A Provider’s Perspective on the Latest Health Care Trends Orange County Employee Benefits Council Breakfast February 12, 2015 Diane Laird, MPH MHS Chief Strategy Officer Greater Newport Physicians CEO
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
A Provider’s Perspective on the Latest Health Care Trends
Orange County Employee Benefits Council Breakfast February 12, 2015
Diane Laird, MPH MHS Chief Strategy Officer
Greater Newport Physicians CEO
MemorialCare Health System
Five Major Trends
1. Consolidation/Alliances
2. Private Exchanges
3. Population Health
4. Consumerism
5. Value
Our Existing Business Model
Staying Afloat Through Cross-Subsidization Traditional Hospital Cross-Subsidy
Below Cost Above Cost
Commercial Insurance Public Payers
• Above-cost pricing
• Robust fee-for-service volume growth
• Steady price growth
• Only one component of our total business
Hospital Payment-to-Cost Ratio, Private Payer, 2012
149% Hospital Payment-to-Cost
Ratio, Medicare, 2012
86%
Source: American Hospital Association, “Trendwatch Chartbook 2014,” available at: www.aha.org; Health Care Advisory Board interviews and analysis.
Five Major Trends
Consolidation/Alliances Private Exchanges Population Health Consumerism Value
OC Consolidation/Alliances
• MemorialCare Health System– Bristol Park (2010), Greater Newport Physicians and Nautilus Healthcare Management Group (2012)
• United Optum – MHIPA (2011), Monarch (2011)
• DaVita – HealthCare Partners (2012), Arta (2012)
• St. Joseph Health System – Mission Internal
Medical Group (2011), Hoag (2012)
MemorialCare Alliances
• MemorialCare Medical Foundation
• Imaging Centers
• Ambulatory Surgery Centers
• Seaside Health Plan
• UC Irvine Health
• Vivity
Innovative Alliances
offered by
JV between Anthem and 7 prominent health systems
Consolidation/Alliances Private Exchanges Population Health Consumerism Value
Private Exchanges
• Private exchanges support market shift from “defined benefit” to “defined contribution” by offering more choice of plans and coverages
Overview
• A benefits strategy that drives cost efficiency through the
healthcare and insurance supply chain – Creates new competition among insurers, providers – Reduces administrative costs and improves quality through
standardization – Supports new market entrants enabling competition
$4T
2015F 2010 2005 2000
Health Care Costs
Con
tinue
d C
ost P
ress
ure
PRIVATE EXCHANGES:
Hea
lthca
re
Ref
orm
• Support healthcare reform compliance and leverage its benefits – Streamlines compliance requirements – Mitigates 40% excise tax in 2018 – Leverages ability to offer non-sponsored employees and retirees
support for individual medical plan enrollment
Shifting Responsibilities
Individuals Employers
Empo
wer
Em
ploy
ees
• Offers improved employee benefits appreciation – More choice, greater support
• Can address the needs of all employees and retirees – Full and part time employees, pre-Medicare and Medicare
retirees
MERCER
Poised for Rapid Growth
Employers are moving rapidly to defined contributions
contribution and private exchanges
large employers will be offering benefits through private exchanges
In 2014…
exchanges
carriers participating on third-party exchanges
types of products available through private exchanges
100+
35+
180+
25+
Private exchange growth has just begun
25
50
Millions of lives
Private Exchange
0 2013 2014 2015 2016 2017 2018
• Private exchanges will be mainly employer-sponsored • 65%+ of employees will likely choose different benefits
than they have today
MERCER
Implications for Employees
• More choice of plans • Increased choice of ancillary products
(dental, vision, critical illness, etc.) • May “trade down” to cheaper options –
higher deductibles, narrow/tiered networks
Consolidation/Alliances Private Exchanges Population Health Consumerism Value
Linking the Triple Aim to Strategy
• Better health of a population
• Better patient experience
• Lower per capita cost
Challenges
• Identifying the “population”
• Developing a solid data analysis system/IT
• Establishing a care management team (roles, responsibilities and workflows)
• Quantifying outcomes beyond cost of care
Essential Components
• Risk based payment • Infrastructure
– IT – Experienced
care management teams – Scale
• Alignment of provider incentives • Engaging the consumer
Care Management
High-Cost Patients
Rising-Risk Patients
At-Risk Patients
Healthy Patients
Risk Stratification and Predictive Modeling
5% e.g., poorly controlled CHF
With multiple comorbidities
e.g., patient with diabetes And depression 20%
40% e.g., pre-diabetic patient
35% e.g., patient with no disease diagnosis
Coordinated Care • Wellness & Prevention
– Health Coaching – Preventive Screenings – Vaccination Outreach
• Ambulatory Care Management – 24/7 Telephone Advice Nurse – Primary Care Case Mgmt. – Specialized Clinics
• Anti-coagulation • Discharge Clinic • ACTIVE Diabetes • Back pain
• Specialty Care Management
– Complex & High Risk Care Management
– Virtual Care Conference
• Hospital Care Management – 24/7 Hospitalists – After hours RN Triage – Repatriation/Concurrent
Review – Care Transitions
• Disease Management Programs – COPD – CHF – Diabetes – Palliative Care – Medication Reconciliation
GNP - Case Study
• ACTIVE Diabetes
• Results:
HbA1C 9.7 7.8
• Right Care Initiative Award
Caring for our Own Employees
• The Good Life • Linking Benefits to Behavior • Chronic Condition Management
In Balance
First Year Results - In Balance
Participants with diabetes & hypertension
• 84% participant retention • 92% compliance with
medications • BMI: 50% achieved or
maintained BMI < 25 • Diabetes: average HbA1c
improvement of 10% • Hypertension: average BP
reduction of 20/13
Per Capita Costs National Average
Health Care Spending Rate Increase over 5
years = 8.5%
MemorialCare Average Health Care
Spending Rate Increase over 5 years
= 3.5%
Consolidation/Alliances Private Exchanges Population Health Consumerism Value
Employers Driving Consumerism • High deductible health plans
• Wellness initiatives
• Steerage and incentives
• Price transparency tools
Patients vs. Consumers
Consumers are Engaged • Physician recommendation &
verification • Online tools & social media • Personal experience & comparison shopping • Value = access + service delivery
+ outcomes + cost
INFORMED & EMPOWERED
Consolidation/Alliances Private Exchanges Population Health Consumerism Value
Attributes for Success
Clinical & Service Quality
Geographic Reach
Cost
Quality
Greater Newport Physicians – MemorialCare Medical Group -
Centers for Medicare and Medicaid Services (CMS) Medicare Five-Star Quality Measures
Standards of Excellence 4 Star Elite Status Eight consecutive years - Greater Newport Physicians MemorialCare Medical Group
Long Beach Memorial Orange Coast Memorial Saddleback Memorial Receive A –Hospital Safety Score
Long Beach Memorial Orange Coast Memorial Saddleback Memorial Ranked as High Performing in multiple specialties by US News & World Report.
Geographic Reach
Cost
MemorialCare Controllable Expense per Discharge
Questions?
Related Documents
