UPMC for Life

1. UPMC for Life Hazem Alsahlani, Esq. Director, Medicare August 7, 2019 The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

2. Overview of UPMC Leading Academic Medical Center $20B Global Health Enterprise Integrated Delivery & Financing System 87,000 Employees Health Services Insurance Services 40 academic, community, and specialty hospitals More than 6,000 affiliated physicians, including 4,900 employed physicians; #14 Best Hospital; #8 Best Children’s Hospital – U.S. News Partnership – University of Pittsburgh – #3 NIH funding 3rd Largest GME program (1,900 Residents and Fellows) 3.5M Health Insurance Members Leading market share: Medicare, Medicaid & Children’s Health, LTSS and Behavioral 4 and 5 star Medicare and Commercial Ratings NCQA #1 member satisfaction in PA – J.D Power Multiple PCORI awards

3. Growing Membership and Service Area • Quick facts: • Largest individual HMO in PA with 26% market share • Second highest individual Medicare Advantage plan in PA • Over 28,000 D-SNP members Source: CMS data

4. UPMC Health Plan’s Approach to VBID • 2016: Planning and application • 2017: Implementation • Successes, challenges, and opportunities • 2018: Data collection and analysis • 2019: Program modifications and continued data analysis • 2020: More informed decisions

5. Analytics Drove the Decision Target vulnerable population who have opportunity to improve • High medical and Rx expense • High utilization of hospitals and medications • Potential to reduce costs through interventions • Ability to improve conditions and reduce complications • Balance risk and reward • Large enough to be relevant…yet small enough to manage and minimize potential loss • Ability to influence behavior through sustained engagement • Chose the combinations of • CHF and Diabetes • CHF and COPD • CHF, Diabetes, and COPD

6. Goals and Guiding Principles • Self-management for better health, improved quality of life, and reduced medical costs • Member Engagement and Education • Create simple steps to identify health issues and prevent deterioration • Focus on incremental changes that can be sustained • Provide members with meaningful rewards and positive reinforcement • Improve members’ understanding of their conditions, medication, and lifestyle choices • Health Plan Resources • Direct members to appropriate resources to address social determinants • Integrate with Plan-wide Population Health Strategy • Measure and Monitor • Use data to drive interventions

7. VBID Model: Our Approach to Behavioral Economics Incremental Reward • In 2017 and 2018, checks were issued upon quarterly activity completion • In 2019, members are given an OTC debit card. Money is loaded onto the card upon quarterly activity completion

8. Administrative Goals

9. VBID Team

10. Program Measurement

11. Spark Your Health 2017

12. 2018 program modifications • Limited time frame for modification with real time actionable changes • 2018 program changes due 1.31.17 yet only implemented on 1.1.17.  • Changes in program • Shorten the survey and combine with the Personal health Review (PHR) • Combined survey and assessment will be $50 reimbursement • Expect to see higher engagement now that members know they will be receiving checks for completing activities. • Flu shots will count as reimbursable activity ($25) • Working to maximize program engagement and impact

13. Streamlined Process in 2018 Working to maximize program engagement and impact

14. Changed incentive in 2019: Over-the-Counter debit card • Looking to make rewards more immediate • Focusing on health related items

15. Step 1: Personal Health Review • Member calls Member Services to “opt in” • Case Manager calls to conduct assessment and Personal Health Review • Identifies additional information related to medical and non-medical determinants of health • Care Plan created in collaboration with the member

16. Step 2: Personalized Quarterly Activities Based on PHR, CM recommends healthy activities, and the member selects activities from an approved list of options

17. 2017 & 2018: VBID performance • Worked effectively • Data flow • Internal collaboration with all departments • Some positive member testimonials • Needed Attention • Enrollment process • Engagement • Incentive

18. CMS Engaged RAND • CMS contracted with RAND to conduct onsite visits and learn more information about each participating plan’s VBID programs • The interviews focused on a series of topics including: • Motivation for joining VBID • Rationale for the conditions selected • Expectations about future VBID outcomes • Financial and actuarial assumptions • Application submission process and early implementation experiences • Communication strategies with beneficiaries and providers • Program design, care management approach, and administration • Challenges during early implementation

19. Snap Shot • Member Profile • Total Eligible Population • Overall Engagement

20. 2019: More Informed Decisions • Is this the right population? • Targeted population is very sick • Explore other diseases or model • What works? What doesn’t? • 2019 changes • Moved away from reimbursement checks to OTC debit cards • Members do not have to have OOP cost sharing to receive reward • Immediate rewards (upon activity completion) • Added activities (prescription for wellness, advanced care planning)

21. 2020: Expanded Opportunities • UPMC program goals: • Improve clinical outcomes • Test innovations • Member retention • Reduce costs Permissible interventions: 1.Reduced cost-sharing for high-value services 2.Reduced cost-sharing for high-value providers 3.Reduced cost-sharing for enrollees participating in disease management or related programs 4.Additional supplemental benefits (non-health related)

22. VBID looking ahead • Timing of VBID application • Overlap between VBID and Flex • VBID hospice • Continued program evaluation (RAND)

23. Questions?