Value-based Care Strategies in Utah: Paying for Better H ealth O utcomes

1. Value-based Care Strategies in Utah: Paying for Better Health Outcomes Governor’s 2014 Health Summit Afternoon Breakout Session September 30, 2014

2. Utah Partnership for Value-driven Health Care • Who we are: A community collaborative of health care purchasers, payers, providers, and the public • Mission: We seek to advance higher value health care in our community through shared strategies that address • transparency • variation in cost and quality • community approaches to improvement in health care delivery http://healthinsight.org/upv

3. Value in Health Care “In health care, value is defined as the patient health outcomes achieved per dollar spent.” Health Outcomes $$ . Porter ME. What is value in health care? N Engl J Med 2010; 363:2477-81

4. Value in Health Care “Value should be the preeminent goal in the health care system, because it is what ultimately matters for customers (patients) and unites the interests of all system actors.” -Michael E. Porter, Ph.D . Porter ME. What is value in health care? N Engl J Med 2010; 363:2477-81

5. What the Focus Should Be: How to Reduce Costs By Improving Health better health Patients LowerCosts Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

6. Improving Health/Reducing Costs:Prevention and Wellness HealthyConsumer ContinuedHealth HealthCondition Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

7. Improving Health/Reducing Costs :Avoiding Hospitalizations HealthyConsumer ContinuedHealth HealthCondition NoHospitalization Acute Care Episode Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

8. Improving Health/Reducing Costs :Efficient, Successful Treatment HealthyConsumer ContinuedHealth HealthCondition NoHospitalization Efficient Successful Outcome Acute Care Episode High-CostSuccessfulOutcome Complications, Infections,Readmissions Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

9. Improving Health/Reducing Costs :Is Also Quality Improvement Better Outcomes/Higher Quality HealthyConsumer ContinuedHealth HealthCondition NoHospitalization Efficient Successful Outcome Acute Care Episode High-CostSuccessfulOutcome Complications, Infections,Readmissions Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

10. Often, We Don’t Pay for the Things That Support Value CURRENT FEE FOR SERVICE PAYMENT SYSTEMS Health Insurance Plan $ $ $ Office Visits ERVisits HospitalStay PhysicianPractice Avoidable Avoidable Phone Calls Lab Work/Imaging ...No penalty or reward forhigh utilizationelsewhere NurseCare Mgr Avoidable No payment for services that can prevent utilization... Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

11. How About Different Ways to Pay? Global Payment Shared Risk/Shared Savings Financial Risk Bundled Payment, Episode Payments Accountable Care Organization Warrantied/ Condition-based payments Care Management Payment Centers of Excellence Incentivize quality and appropriate utilization Performance-Based

12. How Different Payment Might Alter the Landscape COMPREHENSIVE CARE/GLOBAL PAYMENT Health Insurance Plan Condition-AdjustedPer PersonPayment $ Office Visits ERVisits HospitalStay PhysicianPractice/ACO Avoidable Avoidable Phone Calls $ Lab Work/Imaging NurseCare Mgr Avoidable Flexibility and accountabilityfor a condition-adjusted budgetcovering all services Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

13. Barriers to Patients’ Access to Value Information on best value service Information not available Meaningful co-pay, deductibles Do not promote cost-conscious choice Services Unavailable or Not Affordable Non-MedicalSupport(e.g., weight loss) PATIENT Accessible PCP orMedical Home Lack of ability to navigate Multiple DaysOff Work Accessible Specialist Lack ofTransportation Accessible Lab/Radiology Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

14. Providers Will Need Alignment toAllow Focus on Better Care Payer Payer Payer BetterPaymentSystem B Better Payment System A Better PaymentSystem C Provider Patient Patient Patient Even if every payer’s system is better than it was, if they’re all different, providers will spend too much time and money on administration rather than care improvement Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

15. Utah Payment Reform Initiatives: Public and Private • Medicaid ACO implementation • Patient-centered Medical Home initiatives • Provider and plan preparation for Accountable Care or Shared Savings • Direct contracting with providers by private and public employers • Payer, state, and community-led efforts to measure and share pricing and quality performance • Onsite work clinics developed by providers

16. Panelists • Linn Baker, CEO, ARCHES Health Plan • Chuck Norlin, Chief of the Division of General Pediatrics, University of Utah • Gina Pola-Money, Director, Utah Family Voices • Scott Barlow, CEO, Central Utah Clinic, Provo, Utah

17. Q and A • Write a question on a 3X5 card on the table • Take it to one of designated staff persons

18. Next Steps • Contact swoolsey@HealthInsight.org to continue the dialogue with the Utah Partnership for Value • Break begins at 2:45pm • Sessions resume at 3:00pm