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Pankaj Patel MD MSc Senior Medical Director, Advocate Physician Partners

Obesity Symposium-Ignite the fight against Obesity: Advocate’s Approach to Population Health Management September 26 th 2014. Pankaj Patel MD MSc Senior Medical Director, Advocate Physician Partners. “Knowing is not enough, we must apply Willing is not enough, we must do”. Goethe.

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Pankaj Patel MD MSc Senior Medical Director, Advocate Physician Partners

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  1. Obesity Symposium-Ignite the fight against Obesity: Advocate’s Approach to Population Health Management September 26th 2014 Pankaj Patel MD MSc Senior Medical Director, Advocate Physician Partners

  2. “Knowing is not enough, we must applyWilling is not enough, we must do” Goethe

  3. Market Trends and Health Reform: It’s A New Day • Pressure on Commercial Payers • Medicare Insolvency • Medical Inflation>Economic Inflation • Population Aging and Uninsured • ‘Tragedy of the Commons’ Population Health Patient Experience Cost Per Capita

  4. Insurers Acknowledge Difficulty in Controlling… • Utilization of High End Imaging • Readmissions • Outpatient Trend • New Drugs & Technologies • Ambulatory Sensitive Conditions

  5. Options • Reduce Unit Price • ACO with aligned incentives to pursue ‘Triple Aim’ Population Health Patient Experience Cost Per Capita Pankaj Patel

  6. APP’s Reimbursement Model Is Shifting

  7. Value Based Agreements ACO = Accountable Care Organization 14

  8. The Cost Equation to Manage Risk Volume Cost Price Revenue Profit FFS Surgicenter Imaging PT ED visits Readmissions VBC Appropriate Coding Surgicenter Imaging PT ED visits Readmissions Avoidable morbidity Low Cost Centers Standardized Care Approach

  9. Population Health Management Source: The Advisory Board, Population health managers, meet the three patient types central to your success, June 14, 2013

  10. Evolution of Clinical Integration 5 Performance Domains: • Chronic Disease Care • Health and Wellness • Efficiency • Care Coordination • Patient Experience

  11. Evolution of Clinical Integration Population Based Outcome Metric AdvocateCare Index • Length of Stay • Admits/1000 • ED Visits/1000 • 30 Day Readmissions • % Days In-Network Additional sub metric 2015 • Total cost of care • Episode • pmpm

  12. Evolution of Clinical Integration Change in Incentive Payment Incentives For All Physicians: Move from pay for performance to pay for value contribution Value Contribution = Performance x Volume of patients managed x Coordination of Care factor

  13. Advanced Analytics and Other Care Management Solutions • DART - ActiveHealth (HDMS) • Predictive Tools • Readmission Risk - Cerner partnership • Falls Risk - Cerner partnership • Risk Stratification - ActiveHealth (HDMS) • Patient Impactability (under development) • Total Cost of Care and Resource Use – Licensed from Health Partners • Integrating EMRs - CareNet + • Care Management Work Flow Tools - ActiveHealth • Referral Management ERMA - APP

  14. Advancing Evidence Based Clinical Decisions • e University CME Programs • Clinical Pathways Development / Point of Care Patient Management Protocols • Pharmacy Academic Detailing • Learning Collaborative • Physician Office Staff Training • Patient Outreach and Education • Patient Health Coaching Program through Care Management Program • Patient Self Management Tools

  15. Obesity: • Impact on Population Health • BMI>30 results in 200-300% increase in Mortality • Increase in HTN, DM, CVD, DJD • 36% increase in Medical costs • Gluttony or Sloth or Both • Imbalance: Energy consumed and Used • BMJ 1995 Energy consumed declining but obesity increasing

  16. Obesity Related Measures • 2012 • BMI Assessment • 2013 and 2014 Adults and Pediatrics • BMI Assessment and Follow Up Plan if abnormal • Exercise Assessment and Counseling • 2015 • Above Plus • Online CME for Diabetes (includes focus on lifestyle changes and consideration of Bariatric surgery)

  17. BCBS ACO Performance

  18. Value-based Agreement Results Commercial ACO • Cost Savings • 2.0% Improvement in PPO cost trend (Q3 2013) • 3.1% Improvement in Combined HMO cost trend (Q3 2013) • Quality* • HMO – 6 of 8 key metrics improved, 1 no change, 1 decreased Medicare Shared Savings Program • Cost Savings • 0%, Flat (Preliminary results, First 12 months, Q2 2013) • Quality • Completely and accurately reported all 33 quality measures-100% • Estimated score 79% *PPO Quality Data is not available due to new cohort measurement.

  19. Summary • Emerging payment models create a focus on population health management • Population health requires • A new focus on wellness and health status • A team approach

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