Accountable Care: The Challenge of the Decade

1. Accountable Care: The Challenge of the Decade Michigan’s Premier Public Health Conference October 13, 2011 Kim Horn President and CEO Priority Health

2. Medical Index ProjectionsHealthcare costs for American families

3. How Does This Relate to Us? • There can be no doubt about the societal mandate to address these trends. Failure will destroy our economy. • There can be no doubt about the magnitude of the challenges. • What will be major requirements? • A major cultural change: Focus on efficient, effective use of resources vs. generating revenue • Comprehensive primary care and intensely coordinated care of complex disease across delivery systems • Relentless focus on variations in care • Moderation in pricing strategies by many

4. Accountable Care StrategyPartners in Performance

5. The foundation for accountability • Each and every member has a medical home • Patient Centered Networks (PCN) comprised of physicians and hospitals. Commitment to enable coordinated patient centered care, regardless of model. • Measurement of experience, quality and cost for each and every patient. Transparency and performance incentives spur continuous improvement. • Enabling patients to make informed decisions.

6. Enable the Triple Aim Patient Centered Networks

7. Measurement and engagement Plan Wide Region PCN Specialty Practice Physician

8. Understanding variation Group A Group B Group C Group D Group E Group F Group G Physician Organization Group H Group I Group J Group K Group L Group M Group N Group O Group P Group Q Group R

9. The Evidence Supporting Shared Decision Making Number of Unnecessary Surgeries Can Be Decreased and the Quality of Necessary Surgeries Can Be Improved • Surgical utilization varies dramatically by region (Wennberg, Dartmouth Atlas) • 25% of all surgeries are unnecessary (RAND Corporation) • Studies* show that “Decision Aids”: • Quality of outcomes is maintained • Patient satisfaction is improved • Overall effect: 24% decrease in surgical utilization (O’Connor et al. 2003) • Quality of outcomes is maintained *Whelan et al. 2004; Kennedy et al. 2002; Murray et al. 2001; Deyo et al. 2000; Morgan et al. 2000; Bernstein et al. 1998; Barry et al. 1997; Street et al. 1995 9

10. Member engagement • Patient incentives • Benefit plans that reward appropriate health behaviors • Value-based benefits • Patient education • Re-design systems of care to assure that patients receive information regarding all options available for preference-sensitive conditions and for end-of-life care • Spine care—physiatrist visit • Other preference-sensitive conditions • End-of-life care

12. Step 3 • Understand I have 2 or more treatment options to consider • Identify what I want to achieve through treatment • Get a list of potential treatments options to discuss with my doctor • View animations of surgeries and understand risks and benefits of each

13. Preference sensitive care:Our success is being replicated with other conditions • 26% reduction in back surgeries • 12% reduction in high-tech radiology • 74% satisfied/very satisfied • 83% seen within 10 days • 87% better understood options

14. Evolution of Partners in Performance • Patient Centered Networks (Triple Aim) • Strong primary care base that assumes accountability for managing population health • Living within a budget • Relentless focus on elimination of variation • Integration – clinical and economic alignment, collaboration • Honor patient choices and values