Minnesota's HealthPartners View of the Future of Integrated Care and Role of Laboratory Testing

Transcription

1 Minnesota's HealthPartners View of the Future of Integrated Care and Role of Laboratory Testing May 1, 2018 Rick Panning, MBA, MLS(ASCP) CM Senior Administrative Director, Laboratory Services HealthPartners Bloomington, MN

2 HealthPartners Mission: Why are we here? To improve the health and well- being in partnership with our members, patients and community Vision: Where are we headed? Health as it could be, affordability as it must be, relationships built on trust.

3 HealthPartners: Supporting health and well- being for 60 years

4 Laboratory Focus - internal Focus on improvement for the family of care through Optimizing Care Model Process Optimizing Total Cost of Care Improving patient and provider experience Note: We do have outreach business and plan to expand, but options in Minnesota are limited due to strong integrated affiliations of physician practices.

5 HealthPartners Laboratory Strategies: The 4 Pillars People Workforce planning Personnel Development Health Beaker implementation Risk Assessment Action Plan Standardization and consolidation Genetic Strategy / Utilization Management Experience Optimize ambulatory testing / process Patient experience Stewardship Total Cost of Care / budget Growth Payer Partnership

6 Stewardship: Utilization Management All utilization management or stewardship activity done in the context of Total Cost of Care. Laboratory process partnership with primary care, urgent care and pediatrics Goal for HealthPartners to perform at 5% below the median cost of care and resource utilization for the market. Inpatient care Ambulatory care By department:

7 Total Cost of Care Average Cost Per Patient Per Month Minneapolis- St. Paul Health Systems $700 $600 $500 $400 $300 $200 $100 $0 Org A Org B Org C Org D Org E Org F Org G Org H HealthPart ners

8 ACO experience: HealthPartners and Allina

9 Genetic Testing Strategy Partnership with health plan by developing payment policy. Two laboratory genetic counselors hired in Review of all genetic test orders across the system. Partner with providers to approve, modify and cancel test orders. Laboratory genetic counselors counsel patients in specialties without clinical genetic counselors Establish an infrastructure to coordinate and meet the demand for genetics (personalized medicine) services across the care group

10 Laboratory Genetic Counselors (GCs) Genetic Testing Decision Support program Metrics for 2017 Genetic Testing Decision Support program Metrics from Jan. to Dec Metric Total cost avoidance savings* (>$1M since program start) Total number of test orders reviewed by genetic counselors Results $884, Average cost savings per test order $650 Average test order approval rate 77% Average test order modify rate 2% Average test order cancel rate 7% Average test order override/investigational rate** 14% Process innovation: Provider places EMR order to genetic counselor for Genetic Testing Decision Support * Savings = list/contract price of test minus final price via institutional or direct to insurance billing. ** Override = provider/patient proceeds with order despite other recommendation(s) Investigational = clinical utility may not be proven but provider/patient decide to proceed with order EMR = Electronic Medical Record 31% 10

11 Health Plan: Outcomes- related Genetic Testing Policies Year Total Plan Paid Plan Paid PMPM Services Per $11,605,700 $ $10,032,900 $ $7.478,800 $ Plan paid PMPM decreased by 19% from 2015 to 2016, and by 27% from 2016 to 2017 Utilization decreased by 12% from 2015 to 2016, and by 11% from 2016 through 2017 Improved policies and improved genetic laboratory contracts

12 Meeting the PAMA and Reimbursement Financial Challenge Balance finances across a broad geography and diverse practice environments. Expansion of urgent care and expanded primary care hours Higher percentage of commercial insurance. Balance financial performance between provision of care and health plan. PAMA 2018 YTD Hospitals: minimal impact Most impact in ambulatory care (clinics) and independent central laboratory. March YTD: Medicare reimbursement down 9.4%. Overall reimbursement down 1.6%

13 Optimize ambulatory testing / process Expansion of hours: urgent care, primary care Current process improvement to optimize patient workflow Decentralize testing to support physician workflow as part of the Care Model Process. INR testing decentralized in October 2017 Implementation of PCR based strep testing May 2, 2018 Implementation of BD Affirm Evaluating additional testing: A1C, urgent care chemistries, baby bilirubins Expand STD testing through in- home self collection. Working with Virtuwell (HealthPartners Virtual Clinic)

14 Partnerships Laboratory: healthplan and payer contracting Clinician partnerships Partnership with other laboratory system in market to jointly contract for reference laboratory testing. Additional future possibilities. Vendor partners Primary reference laboratory Testing optimization Test catalog Utilization Management consulting Outreach strategy consulting

15 Rick Panning (cell)