Across The Chasm: The Transition From Volume To Value Joseph Bisordi, MD, Executive Vice President & CMO Ochsner Health System Our Mission is to Serve, Heal, Lead, Educate, and Innovate $1.6 Revenue ($B) $1.8 $2.0 2010 2012 2013 Annual Patient Activity More than 56,000 discharges More than 1.4 Million clinic visits More than 250,000 ED visits More than 72,000 surgeries More than 6,600 Deliveries Largest Health System In Gulf South 11 hospitals (Owned & Managed) 15 Affiliated Hospitals 45 Health Centers 950+ group practice physicians in over 80 subspecialties 1,600 Active Community Physicians 9 of 12 specialties nationally ranked by U.S. News & World Report Top 15 Teaching Hospitals in America Largest Private Employer in Louisiana #1 fitness chain in Louisiana 1
Ochsner Health System 4 2
Proven Quality - Top 1% in U.S. #28 in Diabetes & Endocrinology #36 in Ear, Nose and Throat #18 in Gastroenterology & GI Surgery #46 in Geriatrics #34 in Nephrology #24 in Neurology & Neurosurgery #41 in Orthopedics #26 in Pulmonology #46 in Urology A Paradigm Shift 3
Online Retail Sales Increased More than Double the Rate of Brick & Mortar Retailers During the 2013 Holiday Season Square Footage of New Retail Space Last Year Down 87% from 2006 Mobile Devices Expected to Account for 25% of Retail Sales by 2017 4
Why Healthcare is Next Annual Expenditures Near $3 Trillion with Low Margins Industry Historically Slow to Change Increasing Competition Patient Choice Playing a Bigger Role Inconsistent Performance Across Industry Pricing Transparency Change Is Happening Now 5
Self Care Higher Out of Pocket Cost Technology Insurance Exchanges What is Changing for O New Delivery Transparency Options ur Patients? Health Insurance Exchange Metal Plans What Kind of Plans are People Choosing? 80% of Those Who Have Purchased Plans Selected Either the Bronze or Sliver Plan These Plans Require Higher Out of Pocket Expenditure 6
The Impact of High Deductable Plans Number of Individuals Enrolled in HDHP Rose from 1 Million in 2005 to 13.5 Million in 2012 Increase in Patient Collections Delays in Diagnosis, Treatment and Preventative Care Change in Patient Expectations Payment Cuts New Payment Models Transparency Declining Discharges Independent MD Hospitals & Systems What is Changing for Technology Pr O viders? Increased Competition 7
The Era Of Payment Declines Is Here Governmental Payments Will Continue to Decrease The Health System Of The Future Be Better Be Faster Innovate Be Leaner Be Bigger Quality Safety Access Coordination Process Change Market Changes Teamwork Care Models Disease Mgmt Technology Best Practices Reduce Waste Improve Processes Consolidate to Leverage Scale and Reduce Cost 8
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The New World in Healthcare Payment Incentives Focus Role of Provider Information Volume Based Fee For Service Volume Acute Episodes Single Episodes Retrospective Value Based Global With Bundled Payment Value Quality, Service, Cost Manage A Patient s Health Responsibility For Overall Care Real-time & Predictive Financial Impact of Volume-to-Value Transition Source: Kaufman, Hall & Associates Inc., 2014 10
Ochsner s Dual Strategy Center of Excellence Strategy Population Health Management Strategy Being The Place People Want To Come To Focus on Wellness and Effective Management of Chronic Disease Fee For Service Global Payments Ochsner Centers of Excellence Strategy Destination Center Health Management Center Where People Want To Be Cared For Top Clinical Outcomes Leading Clinical Research Strongest Referral Relationships Improving Quality Of Life Active Patient Relationships Chronic Disease Management Prevention Lowering the Cost of Care The Trusted Partner in Care Clinical, Quality & Care Delivery Infrastructure & Support Operations Payor and Employer Partnerships Digital Health Solutions Solution Center 11
% Population 11/6/2014 The Distribution of Costs Across a Population Well & Low Risk Chronic Chronic Care Management Complex 80% 19% 1% % Cost 20% 59% 21% Source: AHRQ Healthcare Costs, 2011 Ochsner Managed Lives 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2013 2016e Risk Lives FFS Lives Full risk 40,000 Medicare Advantage seniors (Humana & PHN) 16,000 employees + dependents (self-insured) Shared Savings 22,000 Medicare (ACO-MSSP) 47,000 BCBSLA commercial 7,500 CIGNA commercial 15,000 United commercial Total risk: 148,000 out of 395,000 (>1/3) 12
Plan, Coordinate & Manage Care Goals Tools Population Health Prevention Disease Management IT Registeries Quality Metrics (HEDIS) CHF Telehealth, COPD program, Diabetes Boot Camp Triple Aim Patient Experience Access Care Coordination Navigation MyOchsner Patient Portal Expanded Hours Take Care Clinics Health Coaches Complex Care Managers Transition Navigators Total Cost of Care Resource Stewardship High Value Network Pursuit of Value ED Avoidance Program Generic Dispensing Post Acute Network Clinical Integration Network HEDIS- The Drive For Five 13
Ochsner 5-STAR Summary Ochsner HEDIS rates-humana Gold MY 2012/RY 2013 Measure Ochsner Weight Measure Name Score 2 Star 3 Star 4 Star 5 Star 1 Adult BMI 94.00% 52% 68% 77% 89% 1 Drug Therapy for Rheumatoid Arthritis 85.00% 51% 66% 78% 83% 1 Breast Cancer Screening 82.00% 50% 63% 74% 81% 1 Diabetes Eye Exam 75.00% 41% 53% 64% 70% 3 Diabetes-HgA1c control </=9.0% 77.00% 48% 64% 80% 84% 3 Diabetes-LDL-Cholesterol < 100 mg/dl 58.00% 31% 44% 53% 59% 1 Diabetes-LDL-Cholesterol Screening 86.00% 79% 83% 85% 93% 1 Diabetes-Nephropathy Testing 89.00% 80% 83% 85% 89% 1 Cardiovascular-LDL Cholesterol Screening 94.00% 78% 83% 85% 89% 1 Care for Older Adults-Functional Status 97.00% 30% 42% 62% 87% 1 Care for Older Adults-Medication Review 93.00% 51% 65% 75% 92% 1 Care for Older Adults-Pain Screening 90.00% 36% 52% 76% 91% 1 Colorectal Cancer Screening 81.00% 40% 49% 58% 65% 1 Glaucoma Screening in Older Adults 79.00% 29% 64% 70% 77% 1 Osteoporosis Mgt after Fracture (females) 28.00% 16% 36% 60% 70% 3 Plan All-Cause Readmissions 14.00% 21% 14% 11% 9% 3 Controlling High Blood Pressure 71.00% 37% 49% 63% 77% Ochsner Diabetes LifePlan Diagnosis Protocols Diabetes BootCamp Diabetes Empowerment Diabetes Long-Term Management 14
costs (thousands $) HgA1c% 11/6/2014 Diabetes BootCamp Outcomes 7.6 7.4 7.2 11.4% Reduction! 7 6.8 6.6 6.4 Control N=129 Boot Camp=78 6.2 Pre Post Episode Costs for Heart Failure (2012) 30 Days after Index Admission $16.0 $2.31K $404.59 $153.47 $108.92 $15.82K $12.8 $4.21K $9.6 $1.64K $6.4 $7.0K $3.2 $0.0 Index Admission Physician Subsequent Admissions Skilled Nursing Facility Hospital Outpatient Hospice Home Health Total Source: Advisory Board Episodic Cost Profiler: http://fac.advisory.com/2013_b_dag_bgframework/main/getsession/?var=60306d67-d71e-41b6-a676-ff6310aca162 15
At discharge, patients receive home monitoring kit. Out-patient visit within 3 business days. Level 3: Outpatient Home Monitoring metrics scrubbed thru condition specific algorithms X potential readmission avoided patients stratified by risk status high risk patients intervened by medication adjustment and/or outpatient visit 16
Readmission Rate Post-Intervention Note: reflects only readmissions to OHS hospitals Plan, Coordinate & Manage Care Goals Tools Population Health Prevention Disease Management McKesson Registry Quality Metrics (HEDIS) CHF Telehealth, COPD program, Diabetes Boot Camp Triple Aim Patient Experience Access Care Coordination Navigation MyOchsner Patient Portal Expanded Hours Take Care Clinics Health Coaches Complex Care Managers Transparency Total Cost of Care Resource Stewardship High Value Network Pursuit of Value ED Avoidance Program Generic Dispensing Post Acute Network Clinical Integration Network 17
Connecting with More Patients in More Ways 190,000 Patients Now Using MyOchsner 3.5% Established Patient Visits Scheduled Online Increased Online Booking 45% In 1 Year Appointments Booked Online Have A 50% Lower No Show Rate Providing Wellness Solutions For Our Patients System Goal Of Hiring 50+ Primary Care Physicians & APPs For Wellness & Prevention By End Of 2014 Expanding The Model Of Care Through Extended & Weekend Hours Center For Primary Care & Wellness: M-F, 12-8; Sat, 8-4:30; Sun, 10-4 Covington: M-F, 12-8; Sat, 8-12 Westbank: Sat, 8-1; Sun, 8-5 Baton Rouge: M-F, 8-8; Sat, 8-12 18
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Plan, Coordinate & Manage Care Goals Tools Population Health Prevention Disease Management McKesson Registry Quality Metrics (HEDIS) CHF Telehealth, COPD program, Diabetes Boot Camp Triple Aim Patient Experience Access Care Coordination Navigation MyOchsner Patient Portal Expanded Hours Take Care Clinics Health Coaches Complex Care Managers Transition Navigators Total Cost of Care Resource Stewardship High Value Network Pursuit of Value ED Avoidance Program Generic Dispensing Post Acute Network Clinical Integration Network Pursuit of Value Our Mission: Highest Quality Care at an Affordable Cost Our Approach Our Structure Physician Led 1 3 Cost Engineering 2 Variation Our Reduction Approach Process Improvement Project Mgmt. Clinicians Supply Analytics 40 20
Total Cost of Care: Working Outside Our Walls 4,100 Total Physicians across our Region 950 OHS Group Practice 250 Ochsner Physician Partners OHS Group Practice Ochsner Physician Partners Independent Physicians Competitively Employed Physicians 1950 Independent Physicians - 640 Primary Care - 1310 Specialists 950 Competitively Employed Physicians Source: Ochsner Physician Partners Database Driving Down The Cost Of Care Cost Trend Per Humana Medicare Advantage Member 6.00% 4.00% 4.80% 3.70% 2009 2.00% 0.00% 0.60% 2010 2011-2.00% -4.00% -6.00% -8.00% -0.90% -6.40% -4.70% 2012 2013 2014YTD 21
The best way to predict the future is to create it Peter Drucker 22