Leading Change in Health System...
Transcript of Leading Change in Health System...
Leading Change in Health System TransformationGeorge Kerwin, President and CEO, Bellin Health
Helen Macfie, Chief Transformation Officer, MemorialCare Medical Centers
Al Kurose, President and CEO, Coastal Medical
L. Gordon Moore, Senior Medical Director, 3M Health Information Systems, Inc.
These presenters do not have anything to disclose.
February 22, 2017
Objectives
After this session, participants will be able to:
� Define one way they can improve their ability to manage the health of people they serve
� Identify the elements of will-building, vision and strategy setting in three organization’s leadership journey
� Understand how local market dynamics influence strategy setting for leaders undertaking population health management
How Bellin Health Began Taking Accountability for the Health of Its PopulationGeorge Kerwin, President and CEO, Bellin Health
Wisconsin4
Serving a Market of 636,682 People
Bellin Hospital, a 244-bed community hospital with proven excellence in
heart and vascular care; orthopedics and sports medicine; family
programs and services; cancer care; and minimally invasive procedures
including robotic surgery
Bellin Health Oconto Hospital, a 10-bed critical-access hospital in
Oconto
Bellin Medical Group and NorthReach Healthcare, a 121-member
primary care group with 32 clinic sites and proven excellence in disease
management and wellness care
Employer Clinics, 83 clinics located within employer facilities
FastCare Retail Clinics, 4 convenient care clinics in discount retail stores
Bellin Health Partners incorporates all of Bellin Health System, their
employed providers and approximately 116 independent providers
Bellin Psychiatric Center, a dominant provider of in- and outpatient
behavioral health services, staffed by 10 psychiatrists, 4 psychologists,
and 35 licensed mental health & addiction therapists
Unity Hospice, providing hospice and palliative care services
Bellin Health Overview 5
6
The Bellin Health Story
Lower healthcare costs measured as PEPY:
� Averaging 15% below the national average for 12 years totaling over $22 million less than average
� Strong culture maintained
� Employees as empowered
healthcare consumers
� Improved health (increasing
HRA scores)
� Marketplace credibility and leadership
Bellin’s Results
Encourage proper utilization, improve health, and createsmart healthcare consumers by:
� Redesigning our health plan
− Consumer Driven Health Plan
− Incentives for engagement and accountability
− Value-based primary care for specific conditions
� Providing resources
− Health Risk Assessments
− Personal Health Coaches
− Medical Home
� Utilizing our partners to receive the lowest cost/best value services
Bellin’s Solution
Huge healthcare costs measured as PEPY in 2002
� Double-digit increases: 30% projected 2002 to 2003 if no changes made to plan
� Unknown health status
� Heavy healthcare users
� Fear of culture impact if changes made
� Marketplace credibility
Bellin’s Problem
Progression of Health Benefit1. AWARENESSEarly 2000’s
• Health Care costs rapidly rising
2003
• Incentive for HRA with plan design
• Development of Health Coach Concept
• Senior Leadership Engagement is Key!
2005
• PBA created to reduce personal expenses and to raise awareness of
consumerism.
2. ENGAGEMENT2006
• HRA scores defined plan for engagement
• Plan of Improvement introduced with primary care
2009
• Pilot program with Health Coach for employees with score of 60 or less
• Six chronic diseases coverage covered at 100% for pilot group
• FastCare Benefit
3. ACCOUNTABILITY2010
• HRA scores define plan level for participant
• Wellness Certificate tied to two levels of PBA dollars
• Expanded coverage of six chronic disease conditions to be covered at
100% for all health plan participants
4. CULTURE OF HEALTH2011
• HRA scores define two premium levels
• Second Health Coach added for Bellin Employees and Spouses
• Culture of Heath Steering Team developed for the organization
2012
• HRA scores defined by three premium levels
2013
• Medical Home Incentive
• Referral Incentive
• Increased dollars tied to Wellness Certificate
8
Improved Health: HRA Results
Improved Experience
Prevention: 91% compliance with age and gender screenings – 6 years ago: only 20% of $50,000+ claims
Large Cases ($50,000+): 24% reduction in cases, 34% reduction in spend– Percent Large Case Spend: 27% to 19% of total spend
Removing Barriers: Value-based primary care with 695 individuals in chronic care condition program at an average visit cost of $286
9
-$3.9
-$2.5
-$1.9
-$2.1
-$1.3
-$1.2
-$0.6
-$1.1
-$2.0
-$1.7
-$2.6
-$2.5
-$2.2
$0.8
$0.5
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
Bellin's Cost Difference Compared to Average (In Millions)
Improved Cost
$25.6+ Million Saved
OVER AVERAGE
UNDER AVERAGE
10
Providing solutions to over 2,500 employers
Establishing 115 employer clinics
Bell
11
12
Three Keys to Successfully Taking Accountability for the
Health of a Population
Build Will
Bellin Health Mission:
Bellin Health is a community-owned not-for-profit organization responsible for improving the health and
wellbeing of people living in Northeast Wisconsin and the Upper Peninsula of Michigan, and all others
we serve.
We carry out this responsibility through individualized care excellence, community health improvement,
and equitable healthcare financing plans –all designed to positively impact health and wellbeing. We are
steadfast in our commitment to providing compassionate, safe, and coordinated care that is accessible
and affordable for everyone.
We build trusted relationships and advance true collaboration, fueling our desire to constantly improve
and innovate.
13
Build Will
Bellin Health Vision:
The people in our region will be the healthiest in the nation, resulting in improved economic vitality in the communities we serve.
14
15Develop Capability: The New Integrated System
System of Production
Individual
Solutions To
Problem
System Clinical Care
Solutions Across the Continuum (Connected Experience)
Primary
Care
Specialty
Care
Acute
ServicesAfter
Care
Integrated System
Po
pu
lati
on F
am
ily &
C
om
mu
nity
R
eso
urce
s
Access
Platform
Team Based Care
Population
Health Needs
Manage Populations
Brown County Municipality • Covered Employee Health Plan Lives:
1,341 employees with health plan
3,462 total employees and dependents covered
• Health Costs:
3.3% average decrease last 4 years
2015 Brown County spend at $10,834/EE/ plan
2015 Av. WI County spend at $14,446/EE/p
• Health Risk Appraisal Scores:
5.7 points above national average
• Savings per year from average WI County spend:
$4,843,692 per yearBellin Strategic Partner &
“Win” for Employer
Deliver Results16
SYSTEM RESOURCES
• 715 Physicians
• 57 Primary Care Locations
• 3 Tertiary Hospitals
• 4 Critical Access Hospitals
• 1 Psychiatric Hospital with full-service Behavioral Health Clinic
• Hospice & Palliative Care Services
• Skilled Nursing Facilities (1 system-owned)
POPULATION SEGMENTS
• Employees, Children & Families 540,000 people
• Medicare160,000 people
• Medicaid 180,000 people
• Uninsured 120,000 people
• Total Population 1,000,000 people
2 Hospital Systems700 PhysiciansPopulation 1,000,000
Deliver Results - Pioneer 17
Deliver Results - Pioneer
1. Commercial
• Self-Funded
• Fully-Funded
• Individual
2. Medicare
• Medicare Advantage
• Fee-for-Service
3. Medicaid
4. Other
12% of Net Revenue
44%
of Net Revenue
27% of Net Revenue
10% of Net Revenue
7% of Net Revenue
Payer Segments by % of Net Revenue
18
Characteristics of Medicare Pioneer ACO• Medicare “Fee for Service” program
• ACO consists of Bellin, ThedaCare, and many independent physicians within the respective markets
• Members are assigned based on attribution methodology
• Shared savings program with risk for total cost of care
• Quality metrics determine the amount of shared savings
Deliver Results - Pioneer19
National Trend$10,914 (PY1)
$10,731 (PY1) $10,990 (PY2)
$8,419 (PY1)$8,583 (PY1)
$8,030 (PY1)
$8,451 (PY2)
$8,274 (PY2)
BTHP
20132012
$10,819 (PY3)
$8,355 (PY3)
$8,521 (PY3)
2014
Pioneer 2012-2014
Annual Cost Per Enrollee for All Medicare Pioneer ACOs
21
Clinical Quality for all Medicare Pioneer and Shared Savings ACOs
22