Driving Affordable Quality Healthcare
(in a community without integration)
Michael W. Cropp, MD
President & CEO
Independent Health
1
Western New York Community
• Three Not-for-Profit Health Plans (85% market share)
• Two Major Health Systems
• One Multi-specialty Medical Group
• University Faculty Group
• Aging population
• High Managed Medicare penetration (>50%)
2
Community Collaboratives
• Western New York Health-e-Link (RHIO) – BEACON
Award Winner
• P² Collaborative of Western New York – AF4Q
Participant
3
Root Causes of the Affordability / Quality Gaps
• Uneven access to care
• Flawed payment methodology
• Information gaps at point of service and in planning
• Diffuse or lack of accountability
• Minimal individual incentives and engagement
• Underdeveloped community capacity for change
• No formal integration
4
Focus of Work
• Process Improvement
– Advanced Primary Care
– Other
• Technology
– EMR
– Connectivity
• Personal Engagement
• Payment Reform
5
Independent Health
• 375,000 member IPA- model
Health Plan
• Founded in 1980
• All Lines of Business
– Commercial HMO
– PPO
– Self-Funded
– Medicare Advantage (55,000)
– Medicaid (35,000)
• 30% market share
6
Independent Health Strategy
• Manage quality and cost by engaging providers and
members to “rationalize” units of service with a focus on
prevention and evidence-based medicine
7
How Do We Move Forward?
• What has to be done?
• What can we do alone?
• What must be done in concert with others?
– Competitors
– Providers – Physicians, Hospitals, others
– Both of the above
– Community
8
WNY Health-e-Link - Technology
• 3 Health Plans, 4 Health System “Owners”
• Information Highway
– Electronic Prescribing
– Results Reporting
• Electronic Medical Record Adoption
• BEACON Award Focus – Diabetes Management
9
Process Improvement – Advanced Primary Care
• Independent Health Initiative
• 140 PCP’s (Approximately 18% of Total)
• Triple Aim Focus
• IDCOP Elements (and then some)
• AF4Q – PEA’s
10
Process Improvement - Other
• Centers of Excellence
• PCP-Driven SCP Care Redesign
11
Personal Engagement
• Benefit Redesign
• AF4Q
– Consumer Engagement
– Public Reporting or Physician Performance
• Stanford Living with Chronic Disease Model
• Worksite Initiatives
12
Payment Reform
• PCP Model
– Case Management Prospective Risk Adjusted
– FFS for Preventive Services
– Retrospective Risk Adjusted Outcome Based
• SCP/Other - TBD
13
New Model
• Competition
• Collaboration
• Triple Aim Focused
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