prosetta inc. peter bernard has nothing to samuel skootsky...

12/10/2013

1

Health Systems as Employers

Molly J. Coye, MD, MPH, Chief Innovation Officer, UCLA Health Bradley Wozney, MD, Family Physician and Medical Director, Ambulatory Quality and Informatics, Bellin Health Peter J. Bernard, CEO, Bon Secours Virginia Health System Samuel A. Skootsky, MD, Chief Medical Officer, UCLA Faculty Practice Group and Medical Group

RFB – Rapid Fire Workshop

December 10, 2013 11:15 a.m. – 12:30 p.m.

Dr. Coye discloses serving as a

board member for Aetna Inc. and

holds stock or stock options from

Prosetta Inc.

Peter Bernard has nothing to

disclose.

Samuel Skootsky, MD has nothing

to disclose.

Session Objectives

Explain how Bellin Health, Bon Secours Health System –

Virginia, and UCLA have framed their risk as employers,

selected innovations to improve employee engagement

and health, and the results they have achieved.

Describe how these systems have engaged employees,

and which platforms and programs have been most

successful

Identify Barriers & Opportunities along the way that

provide Insights into Creating a Healthy Workforce

Point to the ability to Leverage Methodology & Learnings

for other Population Segments

P2

12/10/2013

2

Cumulative Increases in Health Insurance Premiums,

Workers’ Contributions to Premiums, Inflation, and

Workers’ Earnings, 1999-2013

57%

119%

182%

56%

117%

196%

14%

34%

50%

11%

29%

40%

0%

50%

100%

150%

200%

250%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Health Insurance Premiums

Workers' Contribution to Premiums

Workers' Earnings

Overall Inflation

SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2013. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2013; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2013 (April to April).

P3

* Estimate is statistically different from estimate for the previous year shown (p<.05).

SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2013.

Average Annual Premiums for Single and Family Coverage, 1999-2013

$16,351*

$15,745*

$15,073*

$13,770*

$13,375*

$12,680*

$12,106*

$11,480*

$10,880*

$9,950*

$9,068*

$8,003*

$7,061*

$6,438*

$5,791

$5,884*

$5,615*

$5,429*

$5,049*

$4,824

$4,704*

$4,479*

$4,242*

$4,024*

$3,695*

$3,383*

$3,083*

$2,689*

$2,471*

$2,196

$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000

2013

2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

2002

2001

2000

1999Single Coverage

Family Coverage

12/10/2013

3

Context: Transformation

Video

P5

http://www.youtube.com/watch?v=LsJiGF_Groo

A key aspect of Innovation Is Engaging

Stakeholders in the Process of Transformation

Example: • PCMH + population health management components • Five clinics in six months: 33,000 patients • Rapid replication to 14 clinics: 100,000 patients • Completed replication 26 clinics 160,000 patients • Platform for continuous introduction, design, testing and deployment

Planning Phase Design Phase Implementation

Phase Operations Phase

TRANSFORMATION

Define Charter

Innovation Life Cycle

Design Deploy Pilot Evaluate Exchange

P6

http://www.youtube.com/watch?v=LsJiGF_Groo

12/10/2013

4

The Transformation Process

Design/ Implement/ Operationalize

For Accelerated Replication and Scalability

Leadership Team

Design Team Implementation

Team(s) Evaluation

Team Sustainable Operations

• Establish High Level Project Objectives

• Establish Quick Hits • Define Design Team

Charge • Define metrics for

success

• Apply the specific approach and methodology to accelerate the implementation of and sustainability of the objectives

• Apply the process of rapid cycle scalability and replicability

• Define the application of the implementation and operationalization process

• Implements/operationalizes across the systems

• Innovation Science teams

P7

UCLA Innovation/Transformation Model

Replication and Scalability

Design Processes,

Refine Metrics

Document Processes and Metrics,

Identify Scalable and Replicable Components

Share, Advise Others, Replicate and Scale,

Accelerated Spread

12/10/2013

5

Peter J. Bernard

CEO, Bon Secours Virginia Health System

P9

Bon Secours Virginia P10

12/10/2013

6

Employee Focused Culture P11

Program Design

Sources: Bon Secours Virginia Health System, 2013

P12

12/10/2013

7

Value Based Care Delivery P13

Program Timeline


P14

BSV Employee

ACO

2010-present

BSV Expansion to Spouses/Significant Others and Children

(4-13)

2013

MSSP 2013

Replication of Employee

ACO by Bon Secours Health System

(BSHSI) in Additional

States

2013

BSV Expansion to

Employee Dependents Ages 14-26

2014

Replication to Spouses/Significant Others and Children with BSHSI in

additional states 2014

Replication to BSHSI

Employee Dependents Ages 14-26

2015

12/10/2013

8

Program Outline


P15

+ =

or or =

Biometrics Online Profile

50 Challenges Outcomes Coaching

PHA

$300

Routine Physical

$300

Healthy Weight

$300

=

Program Highlights


P16

12/10/2013

9

2012: Early Signs of Success


P17

2012 Total Health Insurance Benefit Expense vs. National Trends

2013 -2.2%

2012

2013: Progress to Date


P18

Decreased admissions per 1,000

Decreased ED Visits per 1,000

Increased in-Network Utilization

Increased Urgent Care & PCP Visits per 1,000

Increased Wellness Exams for the Population

12/10/2013

10

2014: Continuing the Journey


P19

Beyond Employee Populations


P20

30,000 Employees & Dependents across all of the in Bon Secours Health System (National)

Good Help ACO: 60,000 Medicare Beneficiaries in 7 states across Bon Secours Health System

Total Revenue Model: Bon Secours Baltimore, 19,000 Lives with the State of Maryland

Commercial ACO’s in South Carolina & Virginia for assigned lives in HIX 2014 & 2015

12/10/2013

11

Beyond Employee Populations


P21

Samuel A. Skootsky, MD

Chief Medical Officer, UCLA Faculty Practice Group and

Medical Group

Professor of Medicine, David Geffen School of Medicine at

UCLA

P22

12/10/2013

12

UCLA Health

UCLA Faculty Practice Group 1200+ physicians, 250 primary care

Integrated multispecialty faculty practice group

> 400,000 patients in all lines of business

UCLA Medical Group Contracting entity for faculty practice group

Multiple quality awards, >90%tile patient experience scores

PPO + Partial and Global Risk Contracts Commercial HMO and Medicare Advantage (~72,000)

Commercial and MSSP ACO contracts (~24,000)

UCLA Hospital System Acute, Psychiatric, Children

Partner in ACO and Risk Contracts

Highest patient recommends

David Geffen School of Medicine at UCLA

Our Approach Embraces “System” Attributes…

24

UCLA Health System

Primary Care Base

Primary Care Base

12/10/2013

13

UCLA Primary Care

Our vision is a systemic change in UCLA Health

Extends beyond “medical home”

Requires collaboration and support from other components of

UCLA Health

Care coordination a central feature

Innovative care coordinator model & embedded services

IOM 2001 & Triple Aim (better health, better healthcare,

lower or attenuated risk adjusted per capita cost) as

important guides to Value

Maintaining the primary care workforce, returning joy to

practice, making primary care appealing to students

25

I. Implement Practice Re-Design

I. Primary Care Re-design

II. Related “System” Re-design

II. Increase Covered Lives Under UCLA Population Management

I. Seeking collaborations that support payment reform

II. Geographic Expansion

III. Expand Primary Care System Capabilities

I. Pre-primary care & Employer partnerships, Retail Clinics, Telemedicine

IV. Collaboration

I. Internally & Externally

V. Replication

I. Internally & Externally

VI. Evaluation

26 26

Objectives Codified

UCLA Primary Care Innovation Model (PCIM)

12/10/2013

14

UCLA Health

ED Services

Acute Transitions/Hospitalist Programs

In-home services

Access to Secondary Specialists and Ancillaries

Urgent Care Centers, Evaluation & Treatment (ETC), Retail Clinics, Telemedicine

Gaps in Care & Registries Coordination Reports (ED, Hospital Admits)

Community Based Programs

Home palliative care

Primary Care Practice

Existing roles: 1. Physician 2. MA/LVN 3. Front Office 4. Manager

New roles 1. Care Coordinator 2. PharmD

Practice and System Re-design

Clinical Advisors

(RN, LCSW, NP)

27

Behavioral Health Associates

“System” Support: EHR, Data aggregation, Population Registries, Predictive Modeling, Decision Support , Practice Standards,

Quality Measurement and Reporting, Accountability, Tele-Medicine, Tele-Health

Patient- Centered Shared Decision

Making

Traditional Benefit-Based Home Health

Palliative & Hospice Care

Complex Chronic Illness

Home Care & High Risk Clinic

Mild Chronic Illness & Care Support for Self Management

Episodic & Expected Care Preventive Services & Urgent Care

Self-Care & Wellness Programs & Health Education & Self-Serve & Guided Preventive Services

Hospital & Hospitalist-Extensivist Programs

Communication Care Transitions ER interventions

Efficient hospital use

SNFist and SNF

Program

Ensuring Care Implementation in the Community & at Home

•Home Palliative & Hospice •Home Social/Environmental Factors

•Patient Coaching •Transitions of Care

•Use of Community Resources •Comprehensive Care Centers

Optimal

Discharge/ Transitions

28 Updated Mar 2013

Overall UCLA Population Management Plan

12/10/2013

15

PCIM* Effect: UCLA Facility Use

Engaged Cohort* Number of patients in cohort

Trend (mean 7 months observation after intervention)

UCLA Emergency Department Use 1093 -29%

UCLA Acute Care Hospital Use 1093 -19%

*Preliminary observation results as of February 2013, based upon 14 PCMH offices, 1093 patients with 12 months baseline data and at least 6 months (mean 7 months) of observation after care coordinator/PCIM interventions. ** Preliminary results, recent analysis by one contracted health plan

Population Analysis** Number of patients Decline from baseline

All Emergency Department Use 14,000 -15%

All hospital Re-admission Rate 14,000 -30%

P29

*UCLA Primary Care Innovation Model

Clinical Transformation Process to Design/ Implement/ &

Operationalize

Leadership Team

Design Team Implementation

Team(s) Evaluation

Team Sustainable Operations

5.17.2013

30

Articulating the Vision, Agreed upon Goals, Consistency of Effort, Measurement, Local Adaptation

12/10/2013

16

Wellness Programs HRI & Biometric Screen, “person journey”

Engagement Platform

(web, mobile apps, coaching, warm

transfers)

Employee Patient

Emp

loym

en

t R

eal

m

Me

dic

al c

are

Re

alm

Employer-Provider Collaboration

Whole Population Health Management

Total Population

Unknown Risk No Risk Known Risks

March 2013

Absent intervention, a sub-population become “patients” on an ad hoc basis…..those who seek medical care on their own.

UCLA Care: Population Segmentation

12/10/2013

17

UCLA Care: Individual Risk Factor

Reduction

33 Loeppke, R; Edington, D; Beg, S. “Impact of The Prevention Plan on Employee Health Risk Reduction.” Population Health Management. 2010 13 (5): 275-284

UCLA Care: Completed enrollment in our

Employer-Provider Collaboration

Health Coaching/ Concierge/

Care Coordination

HRA, Health & Biometric Screenings & Risk

Assessment

Medical Home/ Establish PCP System/ EHR

Chronic Condition Management

Pharma Utilization &

Formulary Compliance

Choose a Primary Care Provider

Patient Journey

Medical Home

“Triple Aim,” Physician/Clinician/ Staff Satisfaction, &

Team-Based Care

HRAs UCLA Care 94% SW 16%

Labs/ TPP reports 79 %

Coaching UCLA Care 73% SW 20.8%

UCLA Care PCP Visits 63%

UCLA Care n=500 Staywell n=125,796

P34

12/10/2013

18

UCLA Health System

Primary Care

Base/PCIM

1. Ability of provider to focus on risk reduction using HRA data. 2. PCIM is a gateway for care coordination and preventive services, and acute and chronic illness services of high value to patients. 3. Role of the specialist is to provide expert evidence and pathway based clinical care of high value.

Provider-Employer Innovation UCLA Care

End

36

prosetta inc. peter bernard has nothing to samuel skootsky...

Documents