Realities of Reform: Navigating New Payment ModelsJuly 18, 2012, 2:00 - 3:00 pm ET

Eric SchultzPresident & CEOHarvard Pilgrim Health Care

Suzette Jaskie

President & CEOMedAxiom ConsultingFormer CEO of West Michigan Heart

Laurel Sweeney (moderator)

Senior DirectorGlobal Health Economics & ReimbursementPhilips Healthcare

Welcome to Philips Healthcare’s “Reimbursement Simplified” WebinarSeries

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Realities of Reform: Navigating New Payment ModelsRealities of Reform: Navigating New Payment ModelsEric H. SchultzPresident and CEO – Harvard Pilgrim Health Care

July 18, 2012

© 2012 Harvard Pilgrim Health Care

What We Know

The market is not a market: no real price connection between patients’ demand and providers’ supply

The system is not a system: care and payment can be fragmented

Health Care Reform expands coverage but adds new administrative expenses and taxes

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© 2012 Harvard Pilgrim Health Care

What’s Next

The Challenge is getting control of medical cost trend while introducing insurance reforms

One size will not fit all

What’s needed are provider, member and employer strategies that include– Information

– Incentives

– Health Engagement

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© 2012 Harvard Pilgrim Health Care

Provider Engagement

Move away from Fee for Service

Introduce Payment for Value

Organize Care Delivery Systems

Offer Transparency – cost, quality and service

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© 2012 Harvard Pilgrim Health Care

What We Are Doing at Harvard Pilgrim

Provide actionable information to physicians and hospitals for population management

Develop care delivery models that are built around patients’ needs

Evolve existing incentive and reward programs (Harvard Pilgrim’s Quality Grant Program)

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© 2012 Harvard Pilgrim Health Care

Consumer Engagement

Transparency

Consumer Incentives

Create Competition among providers - deal with market and brand power leaders

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© 2012 Harvard Pilgrim Health Care

What We Are Doing at Harvard Pilgrim

Tiered Networks

Focus Network SaveOnSM

Healthy Futures rewards program (High deductible plans w/HRA/HSAs, in combination with health and wellness)

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© 2012 Harvard Pilgrim Health Care

Lessons Learned

Offer choice

Defined dollar contribution

Shift financial risk sufficient to change behaviors

Shift volume

Keep it simple

Marketing partnerships with high value providers

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Realities of ReformRequired organizational core competencies

Suzette JaskiePresidentMedAxiom Consulting

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The new payment models are raising the bar….

• Care coordination

• Quality

• Financial justification

• Transparency

• Appropriateness

• Patient engagement

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Environment

• Increased regulatory• Decreased ability to partner, be creative• Public trust of healthcare system at issue• Less money• Individual physician : patient relationship

model

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Every Systemis Perfectly Designed

to Achieve the ResultsThat It Yields.

Demming.

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New model encourages systems thinking

• Create a care delivery system

• Produces Value:– Common notion of quality– Lowest reasonable cost

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PEOPLE

INFORMATION TECHNOLOGY

PROCESSSystem

Components

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Shifting Core Competencies

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Continuous Value Improvement DetailOperation Efficiency:•Lean•Six Sigma•Re-engineering

Goal = eliminating waste

Clinical Effectiveness:•Appropriateness•Guidelines

Goal = Consensus standard of care

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Technology Integration

Data management:•Publically reported data•Registries•Value based purchasing

Solution deployment•EMR•Structured reports•CPOE

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Talent management

Performance environment:•Philosophy•Clear expectations•Metrics base measures•Career ladder

Training and education:•Growth as performance expectation•Planned training•Train the trainer

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Core Competencies applied to Clinical Quality

• Hardwiring evidence based• Hardwiring good documentation• Roles & responsibilities designed to deliver• Digging into the data, not refuting it!• Debate over the gray zone• Sharing not only the good cases• Reaching consensus and evaluating its

application and effectiveness

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SIX TOOLS : Success in the CV Enterprise Today

• Physician /Administration collaborative leadership• Physician driven reduction in variation of care• Care team development• Leveraging information technology advances in order

to manage data and processes• Performance environment to create value• Talent redevelopment

Preparing for transformed CV Enterprise of tomorrow!

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The best way to predict the future is to create it”--Peter Drucker

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We would like to hear your views on today’s webinar. Go to http://www.surveymonkey.com/s/8W9WB5J

For more information on reimbursement, please visit the Philips Healthcare Reimbursement Website at

www.philips.com/reimbursement

Questions?

Please type your questions into the video player window.The moderator will pose questions to the panelists.

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Speaker Bios

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Eric H. SchultzPresident and Chief Executive OfficerHarvard Pilgrim Health Care Eric H. Schultz is President and Chief Executive Officer of Harvard Pilgrim Health Care, the #1 private health plan in America according to an annual ranking of the nation’s best health plans by the National Committee for Quality Assurance (NCQA). Harvard Pilgrim is the only private health plan in the nation to be named #1 for member satisfaction and quality of care for eight consecutive years. During his 26-year career, Eric has taken an active role in defining and implementing changes leading to improvements and greater efficiencies in the financing and delivery of health care through greater consumer and physician engagement. Prior to joining Harvard Pilgrim, Eric was President and Chief Executive Officer of Fallon Community Health Plan, and held executive positions with CIGNA Healthcare, Prudential Healthcare and Nashville Healthcare Physician Group. Eric was recently appointed as Chair of the Board of AHIP. Eric holds an MBA in Health Care Leadership from Yale University’s School of Management, as well as a Bachelor of Science degree in Biology and a Bachelor of Arts degree in Economics from the University of Connecticut.

Speaker Bios

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Suzette JaskieChief Executive OfficerMedAxiom Consulting Suzette Jaskie, CEO of MedAxiom Consulting, is a health care industry thought leader with over 20 years of executive healthcare management experience in both physician practice and hospital environments. Ms. Jaskie has extensive experience in healthcare organizational development, strategic planning, hospital/physician alignment, improving financial, operations and market organization performance, market and program development, financial management and physician compensation. Suzette is a coach and a performance improver who relishes in motivating change and assisting organizations to achieve their optimal performance.

Previously, Suzette served as the CEO of West Michigan Heart, a 33-cardiologist practice, and Executive Director of Spectrum Health’s Frederik Meijer Heart & Vascular Institute, both in Grand Rapids. In that role, Ms. Jaskie provided executive management to both organizations, coordinating 98-physicians in several cardiovascular specialties across a 7 hospital, 14 county system. Ms. Jaskie is a frequent speaker at national meetings and a contributor to several journals and articles. She is a faculty member of American College of Cardiology’s Advanced Leadership Institute. Suzette has a Master’s Degree in Business Administration from the University Of Hartford, CT and a Bachelor of Science from the University of Wisconsin.