

Percentage of population with Asthma Controller to Total Medication Ratio > 0.50

County of Sacramento All SHP 2015 HEDIS 95% Percentile = 73.9

Obesity*

26 8.3% 9.1% 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 2015 2016 Percent of Members with a PCP Visit

*Percentage based on diagnosis during a Physician encounter

Diabetes

27 4.1% 4.10% 9.81% 0% 2% 4% 6% 8% 10% 12% % of Membership % of Total Medical Cost % of Rx Cost

Top 10 Therapeutic Classes by Total Claims

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Disease State Claims % of Total Cost % Generic Cost / Rx

CARDIOVASCULAR DISEASE - HYPERTENSION 6,252 4.9% 97% $35 BEHAVIORAL HEALTH - ANTIDEPRESSANTS 4,264 3.2% 95% $34 BEHAVIORAL HEALTH - OTHER 3,404 6.2% 85% $81 PAIN MANAGEMENT - ANALGESICS 2,917 3.7% 94% $57 INFECTIOUS DISEASE - BACTERIAL 2,287 1.2% 99% $23 CARDIOVASCULAR DISEASE - LIPID IRREGULARITY 2,112 1.5% 94% $33 DIABETES 2,089 9.3% 53% $198 CONTRACEPTION 2,084 1.4% 93% $31 ASTHMA AND COPD 1,915 7.2% 31% $167 UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE 1,899 1.2% 94% $28 % of Total 66.4% 39.8%

Top 10 Brand Rx (Excluding Specialty) by Volume

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Drug Name Therapeutic Class % of Total Cost Claims Cost / Rx

PROAIR HFA ASTHMA AND COPD 0.5% 426 $57 SYNTHROID ENDOCRINE DISORDER - THYROID 0.2% 223 $38 ADDERALL XR BEHAVIORAL HEALTH - OTHER 1.2% 206 $251 ADVAIR DISKUS ASTHMA AND COPD 1.5% 197 $341 VENTOLIN HFA ASTHMA AND COPD 0.2% 156 $53 LANTUS SOLOSTAR DIABETES 1.6% 136 $511 QVAR ASTHMA AND COPD 0.5% 122 $182 NUVARING CONTRACEPTION/OXYTOCICS 0.3% 114 $125 LYRICA SEIZURE DISORDER 1.2% 113 $463 JANUVIA DIABETES 1.0% 109 $420 % of Total 8.2% 4.1%

Top 10 Generic by Cost

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Drug Name Therapeutic Class % of Total Cost Claims Cost / Rx HYDROCODONE-ACETAMINOPHEN PAIN MANAGEMENT - ANALGESICS 0.6% 1405 $19.53 LEVOTHYROXINE SODIUM ENDOCRINE DISORDER - THYROID 0.3% 974 $14.20 ATORVASTATIN CALCIUM CARDIOVASCULAR DISEASE - LIPID IRREGULARITY 0.1% 925 $6.10 FLUTICASONE PROPIONATE ALLERGY 0.1% 754 $6.83 IBUPROFEN INFLAMMATORY DISEASE 0.1% 633 $5.98 OMEPRAZOLE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE 0.1% 837 $4.03 SERTRALINE HCL BEHAVIORAL HEALTH - ANTIDEPRESSANTS 0.1% 563 $5.85 LISINOPRIL CARDIOVASCULAR DISEASE - HYPERTENSION 0.1% 1121 $2.93 METFORMIN HCL DIABETES 0.1% 503 $4.61 AMLODIPINE BESYLATE CARDIOVASCULAR DISEASE - HYPERTENSION 0.0% 616 $2.90 % of Total 1.6% 18.9%

Top 10 Specialty by Total Drug Cost

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Drug Name Therapeutic Class % of Total Cost Cost / Rx

COPAXONE NEUROLOGICAL DISEASE - MISCELLANEOUS 4.7% $5,241 ENBREL INFLAMMATORY DISEASE 3.7% $5,225 AFINITOR NEOPLASTIC DISEASE 2.6% $11,656 ADEMPAS CARDIOVASCULAR DISEASE - HYPERTENSION 2.5% $7,573 HARVONI INFECTIOUS DISEASE - VIRAL 2.1% $30,758 TECFIDERA NEUROLOGICAL DISEASE - MISCELLANEOUS 2.0% $6,028 HUMIRA PEN INFLAMMATORY DISEASE 2.0% $3,853 EPCLUSA INFECTIOUS DISEASE - VIRAL 1.7% $24,561 AUBAGIO NEUROLOGICAL DISEASE - MISCELLANEOUS 1.5% $5,744 NEXAVAR NEOPLASTIC DISEASE 1.3% $7,249 % of Total 24.1%

Rx Utilization

32 14.5% 84.6% 0.9%

Employer Group Utilization

Brand Generic Specialty 12.4% 86.7% 0.9%

Overall Plan Utilization

Cost/Rx County of Sacramento % of Total Cost All SHP % of Total Cost Brand $311 44.5% $270 39.5% Generic $25 20.8% $21 21.7% Specialty $3,828 34.7% $3,599 38.7%

Mail Order Pharmacy

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Top 5% High Cost Members

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5.0% 59.8% 19.6%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Total Membership (189 members) % of Total Cost % of Pharmacy Cost

High Cost Members

Disease Category % Of Total Cost % of Membership Diseases of the heart 4.0% 1.3% Diseases of the urinary system 3.6% 1.4% Spondylosis; intervertebral disc disorders; other back problems [205.] 2.0% 1.5% Intracranial injury [233.] 1.9% 0.1% Cerebrovascular disease 1.8% 0.3%

Top 16% High Cost Members

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16.0% 80.0% 45.1%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Total Membership (611 members) % of Total Cost % of Pharmacy Cost

High Cost Members

Disease Category % Of Total Cost % of Membership Diseases of the heart 6.2% 7.0% Diseases of the urinary system 4.6% 10.3% Spondylosis; intervertebral disc disorders; other back problems [205.] 3.5% 12.4% Diseases of female genital organs 2.4% 11.4% Non-traumatic joint disorders 2.2% 15.0%

Preventive Rx

36 1,196 23 123 42 9 1,996 259 233 104 86 2,083 362 261 81 29 500 1,000 1,500 2,000 2,500 Contraception vitamin, minerals, electrolytes Vaccines Aspirin Smoking Cessation Claims 2014 2015 2016

Rx Adherence*

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*Measure is based on the PQA measure for Proportion of Days Covered (PDC). Adherence is (days of medication on hand in 2016)/(Days since initial prescription) ratio greater than 80%. Continuous enrollment with no more than

• ne gap of 1 month or less.

HDHP Adherent Members HMO Adherent Members Percentage Percentage

DIABETES 66.7% 62.2% HYPERTENSION 63.9% 77.5% STATINS FOR HIGH COLESTEROL 70.2% 66.7%

Disease Management

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*Similar groups include other large municipalities

12.5% 4.1% 0.3% 12.9% 12.6% 10.2% 8.9% 3.0% 0.3% 9.5% 9.2% 7.2% 0% 5% 10% 15% 20% 25% 30% Asthma Diabetes Heart Failure Hypertension Lipids Multiple Disease Management Programs % of Total Membership % of County of Sacramento Membership % of Membership in Similar Municipalities Total County of Sacramento Membership = 28% Total Similar Municipalities = 21%

Health and Wellness

 Wellness Coaching Program for healthy weight, tobacco

cessation and stress management

 Disease Management Program for asthma, heart failure,

diabetes, high blood pressure, high cholesterol

 Personal Health Assessment  24/7 Nurse Advice Line  sutterhealthplus.org/wellness

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SHP Health & Wellness Program Update

Wellness – No or Approaching Risk Low Risk (Rising Risk) Complex Case Management

Disease Management

(DM) End of Life/ AIM ACA Requirements:

• New Member Welcome Calls
• Health Coaching (Smoking, Stress

Mgt, Weight Mgt)

• TBD: Targeted Prevention Outreach

(Colorectal CA Screening, Breast CA

Screening, etc.), Preventive Mailings

NCQA Focus:

• Targeted Health Coaching for

members with DM diagnoses or at high-risk for DM

NCQA Focus:

• Targeted Telephonic Disease Management

for members with chronic condition(s)

NCQA Focus:

• Targeted for member with Complex Case

Management needs

Nurse Advice Line

*Evaluate with ARQS system initiative

Wellness Coaching Program

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Sutter Health Plus - Wellness Program Update

Components Where/How Comments Online Health Risk Appraisal SHP Member Portal Members can evaluate their health risk score on an annual basis Online Self Management Tools SHP Member Portal Available at any time during the year to help members make positive changes Educational Clinical Library and Decision support tools SHP Member Portal Scheduled to start July 2017 Member Newsletters SHP Member Portal Mailed 3-4 times/year Health Coaching (tobacco cessation, stress mgt, weight mgt, heart health) SHP Utilizes proven behavior change methodologies to support lasting changes

Sutter Health Plus - Wellness Program Update

Components Where/How Comments Preventive Services PCP Office Guidelines available on-line and Mailed annually Targeted Outreach on Missed Preventive Metrics (screenings & services) Telephonic Support Staff Scheduled to start July 2017 (examples include breast cancer screening & colorectal cancer screening)

Opportunities and Observations

 Reduce Emergency Room visits  Increase mail order utilization  Increase participation in telephonic health coaching and

• n-line wellness tools

 Increase healthy lifestyle awareness to reduce or avoid

the use of medication for diabetes

 Manage and retain the small number of members with

severe illness which account for a significant amount of the utilization

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Qualifordability—It’s Who We Are.

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Quality and Affordability in a health plan? With Sutter Health Plus the sky’s the limit.

Appendix

1.

COBRA Accounts are rolled up to the Active Employees sub-accounts

2.

Medical Utilization is measured as members with any medical claims or encounters. Excludes Pharmacy utilization

3.

Visits may include multiple institutional or professional claims on the same date of service.

4.

PMPY – Per Member Per Year – Calculated as X/ (Active Membership during measurement period)

5.

Institutional – IP & OP (any encounter/claim billed on a UB-04)

6.

Professional – any encounter/claim billed on a HCFA 1500 (CMS-1500), regardless of POS

7.

Common conditions grouped by primary diagnosis (ICD-9 and ICD-10)

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Excludes Maternity, Mental Health, Skilled Nursing Facilities

9.

PTMPY – Per Thousand Members Per Year – Calculated as X/(Member Months *12000)

10.

Includes both office and pharmacy administered vaccines

11.

Specialty drugs are high cost drugs that treat chronic or complex diseases. They are usually injectable, infused and oral or inhaled drugs that require unique patient training, safety monitoring, or handling, shipping and storage.

12.

Total combined cost is 70% plus 100% of Drug Cost

13.

Interactions with the member services call center

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