Population Health and Wellness: 2 Stories from Cleveland Clinic - PowerPoint PPT Presentation

Population Health and Wellness: 2 Stories from Cleveland Clinic Elizabeth Sump Senior Director, Health Policy 1 Cleveland Clinic

2 population health stories • Cleveland Clinic Employee Health Plan • Cleveland Clinic Medicare Shared Savings Plan 2

E mploye e He alth Plan & Mission $410M 98,000+ 52,000 Self- Book of covered insured employees Business lives “To ensure that our employees receive high quality evidence-driven health care that includes both prevention and treatment at a sustainable cost to the employee and the organization.” 3

E mploye e He alth Challe nge s • Build a Culture of Wellness • Support Healthy Life Style Choices • Promote Personal Responsibility • Use Accurate Objective Data • Control Costs 4

Tools • Active Outreach/Care Coordination • Care and Support Programs • Financial Incentives • Bully Pulpit 5

Resources 6

Caregiver Wellness EHP Employees (2009-2013) and EHP Employees + Spouses (2014-2016) 60% 2016 Goal: 55% 50% 40% 30% 53% 52% 51% 51% 50% 20% 34% 27% 10% 9% 0% Dec 2009 Dec 2010 Dec 2011 Dec 2012 Dec 2013 Dec 2014 Dec 2015 Dec 2016 Percent of Unique Employees and Spouses with Diabetes, Hypertension, Asthma, Hyperlipidemia or BMI >27 enrolled in Care Management 7

2009 vs. 2015 Change in Utilization, Cost and PMPM (Medical and Pharmacy Claims) 50% 44.5% 40% 29.3% 30% 20% 14.2% 14.2% 10% 0% -10% -11.6% -20% EHP Metrics EHP vs. Milliman Benchmark Utilization Unit Cost PMPM Median PMPM Milliman EHP primary members only; claims paid through November, 2016 PMPM normalized for ASC Grouper, PBB and 09/01/2010 rate change Includes pharmacy CMS subsidy, rebates and internal savings 8 PBB = Provider Based Billing ASC = Ambulatory Surgery Center Milliman median commercial benchmark

Pre vs. Post Care Management Enrollment Utilization Trend 9 Number of employees: Diabetes  1,945; HTN  2,510; Asthma  2,260 1. 2. Non-normalized PMPM; claims incurred through 3Q16 and paid through 11/2016

Average Weight Gained or Lost by EHP Population by Healthy Choice Participation Not In Healthy Choice In Healthy Choice 2012 2013 2014 2015 2016 0.0 18000 -0.5 16000 -1.0 14000 -1.5 12000 -2.0 10000 -2.5 8000 -3.0 6000 -3.5 4000 -4.0 2000 14,603 4,747 15,399 5,931 16,493 6,608 16,422 7,211 16,115 6,699 -4.5 0 32 Sources: Wellness database; Weight data from COACH, Epic, Fitness centers Weight data collected and aggregated with Ingenix Reports Number of Members in Yellow

Estimated Percent of Tobacco Users EHP Employees and Spouses by Year 12% 4000 9.9% 3500 9.6% 10% 9.7% 8.5% 9.5% 8.4% 3000 7.8% 8% 8.5% 8.0% 6.7% 2500 6.5% 7.5% 6.3% 6% 5.4% 6.4% 2000 6.2% 6.0% 5.2% 1500 4% 1000 2% 500 2,464 2,707 2,908 3,407 3,605 3,309 3,430 3,242 2,900 0% 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 # of Confirmed Smokers Confirmed Smoking % Max % (if no data = smoker) 11 Sources: Clarity; Optum One CDR “Maximum Percent”: Assumes that members “Not Asked” are smokers

Trended EHP Paid PMPM by Quarter (Medical and Pharmacy Claims) $520 $470 $420 $370 $320 Annual Trend 2004 - 2009 = 7.5% Annual Trend 2010 - YTD 2016 = 2.6% $270 Annual Trend 2013 - YTD 2016 = 0.5% $220 Q2 04 Q3 04 Q4 04 Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12 Q1 13 Q2 13 Q3 13 Q4 13 Q1 14 Q2 14 Q3 14 Q4 14 Q1 15 Q2 15 Q3 15 Q4 15 Q1 16 Q2 16 Q3 16 Q1 04 to Q4 09 PMPM Q1 10 to Q3 16 PMPM Expon. (Q1 04 to Q4 09 PMPM) Expon. (Q1 10 to Q3 16 PMPM) EHP primary members only ; claims paid through 11/30/16; Data Sources: EHP Warehouse, HCTA, EHP Financial Summary 12 PMPM normalized for ASC Grouper, PBB , 09/01/2010 rate change and rate exception (April 2012 – March 2013) Includes pharmacy CMS subsidy, rebates, internal savings and error adjustment PBB = Provider Based Billing ASC = Ambulatory Surgery Center

Estimated Cumulative Savings by “Bending the Trend” Since 2010 $200 $183,000,000 Cumulative Savings (in Millions) $150 $100 $50 $0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 10 10 10 10 11 11 11 11 12 12 12 12 13 13 13 13 14 14 14 14 15 15 15 15 16 16 16 -$50 13 Source: EHP Financial Summary; claims paid through November, 2016

Cleveland Clinic Medicare ACO • Medicare Shared Savings Program – Upside only • 4,000+ Cleveland Clinic hospitals, employed physicians and select Independent PCPs • CCMACO is at risk for ~ 65,000 beneficiaries– Medicare Fee-For-Service • Jan 1, 2015 – Dec 31, 2017

Medicare ACO Shared Savings Model Adjusted Benchmark Savings Historic Benchmark Beneficiary Expenditure 2012 2013 2014 2015 2016 2017

Key Care Model Transformations • Patient centered medical home • Care coordination • Post-acute network • Readmissions • Care paths • Population health analytics • Teamwork

2015 Results n = 62,600 Beneficiaries $10,110 $9,659 Target 2015 Spend Best performing 1 st year MSSP ACO Nationwide 6 th best performance of all MSSP ACO’s

Performance Drivers Inpatient 12% Skilled Nursing 21% 6% 30-day All Cause Readmission

Top Quartile Quality Performance Heart Failure Readmissions Ischemic Vascular Tobacco Screening 90th Disease Falls Screening All Cause Diabetes Screening Coronary Artery Colorectal Screening Disease Pneumonia 80th Hypertension Vaccination Breast Cancer

Total Medicare Shared Savings Program(MSSP) Beneficiaries 80,000 Number of 2016 beneficiaries 8.1% higher than 2015. 70,000 67,675 62,582 60,021 60,000 56,830 54,431 50,000 40,000 30,000 20,000 10,000 0 2012 2013 2014 2015 3Q2016

MSSP Membership by Enrollment Type 70,000 57,419 60,000 52,545 47,463 50,000 43,865 42,146 40,000 30,000 Disabled Declines Likely due to Aged/Dual Medicaid 20,000 Declines due to Expansion MyCare Ohio program 8,344 7,867 7,308 8,477 10,000 7,956 3,587 2,614 1,586 3,813 3,681 627 584 334 648 676 0 End Stage Renal Disease Disabled Aged/Dual Aged/Non-Dual 2012 2013 2014 2015 3Q2016

Utilization Rates 3,000 2,580 2,500 2,350 2,000 1,634 1,558 1,500 1,000 858 841 828 816 810 807 739 697 500 377 355 304 291 276 273 257 251 254 244 199 192 0 Short Term Hospital Skilled Nursing Facility Emergency Department Emergency Computed Tomography Magnetic Resonance Discharge or Unit Utilization Days Visits Department Visits that (CT) Events Imaging (MRI) Events Lead to Hospitalizations 2013 2014 2015 3Q2016

Ambulatory Care Sensitive Conditions (Discharge Rates Per 1,000 Beneficiaries) 20.00 17.73 18.00 17.20 16.54 15.70 16.00 15.28 15.27 14.81 14.68 14.00 12.25 11.68 12.00 10.78 10.00 8.99 8.26 8.00 6.97 6.25 6.00 4.00 2.00 - Chronic Obstructive Pulmonary Disease or Congestive Heart Failure Bacterial Pneumonia Asthma 2012 2013 2014 2015 3Q2016

Post Acute Utilization Rates 900 796 792 782 800 779 777 700 600 500 400 300 218 198 198 185 200 176 100 0 30-Day All-Cause Readmissions Per 1,000 Discharges 30-Day Post-Discharge Provider Visits Per 1,000 Discharges 2012 2013 2014 2015 3Q2016

Lessons Learned • Communication is Key! - Employers are extremely effective at delivering wellness messaging • Incentives work - Make it meaningful for the audience • Cost and quality cannot be considered independently of each other 25

` Every Life Deserves World Class Care 26