Dec 25, 2015
2
250+ Interviews Conducted Prior to MissionPoint Launch
Network Physicians
• Significant behavior change will only occur with “payer” control of 30 – 50% of a physician’s patient panel
• Models that require physicians to “do more” are at significant risk
• Primary Care Physicians favor capitation, as it evens out cash flow and allows them to meet productivity and financial goals without over scheduling
Members
• Non-clinical indicators are strongly predictive of cost
• Low percentage of patients account for high percentage of cost. Significant impact can be achieved by correctly identifying and working with these individuals
• Improvements in most clinical outcomes do not correlate to short-term cost savings
Employers
• Regional or National networks are required to cover 70% of employees that live outside a single market
• Willing to pay for access, but quality should be expected
• TPAs provide a variable amount of analytics to employers depending on size; however, data is not actionable and employers lack resources for effective interventions
Feedback Drives Design
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Market Segmentation Requires Unique Management Strategies
Coverage Type Cost Per Beneficiary
Number of Beneficiaries
Market Size
Self-Insured $4,547 74 Million $332 Billion
Fully- Insured $4,292* 74 Million^ $318 Billion
Medicare (Traditional) $9,702 34.2 Million $332 Billion
Medicare Advantage $8,467 14.6 Million $127 Billion
Medicaid $6,982 54.7 Million $382 Billion
Medicare:http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/FFS-Data.html FFS Datat, 2008-2011 Medicare Advantage:http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/http://kff.org/medicare/fact-sheet/medicare-advantage-fact-sheet/Medicaid: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/Downloads/MedicareMedicaidSummaries2012.pdf PG 29Self-Insured:http://www.healthcostinstitute.org/files/HCCI_HCCUR2011.pdfhttp://www.ebri.org/pdf/publications/facts/fastfacts/fastfact05282008.pdfFully –Insured:• estimate based on premium level• ^estimate based on US Population
Total Market: $1.5 Trillion
Engaging Patients Across All National Markets
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Progressive Employers Looking for Provider Partners
Managing HealthCare Cost Growth
Low Performers
10.3%
Median Best Performers
5.9%
2.2%
Study In Brief
18th Annual Towers Watson/National Business Group on Health Employer Survey
Comparative Annual Health Cost Growth
Employers Surveyed
Best at Holding Cost Growth More Likely to Focus on Provider Strategies
13%Contract directly with hospitals, physicians, ACOs
16%Adopt new accountablepayment models
16%Offer incentives for care
coordination22%
Offer performance-based payments
2%
7%
4%
5%
Best Performers
Low Performers
Products and Services
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Diversified Product Offerings Designed to Meet Employer’s Unique Needs
Survey Support
Engage
Bio Metric Screenings
Health Risk Assessment
Population 360
Environmental Design
Complex Case Management
PCP Connect
Virtual Care Network
Healthy Eating
OnSite Clinics
Smoking Cessation
Readmission Program
Primary Care Membership
Stress Management
Clinically Integrated Network
Clinical Management
These products are focused on helping clients gain intelligence about the risks and opportunities in their population. We use a combination of clinical, claims, and non-clinical data to define each opportunity.
This set of products is presented based on the risk and opportunity profile of each employer. Each product has a flexible pricing model based on geographic, risk, and cost profile of the defined population.
These are the products we’re best known for. These products are often a blend of shared savings and PMPM pricing plus implementation fee – with full at-risk models available for certain clients in 2015.
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Custom Network Design
Additional Physician IncentivesExtended Weekend Hours
Open SaturdaysOpen Sundays
Email with PatientsComprehensive Medication Review
SpecialistsOutpatient Facilities
Inpatient Facilities
MissionPoint Provider Network
Population Identification and Stratification
Care at a Distance
Wellness Partners and Services
Medical HomeInternal Med and Family Practice
Personal Care Team
Per Member Per Month Payment
Shared Savings Pool
MissionPoint Health Partners
MissionPoint Member
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Contracts Standard Yet Flexible
Provider Flexibility
Physician Master AgreementMeets Clinical Integration Safe Harbor:• Committee Participation• Shared Quality Information• Care Collaboration
Addenda Provide Freedom and Flexibility:• Physician can decide what populations
to participate in• Each Addendum contains different rates,
shared savings amounts and quality metrics
• Addenda can have different terms and “opt-out” provisions
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Diverse Focus Areas Addressed on Three Health Partner Teams
Health Partner Solutions
Transitional Ambulatory Integrated Care
Patient Connects to Health Partner: Physician Referral
Self ReferralHospital Discharge
ED Visit
• Hospital Discharge• Long-term Care• Skilled Care• Home Visits
• ED• Disease
Management• Wellness
• Psychosocial Needs
• “Life” Resources• “Family”
Resources
Specialty Care
Primary Care Physician Virtual “Medical Home”
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Payer TPA
Self-Insured
Employer
Options During Open Enrollment
Preferred Network (MPHP)Narrow Network
Dedicated Medical HomeLow Co-Pay Levels
Leveling Monthly PremiumsCoordinated Patient Record
Deep Wellness Support
In-NetworkNarrow Network
Expected Co-Pay LevelsRising Monthly Premiums
Wellness Support
Out-of-NetworkWide Open NetworkHigh Co-Pay Levels
High Monthly PremiumsLow Coordination
Little Wellness Support
Provides Shared Savings Option
Pays Claims and Network Service Fee
Employee Selects Medical Home
Creating Value for the Ecosystem
Employee
Employee/Member
MissionPoint Health Partner
Specialty A
Specialty B
Specialty C
Alliance Network
Partner A
Partner B
Partner C
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Targeted, Fact-Based Solutions to Manage Populations
MPHP Strategic Approach
Identify Segment Prescribe Engage Sustain
Getting to know you:• Personal Health Reports• Clinical Population Analysis• Demographic Review
Find the Right Strategy:• Health Assessments• On-Site Clinics• Health Partners• Telehealth• Narrow Networks
Analytics and Aspirations• Utilization Costs• Location Costs• Avoidable Events• Behavior Modification• Care Experience
Personalized Plans• Type of Engagement• Frequency• Intensity• Duration
Right Time, Right Place• Quarterly Monitoring• Strategy Adjustments• Quality Reviews
Rising-Risk Patients
Low-Risk Patients
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Patient Data Maximized to Guide Effective Interactions
Managing Patient Risk
Prioritize Highest Risk Members:Immediately deploy Health Partners to patients during “trigger events”
Target Members Showing Warning Signs:Track future risk scores and population trends for pro-active Health Partner engagement
Create Opportunities Across Members:Leverage highly effective, low cost screenings and preventative care for optimal health outcomes across members
Benefit Design Steers Members Towards Optimal Use of MissionPoint Network
81%
77%
65%
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Continuous Improvement in Self-Insured Population
Tracking Progress
Quality Metrics by YearMedical Per Member Per Month Cost Trend
2011 2012 2013
8.99%
7.85%
30-Day All Cause Readmission Rate
Nov. 2011-Oct. 2012 Nov. 2012-Oct. 2013
2.23%
3.29%
4.50%
36.30%
71.28%
95.99%Chronic Disease Spend
Above Benchmark
% Avoidable Admissions
ED Visits per 1,000
% Generic Utilization