Feedback Drives Design
250+ Interviews Conducted Prior to MissionPoint Launch
Network Physicians
• Significant behavior change
will only occur with “payer”
control of 30 – 50% of a
physician’s patient panel
Members
•
Non-clinical indicators are
strongly predictive of cost
•
Low percentage of patients
account for high percentage
of cost. Significant impact
can be achieved by correctly
identifying and working with
these individuals
• Models that require
physicians to “do more” are
at significant risk
• Primary Care Physicians
favor capitation, as it evens
out cash flow and allows
them to meet productivity
and financial goals without
over scheduling
•
Improvements in most
clinical outcomes do not
correlate to short-term cost
savings
Employers
•
Regional or National
networks are required to
cover 70% of employees that
live outside a single market
•
Willing to pay for access, but
quality should be expected
•
TPAs provide a variable
amount of analytics to
employers depending on
size; however, data is not
actionable and employers
lack resources for effective
interventions
2
Engaging Patients Across All National Markets
Market Segmentation Requires Unique Management Strategies
Coverage Type
Cost Per
Beneficiary
Number of
Beneficiaries
Market Size
Self-Insured
$4,547
74 Million
$332 Billion
Fully- Insured
$4,292*
74 Million^
$318 Billion
Medicare (Traditional)
$9,702
34.2 Million
$332 Billion
Medicare Advantage
$8,467
14.6 Million
$127 Billion
Medicaid
$6,982
54.7 Million
$382 Billion
Total Market: $1.5 Trillion
Medicare:
http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/
http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/FFS-Data.html FFS Datat, 2008-2011
Medicare Advantage:
http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/
http://kff.org/medicare/fact-sheet/medicare-advantage-fact-sheet/
Medicaid:
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/Downloads/MedicareMedicaidSummaries2012.pdf PG 29
Self-Insured:
http://www.healthcostinstitute.org/files/HCCI_HCCUR2011.pdf
http://www.ebri.org/pdf/publications/facts/fastfacts/fastfact05282008.pdf
Fully –Insured:
•
estimate based on premium level
•
^estimate based on US Population
3
Managing HealthCare Cost Growth
Progressive Employers Looking for Provider Partners
Comparative Annual Health Cost Growth
Employers Surveyed
Study In Brief
18th Annual Towers Watson/National Business
Group on Health Employer Survey
10.3%
5.9%
2.2%
Low Performers
Median
Best Performers
Best at Holding Cost Growth More Likely to Focus on Provider Strategies
Adopt new accountable
payment models
16%
Best Performers
2%
13%
Contract directly with
hospitals, physicians, ACOs
Offer incentives for care
coordination
Offer performance-based
payments
Low Performers
7%
16%
4%
22%
5%
4
Products and Services
Diversified Product Offerings Designed to
Meet Employer’s Unique Needs
Engage
Survey
Support
Bio Metric
Screenings
Health Risk
Assessment
PCP
Connect
Virtual Care
Network
Complex Case
Management
Population
360
Environmental
OnSite
Clinics
Smoking
Cessation
Healthy
Eating
Primary Care
Membership
Stress
Management
Readmission
Program
Design
These products are focused on
helping clients gain intelligence
about the risks and opportunities in
their population. We use a
combination of clinical, claims, and
non-clinical data to define each
opportunity.
This set of products is presented
based on the risk and opportunity
profile of each employer. Each
product has a flexible pricing model
based on geographic, risk, and cost
profile of the defined population.
Clinically
Integrated
Network
Clinical
Management
These are the products we’re
best known for. These
products are often a blend of
shared savings and PMPM
pricing plus implementation fee
– with full at-risk models
available for certain clients in
2015.
5
Custom Network Design
Per Member Per
Month Payment
Medical Home
Internal Med and
Family Practice
Shared Savings
Pool
Specialists
Outpatient
Facilities
Additional Physician Incentives
Extended Weekend Hours
Open Saturdays
Open Sundays
Email with Patients
Comprehensive Medication Review
Inpatient Facilities
MissionPoint Provider Network
Population Identification and Stratification
MissionPoint
Member
Care at a Distance
Personal Care Team
Wellness Partners and Services
MissionPoint Health Partners
6
Provider Flexibility
Contracts Standard Yet Flexible
Additional Addenda
Fully-Insured Addendum
Medicare Shared Savings Addendum
Self-Insured Addendum
Physician Master Agreement
Meets Clinical Integration Safe Harbor:
•
Committee Participation
•
Shared Quality Information
•
Care Collaboration
Addenda Provide Freedom and Flexibility:
•
Physician can decide what populations to
participate in
•
Each Addendum contains different rates,
shared savings amounts and quality
metrics
•
Addenda can have different terms and
“opt-out” provisions
7
Health Partner Solutions
Diverse Focus Areas Addressed on Three Health Partner Teams
Patient Connects to Health Partner:
Physician Referral
Self Referral
Hospital Discharge
ED Visit
Transitional
• Hospital Discharge
• Long-term Care
• Skilled Care
• Home Visits
Ambulatory
• ED
• Disease
Management
• Wellness
Integrated Care
• Psychosocial
Needs
• “Life” Resources
• “Family”
Resources
8
Creating Value for the Ecosystem
Pays Claims and Network Service Fee
Payer
TPA
Provides
Shared
Savings
Option
SelfInsured
Employer
Options During
Open Enrollment
Preferred Network (MPHP)
Narrow Network
Dedicated Medical Home
Low Co-Pay Levels
Leveling Monthly Premiums
Coordinated Patient Record
Deep Wellness Support
Employee
In-Network
Narrow Network
Expected Co-Pay Levels
Rising Monthly Premiums
Wellness Support
Out-of-Network
Wide Open Network
High Co-Pay Levels
High Monthly Premiums
Low Coordination
Little Wellness Support
Specialty A
Specialty
C
Primary Care
Physician Virtual
“Medical Home”
Employee Selects
Medical Home
Specialty
B
Specialty Care
Employee/
Member
MissionPoint
Health Partner
Partner C
Partner
B
Partner A
Alliance
Network
9
MPHP Strategic Approach
Targeted, Fact-Based Solutions to Manage Populations
Getting to know you:
• Personal Health Reports
• Clinical Population Analysis
• Demographic Review
Identify
Segment
Personalized Plans
• Type of Engagement
• Frequency
• Intensity
• Duration
Prescribe
Analytics and Aspirations
• Utilization Costs
• Location Costs
• Avoidable Events
• Behavior Modification
• Care Experience
Right Time, Right Place
• Quarterly Monitoring
• Strategy Adjustments
• Quality Reviews
Engage
Sustain
Find the Right Strategy:
• Health Assessments
• On-Site Clinics
• Health Partners
• Telehealth
• Narrow Networks
10
Managing Patient Risk
Patient Data Maximized to Guide Effective Interactions
Benefit Design
Steers Members
Towards Optimal
Use of
MissionPoint
Network
High
Risk Patients
Rising-Risk
Patients
Low-Risk Patients
Prioritize Highest Risk Members:
Immediately deploy Health Partners to
patients during “trigger events”
Target Members Showing Warning Signs:
Track future risk scores and population trends
for pro-active Health Partner engagement
Create Opportunities Across Members:
Leverage highly effective, low cost
screenings and preventative care for
optimal health outcomes across members
11
Tracking Progress
Continuous Improvement in Self-Insured Population
Medical Per Member Per Month Cost Trend
Quality Metrics by Year
Chronic Disease Spend
Above Benchmark
95.99%
71.28%
36.30%
% Avoidable Admissions
4.50%
3.29%
2.23%
2011
2012
2013
30-Day All Cause Readmission Rate
ED Visits per 1,000
8.99%
7.85%
Nov. 2011-Oct. 2012
Nov. 2012-Oct. 2013
% Generic Utilization
65%
77%
81%
12