Success in accountable care management

Success in Accountable Care ManagementOSF HealthCare Shares its Story

February 12, 2014

The webinar will begin momentarily…1

PresentersTim J. Vega, MD, FAAFP is Medical Director of OSF Health Management and oversees Employee Health at OSF Saint Francis Medical Center as Medical Director of Business and Community Health.

Dr. Vega is also Clinical Assistant Professor for the Department of Family and Community Medicine at the University of Illinois College of Medicine-Peoria, and serves on both the Central Illinois Wellness Council and the Illinois Department of Public Health Board of Directors.

Dr. Vega has been a physician with OSF since 1987 and is Past-President of the Illinois Academy of Family Physicians. He received his undergraduate degree from Illinois Wesleyan University and completed residency at OSF Saint Francis Medical Center.

Brad La Porte is Senior Engagement Manager at Verisk Health, and has more than 20 years of experience in the healthcare industry, working with health plans, hospitals, physician practices, and employer groups in both corporate and consulting capacities.

Prior to joining Verisk Health, Brad worked for Health Dialog, managing population health and wellness programs for health plans and employer groups across the United States. Brad has also worked for a large southern Colorado health system, where he was responsible for strategic and business planning for the organization.

Brad completed his bachelor’s degree from the University of Wisconsin-La Crosse and has an MBA from the University of Denver.

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About Verisk Health

Publicly-TradedFocus on The Science of Risk

Financial Services

Property & Casualty

We drive performance in the business of healthcare. By combining clinical and analytics expertise with advanced technology and services, we help payers, employers and providers solve complex problems with measurable results.

$11.4 B Market Cap

Supply Chain

Healthcare

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OSF Health SystemPopulation Health

Tim Vega, M.D., FAAFPMedical Director, Business and Community HealthOSF Saint Francis Medical Center

Medical Director, OSF Health ManagementOSF HealthCare

OSF Population Health


More Risk, More Sick, More CostWellness Employee Health Health Management

Well

Low Risk, GoodNutrition, ActiveLifestyle

At Risk

Inactivity, HighStress, Weight,High BP, Smoking

AcuteConditionsCompliance

Respiratory, StrainInjury

ChronicConditions

ChronicConditions, DM, CHF

CatastrophicConditions

Stroke,TransplantCancer

WELLNESS Employee HealthCare ManagementMedical Homes

Health Management


Spectrum of Employer Population Health


Blinded dataFuture Risk and Cost of Care

Care Gaps

Likelihood of Hospitalization

Likelihood of ER Visit


Goal Intervention

Manage high costs & help members navigate system

Health Management

Close gaps in care

Care Management

Monitor compliance rates

Manage risk factors Wellness Management

High Costs

($)

High Care Gaps(CGI)

Low Care Gaps(CGI)

Low DiseaseBurden(RRS)

High DiseaseBurden(RRS)

Low Costs($)

Care Management

Employee Population

A

B

C

RRS= Relative Risk Score


OSF Health Management

Evaluation Team:

• Medical Physician• Nursing/Case Management• Psychologist/Behavior Specialist


Focus of Implementation:– Current Doctors– Manageable Diseases– Accountability for participants– Selective Incentives for participation– Measurement (model and control group ROI

estimate)


Blinded data


Performance of Health Management Participants vs. Actuarial Models and Control Group


OSF Wellness


Wellness HRA Activity:

• Health Risk Assessment with feedback• Consultation as identified: Nutrition, Exercise, EAP• Reward for participating


Poor health practices and existing health risks impact OSF Health System bottom line via:

• Increased Health Claims • Decreased Productivity• Increased Absenteeism


Cost and Population Comparison

Cohort Name Total Paid Total Medical Paid Total Pharmacy Paid Average Age % Male % Female No. of Members Cost Per Member $PMPM

OSF Wellness $12,515,714.1

8 $10,671,674.84 $1,844,039.34 42.59 15.5% 84.5% 1,454 $8,608.00 $406.14

Wellness Control Dnst 05152013

$54,874,149.40 $45,983,808.85 $8,890,340.55 41.95 17.5% 82.5% 6,260 $8,766.00 $439.36

Saint Francis Medical Center Employee Wellness Visit Pilot 2012 Measures

12moPredicted

12moActual Difference Risk Score Census

SFMC Wellness $6,044 $5,463 $581 1.45 861SFMC Wellness Control $5,076 $4,881 $195 1.33 3,803

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

PMPY

SFMC Wellness vs Model/Control


OSF Health System Employee Wellness Visit 2013 Measures


Potential OSF Yearly Health Savings



Cohort Name Total Paid Total Medical Paid Total Pharmacy Paid Average Age % Male % Female No. of Members Cost Per Member $PMPM

OSF Welness $15,685,164.42 $13,259,451.44 $2,425,712.98 44.16 13.9% 86.1% 1,645 $9,535.00 $427.95

Wellness Control Group $112,291,905.37 $95,125,604.67 $17,166,300.70 43.05 21.1% 78.9% 12,065 $9,307.00 $510.26

Risk Comparison

Cohort Name RI ARI CGI RRS(18) RRS(26) RRS(56) Average # of Comorbidity

OSF Welness 9.26 11.04 1.77 1.48 1.48 1.47 2.17

Wellness Control Group 8.92 10.51 1.59 1.64 1.52 1.56 2.2

Utilization Comparison

Cohort Name Admission Re-admission Office Visit ER Visit

Average Length of StayCount /1000 Count Rate Count /1000 Count /1000

OSF Welness 186 60.9 1 0.006 14,332 4,692.35 609 199.39 3.1

Wellness Control Group 1,637 89.26 0 0.006 85,068 4,638.6 4,482 244.4 3.7

** Re-admissions are calculated for medical and surgical admissions discharged to a non-facility location.

3mo lag from claim to analysis

Expected Actual Difference RRS NumberWellness $5,905 $5,134 $771 1.23 1,645Control $6,052 $5,728 $324 1.27 9,303

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

PMPY

Wellness vs. Model/Control Group



$735,315Model differences

$1,268,295Population Model

Three Views of Health Claim Measurement Savings

$977,130Actual Differences


OSF Care Management


Cultural Change to achieve the Triple Aim– Improve health of the population served– Enhance the care and patient experience for

individuals (including quality, access and reliability)– Reduce the rate of growth in the per capita cost of care

Develop Accountable Relationships for care delivery with other insurers as well.

Demonstrate to the nation that this can be done.


ACO Relationship Covered Members Annual Considerations

Pioneer ACO 34,000 $340,000,000

Blue Cross PPO Inpatient P4P & Intensive Outpatient Care

24,000 $130,000,000

Humana Medicare Advantage PCMH – Shared Savings

8,500 $63,000,000

Health Alliance HMO Risk Contract

15,000 $67,000,000

Caterpillar PPO Inpatient P4P 46,500 $55,000,000

Quality Care Plan (Employee Medical/RX Program)

25,000 $110,000,000

TOTAL 153,000 $ 765,000,000


Business Level Selection

Cohort Name Medicare Payer Status Region Market Clinic PCP Current CM Selected(2) Selected(2) All All All All

CM Not Enrolled 1 Selected(2) All All All All All


Cohort Name Total Paid Total Medical Paid Total Pharmacy Paid Average Age % Male % Female No. of Members Cost Per Member $PMPM CM Not Enrolled 1 $194,252,418.58 $190,755,125.92 $3,497,292.66 76.08 47.5% 52.5% 3,460 $56,142.00 $2,472.73 Current CM $89,424,584.74 $87,187,691.13 $2,236,893.61 75.79 43.8% 56.2% 2,137 $41,846.00 $1,743.64

Risk Comparison

Cohort Name RI ARI CGI RRS(2) RRS(125) Average # of Comorbidity CM Not Enrolled 1 36 44.81 8.81 3.38 2.64 6.74 Current CM 33.69 44.12 10.43 1.67 1.87 6.89

Utilization Comparison

Cohort Name Admission Re-admission Office Visit ER Visit

Average Length of Stay Count /1000 Count Rate Count /1000 Count /1000

CM Not Enrolled 1 6,981 1,066.37 1,261 0.186 90,490 13,822.65 13,875 2,119.45 5.9 Current CM 3,256 761.84 548 0.186 68,025 15,916.62 7,650 1,789.96 4.9

** Re-admissions are calculated for medical and surgical admissions.

WellLow Risk, GoodNutrition, Active

Lifestyle

At RiskInactivity, High

Stress, Overweight,High BP, Smoking

AcuteConditions

Respiratory, StrainLacerations

ChronicConditions

Prevalent Diseases

CatastrophicConditionspremature infant,

head injury

PRIMARY SECONDARY TERTIARY

Health Promotion Risk Management Assisted Care Disease Management Care Management

Health AwarenessSafety

Wellness ActivitiesSmoking Cessation Self Care/Safety Ed. OSF Medical Home Health Management

Immunizations Coach/Learn/Care Managers

Education ResourcesCase Management

(moderate)

Health Management (severe) Hospital Support Care

Screenings Employee Assistance Wounded Worker/PT Outpatient Support Care (palliative care) Hospice

Newsletter WOW Program Employee Health Clinic STD/LTD

Please type any questions into the Q&A box on your WebEx dashboard.

For more information about Verisk Health, or to request a copy of the slides:

[email protected]

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Success in accountable care management

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