Continuing to Innovate in Healthcare’s Changing Landscape

Ruth Krystopolski

SVP, Population Health

Understanding Jerry’s Journey

60 Year Old Homeless Male Living behind Ford’s Used Tires and on streets for years Alcohol Use Disorder, Malnutrition, Chronic Right Retinal Detachment (Legally Blind) 36 ED Visits in 2017 at Atrium Health

Bringing Health, Hope and Healing for Jerry

• Facilitated connection to Niece for Family Support

Family

• Coordinated transportation to Primary Care and Specialty Appointments

Coordination of Transportation

• Advocated for Patient Placement in Mecklenburg County Supportive Housing

Housing

• Facilitated applications for Medicaid, Food Stamps, and SSI

Government Sponsored Assistance

• Provided a means of contact for patient care

Lifeline Phone

• Connected Jerry to specialists for his Retinal Detachment and Cataracts

Services for the Blind

• Provided clothing and connections to services and agencies in the area

Community Resources

Bringing Health, Hope, and Healing for All Facts about the Community Care Bridge Team and our Patients

Total enrollment of 97 patients in 2017

40 Graduated Patients

(defined as achieving maximum goals of the program and/or

obtaining insurance)

Financial Savings of over $1M in Emergency

Department Charges

43% decrease in Hospital and ED

Utilization

Additional Patients Pending for

Enrollment into Program

Measuring our Impact

Enrollment and Intervention by the

Community Care Bridge

team resulted in $1,614,303

in Savings for 2017 for our 97 Patients

National Landscape

National Landscape – Market Pressures

1. Aging Population 2. Significant Spend Increase

4. Chronic Conditions 3. Not Fiscally Sustainable

15.5%

16.0%

16.5%

17.0%

17.5%

18.0%

18.5%

19.0%

19.5%

20.0%

20.5%

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

National Health Expenditures, per capita

Medicare

Medicaid

Social Security

National

Health

Expenditure

as a % of

GDP

Cardiovascular Disease

History of Heart Attack

History of Stroke

Diabetes

Hypertension

Arthritis

Dyslipidemia

Total US Population

Asthma

Slide Source: Premier

National Landscape – The Demographics

Slide Source: The Weekly Gist

“One of my top four priorities as Secretary, if confirmed, will be to use the power of Medicare and

Medicaid to drive transformation of our healthcare system from a

procedure-based system that pays for sickness to a value-based system that pays for

quality and outcomes.”

- Alex Azar, HHS Secretary

9

How is “Value” Defined?...It Depends…

University of Utah Health Survey 5,031 Patients, 687 Physicians, 538 Employers

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Quality Cost Patient Satisfaction

Patients Physicians Employers

Source: HealthLeaders Media 10

The Journey to Value

Population Health Program

Scorecards and Feedback

Data Analytics

MSSP

Risk Readiness Assessments

Preparation across the organization is on-going to get us ready for this new world by building on the past and into the future

Integrated Systems of Care

Networks and Partnerships

11

Continuing to Innovate 12

Building Infrastructure

13

Ensuring Appropriate Utilization ED High Utilizer Care Management

158 Patients

Over 6,000 ED Encounters

33% Reduction in Utilization

31% Reduction in Cost

$7.5M in Avoidable ED Cost Savings

92 Patients

Over 2,400 ED Encounters

32% Reduction in Utilization

28% Reduction in Cost

$2.5M in Avoidable ED Cost Savings

30+ Visit Cohort 20+ Visit Cohort

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Caring for Large Populations

With over 101,000

assigned

Medicare Beneficiaries,

the

Carolinas HealthCare

System ACO, LLC

is one of the largest

ACOs in the country.

Promoting Health and Wellness HEALTHWORKS Direct to Employer Solutions

Health Fairs and Education

Biometric Screenings Health Coaching On-Site and Shared

Health Centers

Care Management Reporting and

Outcomes Immunizations and

Vaccines 16

Creating Access to Engage Patients

Virtual Health .

Access Wherever and Whenever Needed:

Virtual Critical Care TelePsych And Patient Placement

Telestroke Infectious Disease

Behavioral Health Integration (Primary Care) Virtual Visits

e-Synchronous Visits

17

Building Collaboration

Creating Opportunities: ACO/CIN Collaborative

Working Together in

New and Different

Ways

19

Partnering for Innovative Care Humana Care Management Assisted Visits

“The case managers have valuable information about how the patient is functioning in their home…medication organization and compliance and other needs the patients may have…Having the case managers brought additional health concerns to my knowledge so the overall quality was improved.” -Dr. Marinda Wells

Shelby Family Medicine

Medicaid Strategy: Preparing for

Additional Risk

Value Grand Rounds

Identify Patients

Create Diverse Interdepartmental Team

Meet Regularly to Discuss Difficult Cases

Use Existing Resources to Create Intervention

Identify Gaps in Care/Processes System-Wide for Improvement

Examining Opportunities

Medicare Advantage Strategy

Care Model Redesign

Behavioral Health

Partnerships

Bundled Payments (BPCI-A)

Risk Stratification

Healthe Charlotte

Connecting our Community

Reaching In - Community Resource Hub

25

Renaissance West

Steam Academy

Second Harvest

Mobile Health Units

Read Charlotte

Reaching Out – Community Support Services

Renaissance West

Housing Solutions

26

Connecting the Dots by Capturing New Data

Standardized Social Determinants of Health Screening for Physician

Workflows

1. In the past 12 months, were you worried that your food would run out before you got money to buy more?

2. In the past 12 months, has lack of transportation kept you from medical appointments, getting your medicines, non medical meetings/appointments or getting things that you need?

3. Are you worried or concerned that in the next two months, you may not have stable housing?

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Stronger Together

Public Health

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One Charlotte Food Insecurity Pilot Program

Novant Atrium Health Loaves & Fishes

29

30

Focus on Gaston County

Expanding Virtual Care

31

Cleveland County Pilot Program

Integration of Virtual Clinic in

Nursing Office

Outcomes: Improved Access to Primary Care

Establishment of Primary Care Physician through Shelby Children’s Clinic for care

50% Reduction in Dismissal from School Nurse

77% Reduction in ED Utilization following Virtual Visit

Gaston County Community Impact Regional Team

32

New Regional Structure

Community Assessment Identified Priorities

Specific Community Initiatives

Current Programs at Atrium Health or in the Region

Aligned Vision of Community

Health For All

Caring for Gaston County

33

Clinical Initiatives Gaston Hematology &

Oncology joining Levine Cancer Institute through Atrium Health

Atrium Health Robinwood Road Urgent Care Open Third Urgent Care in Gaston

County

Community Connections

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Holy Angels

• October 29, 2018 at Erin Community Center for OTC Giveaway

MedAssist Mobile Pharmacy

• May 14, 2018 benefitting 98 families by providing health meals

Mobile Food Pantry Program

• Sponsorship of the local activities

• Transportation for those with limited resources

Girls on the Run

• Provided for Gaston Health & Human Services and the Gaston Fire Department

Mental Health First Aid Training

• August 29, 2018 to benefit Garrison Library, Girls on the Run and Family Promise

Day of Caring

• LCH Providers donate time to see mentally and physically disabled children and adults

Focusing on the Future

Managing Change without Being Buried

36

Tax Reform

Bill

Increased MA Participation

Fewer Mandatory

Bundles

Growth in ACOs

Increased Spending

Readmissions on the Rise

BCPI Participation Fluctuation

Medicaid Reform

Increased Exchange

Enrollment

Source: Advisory Board

Disruptive Developments

Source: Modern Healthcare 37

Keys to Staying Ahead

Sticking to our Strategic Beliefs:

• Value is defined by the customer – those who consume care and those who pay for it

• Long-term financial viability requires delivering value

through sustainable models

• The ability to keep individuals and populations

healthy is a key determinant of future success

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Destination 2020

250K By 2018

275K By 2019

300K By 2020

Improving Lives within Sustainable

Value Based Care

Models

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