Introducing HealthSpan
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Founded in 1991
Partner organization to
Catholic Health Partners
(CHP)
Cleveland
Youngstown
Lima
HealthSpan Partners:
• HealthSpan Integrated Care
• HealthSpan Physicians
• HealthSpan, Inc.
•
Toledo
30% interest in Summa
Health System
Springfield
Cincinnati
HealthSpan Integrated Care
(HMO)
HealthSpan Inc. (HMO)
HealthSpan Inc.
(Indemnity/PPO)
The Changing
Healthcare Landscape
Presented by:
Dr. Nick Dreher, Medical Director
Payment Reform
Average US Salary vs. Health Insurance
Premium
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From 1999 – 2009, salaries have increased 38%
while premiums have increased 131%
If other prices grew as quickly as healthcare
costs since 1945
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Dozen eggs would cost $55
Gallon of milk would cost $48
Dozen oranges would cost $134
Institute of Medicine, 2011
Affordable Care Act and Healthcare Reform
Current: Fee For Service
New Model: Reward Quality Outcomes
and Stewardship of Resources
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Extreme Makeover Home Edition
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Uncoordinated care
Over-loaded schedule
Physician and practice-centric
Arbitrary quality improvement
projects
• Lack of clear leadership and
support
• Team-based approach
• Open access
• Patient engagement and
empowerment
• Data-directed quality
improvement
• Engaged leadership
What is Population Health
Management?
Define
Population
Measure
Outcomes
Identify
Care Gaps
Manage
Care
Stratify
Risks
Engage
Patients
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What Is the Solution?
TRANSFORMATION
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beyond transaction
through technology
to manage shared risk
by connecting
for our patients
VALUE DRIVEN CARE
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How Do We Improve Care and
Manage Costs?
Patient-Centered Medical Home (PCMH) is one way
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Care Coordination: What Is It?

The goals of coordinated care
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Ensure that patients, especially the chronically ill, get the
right care at the right time
While avoiding unnecessary duplication of services AND
preventing medical errors
VALUE for the Patient = QUALITY/COST
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Care Coordination
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AIM
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Effectively identify, manage and track results of
PCMH’s high risk patient population through care
coordination, patient coaching and education,
application of Evidence Based Medicine, and
population data analysis and reporting
Interventions
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Embed Care Coordination Teams in Primary Care
offices, identify high-risk patients and provide high
touch to these patients
What Is the Goal of the ACO?
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What Are the Cornerstones of the
ACO?
Evidence Based
Care
Guidelines
Coordination
Clinically
Integrated
ACO Network
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Information
Financial
Technology
Management
What Are the Components of the ACO?
A group of providers willing and capable of accepting accountability for
the total cost and quality of care for a defined population.
Payer Partners
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Insurers
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Employers
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States
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CMS
Core Components:
•People Centered Foundation
•Health Home
•High-Value Network
•Population Health Data Mgmt
•ACO Leadership
•Payer Partnerships
Tying It All Together
Integrated elements of a successful ACO
• Improved clinical outcomes and patient satisfaction
linked to
• Care Coordination embedded in
• Patient Centered Medical Homes practicing
• Improvement Science Methodologies that support
• Population Health Management using
• Data Analytics across a Clinically Integrated
Organization
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Where Does Wellness Fit In?
(To Date, Wellness has not Proven Sustainable Outcome Improvements for
Large Populations.)
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Interlinking Electronic Medical Record with
Wellness Platform.
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Physician participation in Wellness goals and
monitoring.
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Physician based treatment protocol for
behaviors related to morbidity, (addiction,
obesity, etc…)
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Comments and Questions
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