Mi Mid-Sou South M MGM GMA Febru ruary 28, y 28, 2019 2019 - PowerPoint PPT Presentation

Mi Mid-Sou South M MGM GMA Febru ruary 28, y 28, 2019 2019

Age genda • Value Based Care Overview • Local Efforts • Key Elements to Success 2

Val alue Base Based Car Care O Overview

He Healthcare e Envi viron onmen ent T Today • Health care economics have changed – shifting from volume to value • Market-driven accountability for quality, cost and value of healthcare • Physicians lead the change emphasize value • Employers want proof they are receiving quality care for the money are spending 4

-Delegates Credentialing for UHC and CIGNA -366 Practices MetroCare Physicians -2,085 Providers -CIGNA and UHC Contracts Trilogy CIN -175 Practices -1,531 Providers MSSP -MSSP Track 1 - Methodist Hospitals -14 Practices -402 Providers 5

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Key y Features s of Trilogy • Physician-led and governed • Independent, employed and university physicians working together • Staff with years of local market experience • Evidence-based guidelines to improve patient care, decrease cost, and demonstrate value • Improve Quality with Data Analytics • $3 Million Investment in Optum Analytics • Timely performance feedback to physicians 7

Evolution of Value Based Care Aggregation and Measurement Performance and Improvement Quality Coordinated High-Preforming Affiliated Engaged Shared Risk and Shared Savings and Fee for Service Pay for Performance Bundled Payments Capitation Risk 8

Evolution of Value Based Care Collaborate & Improve Improve Quality Quality Report Distribution Cost Transparency and Identify High Risk Patients Utilization Analysis Care Coordination Integrate with Coordinated Cost Reduction Payer/Employer Programs Shared Savings and Bundled Payments 9

Loc ocal E Efforts rts an and Su Succe ccess 10

HealthCh He Choi oice T e Trilogy gy C Com ommer ercial A ACO Contracts United HealthCare CIGNA Year 1 May 1 2016- April 30 2017 Year 1 October 1 2016- September 30 2017 Year 2 May 1 2017- April 30 2018 Year 2 October 1 2017- September 30 2018 Year 3 May 1 2018- April 30 2019 Year 3 October 1 2018- September 30 2019 11

Un United ed He HealthCa Care • 20,000 covered lives • Shared savings, upside only (No Risk) • Providers paid current fee for service • Shared savings are created by efficient cost control • Shared savings pool is retained by quality metrics 12

Cigna Ac Accountable Care (CAC) • 70,000 covered lives • Shared savings, upside only (No Risk) • Providers paid current fee for service • Shared savings are created by efficient cost control • Shared savings pool is retained by quality metrics 13

Shared S Savi vings D Distri ributi tion United HealthCare CIGNA Year 2 Year 1 • $1 million distributed to Trilogy • $1.8 million distributed to Trilogy Clinically Integrated Network Clinically Integrated Network 14

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Measurem emen ents f from om Payer ers Outpatient Clinical Measures Hospital Based Clinical Measures • Screenings • Inpatient Focus • Breast Cancer • Length of Stay • Cervical Cancer • All Cause Readmissions • Colorectal Cancer • Escalation Rate • Appropriate Care • Emergency Department Focus • Diabetes Care • Visits per Thousand • Low Back Pain • High Utilizer Visits per Thousand • Statin Use in CAD Patients • Avoidable Visits per Thousand 16

Medicar are S Shared S Savings gs Program am ( (MSSP SSP) 17

Governmental Shift of Medicare Reimbursements from Volume to Value-based* 20% Value $72.4 30% Value $108.6 50% Based Billion $181 Based Billion Volume Billion 100% Based Volume 80% 70% Based $362 $289.6 $253.4 $181 Volume Volume Billion Billion Billion Billion 50% Value Based Based Based 2011 2014 2016 2018 *All Financial figures based on 2014 Medicare Payments 18

MSSP on a National S Scale • $1.1 Billion in savings for 2017 • $780 Million in bonuses • $313.7 million in net savings • Saving generated by 60% of the participating ACOs • 561 ACOS in MSSP • 82% are Track 1 19

Health Choice MSSP-De Demographics MSSP ACO 3rd Q 2018 Category 3rd Q 2018 # Average % % 3rd Q 19,702 11,404 Total Bene from Distribution by Eligibility* # Deaths 484 # Survived 19,218 # Assigned % Distribution by Eligibility Bene. % Aged Non-Dual 16,466 85.4% 81.24% % Aged Dual 769 3.99% 6.07% % Disabled 1,650 8.55% 11.50% % ESRD 403 2.09% 0.69% 19,702 % Distribution by Age % 0-64 2,436 12.4% 14.53% % 65-74 9,818 49.83% 45.51% % 75-84 5,579 28.32% 27.38% % 85+ 1,869 9.49% 11.40% % Distribution by Gender % Male 8,262 41.9% 0.43% % Female 11,440 58.1% 57.01% 20

Health Choice MSSP-Uti tilizati tion Metr trics HealthChoice HealthChoice HealthChoice All MSSP 3rd 1st Q 2018 2nd Q 2018 3rd Q 2018 Q 2018 Category (Per 1,000 Person Years) 2017 19,462 19,703 19,702 11,404 Utilization By Care Setting IP discharges per 1,000 285 290 282 282 306 Short-term discharges per 1,000 256 261 254 253 282 LTCH discharges per 1,000 1 1 1 1 2 IRF discharges per 1,000 22 22 21 22 11 IP Psych discharges per 1,000 6 6 6 6 7 SNF discharges per 1,000 22 20 20 20 53 OP ED visits per 1,000 643 633 621 607 686 IP ED visits (EDV that are admitted) 196 202 198 197 206 CT visits per 1,000 854 662 662 672 624 MRI visits per 1,000 277 191 190 193 225 Primary care visits per 1,000 (> = better) 8,804 8,678 8,722 8,838 9,752 w. a PCP (> = better) 3,266 3,240 3,299 3,389 3,782 w. a specialist 4,481 4,376 4,347 4,355 4,365 w. a NP/PA/CNS 1,043 1,050 1,062 1,081 1,188 w. a FQHC/RHC 14 11 12 14 34 Other Utilization Metrics Readmissions per 1,000* (30 day all cause) 161 166 not provided not provided not provided 30 day post discharge provider vists per 1,000 739 735 737 736 804 COPD discharges per 1,000 (add asthma 2nd Q) 6.67 6.98 6.63 6.53 8.76 CHF discharges per 1,000 16.38 17.73 17.10 18.09 16.09 21

Health Choice MSSP- Measurem emen ents 22

Key y El Elements t ts to o Su Succ ccess ss

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Physician E Educati tion-Pharm rmacy • Since 2017, Trilogy has been working with an Academic Detailing Pharmacist through a relationship with the PBM, Express Scripts • Initiatives Include • Trilogy RX Report Newsletter • Creation of clinical drug-information reference documents • Actionable drug cost-savings opportunities for expensive meds • Peer-Benchmarking reports for the prescribers • Drug and Therapy Class Evaluations/ Clinical Reviews 26

Physician E Educati tion-Pharm rmacy 27

2019 T 2019 Tac actics • HCC Coding • Educational opportunities at MetroCare • Annual Wellness Visits • Night program with Coding • Data reporting process beginning Educator Steve Adams, University • Initial roll out with MSSP of Memphis, April 3 rd • Annual Preventive Visit • Care Pathways for Following • Practice visits and data review • Diabetes Intensive Management • CHF • COPD 28

Upcoming Edu ducationa nal O Opp pportunities • Reporting Pediatric Services with Attention to Value-Based Measures • Basic Chart Auditing • HCC Coding and Risk Adjustment • Self- Auditing for HCC and Risk Adjustment For Physicians • Coding Bootcamp • Modifiers for Physicians • Getting It Right with Modifiers, & Place of Service in 2019 • Dissecting & Coding OP Notes 29