TRANSFORMING HEALTH CARE: BETTER, SIMPLER, MORE … · GOALS FOR BLUE PREMIER By 2020 By 2024 ... +...
24
1 Von D. Nguyen, MD, MPH Vice President, Clinical Operations and Innovations Blue Cross and Blue Shield of North Carolina [email protected] TRANSFORMING HEALTH CARE: BETTER, SIMPLER, MORE AFFORDABLE
Transcript of TRANSFORMING HEALTH CARE: BETTER, SIMPLER, MORE … · GOALS FOR BLUE PREMIER By 2020 By 2024 ... +...
1
Von D. Nguyen, MD, MPHVice President, Clinical Operations and Innovations
Blue Cross and Blue Shield of North Carolina
TRANSFORMING HEALTH CARE:BETTER, SIMPLER, MORE AFFORDABLE
2
People who report problems paying medical bills
Uninsured adults who cite cost as the reason for not having insurance
26%
45%
THE AFFORDABILITY CRISIS
PROPRIETARY & CONFIDENTIAL SOURCE: Kaiser Family Foundation, Americans’ Challenges with Health Care Costs, June 2019
3
DEMAND GOES DOWN, PRICES GO UP
SOURCE: Health Care Cost Institute, Employer-Sponsored Coverage Study, January 2018
Unit price increases in employer coverage, 2012-2016:
PROPRIETARY & CONFIDENTIAL
4
BRINGING VALUE TO HEALTH CARE
+ Give physicians and clinicians flexibility to deliver value
+ Better care coordination
+ Incentives for cost-efficient innovations, prevention
+ Population health
+ Focus on the patient experience
THREE AIMS OF TRANSFORMATION
+ Better care+ Simpler system+ More affordable
PROPRIETARY & CONFIDENTIAL
5
SHIFTING OUR PRIORITIES
ABlue Premier: Changing the Way We Pay for Care
B Primary Care
C Behavioral Health
D Population Health
PROPRIETARY & CONFIDENTIAL
6
BLUE CROSS NC: LEADING TRANSFORMATION
Blue Cross and Blue Shieldof North Carolina
+ Almost 4 million members
+ Approximately 5,000 employees
+ Over $10 billion revenue
+ Insure majority in NC commercial market, many for most of their lives
PROPRIETARY & CONFIDENTIAL
7
BLUE PREMIERFor the first time, true shared risk and savings
+ One of the nation’s first shared savings model with two-sided risk
+ Rapid shift limits fee-for-service increases, builds network of ACOs
+ Makes primary care a priority
PROPRIETARY & CONFIDENTIAL
8
CURRENTBLUE PREMIER PARTNERS
PROPRIETARY & CONFIDENTIAL
9
Current
GOALS FOR BLUE PREMIER
By 2020 By 2024
25% 50% 100%
Blue Cross NC Medical Spending in Blue Premier Contracts PROPRIETARY & CONFIDENTIAL
10
PRIMARY CARE
1 National Ambulatory Medical Care Survey, 20152 Milbank Memorial Fund, 2017 “Standardizing the Measurement of Commercial Health Plan Primary Care Spending”
51%
% of all physician office visits in 2015 were to
primary care1
7.7%
% of medicalspending onprimary care2
10%
% of medicalspending onprimary care
CURRENT GOAL
PROPRIETARY & CONFIDENTIAL
11
PROPRIETARY & CONFIDENTIAL
PAYING FOR WHAT MATTERS MOST
12
BETTER CARE, BETTER ACCESS
+ Intensive primary care
+ Rural primary care
+ Physician Assistants training
+ Aledade, independent primary care
+ Blue Cross NC Foundation
Photo Credit: UNC School of MedicinePROPRIETARY & CONFIDENTIAL
13
WHAT BETTER CARE LOOKS LIKE
+ Greater focus on the patient experience
+ Fewer patients, more time with each
+ Integrating behavioral and mental health
+ Screen for non-medical drivers of health
+ Incentives for patient outcomes and total cost of care
+ Primary care team helps patient navigate system
PROPRIETARY & CONFIDENTIAL
14
BEHAVIORAL HEALTH STRATEGY
Integrated behavioral
and physical health
Optimized behavioral
health network
Best-in-class
solutions
PROPRIETARY & CONFIDENTIAL
15
PUTTING STRATEGY INTO PRACTICE
Integrated NetworkBlue Cross NC investing in integrating behavioral health into primary care, building a high-performance network
• QuartetIdentify patients with underlying mental health conditions, give physicians data and resources
• Substance use disorder Investing in nonprofits and health systems for prevention, treatment, recovery
PROPRIETARY & CONFIDENTIAL
16
INVESTMENTS IN DRIVERS OF HEALTHTo build healthier communities
+ Food insecurity
+ Early childhood development
+ Housing
+ Transportation
PROPRIETARY & CONFIDENTIAL
17
MOVING BEYOND INCREMENTAL CHANGE
+ Diabetes
+ Smoking
+ Healthy births
+ Health and well-being
PROPRIETARY & CONFIDENTIAL
18
THE I.T.
BEHIND BLUE
PREMIER
PROPRIETARY & CONFIDENTIAL
02 attribution
05 financial
01 digital tools
04 provider reporting
03 data exchange
06 providerpartnerships
01 02 03
060605050404
0101 0202 0303
060504
19
OUR “DnA” TEAM
Consolidation and scalability
Accessibility Governance
PROPRIETARY & CONFIDENTIAL
20
DnA AND IT: MAKING HISTORY TOGETHER
+ Successful exchange in real-time
+ Right information to the right place at the right time
+ Playbook for data exchange capabilities with other Blue Premier partners
+ Foundation for future program design
PROPRIETARY & CONFIDENTIAL
21
HOLDING OURSELVES ACCOUNTABLE
Delivering an Exceptional
Experience for Consumers
+ Changing the way we do business
+ Established Customer Experience team
to capture the voice of the consumer+ Best Net Promoter Score in the history of the
company – but we are driven to do better
Improving the Provider Experience
+ Assess provider touchpoints,measure satisfaction
+ Reimagining our relationshipswith providers for easier, moreeffective collaborationPROPRIETARY &
CONFIDENTIAL
22
MAKINGHEALTH CARE MORE AFFORDABLE
Lower Premiums
+ Over 4% reduction for 2019 ACA rates
+ Over 5% reduction for 2020 ACA rates+ 3.3% reduction for 2020 small group rates + Average rate decrease in all 100 counties for the
first time
Affordability Index
+ Developing metrics to hold our company accountable to our customers
Managed Care + Serving North Carolina’s Medicaid population
PROPRIETARY & CONFIDENTIAL
23
CALL TO ACTION
Health Insurers+ Pay based on value
+ Support physicians with data and resources
+ Provide members with cost and quality transparency tools
Individuals/Consumers+ Shop for health care based on value
+ Engage on improving personal health
Employers+ Demand value, help employees navigate the system
Providers+ No going back to fee-for-service
+ Use data to improve care, lower costs
Policymakers and Regulators+ Support broad definition of health (drivers of health)
+ Allow competition to flourishPROPRIETARY & CONFIDENTIAL
24
VON D. NGUYEN, MD, MPHVice President, Clinical Operations and Innovations
Blue Cross and Blue Shield of North Carolina
PROPRIETARY & CONFIDENTIAL
