Affordability AMGA - MIPS Webinar Beth Averbeck, MD Senior Medical Director Primary Care, HealthPartners
Consumer-governed, non-profit HealthPartners Medical Group Primary Care: 500,000 patients 29 locations 400 physicians Mixed payer population Integrated health care delivery and financing Clinics and hospitals Health plan Twin Cities & surrounding communities (MN & Western WI)
Background NCQA Tier 3 ACO (HealthPartners) Next Gen ACO (Park Nicollet) 5 Star Medicare ranking (health plan) Truven Top 15 Health System in the US
Minnesota Community Measurement High Performing Medical Groups in 2016 (Primary Care) Measure Park Nicollet Health Services 17 out of 21 HealthPartners Clinics 16 out of 21 Mankato Clinic, Ltd. 13 out of 21 Stillwater Medical Group 13 out of 21 Fairview Health Services 12 out of 21 Allina Health 11 out of 21 ADHD Adolescent Immunizations Breast Cancer Screening Bronchitis Cervical Cancer Screening Childhood Immunization Status (Combo 3) Chlamydia Screening Colorectal Cancer Screening Controlling High Blood Pressure COPD Depression Remission at 6 months Depression Remission at 12 months Maternity Care: Primary C-Section Rate Optimal Asthma Care - Adults Optimal Asthma Care - Children Optimal Diabetes Care Optimal Vascular Care Pediatric Mental Health Screening Pediatric Overweight Counseling Pharyngitis URI = Medical Group rate and confidence interval fully above average Blank = measure reported but rate was average or below average
The Triple Aim Improved health of the population Simultaneously deliver: Improved health Optimal experience Affordable care and coverage Exceptional experience for the individual Improved Affordability
Moving from volume to value
Total Cost of Care WHAT IS TOTAL COST OF CARE? Population-based model Attributable to medical groups for accountability Includes all care, treatment costs, places of service, and provider types Measures overall performance relative to other groups Illness-burden adjusted Drillable to condition, procedure and service level Identifies price differences and utilization drivers National Quality Forum-endorsed Total Cost of Care Resource Use Price https://www.healthpartners.com/hp/about/tcoc/
TCOC Uptake More than 215 licensees across 37 states and the District of Columbia
Dashboard HPMG Park Nicollet Stillwater
Triple Aim Project Portfolio Avoid these things Preventable inpatient admissions Avoidable use of Emergency Rooms Unnecessary labs & hi-tech diagnostics Use of high cost pharmaceuticals when alternatives exist Do these things Keep people healthy Avoid harm Practice evidence-based care Engage patients and communities Manage costs and be efficient Offer most cost-effective settings for care Coordinated care for chronic/complex conditions
Condition Focused Examples Condition Members TCI Price Index RUI ARTHRITIS 600 1.02 1.02 1.03 ASTHMA 1,500 1.06 1.02 1.03 BACK PAIN 3,500 1.03 0.99 1.04 CHF 50 1.03 1.00 1.03 CHRONIC RENAL FAILURE 105 0.91 1.03 0.89 COPD 175 0.91 1.08 0.85 DEPRESSION 2,300 1.04 0.99 1.05 DIABETES 1,300 1.05 1.00 1.03 HYPERLIPIDEMIA 3,700 1.03 1.02 1.03 HYPERTENSION 3,500 1.06 1.02 1.04 ISCHEMIC HEART DISEASE 350 1.00 0.99 1.00 ALL OTHER CONDITIONS 12,500 1.07 1.02 1.05 Provider XYZ 26,000 1.03 1.00 1.03
Higher Rates of Spine Surgery in MN
Hypothesis: Incorrect
Medical Spine Care Model Engaged key stakeholders across primary care, specialty care, ancillary services, and a health plan Using standardized tools, messages and metrics Primary Care Physician Chiropractor Conservative Management Active Physical Therapy Medical Spine Specialist Surgical/ Interventional Management Conservative Rehabilitation Physician Directed Consultative Relationship
Medical Spine Care Model Results Lumbar fusions 39% Lumbar Surgeries 15% $1 Million in savings Lower admission rate $400,000 savings Fewer prescriptions written $140,000 savings Decreased use of hi-tech imaging $75,000 savings Reduced emergency room use
Optimal Low Back Pain Measure 100% Feb 2017; overall n-size = 1,280 (HPMG) 80% 60% 40% 20% 0% No narcotic Rx No imaging order No injections No surgical referral Optimal ED Primary Care Specialty Urgent Care Definition: % of patients with low back pain diagnoses, with no qualifying encounters in the previous 180 days, who did not have any of the above within the first six weeks of the initial visit.
Orthopedics Geriatric Ortho Service Portable x-ray Remote care plan Ortho to geriatric team Ortho NP makes house calls in skilled nursing facilities Cost of x-ray and MD time < cost of ambulance and ED visit Ortho Joint Place of service Preparation for procedure Home vs. TCU TRIA Acute injury care Hotel rehab Moved total cost index from > 1 to < 1
Improvement: Actionable information Lab/Path Count Index 2014 2015 1.05 1.06 1.00 1.00
Effective Use Laboratory Testing Help clinicians order only the tests the patient needs & when they need it Eliminate unnecessary duplication or tests that don t benefit the patient
Lab Alerts for Decision Support Vitamin D Folate
Appropriate Medication Use: Avoiding high risk medications in the elderly Don t start (less is more) Stop ( graduation ) Examples: Alzheimer's medication Statins Hypoglycemic Hypnotics Opioids Proton pump inhibitors
Appropriate Medication Use: Opioid Metrics Ambulatory scorecard: 1. Diagnosis capture rate 2. New prescription average quantity Americans represent 5% of the world s population, yet consume 80% of the world s opioids. $55 billion in health and social costs related to prescription opioid abuse each year Additional measures available in analytics tool: 1. % of active patients with at least one prescription 2. % of active patients with a new prescription (defined with a 6 month clean period) 3. % of active patients with a chronic prescription (defined as 3 or more prescriptions in a 6 month period) 4. Average, median, mode, range of pill quantity 5. Number of patients with concurrent opioids and benzodiazepines
Appropriate Site of Service Emergency Room use reduction Care plans for complex needs Automatic routing of notice of ER use to care team Call, Click, Come In Same day appointment access Walk-in access virtuwell Outpatient hospital vs. Same Day Surgery Center Leverage OR smoothing work at Regions Hospital Practice specific data at the department level Joint replacements (?) Clinic vs. Same Day Surgery Center Carpal tunnel surgery Vein ligation Cataracts (?)
Population Consultant Moving knowledge and information, not patients A new approach to mental health and diabetes care in Endocrinology: Share knowledge and best practices through the use of tele-video Discuss difficult diabetes cases with experts and other providers Build relationships with colleagues Joy in practice
Mental Health Cognitive Behavioral Therapy delivered via proven, interactive, online model Catholic Charities: Higher Ground Saint Paul
Advanced Directives Primary care Geriatrics Cardiology CHF Pulmonary COPD Nephrology dialysis Oncology
Do Everything Workplan Spine Care / Acute back pain Specialty Care Specific Work Payment and model of care reform Addiction Medicine Site of Service Oncology Innovations Use of opioids / benzodiazepines Pharmacy deprescribing Emergency Room Use Admissions / Readmissions Beating the Blues Re-visit rates Antibiotic stewardship Order variation assessment Hospital-at-Home End-of-Life
Cost as a four letter word It s OK! Critical part of triple aim Choice: Influence and own it OR regulation Patients expect us to care about it Engage physicians in identifying opportunities
Thank You! www.healthpartners.com/tcoc