Employers as Change Agents – New Opportunities through Direct Relationships.

Employers as Change Agents – New Opportunities through

Direct Relationships

THE HDP PREMISE

Employers are ready for cost containment solutions based on Patient-Centered quality care, with competitive pricing.

2

SO….

WHAT’S THE

PROBLEM?

3

“7 OF 10 CFOS AND OTHER TOP FINANCIAL EXECUTIVES RANKED HEALTH CARE AMONG THEIR TOP

BUSINESS CONCERNS FOR 2013.” 

Bank of America Merrill Lynch Survey In USA Today, 7/23/13

4

HOW MUCH HEALTH CARE COST IS WASTE?

PwC 2008* – 54.5%

In 2008 - $1.2 trillion

8% of 2008 GDP

Equal to income tax receipts

> The US’ 2012 Budget Deficit* PricewaterhouseCoopers’ Health Research Institute The price of excess: Identifying waste in healthcare spending

5

6

TOP THREE CAUSES FOR $1.2 TRILLION WASTE OUT OF A $2.2 TRILLION TOTAL SPEND Defensive medicine –

including unnecessary test and procedures

Inefficient healthcare administration

Cost of care necessitated by preventable lifestyle driven conditions * PricewaterhouseCoopers’ Health Research Institute

The price of excess: Identifying waste in healthcare spending

AVG ANNUAL HEALTH INSURANCE PREMIUMS AND WORKER CONTRIBUTIONS FOR FAMILY COVERAGE, 2009-2013

7

If health care costs tracked general inflation over the prior 15 years, in 2010 average family income would have been $8,410 (13.9%) higher ($68, 805 vs. $60,395).

Young and Devoe Family Medicine, Oct 2012

IMPACT ON FAMILY INCOME

8

OccupationalHealth

Convenience/Urgent Care

WHAT THEY’VE BEEN DOING FOR YEARS HELPS – BUT DOESN’T SOLVE THEIR PROBLEM

+

Rx Dispensary& Mgmt Chronic Disease

& Lifestyle Mgmt

Referral Mgmt

Benefit Refinement

Utilization Review

Case Management

Carrots & Sticks

Stop-Loss Arrangements

Health IT

9

Primary Care Medical Home

High PerformingNarrow Networks

Telemedicine

On Site Clinics

NOW THEY’RE WILLING TO GO DIRECT, USE THEIR BUYING POWER AND EMPOWER MEMBERS WITH DATA

Centers of Excellence Centers of Excellence

10

THE HDP PREMISE – REDUX

Employers are ready for cost containment solutions based on Patient-Centered quality care, while maintaining competitive pricing…. And here’s what’s

new….. they’re going direct and moving market share

11

BASED ON THE TRIPLE AIM

12

Old model –

Is care cost effective?

Are discounts best available?

New model –

Is care necessary?

Care most effective for the presenting patient?

Patient engaged and in agreement with approach and satisfied with care?

Are there good outcomes?

Is pricing in a format that assumes risk?

EMPLOYERS WANT CHANGE

In a word… VALUE

13

14

Evidence-Based Integrated Care Delivery

Plus

Patient- Centered Collaborative Decision Making with an Integrated Team

Plus

Appropriate & Affordable Risk-Based Price

Healthcare Value Results From……

WHAT DO EMPLOYERS WANTIN DIRECT RELATIONSHIPS?

Take care of the patient (my member) first and foremost

Deliver appropriate, evidence-based care

Engage the patient as a critical member of a multi-disciplinary integrated team

Exercise team-based decisions on care

Create a timely and transparent process, holding everyone accountable

Charge a reasonable fee – preferably at a bundled rate

15

Centers of Excellence/Domestic Medical Travel

Accountable Care Organizations, Medical Homes, Narrow Networks

16

“DIRECT TO EMPLOYER” MODELS

Patient Centered Medical HomesPaul Grundy, MD, MPHGlobal Director of Healthcare Transformation IBM, President PCPCC

17

DIRECT TO EMPLOYER MODELS

IBM Unleashes "Primary Care Spring"

“Utilizing a collaborative care model, the patient becomes a valued member of the care team – more than just a vessel for billing codes. Patients win. Physicians win. Employers win.” Dave Chase

8/27/2012

MERCER’S 2012 SURVEY ONWORKSITE MEDICAL CLINICS

Who is offering clinics…

37% of employers with 5,000 or more employees operate their own health clinics for occupational medicine and/or primary care

Increased from 32% in 2010

Another 15% - considering installing a clinic within 2 years

15% of companies with 500 to 4,999 employees have workplace clinics

18

Our CLINIFIT® Program

Fully carved out domestic travel surgery program For frequent high cost surgeries:

Cardiothoracic surgeries Spine surgeries Joints – Hip and knee replacements Transplant management 1/1/2016 adding bariatric surgery

Currently with self funded Fortune 200 companies WalMart, Lowe’s, PepsiCo, McKesson, others Available to over two million lives

19

WA

OR

CA

NV

ID

MT

WY

COUT

NMAZ

TX

OK

KS

NE

SD

NDMN

WI

IL

IA

MO

AR

LAAL

TN

MI

PA

NY

VT

GA

FL

MS

KY

SC

NC

OHINWV

NJ

CT

MA

ME

VA

NH

MI(upper pennisula)

RI

DEMD

ClinifiT ® Centers of ExcellenceVirginia Mason Medical Center

Mercy Hospital Geisinger Health System

Johns Hopkins

Cardiac

Spine

Joints

Southeast Center Coming in 2016

Kaiser Irvine Medical Center

20

MEDICAL CENTER CRITERIAQuality – Components:

Published outcomes begin evaluation Demonstrated practice of patient-centered, evidence-

based medicine Systematic, formal, documented quality driven

management process (e.g., Lean, Six Sigma, Adaptive Design)

Comprehensive team approach to clinical decision-making, willing to work collaboratively and as partner

Closely managed transitions of care Support of patient and “caregiver” throughout the

process Demonstrated accountability and transparency

Price – competitive and comprehensive bundled pricing – Requirement for consideration.

21

SAVINGS RESULT FROM Better outcomes with fewer complications Integrated care delivery with well managed

transitions Advanced care delivery techniques Commitment to totally patient-centered

approach – seeing everything through the “lens of the patient”

Patient engagement reduces cost; promotes better outcomes

Collaboration with other centers promoting best practices

Avoidance – HDP’s CoE experience Appropriate pricing & price structure (preferably

bundled)22

22

23

BUT WAIT… THERE’S MORE

Other Critical Factors Creating Value… Employee return to

work

Employee disruption – lost work time

Presenteeism

Employee relations – my employer cares about me and my family

SECRETS TO SUCCESS FOR A COE? Commitment to integrated, patient-

centered care delivery Physician leadership committed to

quality, service, evidence, patient engagement, and transition of care

Commitment to transparency, collaboration and working as a partner with TPA, employers and other centers

Commitment of necessary resources

Commitment to communication and valuing the whole team

Ultimately – Seeing and delivering all care “through the lens of the patient”

24