Tales from the Front Line: Lessons Learned from a - LAN Summit

Tales from the Front Line: Lessons Learned from a - LAN Summit

Tales from the Front Line: Lessons Learned from a Virtual ACO Julie Panek Blue Shield of California October 26, 2015 1 blueshieldca.com Accounta...

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Tales from the Front Line: Lessons Learned from a Virtual ACO

Julie Panek

Blue Shield of California October 26, 2015

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blueshieldca.com

Accountable Care Organizations (ACOs) Collaborating with medical groups and hospitals – aligned with the purpose of:

Hospital

Medical Group

• Raising the benchmark for quality care • Integrating process and technology for a more coordinated member experience

Blue Shield of California

Innovation in integrated health care

• Lowering the cost of health care

2

What WE mean by ACO 3 way partnership – hospital, physician, Blue Shield

VIRTUAL INTEGRATION

Built on provider partners with “will & skill” Aligned incentives Multi-year commitment Senior level engagement and governance HOSPITAL

Pass savings to customers prospectively

3

MEDICAL GROUP

The nation is watching… national recognition as innovative leader

transforming provider relationships

“This program is on our radar screen as one of the best examples of patient care in the country, and the kind of care that people elsewhere hope to enjoy in the future.”

“This is how healthcare should be done in the future!“

- Kathleen Sebelius, Former US Secretary of Health & Human Services

“We consider Blue Shield the gold standard among our health plan relationships. Blue Shield has served as a true, collaborative and patient focused partner.”

- Greater Newport

“One of the oldest and largest ACOs in the country.” - Health Affairs

- John Muir Health

4

4

Transforming provider relationships Here’s more of what our providers are saying... “Our doctors found the meetings one of the best and most productive so far. You are doing great job with kick starting this new ACO.” – Adventist

“Our ACO partnership with Blue Shield has taken down historical barriers and allowed for data driven, honest conversations on how we can improve our care delivery model to reduce redundant care and wasteful spending.” - AppleCare

“There is no health plan out there that is doing the kind of work that Blue Shield is doing – thank you for being the innovators.” - AllCare

“Dr. Stuart Levine has challenged our team to think in new ways around population management and how to realign critical clinical resources to improve our ability to impact quality and cost.” - AppleCare

“Blue Shield is the ONLY health plan that has developed a model/structure that works – through this process we have been able to work with some of the best and brightest in the field.” - Facey/Providence

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Expanding across California 35 ACOs… and growing Number

Regions Covered

HMO

26

17

PPO

9

6

Total

35

23

ACO

Target: 60% healthcare spend in an ACO by 2018

6

What we’ve delivered The HMO program is delivering significant results across multiple markets and different provider organizations Annualized Non-ACO 7.1% annualized trend

$313M

Annualized ACO 3.8% annualized trend

Comparison of baseline (pre ACO) to most recent completed ACO contract period Annualized ACO Trend is demographic and benefit adjusted, weighted average since ACO inception

7

aggregate cost savings

What we’ve delivered Alongside our provider partners, we implement robust interventions to ensure care is delivered at the right place and at the right time ACO # 1

ACO # 2

ACO # 3

ACO # 4

ACO # 5

ACO # 6

Inpatient admissions

Inpatient admissions

Inpatient admissions

Inpatient admissions

Inpatient admissions

Inpatient admissions

Inpatient bed days

Inpatient bed days

Inpatient bed days

Inpatient bed days

Inpatient bed days

Inpatient re-admissions

Inpatient re-admissions

Inpatient re-admissions

-17%

-11%

-15%

Inpatient readmissions

Inpatient re-admissions

ER visits

ER visits

-27% -9%

-10%

-28%

-20%

-23%

-29% -5%

-9%

ER visits

ER visits

-6%

-6%

*Includes HMO ACO partners with experience through October 2014 8

-6%

-19%

-4%

-20%

-15%

-27%

Deeper view into our earliest ACO Hill Sacramento CalPERS ACO Utilization excluding Medicare Supplement members

CY 2009

CY 2010

CY 2011

CY 2012

CY 2013

% change 2009 versus 2013

Admissions per 1,000

52.1

50.4

53.7

50.2

50.8

-2.5%

Days per 1,000

203.5

172.7

196.1

182.3

157.1

-22.8%

3.9

3.4

3.6

3.6

3.1

-20.5%

ER Visits per 1,000

127.2

133.0

133.2

144.5

146.0

14.8%

Readmission Rate

5.6%

5.3%

5.3%

6.4%

7.1%

1.5%

37,981

38,724

38,874

38,093

36,806

-3.1%

Average Length of Stay

Average Membership

From 2010 through 2013 this ACO has achieved $119M in gross savings with a net savings to CalPERS of $108M and an annualized trend of 2.2%. 9

…and the challenges we faced last year 2013 vs. 2014 Outcomes

2013

2014

Days/1000 increased

157.6

208

ALOS increased

3.09

4.11

Catastrophic* days/1000

34

83.1

Catastrophic* ALOS

15.63

23.80

ER visits/1000 increased

146

149

Cost of healthcare 12 month trend at 16.3% (compared to target of 3.2%) % inpatient claims over $100K doubled In comparison, aggregate 2010-2013 trend 2.2%

Pharmacy Pharmacy costs increased 26% • Hep C accounts for 3.7% of the pharmacy increase * inpatient admission at least 10 days in duration

10

So far, so good – but we must do more Collaborative model

Enhanced member experience

Empowering members

Evolving toward even deeper integration with our ACO provider partners

Care coordination

Feeling of mutual investment

Enhanced wellness

Coaching and education

Best-in-class quality

Technology integration

Focusing on delivering best-inclass quality results to implement best practice care delivery systems

Right information at the right place at the right time Sharing solutions on population/patient management with ACO partners

Established the Quality Council with statewide provider leadership

Exceptional trust and transparency

11

We must go even deeper in our partnerships... Leveraging the Medical Management Inventory Tool to drive deeper change:

12

...and collaborate closely to transform care By deepening our partnership and focusing on core care elements, we will improve overall quality and experience of care... Together we aim to:

1. Advanced Facility Care

Improve day-to-day patient care and provide consistent “patient-centric service” 4. Care Management/ Coordination

More effectively manage the most challenging and complex patients Free up provider time, thus resulting in improved patient engagement and outcomes

3. High Risk Clinics

Improve quality of care, resulting in decreased utilization and improved efficiency

2. Home Care

In conjunction with optimized primary & specialty care

13

Key realities and lessons learned • Senior leadership engagement is key • Financial integration drives performance • Quality alone is not enough • Hospitals must have a seat at the table – but they are struggling to transition • Transparency is a must – and is hard • Program insights applied to entire book of business – “free rider” effect • Success = investment of time and resources for all partners • Gaining trust across the stakeholders, and driving cultural change, are the greatest challenges 14

14

Our mission is simple – and challenging

To transform a dysfunctional health care system into one that is worthy of our family and friends

15

Questions?

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