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7/28/2019 Building a New Partnership for Value
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Building a New Partnership for Value
Event Title: Innovative Care Delivery Models: Payor Provider Partnerships toImprove Health & Lower Costs
Location: Washington, DC
Date: Wednesday, April 17, 2013
Mike EnglehartPresidentAdvocate Physician Partners
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Advocate Health Care Overview
Why we Entered into this Arrangement
Key Drivers
New Competencies
Results
Challenges
Discussion Topics
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$4.7 Billion Annual Revenue
AA Rated
12 Acute Care Hospitals
1 Childrens Hospitals
5 Level 1 Trauma Centers
4 Major Teaching Hospitals
4 Magnet Designations
Over 250 Sites of Care
Advocate Medical Group
Dreyer Medical Clinic
Occupational Health Imaging Centers
Immediate Care Centers
Surgery Centers
Home Health / Hospice
Physician Membership
1,200 Primary Care Physicians
2,800 Specialist Physicians
Total membership includes 1100
Advocate-employed Physicians
Central verification office certified by NCQA
9 Physician Hospital Organizations ( PHOs)
230,000 Capitated Lives / 700,000 PPO Lives /
245,000 Attributable Lives
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Total physicians on medical staffs = 6,500
Total APP Physicians = 4,100
Independent non-APP
= 2,400
Employed/affiliated =
1,100
Affiliated (Dreyer) =
200AMG (employed) = 900
Independent APP = 3,000
Advocates Physician Platform
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Blue Cross Blue Shield of Illinois (BCBSIL) &Advocate/APP faced 2 choices:
Lower unit cost now
Partner together/reduce inefficiencies
Employers demanding change
Prepares for Medicare value basedpurchasing
Prepares for Medicare Shared SavingsProgram - MSSP (ACO)
Prepares for Exchange price point in 2014
Two Years Ago
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Blue Advantage (BA) small network HMO
added APP to network Feb. 2011
HMOI Risk adjusted global cost of care
PPO - Shared Savings Model
Measured on attributable patients
Focus on trend in the total cost of care
Need to attain outcomes, safety, andservice targets
BCBSIL Contract Highlights
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Contract Lives Total Spend
BCBSIL 380,000 $1.8 B
Medicare
Advantage 32,000 $0.3 B
Advocate
Employee 22,000 $0.1 B
Medicare ACO 115,000 $1.2 B
Total 549,000 $3.4 B
Value Based Agreements
ACO=Accountable Care Organization
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From TO
Silo Care Management Enterprise Care Management
Episodes of Care Coordination of Care
Discharges Transitions
Utilization
Management
Right care, at the right place, at the right
timeCaring for the sick Keeping people well
Production (volume) Performance (value)
Changing Paradigms
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Key Drivers
Culture
Governance
Infrastructure
Incentives
Transparency of
Results
Feedback
Loop
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Strategy Tactic
Outpatient
Enterprise
Care Manager
(ECM)
Dedicated/embedded caremanagers in physician practices for
high-risk patients (2%-5%
commercial population)
Care Manager (CM) workload andpredictive modeling system to target
actionable patients
Inpatient ECM Enhanced inpatient and ED care
manager role Readmission risk tool
Follow-up appt. with PCP office
Medication reconciliation
Physician-partnered CM model
AdvocateCare Strategies & Tactics
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Bent the cost curve in 2011 and 2012 while
maintaining or improving outcomes and
satisfaction
2% HMO membership growth; marketdropped >10%
11% PPO attributed patient growth
PPO In-network use up 3.4% points
APP physician membership growth
What Results Have We Seen?
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Outpatient Care Management
- Early results for managed vs. control
group showing reduction in ED and Inpatient use
SNF Readmissions: 13.6% compared to
national average of 20.3%
SNF LOS: 19.2 days compared to national
average of 27 days
Transition Coach: 26% reduction in
readmissions
What Results Have We Seen?(continued)
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Redesigning Primary Care-AdvancedMedical Practice
IT Connectivity
In Network Care Coordination
Discipline to create a standard approach
Management / Governance Succession
Planning
Patient Experience
Biggest Challenges Moving Forward
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C Suite Leadership Engaged
Transparency
Regular, frequent meetings at various levels
Full Data set exchange
Multi Year Commitment
Financial arrangement has to be win-win
Grows market share
Ideal ACO Partnership
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Tighter attribution models
Benefit plan design to support in network
care coordination
Narrow Networks - EPOs
2014 Exchanges Private and Public
Looking Ahead
EPO = Exclusive Provider Organization
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Questions?
Questions?