Enabling New Models of Care: Practical Considerations

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Introductions

Ann Hepworth leads business development in the UK. Joined Optum 18 months ago after 25 year career in healthcare, both NHS and with HealthSkills in OD.

Kira Levy leads Population Health Solutions in the UK. Joined Optum 18 months ago, after 15 year career in healthcare, both with NHS and internationally. She is an epidemiologist.

Objectives of session • Explore different model options on

the journey to integrated care

• Identify core capabilities required

• Provide practical examples and a

roadmap for success

• Provide opportunity for you to ask

questions from people who have

done this elsewhere

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Perceptions of challenges

• Lack of actionable intelligence

• Knowing where to start

• Identifying optimal model design

• Workforce development

• Value-based contracting and payment models: transitioning to capitation: understanding risk

• Technology and infrastructure requirements

• Activation of patients and families in managing their own health

• Cross-system engagement, leadership and governance

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Optum: our mission

‘To help people live healthier lives,

and to help make the health system work better for everyone’

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Connecting and serving the health system

Healthier

Life Sciences

1 million people Receiving home

visits

300 Health plans

2 million people Receiving care in one of 24 Optum-run ACOs

50 million lives On which we take risk globally

Pharmacies

74 million Consumers, including 25

million outside US

The ACO experience…

• Lessons from international best practice

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Optum Collaborative Care ‘ACO’ business

A Strong Foundation Built On Local Partnerships

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Why population health?

• Increasing costs – reactive, fragmented, activity-based systems no longer fit for purpose in light of growing LTCs

• Lower than desired quality outcomes due to lack of coordination and difficulties for patients and clinicians to navigate health systems

• Variable access

• Changes in provider landscapes (e.g. increasing pressure on primary care systems globally)

Internationally, drivers of population health are similar

Population health is a proactive, patient-centric approach that engages patients, clinicians and providers in wellness,

prevention, care coordination and management, improving outcomes and reducing costs.

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No single ‘right’ model

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US Experience: Moving along value-based spectrum

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Core population health capabilities

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Primary Care / GP - led example: WellMed (an Optum company)

Primary Care based ACO headquarters in San Antonio, TX, with additional markets

throughout TX and in Tampa FL 60+ physicians in 20+ clinics

Early model Primary Care Medical Home / Primary Care ACO– WellMed has been one of

the earliest adopters of a primary care driven, non-hospital ownership model for population

health. They have been operating under a Global Capitation / Full Delegation model with

various insurers for 15+ years.

Senior Population focused: Primary focus is on adults 65+ (Medicare population).

Primary care physician base is a mix of Geriatricians, Internal Med and Family Practice.

Community Centers: Partnership with City of San Antonio has resulted in multiple

senior-focused community centers that have daily average attendance of 600+ visitors

Coverage: Population includes delegated financial risk on 100,000 + patients in addition to

regular fee-for service patient panels.

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WellMed: Solutions to business challenges

• Delegated, Full Global Risk capitation contracts with multiple payers • Full data warehouse of claims and clinical EHR data • Community Centers attached to GP Surgeries

• Longitudinal data across multiple providers available because WellMed has financial responsibility for global health budget and has access to all touch points

• Predictive Risk models that identify high-risk patients, next tier at risk • Monthly reporting and feedback on panels to GPs on total population

• Partnership with City of San Antonio for building Community Centres which function as group education, fitness classes, etc.

• Transportation benefits to bring Seniors to Surgeries

• GPs paid on salary with 40% of total compensation based on performance outcomes (quality and utilisation) • Strong partnership with Acute hospitals to staff “hospitalists” on-site • Data sharing and benchmarking across all physicians and providers

• Multi-specialty care teams (GP, Pharmacist, Nutritionist, Mental Health, Social Worker, etc.) do shared surgery visits

• Single coordinated care plan that covers home visits, telephonic and on-line support and is shared with other providers in the market

• Proactive outreach to risk patients for an annual assessment (vs. problem driven)

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Primary care led example: 65+ population

Translating to the UK…

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Dorset Integrated Wellness Model

• Purpose to protect and improve health and wellbeing, enabling sustainable behaviour change in key lifestyle areas

• Central Hub promotes and provides the service directly and indirectly through single point of access to 750,000 population

• Opportunity to move away from fragmented silos of service, and towards a more holistic model; empowering consumers to take ownership of their health and wellbeing

• Team of Wellness Advisors and Coaches: COM-B approach to assessment and tailored intervention planning

plus range of Tier 1 brief interventions

• Targeted outreach and social marketing: a universal offering, also actively engaging communities and promoting the service to ‘hard to reach’ groups where health

outcomes are poorest.

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Livewell Dorset service model

• Telephonic call centre • Referral facilitation service • Shared care management tool (in development)

• Robust data capture and outcome recording • Analytics to evaluate and adapt service model • Report sharing with partners

• Proactive outreach to hard-to-reach communities, using assets based approach • Comprehensive marketing and communication programme • Online engagement tools • 1:1 wellness planning based on individual goals (using COM-B)

• Comprehensive service directory • Network of collaborative partners, including 3rd sector • Outcomes tracking across service users • Provision of training and upskilling to key partners

• Delivery of Tier 0 and 1 brief advice and interventions around smoking cessation, health eating, physical activity and alcohol

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Early outcomes

• Successful engagement with GPs and local voluntary network – strong relationships with local CVS, Health Promotion Devon, Community Action Dorset and Healthwatch

• Re-trained local staff as Wellness Advisers and Coaches

• Re-branded and launched LiveWell Dorset, a single point of access service – ‘one number, one website, one front door)

• Received over 300 contacts in month 1 including:

– 50% from GP surgeries

– 26% self-referrals

– 49% of people accessing service are from top 40% most deprived areas in Dorset

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Implications for New Models of Care

• No right way to deliver new models of care

• Different approaches with different rewards/risks – layers of protection as you build confidence in working differently

• Requires new capabilities, new relationships and new ways of working

• No perfect ‘starting point’ – understand where you are on curve and where you want to go

• Be realistic – population health requires upfront investment for long term benefits – what can you be doing now to plan for future?

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Questions

?

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Visit the Optum Stand 4

• Website: optum.co.uk

• Email: info@optum.co.uk

• Telephone: 020 7121 0560