Annual Meeting June 4, 2019 Annual Meeting Agenda Welcome & - PowerPoint PPT Presentation

Annual Meeting June 4, 2019

Annual Meeting Agenda • Welcome & Prayer – Troy A. Tyner, DO, MMM, FACOI • Objectives • Local View • Value Report for KPP & PHA • National View – Introduction of Speaker – Mike McCullough, MD, MBA, FACOG • Population Health – why it matters to our region and ME! • David J. Amin, MD, MBA, FACEP, FAAP • Breakout Feedback Sessions • Questions & Answers

Objectives • Value Report to assist providers in understanding what benefits/tools provided to them thru PHA and KPP • “Why Population Health matters to me” as a provider – why is it critical for us to perform well in our market. • Share what your needs are in this quickly evolving healthcare arena to provide value added services that will support practice.

Value Report Physician Hospital Alliance Kettering Physician Partners

Introduction of TOOL BOX KPP/PHA Vision - toolbox that develops and prepares physicians and the network for the future, providing desirable resources for facilitating financially viable, quality driven and patient centered physician practices.

PROVIDER ENGAGEMENT • Monthly Educational Lunch n Learns for Office Managers • Quality Improvement Advisors • 98% Phase 3 prep for MIPS • No penalties • 88% achieved high performance score--additional 1% bonus • revenue of $800k for practices in program • Physician Quarterly Education to prepare for Value & Risk • Membership PHA – 1284 KPP - 1664

PROVIDER ENGAGEMENT • Monthly Educational Lunch n Learns for Office Managers • Quality Improvement Advisors • 98% Phase 3 prep for MIPS • No penalties • 88% achieved high performance score--additional 1% bonus • revenue of $800k for practices in program • Physician Quarterly Education to prepare for Value & Risk • Membership PHA – 1284 KPP - 1664

PRACTICE SOLUTIONS • Guiding Quality in Primary Care - Gaps in Care Reports & Quality Meetings • Medical Malpractice Insurance Discounts – $350k value • IT Discount Resources - $50k/yr • Other Group Purchasing Discounts - >$250k value • Physician Referral Services – 16,000 referrals • Resources for Billing/Revenue/Coding • Provider Portal for communication and contract performance

CARE RESOURCES • Eligibility Quality Metrics achieved for 2 contracts • Care Management for the High Risk Patients Launched • Negotiated Care Management support dollars for several contracts • Clinical education monthly lunch and learns for office managers • Annual Wellness Visit Educational Resources provided • Coding Accuracy Education • Coding Dashboard by provider in development

2018 Incentive Plan for KHN Employees Claims Paid Measurement Contract Through 2018 Goal Nov 2018 94.4% 80.0 % HbA1c Determination Medical Attention for 89.7% 85.0 % Nephropathy 56.9% 50.0 % Nephropathy Screening

UHC ACO: 2018 Eligibility Criteria Measures Rate through Contract Measurement December 2018 Goal 2018 92.6% 80.0 % HbA1c Determination 91.4% 85.0 % Nephropathy Screening 97.1% 65.0 % BMP, CMP or Renal Panel 79.9 % 75.0 % PCP Visit

Contracting & Finance • 13 Contracts negotiated PHA • Dollars distributed for: • 14% better than budget – Care Management • CMS Grant - $200k value – Shared Savings • 3 Fee for Service – Quality Contracts – Annual Wellness Visits

KPP Payer Tracking Grid – Completed Employee Medicare Medigold Custom Network Benefits MedBen Design MMO – MMO – Anthem Health Comm. Source KHN UHC Care Ohio Plan ACO MA 8/1/2017 – Incnt = Effective 11/1/2016 1/1/2017 1/1/2017 FFS 1/1/19 - 8/1/2017 1/1/19 1/1/18 1/1/19 1/1/19 1/1/19 Date Quality FFS = 1/1/19 Medicaid, Product Incentive Fee for Commercial Medicare Medicare Medicare Commercial Medicare Medicare, & Commercial Type Only Service Exchange 3,574 4,161 12,000 Number of (2,446 KPN / (2,704 KPN / 8,400 (KPN) / Lives KPN / 16,000 15,000 415 2,000 20,000+ New New 1,128 Non- 1,457 Non- 3,600 (Non- Independent KPN) KPN) KPN) Quality/Share Quality & Upside in PMPM with Fee for d Savings HEDIS Shared Fee for Fee for Fee for Upside years 1-2, Incentive Upside years Incentive for Service Measures & Savings Service until Service Type Service Only Incentive downside in 1-2, downside care gaps & Only & HEDIS Upside in all Only readmission year 3-mirror year 3 readmission 3 years EPHC Care Mgt. PMPM & Care Mgt. PMPM & Quality & Shared Quality & Shared Incentive n\a PMPM Shared PMPM for PMPM n\a n\a Savings Shared Savings Savings Quality Savings Fee for Yes Yes No Yes Yes No Yes Yes Yes Yes Service

Kettering Physician Partners Payer Revenue and Disbursement Summary - March 2019 Revenue Earned Revenue Distributed Undistributed 2017 2018 2019 2017 2018 2019 Revenue Care Management $0 $230,540 $303,035 $230,540 $87,744 $215,291 Quality $584,454 $297,402 $0 $427,638 $454,218 $0 Shared Savings $1,044,550 $0 $0 $1,044,550 Total $1,629,004 $527,942 $303,035 $0 $658,178 $541,962 $1,259,841 Payer incentives payments are shown for the time period in which they were earned Distributions are shown for the time period dispersed to KPP members.

2018 PHA Total Charges $11,530,086

Speaker Introduction by Mike McCullough, M.D. David J. Amin, MD, MBA Chief Operating Officer Monj Health

Hig igh Performing Healthcare in in a Value and Risk Base sed World Kettering Health June 4, 2019 6:00 PM Dave Amin, MD, MBA, FACEP, FAAP 18

Dave, , te tell ll me me this this is s al all l goi going aw away, rig ight ht? Dr. Ronald “Hoppe” Hopkins, CMO Nor Lea Hospital District Monj Health Sorry Hoppe, the shift to value and risk in healthcare is quite real … … but it might not be as difficult to navigate as it seems 19

Putt uttin ing the the Le Legos Tog ogether Each piece is necessary but not sufficient … 20

Elements of success … • Data analytics • Care management • A business model for all horizons • Accurate risk profiles • A patient centered approach to care • Alternative care models • Behavioral health integration • Aligned financial incentives • Strategic partnerships 21 • Clin Clinica cal l lead eadersh ship and nd a st stud udent min mindset

What’s in your warehouse? (da (data an anal alytic ics) YOUR data warehouse is the source of all knowledge … … and it exists for YOU and no other reason • Accessible • Curated • Actionable • Connected (orphan data is not acceptable) • Governed by YOU 22

Parameters: Dates of service between 1/1/2016 & 12/31/2016 Patient Statuses include Active (WithClaims) & Deceased/Active (WithClaims) ED visit include those admitted as well as those treated & released Diagnoses are from ICD9 codes (DRGs not listed on outpatient claims) ED visits counted using revenue codes: 0450-0459, 0981 Community Avg HCC Attribution Total ED Cost ED PPPY ED PPPY Adj ED Visits ED per 1000 Weeks Medical Center 1.30223 1218 $2,098,583 $1,723 $1,323 1331 1092.8 Littleton (LRH+ACHS) 0.99385 2651 $3,262,146 $1,231 $1,238 2245 846.9 Berlin (AVH+CCFHS) 1.09917 2243 $2,052,413 $915 $832 2044 911.3 Colebrook (UCVH+ISHC) 0.97524 798 $740,391 $928 $951 577 723.1 North Country Totals: $8,153,533 $1,180 $1,092 6,197 896.8 Caravan Overall: $404,422,401 $1,719 $1,585 198,109 842.2 23

Parameters: Dates of service between 1/1/2016 & 12/31/2016 Patient Statuses include Active (WithClaims) & Deceased/Active (WithClaims) ED visit include those admitted as well as those treated & released Diagnoses are from ICD9 codes (DRGs not listed on outpatient claims) ED visits counted using revenue codes: 0450-0459, 0981 Community Avg HCC Attribution Total ED Cost ED PPPY ED PPPY Adj ED Visits ED per 1000 Weeks Medical Center 1.30223 1218 $2,098,583 $1,723 $1,323 1331 1092.8 Littleton (LRH+ACHS) 0.99385 2651 $3,262,146 $1,231 $1,238 2245 846.9 Berlin (AVH+CCFHS) 1.09917 2243 $2,052,413 $915 $832 2044 911.3 Colebrook (UCVH+ISHC) 0.97524 798 $740,391 $928 $951 577 723.1 North Country Totals: $8,153,533 $1,180 $1,092 6,197 896.8 Caravan Overall: $404,422,401 $1,719 $1,585 198,109 842.2 24