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Marjie Harbrecht, MDChief Executive Officer

It Takes a RegionWorking Together to Transform Healthcare

400-526707

HealthLINC ConferenceFebruary 17, 2012

Abbott Sponsorship Disclosure

“This presentation is sponsored by, and on behalf of, Abbott, and the presentation contents are consistent with all applicable FDA requirements. The Speaker for this program has been selected by Abbott and is presenting the program material on Abbott’s behalf.”

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400-546705

Health Care Expenses in an International Context

For All the Money We Spend, How Well Does Our System Perform?

THE CURRENT SYSTEM IS

UNSUSTAINABLE!!!

We need a NEW way of thinking and

NEW systems and payment models to support the care we want

delivered.

Trying harder will not work!

Changing systems of care will…

A nonprofit collaborative working to redesign healthcare and promote integrated communities of care, using evidence based

medicine and innovative systems to optimize health, improve quality and safety, reduce costs, and improve the care experience for

patients and their healthcare teams.

Have trained over 250 practices, 1500 providers impacting over 2 million patients!

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© MacColl Institute at Group Health 9

Triple Aimby

Institute of Healthcare Improvement

PopulationHealth

Experienceof Care

Per CapitaCost

Patient-Centered Medical Home (PCMH)

An approach to providing high-quality, safe, continuous, coordinated, comprehensive care, with a partnership between patients

and their personal health care team…

“The kind of care you’d want your Mom to have!”

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PROMISING TRENDS

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The world is changing

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The Colorado Multi-Payer PCMH Pilot

Multi-Payer Pilot Stakeholders

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Patients

Health Plans

Employers

Community Resources

Funders

Associated IPAs and Societies

Evaluator

Hospitals

Primary Care &

Specialists

• Three-year pilot• Planning Year - 2008

• May 2009 – April 2012

• 16 Family & Internal Medicine Practice sites• 83 providers; 258 staff

• Various sizes across the Front Range

• NCQA PCMH Recognition• 14 at Level III; 2 at Level II

• 7 Health Plans – public/private• Fee for service (FFS); Care management fee (PMPM); P4P

• 20,000 patients covered (100,000 affected)

Pilot Parameters

Making a House a Home!

Making a House a Home!

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What Do People Really Want?

• Trusting Relationship with Care Team • “I can reach someone who knows me, knows my history, can

advise me and cares about my issues”

• Service• “I can get care or contact with someone when I feel I need to,

without having to always come in”• “Less waiting in general” – during visits, for test results, for

referrals, for refills, etc. • Reliable, Coordinated Care

• “My care is coordinated” – between providers, hospital/ER, home health, behavioral health, etc

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What Do We Want?

• Trusting Relationship with Our Patients and Staff

• Work-Life Balance

• Job Satisfaction • “Providing the best, most efficient care possible

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So what does it take?

So what does it take?

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Building a Solid InfrastructureFundamentals for Transforming

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Technology & Outcomes Reporting

Leadership & Team Based Care

Practice Viability & Efficiency

Care Mgmt, Coordination & Communication

Patient Engagement &

Access

Medical Homes &Medical

Neighborhoods

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Tactical

• Technology• Registry/EMR• Health Information

Exchange (HIE)

• Systems Redesign• Increased Access• Guidelines/Protocols• Workflow Redesign• Care Coordination/Care

Management• Test/Referral Tracking

Cultural

• Leadership• Team Based Care• Patient Activation

• Shared Decision Making

• Communication & Building Relationships

• Continuous Quality Improvement

Tactics vs Culture

“Culture eats strategy for lunch…over and over again.”

– Anonymous

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Technical Assistance

• On-site Coaching

• Learning Collaboratives• Share lessons learned

• Data to Achieve Triple Aim• Meaningful Use, HIE and Beyond…

You can’t manage what you can’t measure

Data is CRUCIAL…

To Guide Your Team & Assess Gaps

To Engage Your Patients

To Outreach To Those Needing Care

PROVIDER_ID PROVIDER_NAME COST TOTAL_MED TOTAL_RX AGE SEX PRIM_DXT_DESC

000095431770414832 KATHERINE FLARE MD $ 65.15 $ 705,353.84 $ 19,828.84 62M ACUTE OSTEOMYELITIS ANKLE

000095485770414832 ADRIANA PANDER MD $ 130.27 $ 423,103.62 $ 2,587.37 46F SEPTICEMIA UNSPEC

000095412770414832 SHARON L BREECE MD $ 300.36 $ 214,217.60 $ 6,654.81 56M ATHEROSCLER NATIVE COR ART

000092486770414832 AL FARE MD $ 182.46 $ 209,287.22 $ 365.79 54M LUMB/SAC DISC DEGENERATN

000405537770414832 ED RAMOS MD $ 64.52 $ 146,996.08 $ 3,450.81 52F RADIOTHERAPY

000442566770414832 AMY CARD MD $ 353.24 $ 113,608.34 $ 4,339.82 71F CHR INFLAM DEMYEL POLYNEURIT

000087963770414832 MARY SEK MD $ 207.21 $ 101,326.63 $ 5,285.18 47M END STAGE RENAL DISEASE

000511092770414832 MICHAEL GAYLE MD $ 139.62 $ 91,490.92 $ 382.87 56F MALIG NEO BREAST UP OUTER

000334824770414832 KEVIN W LONG MD $ 2,786.30 $ 91,033.04 $ 0.35 0 M TWIN BIRTH MATE LB IN HOSP

000262829770414832 ALICE G KELT MD $ 130.30 $ 88,755.67 $ 2,041.18 58M SEPTICEMIA UNSPEC

000060005770414832 RICHARD BRACK MD $ 495.21 $ 82,053.13 $ 4,227.43 58M IDIOPATHIC SCOLIOSIS

000095412770414832 SHARON L BREECE MD $ 99.04 $ 73,923.77 $ 17,177.89 63F END STAGE RENAL DISEASE

000095478770414832 KEVIN J WHITE MD $ 335.79 $ 69,478.83 $ 12.65 18F ANOREXIA NERVOSA

000095485770414832 ADRIANA PASH MD $ 545.50 $ 66,043.47 $ 376.97 36F CHR INFLAM DEMYEL POLYNEURIT

000405537770414832 ED RAMOS MD $ 49.52 $ 54,782.70 $ 5,278.77 44F FITTING OTHER DEVICE

000095485770414832 ADINA PALVIA MD $ 449.76 $ 53,393.74 $ 382.47 36M ACUTE VASC INSUFF INTESTINE

000060005770414832 RICH BLAKE MD $ 324.44 $ 49,676.46 $ 2,218.76 57M CHRONIC LIVER DIS UNSPEC

000060005770414832 RICH BLAKE MD $ 465.38 $ 48,638.97 $ 1,224.57 49M MORBID OBESITY

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To Identify/Manage High Risk, High Need Patients

To Monitor Progress, Drive Improvement

Dec

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Pct of Heart patients with LDL < 100

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Pct of Heart patients with >=1 Lipid Profile

To Connect With Others -HealthLINC

• Get ALL data on patient when needed• Know when patients have been in

ER/Hospital – prevent re-admissions• Coordinate Care – “conversation”

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To Compare With & Learn From Others

0%5%

10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%

100%

Oct Feb Mar Apr May June

LDL Documented

CCFM

BFP

CFHS

iPN

BUT BEWARE…

• GIGO….it’s important where and how you enter data

• All that can be measured is not important and all that is important cannot be measured

• Data is a guide, it’s NOT the end all be all…

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Remember Why We’re Doing This…

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New payment modelsAllow a new way of thinking!

• Transition from FFS “Treadmill Medicine” to coordinated planned management of entire panel, with extra care for those who need it

• Redefine “VISITS”• Secure email and/or phone• Save appointments for those needing it most (Outreach)

• Care Coordination - Care Management

Care Coordination - Care Management

Internal

Care Coordination

Lab and Referral Tracking

Registry

Navigator

Care Management

Chronic Care Management

Patient Self Activation

Prioritizing High Risk / High Need

Medication Adherence

Prevention & Wellness

External

Medical Neighborhood

Hospital System

Specialists

Mental/ Behavior Health Systems

Community Resources

Shared Services

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Patient Centered Planned Care

• Before, During, and After Visit

• Develop Customized Care Plan• Shared-decision making• Prevention, Chronic Conditions, Acute Care Issues

• Warm Handover to Care Coordinator/Care Manager• Track tests/referrals, coordinate with medical neighborhood,

monitor registry (outreach and quality reports)• Engage patients, help them overcome barriers• Concentrate on high risk/high need patients

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Prioritizing Care Plan Management & Care Coordination

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Multiple Chronic

Conditions &

Complex Patients

COLORADO MULTI-PAYER PILOT

RESULTS TO DATE

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Goals/Measures• Improve quality

• Diabetes• Cardiovascular disease• Tobacco• Depression• Prevention

• Reduce cost trends • Emergency room (ER) visits• Hospital admissions• Generic pharmacy

• Improve experience/satisfaction • Patients/families• Healthcare Team

• Internal • External

• Matched comparison design

• Meredith Rosenthal

• Harvard

Team Approach

Information System Support

Self management Support

Use of Guideline

s

Quality Improvemen

t

Population Managemen

t Coordination of Care

Patient-centered Care

Mental

Health

Issues

Survey Group TA ISS SMS UG QI PM CC PCC MH Pilot Average - Baseline (n=60)

70% 73% 77% 81% 75% 74% 70% 73% 71%

Pilot Average - Yr 2 (n=63) 78% 81% 79% 85% 80% 82% 74% 80% 86%

Infrastructure & Process

Quality Measures

Utilization

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Pilot Diabetes Data

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Pilot Cardiovascular Data

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Pilot Prevention Data

Patient Satisfaction

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98% Feel they get care when they need it

97% Would recommend their practice to friends and family

90% Find it easy to speak to a physician

95% Find their clinics well-organized, efficient and respectful of their time

Provider/Staff Satisfaction*

• 44% less difficult to provide quality care• 90% less difficult to communicate with outside

specialists• 94% increase in calling patients overdue for visit• Equivocal – job satisfaction• 90% very busy/chaotic

*Meredith Rosenthal, PhD - Harvard School of Public HealthJob Satisfaction and Work life Survey - Minimizing Errors/Maximizing Outcomes (MEMO) Survey

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Cost/Utilization Data

Still early but...

HOT OFF THE PRESS!

“In a pilot program with other insurers and reform groups, Anthem found that paying primary-care doctors more to coordinate patient care cut hospital admissions by 18 percent and emergency room use by 15 percent.”

“Anthem has found spending money on the primary-care incentives creates a return on investment of 2.5 times to more than four times, Kraft said.”

Denver Post February 2, 2012

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HOT OFF THE PRESS !!

“WellPoint officials said they think the company's upfront investment in primary care could reduce its projected medical costs by as much as 20% by 2015 by improving overall patient health and reducing the

need for costlier medical services”

“The impact could be amplified by another new effort, by health insurer Aetna Inc., which will start paying the 55,000 primary-care doctors across its network an extra fee if their practices are certified as meeting certain standards for providing access for patients and

coordinating their care.”

Wall Street Journal, January 27, 2012

“Efforts to change how Americans pay for health care are gathering momentum on a national scale as UnitedHealth Group Inc., the largest U.S. health insurer, becomes the latest carrier to say it is

overhauling its fees for medical providers.”

Wall Street Journal, February 9, 201250

“The current system will implode if we don’t

fix it. … And the only way to achieve that is

by crossing tribal boundaries.”

— Michael Soman, President and Chief Medical Executiveof Group Health Permanente

A Medical Home Without An Integrated Medical Neighborhood

Is Just An Island

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Integrated Community Care (Accountable Care Organizations)

Building The Medical Neighborhood

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• Shared Services Model- Complex Care Managers, Clinical Pharmacists, Social

Workers, Educators, Mental Health Providers, etc

• Specialists– Compacts

• Hospitals– Identification, Notification, Communication

• Mental/Behavioral Health– Overcoming HIPAA, Carve Outs

• Community Resources– Awareness and Connections

Ultimately, working together to assist patients in achieving the highest level of health they can, preventing problems BEFORE

they occur!

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Key Elements to Consider for Payment Reform

• Multi-payer or high penetrance - (ASOs!!)

Attribution x PMPM = Redesign Budget

• Reduce FFS Treadmill – “think panel”

• Build “new” solid infrastructure (PMPM)

• Maintain “new” infrastructure (PMPM)

• Performance incentives (P4P/Shared Savings)

• Incentivize “neighborhood” to work together (PACs/Shared Savings)

• Incentives for patients – (Value-based benefit designs)

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Employers--Health Plans--Providers Reduce Fragmentation – Increase Impact

• Common approaches for:• PCMH program• Quality measures• Aggregated Data • Payment structures

• Build on positive attributes already in place

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IN SUMMARY

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NOW IS THE TIME!!!

Our Healthcare System Needs to be Rebuilt!

WE ARE IN THE BEST POSITION TO LEAD THIS CHANGE BUT…

THIS WILL TAKE A COMPREHENSIVE

TRANSFORMATION AT ALL LEVELS

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• Medical Groups• Willing to redesign and coordinate care

• Hospitals• Coordinate care - different business models

• Health Plans• Payment reform - data to practices/aggregators

• Employers• Participation in pilots - incent employees

• Patients/Consumers• Engage in their care and healthy outcomes - value

based choices

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CULTURE CHANGE FOR ALL!!

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Investment Required to Reduce CHAOS and Build Solid Infrastructure

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IT’S ALL ABOUT RELATIONSHIPS!!

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With Our TEAM

Building Accountability to Each Other and Our Communities

With Our NEIGHBORS

With Our PATIENTS!

For stepping up to the plate and having the courage to build a better

health care system!

SO…CONGRATULATIONS!!

QUESTIONS?

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www.healthteamworks.org720-297-1681