Tom Cooke Sr. VP, Business Development, Aetna Accountable Care Solutions
Mark Shields, MD, MBA
Sr. Medical Director, Advocate Physician Partners
Beth Waterman Chief Improvement Officer, HealthPartners
Mark Shields, MD, MBA Sr. Medical Director, Advocate Physician Partners
From Clinical Integration to Accountable Care Implications for AMCs
Alliance of Independent Academic Medical Centers (AIAMC) 2012 Annual Meeting
Organizational Strategies for Accountable Care March 29, 2012
Mark Shields, MD, MBA Senior Medical Director
Disclosure • Nothing in Today’s Presentation Should Be
Construed as Advising or Encouraging Any Person to Deal, Refuse to Deal or Threaten to Refuse to Deal with Any Payer, or Otherwise Interfere with Commerce
• Opinions Expressed by Speakers are Their Own • APP Assumes No Responsibility for the Reliance
by Conference Participants on Materials Presented at Today’s Session
4
Learning Objectives Participants Will Be Able to: • Understand Challenges to AMC and GME Due
to Payment Changes • Understand Challenges to ACO Development • Understand How Clinical Integration Drives
Outcomes • Describe Key Components of Clinical Integration
that Lead to Success
5
Presentation Topics • Challenges for Academic Medical Centers • APP Overview and Role of CI • Integrating Physicians • CI to ACO
6
It’s a New Day • Insurers Acknowledge Inability to Manage
Rising Costs • Medicare Finances are Not Sustainable • Payers Can No Longer Sustain Double-Digit
Increases • Population is Aging • Uninsured Will Enter Care Delivery System
7
Industry Has Difficulty Controlling… • Utilization of High-End Imaging • Readmissions • Outpatient Trend • New Drugs & Technologies • Ambulatory Sensitive Conditions
8
Change is Necessary
• Significant Waste In System • Value of Partnering
– To Eliminate Waste – To Have Price Competitive Product
• Current Payment Model Does Not Support Shared Vision
• Sense of Urgency
9
Changing Paradigms
10
FROM... TO...
Silo Care Management Enterprise Care Management
Episodes of Care Coordination of Care
Discharges
Transitions
Utilization Management Right Care at the Right Place at the Right Time
Caring for the Sick Keeping People Well
Production (Volume) Performance (Value)
Concept of ACO Is Not New “The existing deficiencies in health care cannot be corrected simply by supplying more personnel, more facilities and more money. These problems can only be solved by organizing the personnel, facilities and financing into a conceptual framework and operating system that will provide optimally for the health needs of the population.”
Dr. Robert Ebert Dean,Harvard Medical School
Founder, Harvard Community Health Plan, 1969 11
Changing Landscape for Academic Medical Centers • System Based Learning for Trainees • Value-Based Purchasing for Hospitals (and
Ultimately for Doctors) – Accountable Care Organizations, Bundled
Payments, Medical Home Incentives, Risk Programs
• Transparency of Quality, Safety and Costs
12
Can AMCs Compete In This New World? • Kastor (NEJM, Sept., 2011), “Doubtful”:
– Doctors and Hospitals Report Separately
– Traditional Training Yields Expensive Care – Faculty Have Other Priorities – Standardization Across Specialties
Unlikely – Specialists Dominate Primary Care – Hierarchy Reins; Not Collaboration
13
Can AMCs Compete In This New World? • Berkowitz and Miller (NEJM, Sept, 2011): “Perhaps”
– Form Relationships with Other Hospitals and Grow Primary Care
– Pilot Programs Such as Program of All-Inclusive Care for the Elderly or Capitation – Deploy HIT – Multi-disciplinary Collaboration – Change Promotion System – Change Incentives ($ and Others) – Promote Research in Care Delivery Science
14
Some AMCs Have Embraced ACOs • Of the 32 Medicare Pioneer ACOs:
– Beth Israel-Deaconess – Dartmouth-Hitchcock – Detroit Medical Center – Partners HealthCare System (Boston) – University of Michigan
15
Presentation Topics • Challenges for Academic Medical Centers • APP Overview and Role of CI • Integrating Physicians • CI to ACO
16
• $4.5 Billion Annual Revenue • AA Rated • 12 Acute Care Hospitals
– 2 Children’s Hospitals – 5 Level 1 Trauma Centers – 4 Major Teaching Hospitals – 4 Magnet Designations
• Over 250 Sites of Care – Advocate Medical Group – Dreyer Medical Clinic – Occupational Health – Imaging Centers – Immediate Care Centers – Surgery Centers – Home Health / Hospice
Advocate Health Care
17
Advocate 2020
18
Advocate Physician Partners • Physician Membership
– 1,085 Primary Care Physicians
– 2,889 Specialist Physicians
– Total Membership Includes 987 Advocate-Employed Physicians
• 10 Acute Care Hospitals and 2 Children’s Hospitals
• Central Verification Office Certified by NCQA
• 230,000 Capitated Lives/700,000 PPO Lives
• 215,000 “Attributable Lives
Advocate Physician Partners delivers services throughout Chicagoland and Downstate Illinois.
19
Clinical Integration: Definition
20
A Structured Collaboration Among APP Physicians and Advocate Hospitals on an Active and Ongoing Program Designed to Improve the Quality and Efficiency of Health Care. Joint Contracting With Fee-for-Service Managed Care Organizations Is a Necessary Component of This Program in Order to Accelerate These Improvements in Health Care Delivery.
Challenges of Health Reform Large Multi-specialty Groups Are the
Exception 9 of 10 Americans Get Their Medical Care
in a Solo or Small Practice* Infrastructure Is Required to Drive Quality
Outcomes Demonstrated by Multi-specialty Groups
Culture Is Not Created Over Night * NEJM 360;7 Feb. 12, 2009 21
Clinical Integration is the Foundation of an ACO • Provides Infrastructure for Integration of Small
Practices • Overcomes Problems Seen Within the Fee-
for-Service Model – Incentives to Providers Drive Improvement
• Creates Business Case for Hospital and Doctors to Work for Common Goals
• Allows One Approach for Commercial and Governmental Payers
22
Presentation Topics • Challenges for Academic Medical Centers • APP Overview and Role of CI • Integrating Physicians • CI to ACO
23
Key Drivers Culture
Governance
Infrastructure
Incentives
Transparency of Results
Feedback Loop
24
Creating a Culture of Engaged Physicians • Physician Engagement in Governance • Physician Leadership Development • Shared Identity and Values → “Membership” • Infrastructure Investment to Enable Success • Appeal to Pride and Sense of Excellence
– Recognition for Quality and Efficiency – Consistent Use of Evidence-based Medicine – Power of the Outcomes of the Group
25
Total Physicians on Medical Staffs = 6,007
Total APP Physicians = 3,974
Independent Non-APP = 2,033 Independent APP = 2,987 Employed /
Affiliated = 987
Affiliated (Dreyer) = 172 AMG (Employed) = 815
Advocate’s Physician Platform
26
APP Board and Committee Composition
27
Lee Sacks, M.D., Chief Executive Rober t Zimmanck, M.D ,Chairman
Mar ty Manning, President
Contract Finance Committee
Rober t Raines, M.D., Chairman Pankaj Patel, M.D., Chairman
Advocate Physician Par tners Board of Directors
Utilization Management Committee Quality Improvement Committee
Mark Shields, M.D., Chairman
Key Drivers Culture
Governance
Infrastructure
Incentives
Transparency of Results
Feedback Loop
28
Health Plan Commitments Includes All Major Payers in the Market • Risk and Fee-for-Service Contracts • Base and Incentive Compensation • Same Measures Across All Payers
– Common Procedures at Practice Level for All Contracted Plans
29
2012 Performance Metrics
30
• Physician Commitment to a Common Broad Set of Clinical Initiatives – 60 Initiatives – Broad Area of Focus – 159 Individual Performance Measures
• Primary Care and Specialty
– 4 AdvocateCare Measures – 5 Performance Domains
• Medical and Technological Infrastructure • Clinical Effectiveness • Efficiency • Patient Safety • Patient Satisfaction
Physicians Determine All New Performance Measures
Clinical Integration 3.0: Increasing Physician/System Integration
31
Early Years: 2004 - 2006
Primary Care/
Ambulatory Measures Increasing
Specialist Measures
Middle Years: 2007 - 2009
Maturing Years: 2010 - 2013
Increasing Physician/
System Integration
Clinical Integration
to Accountable
Care
Health Reform: 2013 -
32
0%10%20%30%40%50%60%70%80%90%
100%
Cardiology
Family
Practice
Surgery
Internal Med
icine
Orthopedics
Pulmonology
APPNon-APP
Why Physician Engagement Matters Adoption of eICU®- 2007
Year 2004 High Speed Internet Access in Physician Offices
Centralized Longitudinal Registries Access to Hospital, Lab and Diagnostic Test Information Through a Centralized Clinical Data Repository (Care Net and Care Connection)
2005 Electronic Data Interchange (EDI) 2006 Computerized Physician Order Entry (CPOE)
Electronic Medical Record Roll out in Employed Groups 2007 Electronic Intensive Care Unit (eICU) Use 2008 e-Prescribing 2009 Web-based Point of Care Integrated Registries (CIRRIS) 2010 e-Learning Physician Continuing Education
Electronic Medical Records Roll Out in Independent Practices 2011 Care Management Software plus Analytics
Advancing Technologies
33
• Web-Based Commercial Registry • Integrates All Registries, Pharmacy, Labs, Claims
and Performance Reporting • Integrates Physicians • Integrated with EMR
Clinical Integration Registry and Reporting Information System (CIRRIS)
34
35
Advancing Evidence-Based Medicine and Care Year 2004 Physician Reminders for Care
Chart Based Patient Management
2006 Patient Outreach
2007 Physician Office Staff Training
Pharmacy Academic Detailing Program
Generic Voucher Program
2008 Diabetes Collaborative
Patient Coaching Program
Hospitalists
2009 Diabetes Wellness Clinics
Asthma and HF/CAD Collaborative Added
2011 Access and COPD Collaborative Added
Impact of GME on QI, Safety, and Cost-Effective Care in a PHO Environment • Students and Residents Are at the Front Line • Current GME Priorities Drive Improvement:
-Patient Safety -Monitoring and Ensuring Clinical Excellence in Patient Care -Effective Communication Skills -Consistent and Thorough Handovers - Engagement in System-Based Approaches to Care -Fostering Cost-Effective Care with Appropriate Utilization of
Services -Medical Technology and Infrastructure Learning Opportunities, -Engagement in Life-Long Learning 36
Optimum Design of GME
• Faculty Actively Engaged in Safety and Care Improvement Initiatives for System/Hospital – Need to Redesign Rewards for Faculty (See
Dhalla,Detsky, JAMA, March, 2011, p. 932)
• Faculty Models Behaviors – Priority on Safe, Effective, Efficient Care – Patient-Centered Care – Team Based Care Across Specialties – Communication Drives Successful Transitions of
Care 37
Explicitly Address Economic Reality In Medical Education (Sessions, Detsky, JAMA Sept 15, 2010)
• Almost All Medical Schools Offer Course in Health Policy or Medical Ethics
• Core Content Should Cover: Economic Forces, Conflicts, Asymmetry of Information, Concepts of Waste, Efficiency and Opportunity Cost
• During GME, Practical Examples Given: – 15-Fold Increase in Complex Spinal Fusions – Academic Detailing (Avorn)
38
“Everybody has a plan until they get punched in the mouth.”
Attributed to Mike Tyson
39
Key Drivers Culture
Governance
Infrastructure
Incentives
Transparency of Results
Feedback Loop
40
Advocate Physician Partners’ Incentive Fund Design
PHOs 1-9
Residual Funds
Individual Incentives (70%)
Individual Distribution
Based on Individual
Criteria
Residual Funds
Group/PHO Incentives (30%)
Group/PHO Distribution
Based on Group/PHO
Criteria
Tier 1 (50%)
Tier 2 (33%)
Tier 3 (17%)
Tiering based on individual
MD scores
Residual funds are rolled over into general CI fund available for distribution in the following year
41
Calculation and Distribution of CI Incentives to Physicians • CI Incentive Distribution for Each Physician
Based on the Following: – Physician’s Allowable Physician Billings – Individual and Primary PHO CI Scores – Disease Registry Patient Counts – Inpatient Performance
42
Aligning Physician and Hospital Incentives • 2009
– CPOE Core Measures • 2010
– CPOE Core Measures – Readmissions – Core Measures – Length of Stay
• 2011 – ED Efficiency – Meaningful Use – Core Measures – Readmissions – Length of Stay
• 2012 – ED Efficiency – Core Measures – Readmissions – Length of Stay – Transfusion Safety – Elective Induction of Labor
43
Incentives for Outcomes CI Incentive Funds Distribution
Performance Year Funds Distributed
2005 $12.4 Million 2006 $16.7 Million 2007 $25.0 Million 2008 $28.2 Million 2009 $38.0 Million 2010 $50.0 Million 2011 Combined Funds
44
• 230,000 Capitated Lives / 700,000 PPO Lives • 215,000 “Attributable” Lives • Great Clinical Outcomes and Good Business
Key Drivers Culture
Governance
Infrastructure
Incentives
Transparency of Results
Feedback Loop
45
Transparency of CI Performance
• At Direction of APP Board of Directors, Strategy Implemented to Increase Transparency of CI Program Performance
• Statistics Shared with MDs for Them to See How They Compare to Their Physician Peers
• All Individual Physician Performance Results are Available for All to View and Compare (Internally)
46
Generic Prescribing: 6-9% > Local Plans LDL Good Control in Patients with Diabetes:
61% > National Rate Childhood Immunizations: 82% > National
Rate Depression Screening: 93% > National Rate Diabetic Care: Exceeded National Rate on All
10 Measures Asthma Action Plans: 90% > National Rate
Highlights of 2011 CI Program “Moving the Dial on Quality”
47
2011 Value Report
48
www.advocatehealth.com/valuereport or call 1-800-3-ADVOCATE
(1-800-323-8622
Critical Success Factors • Physician Driven • Same Metrics Across All
Payers • Minimize Additional
Administrative Costs • Additional Funds Recognize
Extra Work by Physicians and Staff
• Infrastructure Necessary to Support Improvement
• Physician/Hospital Alignment
49
Value for Physicians
• Better Alignment with Hospital • Marketplace Recognition • Focus on Outcomes • Incentives Compensate for Additional Work • Interface with Multiple Payers
50
Key Drivers Culture
Governance
Infrastructure
Incentives
Transparency of Results
Feedback Loop
51
Presentation Topics • Challenges for Academic Medical Centers • APP Overview and Role of CI • Integrating Physicians • CI to ACO
52
From Clinical Integration to Accountable Care
53
It’s a New Day • Insurers Acknowledge Inability to Manage
Rising Costs • Medicare Finances are Not Sustainable • Payers Can No Longer Sustain Double-Digit
Increases • Population is Aging • Uninsured Will Enter Care Delivery System
54
Unicorn
“The accountable care organization is like a unicorn, a fantastic creature that is vested with mythical powers. But no one has actually seen one.” Ian Morrison
55
Introducing AdvocateCare – A Global Care Contracting Framework • Global Cost Management Overlay On Top
of Existing FFS Structures • Responsibility for Managing Comparative
Trend • Method for Sharing Savings • Involves Partnering With the Payer • One Model for Governmental &
Commercial ACO-Like Contracts 56
Shared Savings Model
$ Per Attributed Life Per Year (Risk Adjusted)
0 Yr 1 Yr 2 Yr 3 Yr 4 Yr 5
Shared Savings
57
Summary Results of the Physician Group Practice Demonstration Performance Years 1-4*
58
Physician Group Practice Percentage of Quality Goals Attained
YEAR 1 YEAR 2 YEAR 3 YEAR 4
Billings Clinic, Billings, MT 90.91 97.78 98.11 92.45
Dartmouth-Hitchcock Clinic, Lebanon, NH 95.45 97.78 92.45 94.34
Everett Clinic, Everett, WA 86.36 95.56 94.34 94.34
Forsyth Medical Group, Winston-Salem,NC 100.00 100.00 96.23 96.23
Geisinger Clinic, Danville, PA 72.73 100.00 100.00 100.00
Marshfield Clinic, Marshfield, WI 81.82 100.00 98.11 100.00
Middlesex Health System, Middletown, CT 86.36 95.56 92.45 94.34
Park Nicollet Clinic, St. Louis Park, MN 95.45 97.78 100.00 100.00
St. John’s Clinic, Springfield, MO 100.00 100.00 96.23 98.11
University of Michigan Faculty Group Practice, Ann Arbor 95.45 100.00 94.34 96.23
• Because the CMS applied different weights to each quality measure, the agency calculated the quality goals attained as percentages, rather than absolute numbers of measures. Data are from RTI International.
Published in NEJM, 364:198-200, Jan 20, 2011
58
Physician Group Practice
Shared Savings Payments ($)
YEAR 1 YEAR 2 YEAR 3 YEAR 4
Billings Clinic, MT 0 0 0 0
Dartmouth-Hitchcock Clinic, NH 0 6,689,879 3,570,173 328,798
Everett Clinic, WA 0 129,268 0 0
Forsyth Medical Group, NC 0 0 0 0
Geisinger Clinic, PA 0 0 1,950,649 1,788,196
Marshfield Clinic, WI 4,565,327 5,781,573 13,816,922 16,154,242
Middlesex Health System, CT 0 0 0 0
Park Nicollet Clinic, MN 0 0 0 0
St. John’s Clinic, MO 0 0 3,143,044 8,185,757
University of Michigan Faculty Group Practice, Ann Arbor 2,758,370 1,239,294 2,798,006 5,222,852
Summary Results of the Physician Group Practice Demonstration (cont’d)
59 Published in NEJM, 364:198-200, Jan 20, 2011
59
Attributed Patient Cost Concentration Supports Care Management Model
Person Years Predicted Expenditures Number Percent Mean $ Percent
Very Low Risk 54,398 30.5% $ 784 3%
Low Risk 78,520 44.1% $ 4,054 22%
Moderate Risk 24,906 14.0% $ 11,517 20%
High Risk 16,056 9.0% $ 24,054 27%
Very High Risk 4,270 2.4% $ 91,062 27%
Total 178,149 100.0% $ 7,987 100%
60
60
CM Risk/Reporting System
Physician Office Performance
Coaches
Market Share Growth/Backfill
Data & Analytics
PCP Access/ Virtual Visits
Communication Strategies
Transitions
2011 ECM Infrastructure & Support
Outpatient Care Management
• Dedicated Outpatient
CMs for High-Risk Patients
Post-Acute
• SNF CM Model • SNF, LTACH,
Inpatient Rehab Network
• Transition Coaches
Emergency/Acute Care Management
• Inpatient CMs • ED CMs • Hospitalists • Physician-Partnered
CM Model
61
Federal ACO Requirements • “Become Accountable for Quality, Cost,
Overall Care” of FFS Beneficiaries • At Least 3 Yr Contract • Formal Legal Structure to Receive/Distribute
Shared Savings • Enough Primary Care for Assigned
Beneficiaries (At Least 5000)
62
Federal ACO Requirements • Report Key Data to HHS: Assignment,
Quality, Etc. • Leadership and Management Structure • Processes to Promote EBM, Patient
Engagement, Quality, Cost, Care Coordination
• Meet Patient-Centered Criteria
63
Implementing ACOs: 10 Mistakes Singer and Shortell, JAMA, 8/9/11
64
Overestimate Organization Capabilities • Manage Risk • EHR • Performance Measures • Implement Protocols Failure to Engage Stakeholders • Balanced Governance
• Engage Patients • Specialist Selection and
Engagement • Regulations/Legal • Integrate Beyond
Structures Failure to Recognize Interdependencies • Address All of Above
Implementing ACOs To Overcome These Mistakes:
• Adapt to Local Contexts • Use Learning Systems Internally and
Externally • Mature Measurement Systems Internally and
Externally
65
Summary of Key Points • Culture Evolves Over Time and Takes
Effort • Physician Engagement Requires Physician
Involvement • Technology Plays Important Role • Evidence-based Management is Key • The Need for Change – Preparing for the
Future • GME Can Play an Important Role as
Change Agent 66
Key Drivers Culture
Governance
Infrastructure
Incentives
Transparency of Results
Feedback Loop
67
Speaker • Mark Shields, MD, MBA, FACP
Vice President, Advocate Health Care Senior Medical Director, Advocate Physician Partners
68
Beth Waterman
Chief Improvement Officer, HealthPartners
HealthPartners as an ACO: Two Perspectives
Beth Waterman RN MBA Chief Improvement Officer
HealthPartners
HealthPartners • Not-for-profit, consumer-governed • Integrated care and financing system
– 12,000 employees – Health plan
• 1.36 million members in Minnesota and surrounding states – Medical Clinics
• 500,000 patients • 800 physicians
– HealthPartners Medical Group – Stillwater Medical Group
• 35 medical and surgical specialties • 50 locations • Multi-payer
– Dental Clinics • 60 dentists • Specialties: oral surgery, orthodontics, pediatric dentistry, periodontics, prosthodontics • 20 locations
– Four hospitals • Regions: 454-bed level 1 trauma and tertiary center • Lakeview: 97-bed acute care hospital, national leader in orthopedic care • Hudson: 25-bed critical access hospital, award-winning healing arts program • Westfields: 25-bed critical access hospital, regional cancer care location
Our Affordability Strategy: The Triple Aim: Value Driven Health Care
Population Health
Experience of Care
Per Capita Cost
• Simultaneously Improve
72
0.8987
9.0%
41.0%
5%
15%
25%
35%
45%
0.880
0.900
0.920
0.940
0.960
0.980
1.000
Tota
l Cos
t In
dex
97.1% 98.3%
90%
95%
0.890
% patients with Optimal Diabetes Control*
* controlled blood sugar, BP and cholesterol (per ICSI guideline A1c changed from < 7 to < 8 in 1Q09 and BP control changed from <130/80 to <140/90 in
3Q10), AND daily aspirin use, AND non-tobacco user
% patients “Would Recommend” HealthPartners
Clinics
Total Cost Index
(compared to statewide average) < 1 is better than network average
TRIPLE AIM: Health-Experience-Affordability HealthPartners Clinics
43%
Triple Aim: Transformation Elements Set goals; aim
high
Redesign Care • Reliability • Customization • Access • Coordination
Align compensation, payment, and plan benefit design with Triple Aim goals
Transparently report results
Provide actionable Triple Aim data
Support healthy lifestyle choices
Proactively identify and engage high risk populations
Culture
Triple Aim: Transformation Elements Set goals; aim
high
Redesign Care • Reliability • Customization • Access • Coordination
Align compensation, payment, and plan benefit design with Triple Aim goals
Transparently report results
Provide actionable Triple Aim data
Support healthy lifestyle choices
Proactively identify and engage high risk populations
Culture
We use the following design principles to ensure our care achieves Triple Aim results:
Care Design Principles
Four Care Design Principles
Reliable processes to systematically deliver
the best care
Care is customized to individual needs
and values
Easy, convenient and affordable access to care and information
Coordinated care across sites, specialties,
conditions and time
Reliability Customization Access Coordination
After the Visit Between Visits
Visit Scheduling
Pre-visit Planning Check-in Visit Follow-up
Between Visits
Before The Visit During the Visit
Visit Cycle
Clinical Topics Team Members Depression Physician Led Diabetes Registered Nurse Preventive Services Rooming Staff Tobacco Cessation Clerical Staff Pediatric Immunizations Ad hoc: dieticians, diabetes Child and Teen Check-up educators, pharmacists Pediatric Asthma
Client success - TURCK • 400 USA employees, International manufacturer • Wellbeing strategy aligned with becoming employer of choice
Broad Program – Individual wellbeing based on intrinsic choice • Health assessment, Biometric health screening • Wellbeing, career coaching and wellbeing challenges • Educational seminars: On-site health coach • On-site clinic and pharmacy services – employees and family members • Use of clinic and one-on – one wellbeing coaching, on company time.
CLIENT PROFILE
PROGRAM DESIGN
Source: Geiger Lora, MetroDoctors The Journal of the Twin Cities Medical Society; July/August 2011: 15-16.
ENGAGEMENT & RESULTS
• Over 62% of employees engage in one-on-one coaching and receive premium reductions
• Over 6,000 PTO hours saved by employees since 2007 clinic opening and over $100,000 saved by employees in clinic copayments
• Company saved over $950,000 in productivity & direct medical savings – 35.1% reduction in office visits – 22.5% reduction in chiropractic services – 82.5% reduction in inpatient admissions
Patient chooses the way they want to access HPMG based on:
1) Do they have an established relationship?
2) What is the presenting problem?
3) What level of convenience do they desire?
4) What level of connection to their provider & care team do they desire?
e.Visit Telephone Visit
Complex Care Visit
Urgent Care
Same Day Clinic
Access
Employer Based Clinics
virtuwellTM
“Call, Click or Come In”
• Available around the clock – 24/7/365 • Custom treatment plan with prevention
advice • A simple $40 price, insurance accepted • Money-back guarantee • Free & easy triage if higher level of care
needed • Free 24/7/365 follow-up care • Evidence-informed & physician-
endorsed, backed by five decades of care delivery innovation
• Ability to connect with a nurse practitioner anytime
virtuwellTM at a Glance
Triple Aim: Transformation Elements
Culture
Set goals; aim high
Redesign Care • Reliability • Customization • Access • Coordination
Align compensation, payment, and plan benefit design with Triple Aim goals
Transparently report results
Provide actionable Triple Aim data
Support healthy lifestyle choices
Proactively identify and engage high risk populations
Culture
Grounded in Partnership: Creating Our Physician Culture
HealthPartners Physician & Dentist Partnership Agreement
ORGANIZATIONAL GIVES Involve and engage doctors • Involve doctors in strategy, business, and marketing • Include doctors in the development of patient centered and doctor efficient practices • Provide opportunities for leadership training • Promote partnership between doctors, staff, and organization • Listen to and be influenced by doctors, assume good intentions, and foster
opportunities and forums for doctors to discuss and deliberate important issues Support a practice that works for both patients and doctors • Be Patient Centered • Support 6 Aims practice and remove barriers at the point of care • Provide an environment and tools to ensure satisfying and sustainable practices • Promote trust and accountability within teams and the medical/dental groups • Create opportunities to educate physicians, dentists and staff about 6 Aims centered
care • Provide support for a healthy and balanced work life for doctors • Respect physicians’ and dentists’ time to allow care of patients
Grow strong and sustainable clinical practice • Recruit and retain the best people • Market HP’s multi-specialty medical and dental groups aggressively • Provide market based, and performance linked compensation • Acknowledge and reward contributions to patient care and the organization’s goals • Create an environment of innovation and learning • Support teaching and research
Demonstrate accessible, accountable, responsive and empathetic leadership • Understand the complexity of health care delivery and apply best management
practices • Seek to understand the clinical perspective • Communicate coherently our mission, vision, direction, and strategy; • Help us to understand the complexity of our dynamic business challenges • Provide performance feedback communicated in the spirit of improvement and
learning • Recognize the leadership, professionalism, and contributions of doctors • Resolve conflict with openness and empathy
PHYSICIAN & DENTIST GIVES Be involved and engaged • Participate in departmental and medical/dental group meetings and activities • Engage and participate in partnership with practice teams, and with clinical and
administrative colleagues • Champion processes to improve care systems service and quality • Provide input to strategy, marketing, and operations development • Develop understanding of the business aspects of care delivery • Raise issues and concerns respectfully • Seek to understand the organizational perspective, assume good intent, and
collaborate effectively • Demonstrate ownership of your practice and clinic
Excel in clinical expertise and practice • Be Patient Centered • Pursue clinical practice consistent with the 6 Aims • Advance personal and care team expertise and excellence • Seek and implement best practices of care for patients • Reduce unnecessary variation in care to support quality reliability, and customized
care based on patients needs • Create innovations for care and care delivery and be open to innovations and ideas for
improvement needed in our environment • Show flexibility and openness to change
Support our multi-specialty group practice • Demonstrate passion and commitment for your practice and our multi-specialty
medical and dental group • Collaborate within and across disciplines and partners to improve patient care • Promote, refer and communicate with colleagues effectively • Use resources responsibly and support care delivery systems that improve care and
reduce costs effectively • Participate in teaching and research
Be a Leader • Demonstrate commitment to the organization’s mission and vision • Lead as a role model • Support colleagues and partners • Communicate respectfully and thoughtfully • Use a problem solving approach when identifying issues • Provide leadership to the care team and delegate effectively • Provide recognition and feedback to other doctors and staff • Participate in and support medical/dental group decisions • Seek ways to continually develop leadership and influence skills
ORGANIZATIONAL GIVES Involve and engage doctors • Involve doctors in strategy, business, and marketing • Include doctors in the development of patient centered and doctor efficient practices • Provide opportunities for leadership training • Promote partnership between doctors, staff, and organization • Listen to and be influenced by doctors, assume good intentions, and foster
opportunities and forums for doctors to discuss and deliberate important issues Support a practice that works for both patients and doctors • Be Patient Centered • Support 6 Aims practice and remove barriers at the point of care • Provide an environment and tools to ensure satisfying and sustainable practices • Promote trust and accountability within teams and the medical/dental groups • Create opportunities to educate physicians, dentists and staff about 6 Aims centered
care • Provide support for a healthy and balanced work life for doctors • Respect physicians’ and dentists’ time to allow care of patients
Grow strong and sustainable clinical practice • Recruit and retain the best people • Market HP’s multi-specialty medical and dental groups aggressively • Provide market based, and performance linked compensation • Acknowledge and reward contributions to patient care and the organization’s goals • Create an environment of innovation and learning • Support teaching and research
Demonstrate accessible, accountable, responsive and empathetic leadership • Understand the complexity of health care delivery and apply best management
practices • Seek to understand the clinical perspective • Communicate coherently our mission, vision, direction, and strategy; • Help us to understand the complexity of our dynamic business challenges • Provide performance feedback communicated in the spirit of improvement and
learning • Recognize the leadership, professionalism, and contributions of doctors • Resolve conflict with openness and empathy
PHYSICIAN & DENTIST GIVES Be involved and engaged • Participate in departmental and medical/dental group meetings and activities • Engage and participate in partnership with practice teams, and with clinical and
administrative colleagues • Champion processes to improve care systems service and quality • Provide input to strategy, marketing, and operations development • Develop understanding of the business aspects of care delivery • Raise issues and concerns respectfully • Seek to understand the organizational perspective, assume good intent, and
collaborate effectively • Demonstrate ownership of your practice and clinic
Excel in clinical expertise and practice • Be Patient Centered • Pursue clinical practice consistent with the 6 Aims • Advance personal and care team expertise and excellence • Seek and implement best practices of care for patients • Reduce unnecessary variation in care to support quality, reliability, and customized
care based on patients needs • Create innovations for care and care delivery and be open to innovations and ideas for
improvement needed in our environment • Show flexibility and openness to change
Support our multi-specialty group practice • Demonstrate passion and commitment for your practice and our multi-specialty
medical and dental group • Collaborate within and across disciplines and partners to improve patient care • Promote, refer and communicate with colleagues effectively • Use resources responsibly and support care delivery systems that improve care and
reduce costs effectively • Participate in teaching and research
Be a Leader • Demonstrate commitment to the organization’s mission and vision • Lead as a role model • Support colleagues and partners • Communicate respectfully and thoughtfully • Use a problem solving approach when identifying issues • Provide leadership to the care team and delegate effectively • Provide recognition and feedback to other doctors and staff • Participate in and support medical/dental group decisions • Seek ways to continually develop leadership and influence skills
Excel in clinical expertise and practice • Be Patient Centered • Pursue clinical practice consistent with
the 6 aims • Advance personal and care team
expertise and excellence • Seek and implement best practices of
care for patients • Reduce unnecessary variation in care to
support quality, reliability, and customized care based on patients needs
• Create innovations for care and care delivery and be open to innovations and ideas for improvement needed in our environment
• Show flexibility and openness to change
Support a practice that works for both patients and doctors • Be Patient Centered • Support the 6 aims of practice and remove
barriers at the point of care • Provide an environment and tools to ensure
satisfying and sustainable practices • Promote trust and accountability within
teams and the medical/dental groups • Create opportunities to educate physicians,
dentists and staff about 6 Aims centered care • Provide support for a healthy and balanced
work life for doctors • Respect physicians’ and dentists’ time to
allow care of patients
HealthPartners Physician & Dentist Partnership Agreement
Triple Aim: Transformation Elements
Culture
Set goals; aim high
Redesign Care • Reliability • Customization • Access • Coordination
Align compensation, payment, and plan benefit design with Triple Aim goals
Transparently report results
Provide actionable Triple Aim data
Support healthy lifestyle choices
Proactively identify and engage high risk populations
Culture
Care Team Scorecards
86
Medical Group
Appr
opria
te
Test
ing
for
Child
ren
with
Ph
aryn
gitis
Appr
opria
te
Trea
tmen
t for
Ch
ildre
n w
ith
Upp
er
Resp
irato
ry
Infe
ctio
n
Avoi
danc
e of
An
tibio
tics
in th
e Tr
eatm
ent o
f Ad
ult B
ronc
hitis
Child
hood
Im
mun
izat
ion
(Com
bo 3
)
Brea
st C
ance
r Sc
reen
ing
Cerv
ical
Can
cer
Ch
lam
ydia
Sc
reen
ing
in
O
ptim
al D
iabe
tes
Opt
imal
Vas
cula
r
Cont
rolli
ng H
igh
Bloo
d Pr
essu
re
Use
of S
piro
met
ry
Test
ing
n th
e As
sess
men
t and
Di
agno
sis
of
COPD
Follo
w-u
p Ca
re
for C
hild
ren
Pres
crib
ed A
DHD
Med
icat
ion
HealthPartners Clinics (10 of 12 )
Park Nicollet Health Services (8 of 12)
CentraCare Health System (7 of 12)
Fairview Medical Group (7 of 12)
Quello Clinic (5 of 12)
Health East (5 of 12)
Allina Health System (4 of 12)
Minnesota Community Measures High Performing Medical Groups in 2011 (Primary Care)
=Medical Group rate and CI fully above average Blank= measure reported but rate was average or below average
Total Cost of Care
Price Resource Use
Total Cost of
Care
• Includes 100% of the care provided. • Illness burden adjusted • Patients are ‘attributed’ based on where care is obtained • NQF Endorsed
Improving TCOC • Primary Care
– Specialty referral preference – Standardized labs – Hospital choice – Screening and test intervals
• Specialty Care and Hospital – Care pathways – Place of service – Consultation balanced with on-going care
• Medical Group – Generics – Fee Schedule – Diagnostic imaging
Paying for Value
1997 • Partners in Excellence
• Financial incentives for better health, better care and lower costs.
2001 • Partners in Progress
• Blends payment for better health, better care and lower costs into market-based reimbursement rates.
2009 • Total cost of care payment approach introduced
• Focuses care systems on the overall cost of providing care, not just the cost of each service.
2011 • 2/3 of members receive care from a provider with a total cost of
care agreement
Another Perspective: Northwest Metro Alliance
Northwest Metro Alliance The Opportunity: 7 year agreement to achieve Triple Aim Results
• Additional focus will be to coordinate planning for physician coverage to ensure the availability of providers, and to avoid duplicative capital expenditures.
• Shared financial risk
Current Initiatives:
Clinic-Based
• Generics
• Bronchitis
• Low Back Pain
Hospital-Based
• Readmissions
• Mental Health 7-day Follow Up
• Safe and Effective Inductions of Labor
• HealthPartners Medical Group, Allina Medical Clinics, and Mercy Hospital care for nearly 300,000 people . The NW Metro Alliance was created to ensure the stability required for care and strategic integration
• The goals of the NW Metro Alliance are to improve the health of residents through a focus on the Triple Aim and to ensure the long-term viability of the healthcare providers and system in the area.
NW Alliance: First Year Results
• Achieved its quality & patient experience goals. • Obtained gains in multiple clinical areas. • Decreased total cost of care trend for the market
NW Metro Alliance - Year over Year PMPM Trend summary, through end of Q4, 2010
8.09%
2.96%
0.00%2.00%4.00%6.00%8.00%
10.00%
Q4, 2009 Q4, 2010“Rather than sitting around a table thinking up ways to do things differently, they [NW Alliance] are in the clinics and hospitals doing things differently.”
- Jim Abeler, Chairman, MN HHS Finance Committee
Results Position us as an ACO
• In top 25 national in NCQA’s Health Insurance Plan rankings for 2010/11 • Obtained Medical Home recognition across all clinics
– NCQA Primary Care Medical Home highest level designation – State of MN Health Care Home certification in Primary Care and Infectious
Disease • Hospital: Leapfrog Group’s Top Hospital designation 2009/10/11 • Benchmark employee satisfaction • Physician satisfaction (AMGA survey)
– 25th percentile → 88th percentile • Achieved margin target in each of last 9 years • Plan administrative costs at 5.4%; clinic unit costs moderated (1.07%
compound annual growth rate 2004-10) • Growth
– 20% increase in medical plan membership over three years; 15% in dental plan
– Regions Hospital achieved top market share position in 2011 – Clinic’s active patients increased
Questions?
Tom Cooke Sr. VP, Business Development, Aetna Accountable Care Solutions
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Need Insurance?
Collaborating to Transform Healthcare Aetna Accountable Care Solutions Overview
AIAMC Meeting Tucson, Arizona
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Our values drive our behaviors and strategy
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
The market is demanding more value
We want to reduce our annual healthcare costs by 15%...” “Willing to exchange access and choice for
affordability…” “Discounts alone are not sustainable...we need
improved unit costs…” “Where do you have innovative models in place with
providers that …?
Economic Conditions
Rising Costs
Globalization
Absenteeism & Presenteeism
Quotes from plan sponsors:
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Unified Theory of Narrow Networks
Base Network
Quality Designation
Network
Low Cost Networks
ACO
• Some customers still demand maximum access • This is the most costly option
• Select providers that meet certain quality standards • Consistent methodology across all geographies • Appeals to multi-location employers • 1st step for customers looking improve quality & cost
• One-off network designs based on local market opportunities (clinical integration, contracting, other)
• Steerage, High Value Network physicians only with benefit changes to achieve a 10% savings
• Results dependant on ability to produce savings, provide superior customer experience
• Tiered Networks may be used w/ACO at Tier 1 • Convenience strengthened through tech / people • May be private label product
100%
95%
90%
85%
100%
60%
40%
25%
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Price, Brand, Benefit Design and Services will Increasingly Drive Buying Behavior through Reform
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
• License • Claims • Member Services • Sales and Marketing • Actuarial / Underwriting • Implementation Services
Health Plan Services • License • Claims • Member Services • Sales and Marketing • Actuarial / Underwriting • Implementation Services
Health Plan Services
Care Management
• Embedded CM • Telephonic CM • DM, UM, CM • Wellness • Senior Programs • Implementation Services
Care Management
• Telephonic / Embedded • UM, DM, CM, BH, MM
Training, Staff & Programs • Wellness and Lifestyle • Clinical / IT Platform • Implementation Services
HIT/HIE
• HIE • CDS
• PHR / Pt Portal • Analytics
• Implementation Services
• CT Suite
HIT/HIE
• HIE • CDS
• PHR / Patient Portal • Analytics
• Implementation Services
• Care Team Suite • HIE
• CDS •
• Analytics & Reporting • Implementation Services
•
Provider Branded Health Plan
Provider Branded Health Plan
Payment Reform
Payment & Incentive Models
Consulting Consulting
Out Patient Facilities Pharmacy Home Health
Physicians Hospitals Staff Out Patient Facilities Pharmacy Home Health
Physicians Hospitals Staff
Accountable Care Solutions Strategy
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Phased Approach to Accountable Care
EMR / PMS
HIE
Population, Risk & Financial
Management
Care Team Portal
HIE
Care Team Portal
Clinical Decision Support
EMR / PMS EMR / PMS
“Accountable Care Enablement”
“Clinical Integration Enablement”
“Meaningful Use Enablement”
HIE
Clinical Decision Support
Outcomes Measurement &
Reporting
• Manage populations • Price / manage risk • Create a sustainable
economic model
Clinical Decision Support
Analytics & Registry
Analytics & Registry
Outcomes Measurement &
Reporting
• Team based care • Manage performance
• Digitization & Interoperability
• Identify gaps in care
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Description Model
Build Population Specific Models
Provider Branded Private Label Health Plan
Clinical Integration
Support All Payers
Medicare: FFS, Pioneer Grant Support and Medicare Advantage Medicaid System Employees Commercial Fully Insured Self Funded Plan Sponsors
Governance Network Development Business, Payment and Clinical Model Development Workflow Redesign, Clinical, IT, Care Management Infrastructure Development Role and Responsibility Definition
Use of insurance license and expertise (e.g., actuarial) to enable private label/co-branded health plan offering and manage risk Leverage scale/operations – claims processing, customer service, call center, &
care management (e.g., staff, programs, technology)
A
C
B
Three Models of Collaboration
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
ACO Scope
Bre
adth
of P
opul
atio
ns S
erve
d 58 Medicare Advantage Provider Collaborations
3 technology enabled Pioneer Pilots to Date
9 Multi-payor PCMHs; Many single payer PCMHs
10+ Medicaid PCMHs 2 Statewide ACOs 30+ bundled payment pilots 30 multi-line, multi-payor ACOs
being contracted or launched >160 providers in pipeline
Experience
We used ACS’ structure and targeted investments to build industry leading experience
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
ACS components
HIE / HIT/ Informatics
EMR, HIE Services Clinical Data Mgmt
Sales & Analytics
Clinical Quality & Efficiency Reporting
Financial Performance Reporting
Local Mkt Analysis Benchmarking
Support health system migration via consulting services & engagement managers Readiness Assessment, community outreach strategies, HIT implementation services, change management…
Care Mgmt
MD Integrated DM/UM/CM
Prevention & Wellness Ancillary Services
Financial Arrangements
Financial/Incentive Design Financial Disbursement
Product Design
Health Plan Core Consumer Platform
Care Delivery Support Local On Line Communities
Patient Education Product & Preferences
Support
1. Find value opportunities
2. Create value via medical management, technology, and patient/consumer engagement
3. Capture & share value via contracting & plan products
Mgmt Reporting Member Service Provider Service
Coherent Individual Health Record
• Personal details • Care Team • Health events. matters
problems, medications, treatments
New Technologies
ontology single best record
protocols
Frag
men
ted
Pro
vide
r/Pla
n D
ata
Medicity
A single understanding of the patient
shared with all involved in care giving including
the patient, doctors, health
coaches & enriched by
analytics
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Next Gen Health IT Enabled Health Plan
Payer Gateway
Rx Hub
Rad
Lab
ADT EDIS
PMS
EHR
Data Integration
Claim
X.12 837
HL7, NCPDP
X.12 837
HL7, CCD, CCR, TEXT HL7, CCD, CCR, TEXT
HL7, TEXT
HL7, LOINC, TEXT
HL7, TEXT
Semantic Normalization
Data Warehouse
(Clinical & Claim data)
Reports • Population analysis • Provider analysis • Risk analyses • Cost analyses • Utilization • Efficiency • Patient analysis • Quality • Outcomes • Comparative
Effectiveness • Profitability
Care Coordination
(Care Apps)
Patient Engagement & Care Team Workflow
Clinical Analysis
(Care Algorithms)
Care Analysis & Alerts
• Enables integration and organization of unstructured clinical data
• Marriage with claims data • Without it, cannot do clinical
reports, PHR is incomplete and Alerts are inaccurate
Data Import & Export
Syntactic Translation
Master Person Indexing
Record Location & Routing • Community
health record • eRx • Referrals • EHR Lite
• Integration into provider work flows
• Provider-oriented reports for managing care and reporting quality and outcomes
• Lack of behind-the-firewall solution • DART for self-service use by providers
EHR
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Member Experience: • Personalized • Convenient • Satisfying
Maintaining health, wellness and independence
– Benefits design to align incentives – Health Risk Appraisal – Senior Care – Disease and Wellness management – Personal Health Record (PHR) – Care Alerts
Efficiently navigating the healthcare system
– Healthcare content and advice – Symptom guide – Provider directory and care match – Cost estimator – Appointment Scheduling – Clinical Capacity Exchange – Concierge services – Patient portal and e-Visits
Critical Success Factor: Patient engagement
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Key Product Features
Medical condition diagnosis (patented algorithms and proprietary clinical content)
Physician finder: • Nationwide directory of
hospital ERs, physicians, urgent care centers, retail clinics, pharmacies and outpatient clinics
• Directions based on GPS, IP Address or specified location
Cost estimation Appointment booking / pre-
registration / ER wait times Links to PHR
Creating a Symptom-to-Provider™ Pathway and Steerage
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Next Gen Health Plan Network Aetna is developing a multi state ACO network
Aetna
Sharp
Employer
State Heart
land
Carilion
BAHN
Data Integration
Banner
• New ACO networks (a national network made up of ACOs) will create value not through broad access or discounts but through data and informatics.
• The intellectual property of how to most efficiently manage a certain patient type or clinical condition becomes a valuable asset that can be leveraged across the next generation network.
• Delivery system members of this network will share clinical data as needed to support seamless patient care regardless of where the member travels
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Private-Label Health Plan
Background
Carilion Clinic, headquartered in Roanoke, VA, is a health care organization with 9,500 employees, more than 600 physicians in a multi-specialty group practice and 8 not-for-profit hospitals Carilion Clinic serves approximately 1 million people in western Virginia Carilion owns and operates its own Medicare Advantage (MA) Plan with 600 members Carilion has more than 1,200 licensed beds and net revenues of $1.25B in FY2009 Pioneer member of Dartmouth-Brookings ACO Collaborative Aetna had less than 10% market share in the Roanoke, VA market
What Carilion Wanted to Achieve
Get out of the red and drive profitable MA growth Lower costs and improve the health of Carilion’s employee plan via an accountable care model Diversify their commercial revenue streams by directly competing with the blues Transition from FFS to performance based payments without sacrificing revenue and profitability “Lose less” or potentially generate margin on Medicaid
Collaboration Model(s)
Medicare Carilion transitioned administration of its MA plan to Aetna continuing use of its own license Aetna deployed its MA provider collaboration model to generate up to $150 pmpm in savings Commercial Carilion transitioned its employees to Aetna in order to improve provider collaboration, operating efficiency and cost
savings Developed and launched a commercial health plan and three tier network targeted at individuals, small group, mid sized
employers. – The product, Aetna Whole Health, used Aetna’s insurance license. – Developed in partnership with Carilion the plan design, pricing, sales and distribution strategy – The network includes both Carilion and HCA, a Carilion competitor, in Tier 1 to reduce the blues local strangle hold
on their revenue. Tier 2 provides access to Aetna’s national par network to attract multi-sited employer groups. Tier 3 is Aetna’s non-par providers.
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Branded Network and Accountable Care Model
Background
Banner Health is an integrated delivery system w/35K employees headquartered in Phoenix and operates 23 hospitals and has 9,000 employed and affiliated physicians across 5 states Banner is a charter member of the Premier ACO collaborative Banner operates its own Medicare Advantage and employee health plan [Medisun] Aetna has 75K lives in the Phoenix market
What Banner Health Wants to Achieve
Launch and monetize the Banner Health Network (BHN) by developing strategic relationships with employers directly and health plans to drive steerage the BHN Demonstrate that the BHN can drive best in market quality and efficiency in managing populations
and potentially risk, over time Ensure Medicaid patients are getting the right care in the right setting at the right time within
Banner or other Phoenix systems Meet or exceed financial risk sharing targets for their Medicare FFS via the Pioneer Grant Award
Collaboration
Model(s)
Commercial Will launch a commercial product targeted at Individuals, Small Group, Public and Labor and other
targeted self insured customers Product—Aetna Whole Health— will include 3-tiered network with Banner Health Network and
Children’s Hospital of Phoenix in tier one Product is priced significantly below market premium based on efficiencies generated through
jointly developed care delivery model; pricing will be sustained Banner and Aetna will go, jointly, direct to employer to create steerage opportunities to the model
Proprietary and Confidential – Preliminary Document for Discussion Purposes Only
Branded Network and Accountable Care Model (Cont’d)
Collaboration
Model(s)
Medicare Deploy Aetna’s entire technology stack and care management support model to assist Banner
achieve pmpm savings targets for the Pioneer Grant. Aetna will take risk on achieving the targets and potentially share in a portion of the savings generated Extend the technology model to deliver improved quality and efficiency results for Banner
Health’s employees Medicaid Deploy a health home model to improve management of Medicaid beneficiaries
Payment and Incentives
Shared savings on Aetna’s existing Fully Insured lives Transition enrollees in new product from FFS, plus gain sharing to up-/downside risk when
enrollment meets jointly defined thresholds Roll-out 1/1/13 model for Banner/Aetna to share in savings generated for self insured customers Assist Banner extend the contracting, payment and incentive model, to other payers
Capabilities and/or Investments
Needed to Support Collaboration
Marketing: B2B and retail marketing campaign to drive product sales and steerage to Banner HIT/HIE: ActiveHealth CareTeam suite integrated w/Cerner/Allscripts; HDMS analytic tools, etc. Care management: Technology platform, health management programs, clinical staff support Health plan services: Aetna insurance license, AetnaOne Concierge Model, call center support Consulting: Dedicated project management office, support workflow re-design, medical
management support, etc.
