Post on 16-Jul-2015
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Our Network
How do we build our Network?
• Find the right provider partners
• Commit to evidence-based decisions and results
• Reduce variation
Northwest Success
• 4 health plans left the NW ETF market
• Through innovative Network strategies, we changed the story
• The result – MLR reduction of 18.3%
Better care, more value
• Keep members well
• When care is needed, it is appropriate
• Decrease variation in resource use
• Shared decision making with members
• Anticipate future care needs
Why Preauthorization?
• Safety of our members
• Only appropriate care provided
• Right setting
• Right price
Example: Sleep Studies
What yields better results for the member? Sleep Studies done in the home or in a sleep clinic?
Shared Decision Making
Low Back Pain Program
• Helps members to make an informed decision about their care
• Percent of low back pain sufferers that require surgery: 1%
Soap
Gauze
Knee Implant
Hospital Day
Physical Therapy
Orthopedic Surgeon
=Knee Bundle (One price for all services necessary)
Warrantee against complications for 90 days
Today, we too often pay for one item at a time – example: knee replacement
Bundling Innovation
Orthopedic & Sports Institute of the Fox Valley
• 40 procedures
• Bundled price includes all services related to the procedure
• A 90 Day warranty is included
Bundles – A Quality Difference
• Infection Rate 0.3%
• Re-admission Rate: 0.8% (National Average: 4%)
• Average cost of a complication: $100,000
Bundles – The Numbers
Procedure Potential Savings
Total Hip Replacement $22,029
Total Knee Replacement $35,417
Rotator Cuff Repair $8,406
$250 Visa debit card will be given to members to drive them toward bundled services.
Neighborhood Family Clinic
• Partnered with as a low-cost, high quality option for Trust members
• Trust members can access at no cost
• Shared mission of reclaiming healthcare