Sutter Health Plus Joint Labor Management County of Sacramento - PowerPoint PPT Presentation

Sutter Health Plus Joint Labor Management County of Sacramento Calendar Year 2016 Presented by Alicia Aguilera Account Manager Jennifer Nuovo, M.D. Chief Medical Officer Patrick Robinson, RPh Pharmacy Director 1

Agenda  Introduction to Sutter Health Plus  Group Demographics  Medical Utilization  Pharmacy Utilization  Sutter Health Plus Member Services  Health and Wellness 2

Grow With Us 3

Sutter Health Plus Service Area 4

Sutter Health’s Medical Network - History Sutter Medical Center, CPMC Davies Campus, Alta Bates, formerly Alta Sacramento, formerly formerly German Bates Sanitarium, 1905 Sutter Hospital, 1923 Hospital,1878 Mills-Peninsula Medical Sutter Santa Rosa Regional Center, formerly Church of Hospital, formerly a small St. Matthew Red Cross community hospital, 1937 Guild, 1908 (founded 1867) 5

By the Numbers 60,000 5,000+ Members Physicians 37 Urgent Care 3 Walk-In Care El Dorado Hills, Elk Grove, 25 Roseville Hospitals and 14 Campuses Northern California Counties 6

Group Demographics All Sutter Health County of Sacramento Comparison Plus Municipalities Subscribers 2,047 - - Members 4,463 - - Average Age 33.2 32.6 .6 Years older Gender (% Female) 53.3% 52.2 1.2% Higher Active Employee % Retention 2016 - 92.1% 2017 - - 7

Group Demographics Membership by Medical Benefit Plan Choice 3000 2,508 2500 2,266 2,091 1,947 1,919 2000 Members 1500 1,334 976 1000 795 500 244 211 188 190 0 Active HMO Active HDHP Early Retiree Jan 2014 (2902 Members) Jan 2015 (3257 Members) Jan 2016 (3811 Members) Jan 2017 (4699 Members) 8

Group Demographics Growth by Plan Type 3,000 10.7% 2,500 9.0% 8.4% 46.0% 2,000 Members 1,500 36.7% 22.8% 1,000 500 15.6% 11.1% 1.1% 1,919 2,091 2,266 2,508 795 976 1,334 1,947 188 190 211 244 - HMO HDHP HMO Active Active Early Retiree Jan 2014 (2902 Members) Jan 2015 (3257 Members) Jan 2016 (3811 Members) Jan 2017 (4699 Members) 9

Group Demographics Membership by Gender 1,600 1,364 1,400 1,252 1,200 1,149 1,144 1,054 1,014 987 960 1,000 942 865 Members 800 674 660 600 494 482 400 395 400 200 136 117 112 105 108 94 85 76 - F M F M F M Active HMO Active HMO Active HDHP Active HDHP Early Retiree Early Retiree Jan 2014 (2902 Members) Jan 2015 (3257 Members) Jan 2016 (3811 Members) Jan 2017 (4699 Members) 10

Member Retention Year over year Retention Percentage 100.0% 92.4% 91.9% 91.3% 90.9% 90.1% 88.0% 81.5% 80.6% 79.4% 80.0% Retention Percentage 60.0% 40.0% 20.0% 0.0% Active HMO Active HDHP Early Retiree Retention Percentage Jan 2014 - Jan 2015 Retention Percentage Jan 2015 - Jan 2016 Retention Percentage Jan 2016 - Jan 2017 11

Medical Utilization Percentage by Gender 100% 90% 89% 83% 82% 80% 80% 80% 71% 69% Percentage Utilization 60% 40% 20% 0% HMO HDHP HMO HDHP Female Male 2015 2016 12

Medical Utilization Percentage by Plan Type 100% 93% 93% 89% 86% 85% 80% 80% 75% 74% Percentage Utilization 60% 40% 20% 0% HMO HDHP HMO HDHP Active Early Retiree 2015 2016 13

Hospital Inpatient Services: Admits PTMPY 70 59.6 60 56.2 55.4 54.8 53.6 52.5 50.1 48.2 50 Admits PTMPY 40 30 20 10 0 Q1 Q2 Q3 Q4 2015 2016 Milliman Moderatly Managed Benchmark = 47.85 Milliman Well Managed Benchmark = 41.32 14

Hospital Inpatient Services: Admits PTMPY* 60 50 45.2 40 40.1 39.5 Admits PTMPY 36.6 30 31.4 31.2 31.0 27.8 20 10 0 Q1 Q2 Q3 Q4 2015 2016 Milliman Moderatly Managed Benchmark = 47.85 Milliman Well Managed Benchmark = 41.32 Comparable Groups *Excludes Maternity, Newborn, Psych, Detox and Skilled Nursing 15

Hospital Inpatient Services: Average Length of Stay 5.0 4.5 4.5 4.0 4.0 3.7 3.7 3.4 3.4 3.5 Average Length of Stay 3.0 2.7 2.4 2.5 2.0 1.5 1.0 0.5 0.0 Q1 Q2 Q3 Q4 2015 2016 Milliman Moderatly Managed Benchmark = 4.23 Milliman Well Managed Benchmark = 3.72 16

Hospital Inpatient Services: Average Length of Stay 4.5 4.0 3.5 3.4 3.3 3.2 Average Length of Stay 3.2 3.0 3.0 2.5 2.5 2.3 2.3 2.0 1.5 1.0 0.5 0.0 Q1 Q2 Q3 Q4 2015 2016 Milliman Moderatly Managed Benchmark = 4.23 Milliman Well Managed Benchmark = 3.72 Comparable Groups *Excludes Maternity, Newborn, Psych, Detox and Skilled Nursing 17

Urgent Care Visits PTMPY 120 100 87.9 85.8 Urgent Care Visits PTMPY 80 83.4 74.5 66.8 60 56.8 52.6 53.0 40 20 0 Q1 Q2 Q3 Q4 2015 2016 Milliman P25 = 84.7 Milliman P50 = 114.0 Comparative Groups 18

ER Visits PTMPY 250 200 194.1 191.4 190.1 188.3 183.5 175.4 164.8 164.8 150 ER Visits PTMPY 100 50 0 Q1 Q2 Q3 Q4 2015 2016 Milliman P25 = 175.1 Milliman P50 = 211.0 Comparative Groups 19

Walk-In Care Roseville, Elk Grove and El Dorado Hills 20

HEDIS: Breast Cancer Screening HEDIS Breast Cancer Screening 80% 79.0% 78.3% 78% 76% 74% 72% 70% % of Population Screened County of Sacramento All SHP 2015 HEDIS 95% Percentile = 77.5% 2016 Measurement Year 21

HEDIS: Statin Therapy for Patients with Diabetes* % of Population That Received Statin Therapy 60% 50.7% 47.8% 50% 40% 30% 20% 10% 0% % of Population That Received Statin Therapy County of Sacramento All SHP New HEDIS measurement for 2016 22

HEDIS: Statin Therapy for Patients with Cardiovascular Disease % of Population That Received Statin Therapy 70% 60.8% 60% 50.0% 50% 40% 30% 20% 10% 0% % of Population That Received Statin Therapy County of Sacramento All SHP New HEDIS measurement for 2016 23

Well-child preventive Care 24

Asthma Medication Ratio Percentage of population with Asthma Controller to Total Medication Ratio > 0.50 90% 77.9% 80% 77.1% 70% 60% % of Population 50% 40% 30% 20% 10% 0% County of Sacramento All SHP 2015 HEDIS 95% Percentile = 73.9 2016 Measurement Year 25

Obesity* 10% 9.1% 9% 8.3% 8% Percent of Members with a PCP Visit 7% 6% 5% 4% 3% 2% 1% 0% 2015 2016 *Percentage based on diagnosis during a Physician encounter 26

Diabetes 12% 9.81% 10% 8% 6% 4.1% 4.10% 4% 2% 0% % of Membership % of Total Medical Cost % of Rx Cost 27

Top 10 Therapeutic Classes by Total Claims Disease State Claims % of Total Cost % Generic Cost / Rx CARDIOVASCULAR DISEASE - 6,252 4.9% 97% $35 HYPERTENSION BEHAVIORAL HEALTH - 4,264 3.2% 95% $34 ANTIDEPRESSANTS BEHAVIORAL HEALTH - OTHER 3,404 6.2% 85% $81 PAIN MANAGEMENT - ANALGESICS 2,917 3.7% 94% $57 INFECTIOUS DISEASE - BACTERIAL 2,287 1.2% 99% $23 CARDIOVASCULAR DISEASE - 2,112 1.5% 94% $33 LIPID IRREGULARITY DIABETES 2,089 9.3% 53% $198 CONTRACEPTION 2,084 1.4% 93% $31 ASTHMA AND COPD 1,915 7.2% 31% $167 UPPER GASTROINTESTINAL 1,899 1.2% 94% $28 DISORDERS - ULCER DISEASE % of Total 66.4% 39.8% 28

Top 10 Brand Rx (Excluding Specialty) by Volume Drug Name Therapeutic Class % of Total Cost Claims Cost / Rx PROAIR HFA ASTHMA AND COPD 0.5% 426 $57 SYNTHROID ENDOCRINE DISORDER - THYROID 0.2% 223 $38 ADDERALL XR BEHAVIORAL HEALTH - OTHER 1.2% 206 $251 ADVAIR DISKUS ASTHMA AND COPD 1.5% 197 $341 VENTOLIN HFA ASTHMA AND COPD 0.2% 156 $53 LANTUS SOLOSTAR DIABETES 1.6% 136 $511 QVAR ASTHMA AND COPD 0.5% 122 $182 NUVARING CONTRACEPTION/OXYTOCICS 0.3% 114 $125 LYRICA SEIZURE DISORDER 1.2% 113 $463 JANUVIA DIABETES 1.0% 109 $420 % of Total 8.2% 4.1% 29

Top 10 Generic by Cost Drug Name Therapeutic Class % of Total Cost Claims Cost / Rx PAIN MANAGEMENT - HYDROCODONE-ACETAMINOPHEN 0.6% 1405 $19.53 ANALGESICS ENDOCRINE DISORDER - LEVOTHYROXINE SODIUM 0.3% 974 $14.20 THYROID CARDIOVASCULAR DISEASE - ATORVASTATIN CALCIUM 0.1% 925 $6.10 LIPID IRREGULARITY FLUTICASONE PROPIONATE ALLERGY 0.1% 754 $6.83 IBUPROFEN INFLAMMATORY DISEASE 0.1% 633 $5.98 UPPER GASTROINTESTINAL OMEPRAZOLE 0.1% 837 $4.03 DISORDERS - ULCER DISEASE BEHAVIORAL HEALTH - SERTRALINE HCL 0.1% 563 $5.85 ANTIDEPRESSANTS CARDIOVASCULAR DISEASE - LISINOPRIL 0.1% 1121 $2.93 HYPERTENSION METFORMIN HCL DIABETES 0.1% 503 $4.61 CARDIOVASCULAR DISEASE - AMLODIPINE BESYLATE 0.0% 616 $2.90 HYPERTENSION % of Total 1.6% 18.9% 30

Top 10 Specialty by Total Drug Cost % of Total Drug Name Therapeutic Class Cost / Rx Cost COPAXONE NEUROLOGICAL DISEASE - MISCELLANEOUS 4.7% $5,241 ENBREL INFLAMMATORY DISEASE 3.7% $5,225 AFINITOR NEOPLASTIC DISEASE 2.6% $11,656 ADEMPAS CARDIOVASCULAR DISEASE - HYPERTENSION 2.5% $7,573 HARVONI INFECTIOUS DISEASE - VIRAL 2.1% $30,758 TECFIDERA NEUROLOGICAL DISEASE - MISCELLANEOUS 2.0% $6,028 HUMIRA PEN INFLAMMATORY DISEASE 2.0% $3,853 EPCLUSA INFECTIOUS DISEASE - VIRAL 1.7% $24,561 AUBAGIO NEUROLOGICAL DISEASE - MISCELLANEOUS 1.5% $5,744 NEXAVAR NEOPLASTIC DISEASE 1.3% $7,249 % of Total 24.1% 31

Rx Utilization Employer Group Utilization Overall Plan Utilization 0.9% 0.9% 12.4% 14.5% Brand Generic Specialty 84.6% 86.7% County of Cost/Rx % of Total Cost All SHP % of Total Cost Sacramento Brand $311 44.5% $270 39.5% Generic $25 20.8% $21 21.7% 32 Specialty $3,828 34.7% $3,599 38.7%

Mail Order Pharmacy 33