narrow networks: why physician quality should drive your benefits strategy

1 | © 2015 Grand Rounds, Inc. [email protected]

Network Optimization: Why Physician Quality Should Drive Your Benefits Strategy


Agenda

• Introduction• Network Design Trends• Innovative Ways Employers Are Optimizing

Networks • Wrap Up


Agenda




Network Design Trends Over Time

Time

Net

wor

k Co

vera

ge

Very Narrow

Very Broad

1970s

HMO Era

1980s 1990s 2000s Today

PPO Era

Narrow Networks

EPOs


38%

32%

30%Ultra-narrowNarrowBroad

Narrow Networks and EPOs – Employers and Carriers

Source: McKinsey Center for U.S. Health System Reform, Nov 2013. McKinsey & Company.

2014 individual exchange (N = 120). Pct of analyzed silver networks

Network distribution on public exchange:

Public exchanges exhibit high percentage of narrow networks


Coverage Restrictions for Academic Medical Centers

35% 94%vs.

Ultra-narrownetworks

Broadnetworks

Networks with Academic Medical Centers in network



Employer Value - Narrow Networks

26% savings between narrow

network and broad offering



So Narrow Networks Are Here, But What Do Employees Think?


Narrow Networks and EPOs – Consumer Perspectives

Source: Kaiser Family Foundation Health Tracking Poll, Feb 2014

Narrow and affordable

Broad and more expensive

Network Choice

51%37%

Which type of health insurance plan would you rather have?


Narrow Networks and EPOs – Consumer Perspectives

Source: Kaiser Family Foundation Health Tracking Poll, Feb 2014

Narrow and affordable

Broad and more expensive

Network Choice

63%23%

Of the 37% who chose narrow and affordable - What if you would not be able to visit the doctors and hospitals you usually use?


The Achilles Heel of Narrow Networks

• Employees think employers are only concerned with cost savings

• Patients don’t trust the quality of physicians in narrowed network


Agenda




1. Direct to InstitutionNetworks

2. Customized Networks

3. Optimized and Augmented Networks

Innovative Solutions Addressing The Cost – Quality Issue

Significant Plan Change Moderate Plan Change No Plan Change


1. Direct to Institutions Boeing Approach


1. Direct to Institutions: Boeing Approach

• It is hard multi-year investment

• Needs to actually impact care to improve cost / outcomes

• Member communication is critical

Source: Boing Preferred Partnership ACO presentation, MBGH


2. Customized NetworksNew Alternative Payors


2. Customized Networks:New Payers

• Strong value & outcomes

• Risk of payer and member push back

• Often look at institutional quality only

• Best suited to geographically concentrated populations


3. Optimized NetworksGrand Rounds Approach


Help patients and organizations achieve measurably better outcomesOur mission at Grand Rounds

Watch a 2 minute patient testimonial. Click here.

https://www.youtube.com/watch?v=AzNRL-5nWng

https://www.youtube.com/watch?v=AzNRL-5nWng


3. Optimized and Augmented Network:Grand Rounds Approach

• Diagnose the Problem with Data

• Influence Physician Choice for Doctor Visits

• Augment Network through Second Opinions


Accessibility of physician level quality data has grown exponentiallyDiagnose the Problem with Data

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Provider Level Data

Source: Reuters Health (Dec 2014) overviewing research Published in JAMA Internal Medicine

Selected states disclosing surgical outcomes data

CMS, medical societies, and additional states begin disclosing outcomes data

State APCDs and commercial data vendors begin selling administrative claims data

Individual hospitals and group practices begin disclosing outcomes data


Quality scores are based on vast, newly available datasetsGrand Rounds Physician Quality Algorithm

PatientOutcomes Training Expertise Practice

AffiliationAwards &

Publications the top

of doctors

10%7 billion clinical data points analyzed with >96%

physicians evaluated


Influence Physician Choices - Average Physician Quality In Orthopedics

Based on quality algorithm output for each HSA with 3+ orthopedists


Influence Physician Choices – With Physician Quality Optimization


Top quality physicians achieve:• 15% lower hospital admission rates• 20–25% lower complication rates• 30–40% lower mortality rates• $1800 saved per office visit case

Optimize Network By Channeling Care


Augment Network Through Second Opinions


Remote expert opinions achieve:• 66% change diagnosis or treatment plan• 2x faster return to work• 40% removal unnecessary surgeries• $10k+ saved per case

Patient

Expert Physician

Augment Network With Expert Opinions


Grand Rounds Customers See Real, Immediate Impact

Talent Retention

MeasurableROI Achieved

MeaningfulPatient Impact

World-class health benefit for employees

20-25% lower complication rates

$1800 saved per visit and $10k+ per opinion


Agenda




Concluding Remarks

Traditional narrow networks:

• Tradeoff between cost, coverage and quality

• Patient backlash and confusion

• Implementation pains from switching networks

Optimized and augmented network design:

• Reduced costs by focus on quality

• No patient frustration

• Current network maintained


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narrow networks: why physician quality should drive your benefits strategy

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