Obesity Symposium-Ignite the fight against Obesity: Advocate’s Approach

to Population Health Management September 26th 2014

Pankaj Patel MD MScSenior Medical Director, Advocate Physician Partners

“Knowing is not enough, we must applyWilling is not enough, we must do”

Goethe

Market Trends and Health Reform: It’s A New Day

• Pressure on Commercial Payers• Medicare Insolvency• Medical Inflation>Economic Inflation• Population Aging and Uninsured • ‘Tragedy of the Commons’

Population Health

Patient Experience Cost Per Capita

Insurers Acknowledge Difficulty in Controlling…

• Utilization of High End Imaging• Readmissions• Outpatient Trend• New Drugs & Technologies• Ambulatory Sensitive Conditions

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Options

• Reduce Unit Price• ACO with aligned incentives to pursue ‘Triple Aim’

Pankaj Patel

Population Health

Cost Per CapitaPatient Experience

APP’s Reimbursement Model Is Shifting

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Value Based Agreements

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Contract Lives Total Spend

Commercial 410,000 $2.0 B

Medicare Advantage 33,000 $0.4 B

Advocate Employee 27,000 $0.1 B

Medicare ACO 122,000 $1.4 B

Total 592,000 $3.9 B

ACO = Accountable Care Organization

The Cost Equation to Manage Risk

Profit Revenue Cost

FFS Surgicenter Imaging PT ED visits Readmissions

VBC Appropriate Coding

Price Volume

Low CostCenters

StandardizedCare Approach

Surgicenter Imaging PT ED visits Readmissions Avoidable morbidity

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Population Health Management

Source: The Advisory Board, Population health managers, meet the three patient types central to your success, June 14, 2013

PCMH

EMR /

MU

Smart

Registrie

s

Care Guidelines

Behavioral Health

Opt.

CM

Medicatio

n Therapy Managemen

t

Post-Acute

Network

OP

Palliative Care

X X X X X X X X X

X X X X X

X X X X X

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Evolution of Clinical Integration5 Performance Domains:

–Chronic Disease Care–Health and Wellness–Efficiency–Care Coordination–Patient Experience

Evolution of Clinical IntegrationPopulation Based Outcome Metric

AdvocateCare Index• Length of Stay• Admits/1000• ED Visits/1000• 30 Day Readmissions• % Days In-Network

Additional sub metric 2015 • Total cost of care

– Episode– pmpm

Evolution of Clinical Integration

Change in Incentive Payment

Incentives For All Physicians:

Move from pay for performance to pay for value contribution

Value Contribution = Performance x Volume of patients managed x Coordination of Care

factor

Advanced Analytics and Other Care Management Solutions• DART - ActiveHealth (HDMS)

• Predictive Tools– Readmission Risk - Cerner partnership– Falls Risk - Cerner partnership– Risk Stratification - ActiveHealth (HDMS)– Patient Impactability (under development)

• Total Cost of Care and Resource Use – Licensed from Health Partners

• Integrating EMRs - CareNet +

• Care Management Work Flow Tools - ActiveHealth

• Referral Management ERMA - APP

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Advancing Evidence Based Clinical Decisions

• e University CME Programs• Clinical Pathways Development / Point of Care Patient

Management Protocols• Pharmacy Academic Detailing• Learning Collaborative • Physician Office Staff Training• Patient Outreach and Education• Patient Health Coaching Program through Care

Management Program• Patient Self Management Tools

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Obesity:

• Impact on Population Health – BMI>30 results in 200-300% increase in Mortality – Increase in HTN, DM, CVD, DJD– 36% increase in Medical costs

• Gluttony or Sloth or Both– Imbalance: Energy consumed and Used– BMJ 1995 Energy consumed declining but obesity

increasing

Obesity Related Measures• 2012

– BMI Assessment• 2013 and 2014

Adults and Pediatrics– BMI Assessment and Follow Up Plan if abnormal– Exercise Assessment and Counseling

• 2015• Above Plus

– Online CME for Diabetes (includes focus on lifestyle changes and consideration of Bariatric surgery)

BCBS ACO Performance

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Value-based Agreement ResultsCommercial ACO• Cost Savings

– 2.0% Improvement in PPO cost trend (Q3 2013)– 3.1% Improvement in Combined HMO cost trend (Q3 2013)

• Quality*– HMO – 6 of 8 key metrics improved, 1 no change, 1 decreased

Medicare Shared Savings Program• Cost Savings

– 0%, Flat (Preliminary results, First 12 months, Q2 2013)

• Quality– Completely and accurately reported all 33 quality measures-100%– Estimated score 79%

Patient/Care Giver Experience 85% Preventative Health 87%

Care Coordination/Patient Safety 65% At-Risk Population 83%

*PPO Quality Data is not available due to new cohort measurement.

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Summary• Emerging payment models create a focus on

population health management

• Population health requires – A new focus on wellness and health status– A team approach