Health Partners PlansHealth Partners Plans

Challenges and SolutionsChallenges and Solutions

in the

Ch i L dChanging Landscape

of Healthcare

WHO IS HEALTH PARTNERS PLANS

• Locally owned by 5 leading Philadelphia hospital systems• Began in 1985Began in 1985• Bucks, Chester, Delaware, Montgomery, Philadelphia counties• Medicaid, Medicare, CHIP lines of business• 200k members across all lines of business• 200k members across all lines of business• 650 employees

OUR NETWORKOUR NETWORK

• 44 Hospitals500 A ill id• 500 Ancillary providers

• 5500 PCPs, specialists, allied health practitioners

The above network includes:

• Small independent practitionersSmall independent practitioners• Large health system practices• All federally qualified health centers (FQHC)

CRNP• CRNPs• PAs

OUR MISSIONOUR MISSION

Our mission statement stands behind everything we do.

• To manage our business to exceed expectationsTo manage our business to exceed expectations

• To operate with respect and dignity in all relationships

• To continually improve the health outcomes of our members

OUR COMPETITIONOUR COMPETITION

LARGEREGIONAL AND NATIONAL PLANS

ACCOLADESACCOLADES

• Ranked #1 Medicaid health plan in Pennsylvania by NCQA• Ranked #1 Medicaid health plan in Pennsylvania by NCQA• Ranked #20 Medicaid health plan in the country by NCQA• Ranked #3 best large place to work in Delaware Valley

2014 PROVDIER SATISFACTION2014 PROVDIER SATISFACTION

Using The Myers Group to administer the tool:

• 79.2% - Overall satisfaction with plan compared to 65.9% across TMG Medicaid book of business88 1% ld d HPP t th id d t• 88.1% would recommend HPP to other providers compared to 80.5% across TMG Medicaid book of business

OUR PCP MAKE UPOUR PCP MAKE-UP

• 215 PCP Tax IDs (TIN) with members assigned to them across all 4 lines of businessall 4 lines of business– 40 of those TINs manage 78% of our members– 18 of those TINs manage 61% of our members– 7 of those TINs manage 45% of our membersg

ALIGNED NEEDSALIGNED NEEDS

AccessData

Provider PayerDataQualityRevenueS ti f tiSatisfactionVolume

BUILDING A PARTNERSHIPBUILDING A PARTNERSHIP

The relationship between provider and payer is more critical now than ever in our industry.

• Local/State/Federal IncentivesLocal/State/Federal Incentives• Medicare STARS• HEDIS

NCQA• NCQA

Provider support and buy-in are necessary for payers to come out winners in these areas.

BUILDING A PARTNERSHIPBUILDING A PARTNERSHIP

HPP has developed a collaborative approach to building these partnerships.

• 9 Network Account Managers• Quarterly meetings with senior leadership• Medical Practice Advisory Committee (M PAC)• Medical Practice Advisory Committee (M-PAC)• Advisory Board

Q lit & D tQuality & Data

Quality will come with lots of data………

I b i bl• It must be actionable• It must be acted upon• It must be focused and targetedg

– Too much data will be overwhelming and not actionable– Providers must know how to respond to the data and what the incentive

will be if they respond to it

Q lit & D tQuality & Data

Quality is not just about outcomes

It is also about how that care is reported to the payer.

ICD9

CRITICAL

CPT4

S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?

Quality Care Plus PCP Incentive Program

S d i J l 2012• Started in July 2012• 100 Members on Panel• Panel must be open to new membersp• Percentile ranked against peers• Rankings below 50th percentile in any given measure receive

no compensationno compensation• QCP compensation accounts for 17% of total PCP annual

compensationTIN d i l l d• TIN and site level report cards

S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?

S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?

Quality Care Plus PCP Incentive Program

Thi l l h d h i hThis program completely changed the way we engage with our PCP network

– Completely refocused our provider relations staffp y p– Routine meetings with senior level staff– Competition within provider groups and outside provider

groupsgroups– Connected with “the person who cares about the money”

S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?

New Provider Portal

C E iCurrent Environment• Using a virtually unknown provider portal vendor• Only payer in our market using this vendory p y g• Limited functionality• Requires separate login• Dissatisfied usersDissatisfied users

S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?

New Provider Portal

N E iNew Environment• Move to Navinet

– Every other payer in our market is on NaviNet• Listened to provider partners feedback

– Single sign-on for all payers– Broad range of functionality

New NaviNet Open platform– New NaviNet Open platform• Impressive user interface

S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?

NaviNet & Risk Adjusted Rates

B ildi f i li i ll k i dBuilding new functionality to systematically work missed diagnosis code opportunities

– From manual paper process to electronic interactive process– Communicates potentially missed diagnosis codes and missed

appointments– Users can update diagnosis codes and submit back to HPP, generating a

l i th h th N iN t f ti litclaim through the NaviNet functionality

S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?

NaviNet

E h i h i Gi i h h h dEnhancing the user experience…Giving them what they need:

• Care Gap Reportsp p• Full suite of authorizations• Claim Reconsiderations• ADT information (still in planning)ADT information (still in planning)

N iN t t ith t iNaviNet – not without issues

HPP initiated this with an aggressive timeline

• Need to impact risk adjust rate scores • Need to move to a platform that was being used heavily in the

community• Need to provide enhanced functionality not available on

current portalcurrent portal

This all lead to:

• Unrealistic expectations• The unknown of a new platform – trying to work out the

d t ildetails• Other pressing priorities

SSummary

• The landscape of health care is changing rapidly – we all know p g g p ythis

• Collaborative payer/provider relationships are critical to keep the pace full engagement must be committed on both sidesthe pace – full engagement must be committed on both sides

• Creative and out of the box approaches work• Get to the person who cares about the money!!• Don’t recreate the wheel, but be on the cutting edge when it

makes sense• Listen to your providers – they have good ideasy p y g

Q tiQuestions