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Marketplace Year 3: Issuer Insights and Innovation (Part 2)

Marketplace Year 3: Issuer Insights and Innovation (Part 2)


>>GREAT, WELL, WELCOME BACK EVERYONE, WE’VE
HAVE ANOTHER GREAT SESSION FOR YOU AND TWO GREAT PRESENTERS, WE’RE GOING TO BE TALKING
ABOUT NOW, THE PARTNERSHIP, OBVIOUSLY BETWEEN THE PLANS AND HOSPITALS, PHYSICIANS AND OTHER
PROVIDERS AND SO, FULL SESSION ON PROVIDER CONTRACTING AND HOW THAT PARTNERSHIP EVOLVED
SO TWO GREAT PRESENTERS, FIRST WE HAVE ANDRE ANASANTANG ELO, WHO IS SEP AND ACTUARY OF
BLUE CROSS BLUE FIELD OF MASSACHUSETTS. SHE’S BLUE CROSS THROUGH SHIELD THROUGH MASSACHUSETTS
REFORM AND THROUGH THE IMPLEMENTATION OF ACA AND BRINGS A WEALTH OF KNOWLEDGE TO THE STAGE
AND PRIOR TO JOINING SHE WAS EIGHT CIGNA NEAR OVER A DECADE SO PLEASED TO HAVE YOU JOIN
US TODAY AND SECOND WE HAVE BRIDGET MEDICINE, DID I DO THAT CLOSE?
ACCOUNT OPERATION AND STRATEGY FOR AETNA, SHE IS RESPONSIBLE FOR THE GROWTH AND PERFORMANCE
OF AET NA KINASE DOMAIN SHREWDING CLINICAL AND CARE DELIVERY MODELS AND PRIOR TO REJOINING
SHE WAS PRINCIPLE AT THE CONACTUALITYING AS I REMEMBER AND LEADER IN THE SEGMENT WHICH
SHE ADVISED CLIENTS ON THE REIMBURSEMENT MODEL SO WEALTH OF EXPERTISE AND NUMBER OF THOSE
QUESTIONS.>>HELLO, EVERYONE HOW IS EVERYBODY DOING.
WELL, THANK YOU FOR THE ORGANIZERS FOR HAVING ME HERE.
I AM DELIGHTED TO BE HERE TO REPRESENT BLUE CROSS, BLUE SHIELD OF MASSACHUSETTS AND TO
TALK ABOUT OUR PAYMENT INNOVATION, NOW SOME OF YOU MAY THINKING MASSACHUSETTS?
WHY ARE WE HAVING A SPEAKER FROM MASSACHUSETTS? THEY’RE SO DIFFERENT.
WELL, I DON’T THINK THERE’S ONE IMPORTANT ITEM THAT WE’RE NOT ALL THAT DIFFERENT IS
AND THAT IS THE CONTINUOUS GOAL OF TRYING TO HAVE IMPROVED QUALITY OF CARE AND AFFORDABILITY.
AND AS YOU KNOW OR MAY KNOW, MASSACHUSETTS EMBARKED ON THE ACA ISSUE OF ACCESS BACK IN
2007. A GOOD CHUNK OF THE AFFORDABLE CARE ACT OF
THE WORK DONE IN MASSACHUSETTS. WHEN WE ADDRESS ACCESS, WE THEN TURNED OUR
ATTENTION TO AFFORDABILITY. AROUND AFFORDABLE IS WHERE ALM THE WORK CAME
IN AROUND OUR PROVIDER PAYMENT INNOVATION AND TRYING TO STAY FOCUSED ON THE AFFORDABILITY
QUESTION ALONGSIDE QUALITY. SO A FEW THINGS TO COVER, JUST A LITTLE HISTORY.
JUST QUICK HISTORY, GET US THROUGH TO WHERE WE ARE TODAY.
EVOLUTION AND IN THE CATEGORY OF LESSONS LEARNED HOW WE EXPANDED IT TO OUR PPO MODEL, FUNDAMENTAL
CORE OF THE AQC MODEL, THE ALTERNATIVE QUALITY CONTRACT WAS BASED ON A HMO POPULATION, A
GOOD CHUNK OF OUR MARKET IS HMO BUT WE DO HAVE CHALLENGES IN EXTENDING IT TO PTO AND
NOW WHAT IS EVOLVING IT AND COMPONENTS AROUND OUR FINANCIAL MODELS AND I WILL SPEND TIME
ON COMMUNICATION BECAUSE AS IT RELATES TO PROVIDER INNOVATION, THERE’S A CONSITUENCE
ED THAT’S SORT OF FORGOTTEN AND THAT’S THE MEMBERS, THE ACCOUNTS AND THE BROKER COMMUNITY
SO I WANT TO TOUCH ABOUT THE ROLL OUT ON THE COMMUNICATION AND FINALLY ON RESULTS WHICH
HAVE BEEN QUITE DOCUMENTS. SO FIRST THE EVOLUTION.
WE STARTED BACK – WE LAUNCHED OUR FIRST PAYMENT INNOVATION MODEL WHICH WE REFER TO AS THE
AQC IN 2009. AT THE TIME WE HAD ROUGHLY 25% OF OUR MEMBERSHIP
IN THAT PRODUCT OR IN THE PAYMENT MODEL. WE HAVE SINCE NOW LAUNCHED IN 2016 OUR PPO
MODEL AND WE HAVE ROUGHLY 80% OF OUR – I’M SORRY, 90% OF OUR PHYSICIAN ORGANIZATION AND
HOSPITALS IN A TOTAL QUALITY CARE MODEL WHICH IS AN EXTENSION OF OUR ORIGINALLY ENVISIONED
HMO MODEL. ALONG THE LINE AS WE WERE DEVELOPING THE AQC
WE HAD A BUNCH OF THEORIES AND CONCEPTS AND MILESTONES IN BETWEEN ARE PLACES WHERE WE
TOOK CHECK POINTS AND LOOKED FOR INDEPENDENT STUDIES AND EVALUATIONS OF OUR RESULTS AS
WELL AS GETTING OUR OWN DATA AND PROCESSES LINES UP TO MEET IMPROVEMENT AND LEADING UP
TO THE PAYMENT MODEL WE WILL SHOW YOU TODAY. SO THE BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
MODEL IS JUST ONE OF THE QUILT WORK THAT EXISTS ACROSS THE BLUE CROSS AND BLUE SHIELD PLAN.
WE HAVE ROUGHLY, RUSE THE BLUE SYSTEM, 42 MILLION MEMBERS IN VALUE BASED CONTRACTS ACROSS
40 STATES. THE BLUE SYSTEM APPROACH IS LOCAL HEALTHCARE
EXPERIENCE WITH NATIONAL REACH AT THE ROOT OF ALL THE BLUE CROSS PLANS IS A COMMON CORE
ATTRIBUTE THAT IS PATIENT CENTERED QUALITY CARE, ACCOUNTABILITY ACROSS THE CARE CONTINUUM
AND DATA AND ANALYTICS. FROM THE CORE THE LOCAL BRANCHES ARE BASED
ON THE EXPERTISE OF THE LOCAL MARKET DYNAMICS. AND THOSE INCLUDE THINGS LIKE WHAT ARE THE
MOST EFFECTIVE REIMBURSEMENT MODELS SO THEY’RE NOT ALL THE SAME, SOME FOCUSED ON PATIENT
CENTER MEDICAL HOME, ON TOTAL MEDICAL COSTS AND THE ENTIRE CONTINUUM OF THAT.
THERE’S ALSO NUANCES AROUND DATA AND REPORTING. WE HAVE EVEN IN OUR OWN MARKETS SOME VERY
LARGE INTEGRATED SYSTEMS THAT HAVE SOPHISTICATED DATA AND REPORTING CAPABILITIES BUT WE ALSO
HAVE SMALL AND LOCAL PRACTICES OUT IN THE WESTERN PART OF THE STATE WHERE THOSE MODELS
DON’T NECESSARILY WORK. SO DATA REPORTING FORMATS THAT ARE MOST EFFECTIVE
ARE UNIQUE ELOCAL COMPONENTS OF THE SYSTEM. I’D LIKE TO TALK A BIT ABOUT OUR EXPERIENCE
IN EXTENDING THIS MODEL TO THE NEXT LINE OF BUSINESS THAT WAS IMPORTANT TO US AND THAT
IS ON THE PPO SIDE. AS I ALREADY MENTIONED WE STARTED WITH THE
MHO MODEL AND WITH AN HMO MODEL IT IS INSIDE THAT EVERYBODY HAS A PRIMARY CARE DOCTOR.
SO ONE OF THE INTERNAL STRUGGLES AT OUR PLAN WAS THIS CONCEPT OF WHAT THE PPO MEMBER LOOKS
LIKE. AND IF YOU KNOW THE PPO IN GENERAL AND I KNOW
MOST OF THE PPO IS THE SAME BASE, YOU DIDN’T HAVE QUITE THE SAME STRUGGLE, WE HAVE THIS
IDEA OR THEORY THAT IF YOU WERE IN A PPO PLAN, YOU CHOSE TO BE THERE BECAUSE YOU DID NOT
WANT THE PRIMARY CARE AND YOU DID NOT WANT TO BE IN A REFERRAL MODEL WHERE YOUR PRIMARY
CARE HAS TO KIND OF GID YOU LONG. SO A COUPLE THINGS WE HAD TO DO.
FIRST WE HAD TO DECIDE ON HOW TO ASSIGN A MEMBER TO A DOCTOR AND WHAT WE DID WAS WE
WORKED WITH A VARIETY OF STAKEHOLDERS AND THEY INCLUDED PROVIDERS AND OTHER LOCAL PLANS
TO DEVELOP A METHODOLOGY THAT WE WOULD ALL AGREE ON AND HAVE A CONCONSENSUS SUCH THAT
IT WOULD LINK TO A PROVIDER WHO WOULD ULTIMATELY TAKE ON THE ATTRIBUTES OF THE CONTRACT WE
WERE TRYING TO ROLL OUT. IT LOOKED A LITTLE BIT LIKE, HAD A LOT LIKE
THIS. AND THAT WAS WORKING OFF – I REALIZE FROM
STAND NOTHING THE BACK OF THE ROOM, THESE SLIDES ARE HARD TO SEE SO I WILL TRY TO WALK
YOU THROUGH WHAT SOME OF THE NUMBERS MEAN BUT FIRST WE STARTED WITH WELL VISITS THAT
STARTED IN THE MOST RECENT 12 MONTHS THEN WE EXPANDED IT TO THE NEXT 24 MONTHS AND JUST
THAT LOGIC ALONE GOT US 50% OF OUR MEMBERS WERE ATTRIBUTED: PRETTY GOOD.
WE WENT THEN TO THE NEXT LAYER WHICH WERE OTHER ENM CODES, NOT JUST WELL VISITS AND
FROM THERE WE LOOKED AT 12 MONTHS RECENT, 24 MONTHS RECENT AND WE GOT ANOTHER CHUNK
OF DATA AND THEN THE LAST STEP WAS TO LOOK AT FARMSY CLAIM BECAUSE THERE’S A LOT OF FOLK
WHO IS JUST HAVE A PHARMACY CLAIM BUT DON’T SEE THEIR DOCTOR BUT THERE’S A PRESCRIBING
DOC TO ATTACH IT TO. SO WHEN ALL THAT IS PUT TOGETHER WE GOT A
ROUGHLY 70% ATTRITION RATE. SO THAT’S PRETTY GOOD.
BUT THE QUESTION IS, DO THE PHYSICIANS AGREE WITH THE LIST OF MEMBERS THAT WE’RE ATTRIBUTING.
SO THAT WAS BE WITH THE STAKEHOLDER, IT WOULD BE HARD TO SIGN A CONTRACT BETWEEN PAY OR
AND PROVIDER AND SAY HERE DR. SMITH YOU ARE ACCOUNTABLE FOR THAT DATABASE AND YOU LOOK
AT IT AND GO THAT DOESN’T MAKE ANY SENSE. ULTIMATELY, THE ACCURACY RATE BASED ON A CONJOINED
LIST OF THE PROVIDER AND THE PAYER ON THIS ALGORITHMS WAS ROUGHLY 99%.
SO WE FELT PRETTY DARN GOOD. IN ADDITION IN MASSACHUSETTS WE ACTUALLY ENDED
UP, PASSING A LAW THAT REQUIRES MEMBERS TO BE ATTRIBUTED AND SO WE HAD TO SENT OUT LETTERS
TO MEMBERS TO SAY PLEASE CONFIRM IS THIS YOUR DOCTOR AND IF THEY DON’T AGREE, WE HAVE TO
CHANGE IT SORE IF THEY JUST WANT TO OPT OUT WE HAVE TO CHANGE IT AND BASED ON THAT WE
HAVE A HIGH SUCCESS RATE OVER 90% ALSO WHICH IS ALSO PRETTY GOOD.
AT END OF THE DAY THIS MODEL SAID YOU KNOW FOR 70% OF OUR POPULATION, THERE IS A DOCTOR
THAT IS THE PRIMARY DOC OF THAT MEMBER, LET’S LAUNCH THIS.
WELL, NOT SO FAST, THE SECOND PART OF OUR PPO PRODUCT ISSUE WAS AS YOU ALL KNOW, WITH
PPO, A MEMBER CAN SELF-REFER TO ANY SPECIALIST. IN OUR MODEL WE ASKED PC P TO TAKE FULL ACCOUNTABILITY
OF TOTAL COST AND ONE ONE OF THE PUSH BACKS WAS YOU CAN’T ASK ME TO DO THAT.
HAVE YOU A PRODUCT THAT GIVES MEMBERS THE INCENTIVE TO GO AND SELF-REFER AND NOT NEED
A REFERRAL AND WE SAID OKAY WELL LET’S SEE HOW OFTEN THAT HAPPENS AND MORE IMPORTANTLY
HOW OFTEN DOES THAT COMPARE TO HMO BECAUSE YOU ALREADY ACCEPTED THAT IN THE HMO MODEL
YOU ACCEPTED THAT SO LET’S DO A LITTLE COMPARE IS CONTRAST.
SO IN THIS CHART, WHAT IT IS IS A BLINDED VIEW OF ALL THE MAJOR PROVIDER GROUPS THAT.
Q. FROM A-Q AND THE DIFFERENCE IN REFERRAL PATTERNS BETWEEN HMO AND PPO.
SO, ANYBODY THAT’S BELOW ZERO MEANS THEY ACTUALLY HAD A TITLE REFER PATTERN IN THEIR OWN PRACTICE
AND ANYTHING THAT’S ABOVE IS PATTERNS THAT WERE OUTSIDE THE HMO THRESHOLD SO CAN YOU
SEE THERE IS ACTUALLY SEVERAL PROVIDERS THAT WERE REALLY, REALLY TIGHT, THOSE ARE THE FIRST
FOUR AND ONE WAS EVEN ACTUALLY BETTER THAN HMO AND THEN AT THE FAR END, IT APPROACHES
ABOUT 15-18% BUT NOT THAT UNREASONABLE. I CAN TELL YOU THIS IS MUCH, MUCH HIGHER.
SO THERE’S OPPORTUNITY FOR IMPROVEMENT, AND THAT LED TO A MORE ROBUST CONVERSATION ABOUT
ENGAGING IN THIS THE PPO MODEL. IT’S SO IMPORTANT BECAUSE AS WE GO ABOUT TALKING
ABOUT AFFORDABILITY, OUR MODEL IS TO LOOK AT THESE TOTAL MEDICAL COSTS WE WOULD HAVE
TO REALLY THINK THROUGH WHAT WOULD CHANGE COMPARED TO OUR HMO MODEL AND HOW WE WOULD
TWIST THINGS AROUND BUT AS WE TURN OUT IT’S PRETTY GOOD.
SO I CALL THIS THE SECRET SAUCE SLIDE. THIS IS THE CORE FUNDAMENTAL OF THE PRINCIPALS
OF OUR MODEL AND FRANKLY IF I HAD SHOWN YOU THIS IN 2009 WHEN WE DEVELOPED THIS MODEL
IT WOULD LOOK A LITTLE DIFFERENT BUT THE WORDS WOULD BE EMPHASIZED IN DIFFERENT PLACES AS
WELL. SO THERE ARE FIVE MAJOR COMPONENTS.
FIRST SUSTAINABLE PARTNERSHIP AND SUPPORT. MOST OF OUR CONTRACTS ARE AT LEAST THREE YEARS.
THERE ARE SOME THAT ARE FIVE YEARS. THAT IS HUGE BECAUSE AS THOSE OF YOU IN THE
AUDIENCE KNOW, THOSE NEGOTIATIONS CAN TAKE A LONG TIME AND BEFORE YOU END ONE YOU THINK
YOU’RE ABOUT TO NEGOTIATE THE NEXT ONE SO THE IDEA OF NEGOTIATING AND HAVING IT DONE
AND HAVING A MODEL WHERE WE WORK IN THE PARTNERSHIP AND HAVE A LONGTERM IS REALLY IMPORTANT TO
US. AND WE HAVE THOSE AND IT STARTS TO GET INTO
HERE’S WHAT WE ARE GOING TO DO AND HERE’S WHAT YOU’RE GOING TO DO.
AND LESS ABOUT HOW YOU GET PAID KIND OF THING. THE OTHER THING IS QUALITY INCENTIVE.
I’LL SAY MORE ABOUT THIS BECAUSE I THINK THERE’S REAL BREAK THROUGH WORK THAT WE DID IN THIS
AREA THAT SURPRISED EVEN OURSELVES AT HOW WELL IT GOT EMBRACED BUT AT THE END OF THE
DAY IT WAS REALLY IMPORTANT THAT WE ATTACH MONEY TO QUALITY MEASURES THAT WERE JUST AS
IMPORTANT AS THE OVERALL EFFICIENCY AND THE COST COMPONENT AND WE’VE GOTTEN GREAT RESULTS
ON THAT AS WELL. THE ACTIONABLE DATA PART, CANNOT BE UNDERESTIMATED.
THIS IS ANOTHER AREA WHERE AS A PLAN WE ARE A LITTLE UNCOMFORTABLE AT THE IDEA OF SHARING
DETAIL AT THE LEVEL OF DETAIL WE SHARED WITH OUR PROVIDERS.
BUT AT THE END OF THE DAY, THE DATA BECAME A BIG PART OF EDUCATING BOTH PARTIES AS TO
WHERE THE OPPORTUNITY WAS, WE LEARNED THINGS, THEY LEARNED SOME THINGS AND AGAIN I’LL GET
INTO SOME OF THE DATA PARTS LATER. THE CARE ACCORD NATION MODELS SHIFTED AS WELL.
WE WENT FROM HAVING CASE MANAGERS CALLED OUR MEMBERS, ALSO HAVING THE PROVIDER START REACHING
OUT WITH THEIR OWN POPULATION HEALTH MANAGERS TO NOW THINKING THROUGH, HMM, MAYBE IT’S BETTER
IF WE CALL FOR THESE THINGS AND YOU CALL FOR THOSE THINGS AND REALLY TRY TO CREATE BETTER
ALIGNMENT AROUND WHO HAS THE ROLE FOR CARE ACCORD NATION SO THAT WE DON’T HAVE REDUNDANCIES
OR INEFFICIENCIES AND OPTIMAL RESULTS OF ENGAGEMENT AND THEN FINALLY THE TOTAL COST ACCOUNTABILITY
EQUATION. I WANT TO EMPHASIZE AT BLUE CROSS AND BLUE
SHIELD OF MASSACHUSETTS, OUR MODEL HAS ALWAYS STARTED OUT WITH TOTAL MEDICAL COST WITH VERY,
VERY FEW CARBONS CARVED OUT INCLUDING BEHAVIOR OF HEALTH, BEHAVIOR OF HEALTH AND PHARMACIES
AND IN THE EARLY DAYS THERE WAS CARVE OUTS BUT AT THIS POINT IT IS A FULL MEDICAL TOTAL
COST VIEW WHICH IS A LITTLE SCARY AT THE TIME BUT I THINK THIS TURNED OUT PRETTY WELL.
SO HOW DOES IT ACTUALLY WORK, SO AT THE END OF THE DAY, THE PROVIDERS ARE GIVEN A NEGOTIATED
BUDGET WITH A GOAL, AROUND TREND AND THE IDEA IS THAT YOU HAVE TO BEAT THE TREND AND BASED
ON THE SAVINGS AND THE – THE – THAT YOU ACHIEVE, YOU SHARE IN THAT SAVINGS, BASED ON YOUR QUALITY
MEASURE. SO IN OTHER WORDS, THE MORE YOU SCORE ON YOUR
ASSAULT SCORES, THE MORE YOU GET TO KEEP OF YOUR EFFICIENCY IMPROVEMENT OR VICE VERSA.
THESE ARE UP AND DOWN SIDE RISK. SO IF YOU ARE IN A DEFICIT, BUT YOU ARE HIGH
QUALITY, YOU DO NOT GET TO SHARE MUCH OF THE DEFICIT.
SO THERE IS AN INVERSE RELATIONSHIP WITH THE QUALITY, TO HIGHLY INSENT THE QUALITY MEASURES
AS L. SO THE OTHER THING THAT’S IMPORTANT TO US IS THAT WE HAD TO SEE SOME OF THESE
RESULTS AND BUILD THEM INTO THE AFFORDABILITY EQUATION.
SO BASED ON THOSE SAVINGS, THE WAY THE MODEL BREAKS OUT IS THAT 30% OF THE SAVINGS GOES
TO OUR PREMIUMS AND WE DROP THAT TO THE BOTTOM LINE IN OUR PREMIUM CALCULATIONS.
30% IS WHERE THE PROVIDERS GET TO KEEP AND THEN THE OTHER 40% IS WHERE WE GET TO SHARE
BASED ON THE QUALITY RESULTS. SO WHAT WE’RE REALLY TRYING TO DO IS MAKE
IT A WIN, WIN, WIN, SITUATION FOR ALL PARTIES INVOLVED.
AS IT RELATES TO QUALITY, THIS IS REALLY IMPORTANT WORK WE DID, THESE ARE THE INITIAL MEASURES
WE USE IN OUR HMO CONTRACT AND A COUPLE THINGS I WANT TO POINT OUT HERE.
FIRST THERE ARE AMBULATORY MEASURES BUT THE THING THAT WAS UNPRECEDENTED WAS THE
OUTCOME MEASURES. AT THE TIME, REMEMBER THIS IS 2008 WHEN WE
WERE NEGOTIATING, WE WERE NOT AWARE OF ANY PROVIDER THAT WAS TELLING A PROVIDER YOU WERE
GOING TO BE HELD ACOULD YOU WANTABLE TO OUT MEASURES AND WE WERE ALSO WONDERING HOW THAT
WAS GOING TO BE RECEIVED. MUCH TO OUR SURPRISE AS WE WERE ROLLING THIS
OUT A LOT OF OUR EARLY ADOPTERS AND THEY WERE PRETTY UPFRONT AND THINKING THIS WAY ANYWAY
BECAUSE THIS ISN’T TOO MUCH OF A LIFT BUT A LOT OF OUR EARLY ADOMENTERS OF THIS MODEL,
THOUGHT NOT ONLY IS THIS IMPORTANT AND WE WANT TO EMBRACE IT BUT WE WANT TO TRIPLE WEIGHT
THESE MEASURES WHEN YOU DEVELOP OUR SCORE. SO THEY TOOK ON THE RESPONSIBILITY OF TRIPLE
WEIGHTING THE OUTCOME MEASURES AND ULTIMATELY IS THE BEST MEASURE OF HAVING A RESULT RATHER
THAN PROCESS AND EXPERIENCE WHICH ARE ALSO IMPORTANT BUT IT IS A PRETTY PHENOMENAL RESULT
AND I’LL SHOW YOU LATER HOW THAT TURNED OUT. AS WE MOVE FORWARD IN THE YEARS, YOU KNOW
WE HAVE HOPED THAT THE NATIONAL QUALITY SET MEASURED WOULD HAVE EVOLVED IN TAKING ON AND
WE WOULD HAVE MOVED WITH IT. BUT THAT HASN’T HAPPENED QUITE AS MUCH.
SO AT THE TIME THESE ARE GOOD MEASURES. THEY’RE FINE BUT BUT I THINK WE CAN ALL AGREE
THAT THESE MEASURES IMPORTANT NECESSARILY GOING TO GIVE YOU THE BREAK THROUGH POPULATION
HEALTH TRANSFORMATION YOU NEED. SO IN ORDER TO DO THAT WE’VE NOW EVOLVED SOME
OF OUR MEASUREMENTS AND STARTED TO INCLUDE WAYS TO INCORPORATE A NEW PIPELINE OF MEASURES
THAT WILL TRY TO ADDRESS AREAS THAT THE MEASURES ARE PARTICULARLY THIN ON, THINGS LIKE CARDIOVASCULAR,
ORTHOPEDICS OB, ONCOLOGY, BEHAVIORIAL HEALTH. ULTIMATE GOAL MIGHTILY THE WAY WE TRY TO DEVELOP
THIS IS TO WORK OFF OF DATA THAT’S COMING FROM THE CLINICAL RECORD THAT DON’T COME FROM
TRANSACTION DATA. THAT COMES MORE FROMLET CLINICAL DATABASE
AND INTEGRATING IT WITH OUR OWN SYSTEMS TO TRY TO THEN HELP THE POOR, NEW EVOLUTION OF
MEASURES SO ALTHOUGH WE DON’T HAVE OUTCOMES FOR THESE YET, WE TRY TO REALLY PRIME THE
PUMP FOR A MORE BROADER NATIONAL CONVERSATION BECAUSE FRANKLY IF WE STICK WITH WHAT WE HAVE,
I DON’T THINK WE’RE GOING TO ULTIMATE GOAL MITTLY GET THE QUALITY WE’RE ALL ASPIRING
TOO. SO AS IT RELATES TO THE JUMP.
QUALITY RESULTSI’M JUMPING HERE. [NO AUDIO ]
SORRY ABOUT THAT. MUST HAVE BEEN SUCH AN IMPORTANT POINT THAT
I FROZE THE SCREEN HERE, IT’S THE RESULTS THOUGH, HOLD ON.
[LAUGHTER] WE WILL HAVE THE WHOLE TEAM WORK ON THIS THE
RESULTS YOU WILL SEE SO THAT I DON’T TAKE UP OTHER PEOPLE’S TIME, THERE WE GO.
EXCELLENT. THANK YOU.
SO THOSE OF YOU IN THE BACK OF THE ROOM, THERE’S TWO LINES HERE IN AREAS OF QUALITY AND HEALTH
RESULTS AND HERE’S WHAT WE DID. WHAT WE DID WAS WE TOOK THE EARLY ADOPTERS
COHORT, COHORT IN 2009 AND WE LOOKED AT THESE PARTICULAR QUALITY MEASURES IN 2007 AND 2008,
AND THEN LOOKED AT HOW THEY TRACKED BETWEEN 2009 AND 2012, AND THE ORANGE LINE IS THETHE
HEATEST NATIONAL AVERAGE FOR ALL THREE OF THESE COMPONENTS AND THEN THE BLUE LINE IS
HOW THESE PROVIDERS TRACKED AGAINST THEIR OWN NUMBER AND AGAIN THE HEATEST MEASURES.
SO, COUPLE OF THINGS, I WANT TO POINT OUT TO YOU IS THAT AGAIN FROM THE PERSPECTIVE
OF TREND LINE THEY ALL WENT UP AND THAT’S A REAL TESTAMENT THAT IF YOU ATTACH THE RIGHT
INCENTIVES TO THE CONTRACT AND PEOPLE START PAYING ATTENTION IT CLEARLY MOVES THE NEEDLE
FOR THEM. COMPARED TO THE HEATED NUMBERS WHICH ARE RELATIVELY
FLAT, IT’S A GOOD INDICATION WE MADE A MOVE THERE.
THE OTHER THING THAT STICKS OUT IS ADULT HEALTH OUTCOMES THAT TOOK THE BIGGEST JUMP AND BASICALLY
WHAT THAT MEASURES IS FOR ADULT MEASURES WHO HAVE CHRONIC CONDITIONS HOW GOOD IS THEIR
CONTROL AND IN THIS EXHIBIT, WHAT IT SAYS IS THAT BY THE TIME WE GOT TO 2012, THIS COHORT
OF GROUPS THAT HAD 61% OF THEIR ADULTS NOT IN GOOD CONTROL JUMPED TO 74%.
SO THAT’S A PRETTY REMARKABLE NUMBER THAT WE CAN GET ALMOST 34thS OF THE ADULTS THAT
WERE DEEMED HAVING A CHRONIC CONDITION IN GOOD CONTROL AND THAT WAS REALLY A TESTAMENT
TO NOT ONLY THE RESULTS OF THE MEASURES BEING THE RIGHT ONES BUT THAT THE PROVIDERS WERE
PAYING ATTENTION AND I WOULD ECHICIZE THAT IN ORDER TO DO THAT YOU HAD TO EMBRACE A CHANGE
IN THE WAY YOU’RE APPROACHES THOSE MEASURES AND ULTIMATELY, IT WASN’T ANYTHING BLUE CROSS
DID. WE SIMPLY PROVIDED THE DATA BUT IN NONE OF
OUR DEALS DID WE SAY, AND YOU HAVE TO DO IT THIS WAY, WE SIMPLY SAID, PAY ATTENTION TO
THESE NUMBERS. WE DON’T HAVE REQUIREMENTS ON HOW YOU GET
THERE, WE DON’T HAVE ENVIRONMENTS ON EVEN THE TARGET.
IT’S AN IMPROVEMENT MODEL AND YOU GET PAID FOR THE IMPROVEMENT.
AS IT RELATES TO HOW WE GOT THERE, I THINK WE LEARNED A FEW THINGS AND I THINK WE CAN
GROUP THEM INTO THESE FOUR CATEGORIES. IT WAS VERY CLEAR THAT WE STARTED TO SEE THE
PROVIDERS CHANGING THE WAY THEY’RE STAFFING FOR PRACTICE.
WE SAW THINGS LIKE ADDING ANALYSTS TO THIS STAFF, JUST LOOKING AT THE DATA SOME BASIC
STUFF, CHANGING OFFICE HOURS TO ACCOMMODATE URGENT CARE SO THEY COULD REDUCE THE E. R.
VISITS BECAUSE WE’RE SHOWING THEM THAT AS WELL.
THERE WERE A LOT OF INTERESTING THINGS. THEY WERE CHANGING HOW THEY APPROACH THE ENGAGEMENTLET.
AGAIN SOME OF THE DAT’S WE GAVE THEM ALLOWED THEM TO SEE WHO WASN’T FILLING PRESCRIPTIONS
AND THAT ALLOWED THEM TO UNDERSTAND THE PROFILE OF THE PATIENTS THAT WERE LIKELY NOT TO RECEIVE
PRESCRIPTIONS OR FILL THEIR PRESCRIPTIONS. THE OTHER THING WE TRIED TO GET THEM TO DO
IS UNDERSTAND OUR BENEFIT AND WHAT THE ALTERNATIVES WERE TO HELP AVOID A QUESTION ABOUT AFFORDABLE
THERE AS. I CAN’T STRESS ENOUGH THE DATA SYSTEMS AND
HEALTH INFORMATION TECHNOLOGY. HAVE I ALREADY MENTIONED THERE’S QUITE A SPECTRUM
IN TERMS OF THE KIND OF PROVIDERS WE WORK WITH AND THE SPECIFIC ONE TOOK OUR DATA AND
EMBEDDED IT AND EPITHELIAL GREATED IN OTHER DATA BUT MANY OTHER PRACTICE THAT THOUGHT
MAYBE WE SHOULD PARTNER WITH RECOLLECT PRACTICES AND CREATE THIS VIRTUAL COMMON PRACTICE AND
SHARE SYSTEMS AND SO THAT BECAME LIKE A 92 AHA, FOR THEFOR THE PROVIDER SYSTEMS TO KIND
OF THINK THROUGH AND VERY OFTEN WE SAW ALIGNMENT OF REFERRALS BETWEEN PROVIDERS THAT WERE A
LITTLE BIT DIFFERENT THAN THEY HAD BEEN PREVIOUSLY AND AGAIN, THESE PROVIDERS WERE TAKING RESPONSIBILITIES
FOR QUALITY OUTCOMES FOR HOSPITALS THEY DIDN’T OWN OR EVEN AFFILIATED WITH.
SO THEY NEEDED TO LIKE REALLY UNDERSTAND, WHERE WERE PEOPLE GOING AND WHAT WAS THE RESULT
OF THAT. AND NOT ONLY THAT BUT ALSO THE COST CHOICES
OF WHO THEY WERE REFERRING TO AS WELL. AND THAT ALSO CAME OUT OF THE DATA WE PROVIDED
THEM BECAUSE WE MADE THAT ALL QUITE TRANSPARENT. AND WE DID SEE A FEW INTERESTING THIOF THES
IN THE MARKET. I SHOULD ALTS SAY THAT WE HAVE A MARKET THAT
THE EARLIER DOCTORS WERE QUITE DIFFERENT. YOU MIGHT HAVE THOUGHT, OH IT’S CLEAREE AN
INTEGRATED DELIVERY SYSTEM THAT THOUGHT THE MODEL FOR THEM, THEY WERE ALREADY THERE.
ACTUALLY OUR EARLIER DOCTORS CAME IN A NUMBER OF DIFFERENT FLAVORS AND THEY CROSSED VARIOUS
SOCIAL ECONOMIC CLASS AS WELL. SO WE HAVETHE SYSTEMS THAT DON’T HAVE A HOSPITAL
AFFILIATION AND OUR SPECIALTY GROUPS EXPOANL WE HAVE SYSTEMS THAT ARE COMPLETELY INTEGRATED
AND ACTUALLY OWN A HOSPITAL SO THEY DID COME IN A VARIETY AND IT WAS GREAT TO SEE THAT
IT DIDN’T MATTER IF YOU SORT OF KNEW WHAT YOU WERE AIMING FOR IN THE CONTRACT, YOU COULD
GET THERE WITH WHATEVER WAY TO GET THERE. WE DID STUFF DIFFERENTLY AS WELL.
AND WE HAD OUR OWN APPROACH TO HOW TO CHANGE. ULTIMATELY IT STARTED WITH SHARING WITH THEM
NEW DATA AND REPORTING, FRANKLY WE WERE ALREADY DOING FOR OUR CUSTOMER BASE.
FOR THOSE OF YOU IN HEALTH PLANS, YOU PROBABLY DO A TREMENDOUS AMOUNT OF ACCOUNT REPORTING
FOR YOUR ACCOUNTS ON A VARIETY OF BENCHMARKS, THE FACT WE DIDN’T DO IT FOR PROVIDERS BUT
WE’RE HOLDING THEM ACCOUNTABLE BECAME AN IMPORTANT PART OF WHAT WE DID SO ULTIMATELY, THAT WAS
A BIG CHUNK OF IT. WE CREATED ENVIRONMENTS FOR CROSS TRAINING
AND PRACTICES ACROSS THE PROVIDER GROUPS. THERE WAS A DATA ANALYST BEST SHARING, PHYSICIAN
BEST PASSES, GO OUT AND DO QUARTERLY CONSULTING REPORTS.
COUPLE THINGS I MENTIONED, IT FEELS LIKE IT’S A PAYORPROVIDER KIND OF THING, SOME MEMBERS
FELT A DIFFERENCE IN WHAT THEY WERE PERCEIVING AS THEIR PRACTICE CHANGE SO WE STARTED TO
GET QUESTIONS FROM ACCOUNTS AND BROKERS AND SO AS PART OF THE PPO ROLL OUT, WE LEARNED
WE SHOULD PROBABLY STEP BACK AND JUST EDUCATE THE MARKET ON WHAT IT IS AND WHAT IT ISN’T,
THERE’S A LOT OF CONCERN ABOUT HABITATION AND SKIMMING ON CARE AND ALL OF THOSE SORTS
OF THINGS ALL I WOULD SAY AGAIN IN THIS AREA IS INTERNAL CHAINING THAT HAS FAILED YOUR
OWN PEOPLE WHO IT IS, WHAT IT ISN’T. BROKER TRAINING ACCOUNT TRAINING.
CONSULTANT TRAINING ALL OF THAT MATTERS IF YOU ACTUALLY WANT TO UNDERSTAND AND GET PEOPLE
TO UNDERSTAND WHAT YOU’RE TRYING TO DO. AND THIS IS KIND OF A WRAP UP OF WHAT IT ACTUALLY
FEELS LIKE. IN THE INTEREST OF TIME I’LL MAKE A COUPLE
OF HIGH LEVEL COMMENTS AROUND THIS. THIS TIES THE RESULTS OF WHAT I MEANT TO DO
WITH MARY AS AN EXAMPLE, WHO IS A DIABETIC THE CHANCE OF HER NOT BEING IN GOOD CARE CAN
BE AS MUCH AS $16,000 ANNUALLY AS FAR AS MEDICAL AND PRODUCTIVITY LOST, ANNUALLY, THAT’S PRETTY
EXPENSIVE, AND FRANKLY FROM THE PRIOR SESSION WE KNOW CHRONIC CONDITION SYSTEM A BIG CHUNK
OF THE ACA MODULATION AND IT IS BECAUSE IT HELPS CHANGE HOW THAT PATIENT IS NOW TREATED
FOR IT. FIRST FIRST THE PROVIDER LEARNED ABOUT THE
PERSON NOT PICKING UP HER PRESCRIPTION AND THEN THEY REACH OUT BECAUSE NOW THEY HAVE
THIS BEFORE, THERE’S A WAY FOR THE PROVIDER TO REACH OUT AND UNDERSTAND WITH THEIR APPROPRIATE
ENGAGEMENT MODELS ON HOW TO FIGURE OUT – THE NEXT VISIT SHOULD LOOK LIKE.
THEN THE IDEA AND HOW IT LOOKS BECAUSE IT’S MORE CUSTOMIZED TO MARY AND MAYBE THESE DRUGS
ARE EXPENSIVE, MAYBE THERE’S ALTERNATIVE TREATMENT PATTERN BECOMES PART OF THE ACCOUNTABILITY
PAYING DIVIDENDS OF COST SAVINGS, THEY SEE A BENEFIT AS WELL FROM NOT HAVING TO INCUR
MEMBER COST SHARING THAT MIGHT BE AVOIDED SO IN SUMMARY I THINK WE HAVE A LOT TO VETERAN
WELLED FROM OUR MODEL, HOPE THAT SOME OF WHAT YOU LEARNED HERE CAN BE APPLIED TO YOUR OWN
MARKET AND HOW YOU SEE THE EXPERIENCE AROUND AFFORDABILITY.
WE’RE PROUD THAT OUR RESULTS HAVE BEEN INDEPENDENTLY VERIFIED SEVERAL TIMES IN THE NEW ENGLAND
JOURNAL OF MEDICINE. WE ARE STILL LEARNING I THINK YOU SHOULD THINK
OF THIS AS A JOURNEY BUT IF YOU DON’T START NOW, I THINK IT’S HARD TO GET TO THAT ULTIMATE
GOAL AND SEVEN YEARS LATER I CAN TELL YOU WE LEARNED A LOT BUT WE HAVE MORE TO DO AND
WE’RE PROUD AND INSPIRED BY THE RESULTS SO FAR SO I WILL TURN IT OVER TO BRIDGET.
[ APPLAUSE ]>>I WILL GIVE YOU THE GOOD NEWS FIRST, A
LOT OF WHAT I CAN SAY HAS ALREADY BEEN SAID. THE GOOD NEWS IS THAT A LOT OF US HAVE BEEN
AT THIS
FOR A WHILE AND WE’RE LEARNING THE SAME THING, WE’RE TAKING A LOT OF THE SAME APPROACHES
AND THAT’S JUST NOT ON THE PAYOR SIDE AND YOU’LL HEAR IT ON THE PROVIDER SIDE AS WELL,
PHYSICIANS, HEALTH SYSTEMS, INTEGRATED DELIVERY SYSTEMS OR NOT, IF WE’RE ALL TO STAND UP HERE
AND TALK ABOUT OUR EXPERIENCE TO DATE, THOSE OF US WHO HAVE BEEN AT THIS FOR A WHILE AND
I COULD BT AGREE ENOUGH, THIS IS INCORPORATING MODELS SO WHAT I WILL TALK ABOUT IS I PROMISE,
I WON’T REHASH WHAT YOU JUST HEARD, I WILL TALK A BIT ABOUT A COMPREHENSIVE APPROACH.
SO AS AETNA�WE HAVE A NATIONAL PRESENCE. WE HAVE AN INTERNATIONAL PRESENCE BUT I’LL
SPEAK TO OUR NATIONAL PRESENCE AND WE WORK IN LOCAL MARKETS ACROSS THE COUNTRYS WHO ARE
VERY DIFFERENT. ABSOLUTELY DIFFERENT CHARACTERISTICS FROM
A HEALTH SYSTEM, PROVIDER AND EVEN INSURANCE MARKETPLACE.
SO I’LL TALK ABOUT THE FEDERAL MARKETPLACE, LOCAL MARKETPLACE AND STATE MARKETPLACE AS
WELL INTO OUR APPROACH. I’M ALSO GOING TO BRING IN THE ASPECT OF CONSUMERS.
SO ULTIMATELY EVERY SINGLE ONE OF US IN THIS ROOM AND EVERYONE WE REPRESENT ARE CONSUMERS
OF HEALTH CARE AND BRINGS THE THOUGHT OF THE CONSUMERS VIEW POINTS, THEIR NEEDS, THEIR
WANTS AND INCORPORATING THAT INTO THE MODELS THAT WE IS EXTREMELY IMPORTANT.
AS WE WORK TO TRANSFORM THE WAY HEALTHCARE IS DELIVERED, PACKAGED AND SOLD IN THIS COUNTRY.
AND THEN I’LL TALK ABOUT LESSONS LEARNED AND HOPEFULLY WE WON’T REHASH A LOT OF WHAT YOU
ALREADY HEARD. VERY QUICKLY IT IS IMPORTANT TO TALK ABOUT
WHAT OUR GOAL IS. WHAT IS OUR GOAL AS AETNA.
SO FROM THE HIGHEST LEVEL, WE COMMIT TO BUILDING A HEALTHIER WORLD.
SO AS AETNA, WE HAVE A LOT OF DIFFERENT BUSINESSES, WORK IN A LOT OF DIFFERENT LINES OF BUSINESS,
SPECIFICALLY TODAY I WILL HONE IN ON THE PART OF AETNA THAT WORKS WITH OUR PROVIDER PARTNERS
AND THAT’S THE PART I HAVE THE PRIVILEGE AND OPPORTUNITY TO LEAD.
WE LOOK AT OURSELVES AS A TRANSFORMATIVE ARM OF AETNA.
IN SOME RESPECTS. WE ALSO LOOK AT OURSELVES AS EDUCATORS OF
BOTH THE PROVIDER, COMMUNITY, THE DISTRIBUTION COMMUNITY OR BROKERS AND CONSULTANTS WHO PURCHASE
PRODUCTS, AS WELL AS EDUCATORS FOR LOCAL COMMUNITIES. WE ALSO EDUCATE INTERNALLY WITHIN AETNA, ABOUT
THESE MODELS AND WHAT WE TRY TO ACCOMPLISH, WHY, WHAT WE LEARNED.
SO TODAY, WE HAVE ABOUT 40% OF OURS SPEND A LITTLE OVER THAT NOW TO BE VERY TECHNICALLY
CORRECT, 4.4% I BELIEVE IS THE LATEST NUMBER OF OUR SPEND THROUGH VALUE BASED CONTRACTS.
THAT COVERS 6.2 MILLION MEMBERS. THESE ARE BIG NUMBERS.
WE’RE WORKING TOWARDS 75% BY THE YEAR 2020. WE HAVE A VERY CLEAR GLIDE PATH FOR THAT.
BUT WE’RE NOT SATISFIED WITH JUST SAYING, YES WE HAVE A PAID FOR PERFORMANCE PROGRAM
OUT THERE. WE ARE LOOKING AT HIGHLY ITERATIVE AND EVOLVED
MODELS SO THAT WE CAN START TO INCORPORATE CONSUMER AND EMPLOYER SO PURCHASER, PURCHASER
STAKEHOLDERS INTO THESE MODELS. THAT IS THE WAY WE BELIEVE THAT LOCAL COMMUNITIES
WILL BE TRANSFORMED IN TERMS OF HEALTHCARE DELIVERY.
THERE’S A LITTLE BIT ABOUT OUR SPECIFIC ACCOUNTABLE CARE APPROACH OR THINK ABOUT IT AS OUR VALUE
BASED CONTRACTING APPROACH OVER ALL. WHAT ARE WE TRYING TO DO, WE’RE SUPPORTING
THE CHANGE IN THE DELIVERY OF HEALTHCARE. AND HOW ARE WE DOING THAT?
SO IT DOES INCLUDE MORE FEED ON THE STREETS. WE BELIEVE WE HAVE TO BE EDUCATORS.
WE DO HAVE AN ORGANIZATION THAT I’M STANDING HERE REPRESENTING THAT WE GO TO THE LOCAL
MARKETS. WE WORK ALONGSIDE PROVIDERS.
AS YOU JUST HEARD, WE LOOK AT MUTUALLY SHARED INFORMATION ABOUT POPULATIONS THAT WE JOINTLY
MANAGE AND WE LOOK AT A DETAILED BASIS AND WE LOOK AT A GLOBAL ACE BASIS AS WELL AND
WE DECIDE TOGETHER WITH PROVIDER PARTNERS HOW WE CAN IMPROVE.
HOW WE CAN IMPROVE ON QUALITY SPECTS, MEMBER OR CONSUMER EXPERIENCE AND HOW WE CAN IMPROVE,
THAT INCLUDES I SHOULD SAY ON OW WE IMPROVE THE AFFORDABILITY ASPECT.
WE DON’TWE DON’T BELIEVE IN JUST SHOVING A CONTRACT ACROSS THE TABLE AND SAYING, THIS
IS OUR MODEL, GOOD LUCK. AND I THINK YOU JUST HEARD THE SAME APPROACH.
WE WANT TO WORK ALONGSIDE OUR PROVIDER PARTNERS TO HELP ENABLE CHANGE.
IT’S NO MORE GOING AND I’LL TALK ABOUT THIS IN JUST A LITTLE BIT BUT IT’S NO MORE COMING
TO THE TABLE AND PAY TOCK ABOUT MOW WE TALK ABOUT SERVICES, THE CONVERSATION STARTS WITH
WITH TWO LIKE MINDED ORGANIZATIONS, TO SAY HOW CAN WE BETTER CARE OR PROVIDE BETTER CARE
AND MORE AFFORDABLE CARE FOR THE COMMUNITIES WE SERVE.
THAT’S WHERE THE CONVERSATION STARTS AND THAT’S WHERE THE CONVERSATION NEEDS TO START.
SO WHEN WE THINK ABOUT EACHENTITY WHETHER WE’RE A PAYOR OR PROVIDER WHAT EACHENTITY
BRINGS TO THE TABLE, I THINK WHAT’S MOST IMPORTANT IS THAT WE HAVE SHARED OBJECTIVES ABOUT WHAT
WE’RE TRYING TO AKOCHLISH. THATI’LL TALK ABOUT THE LITTLE ABOUT THAT
IN THE LESSONS LEARNED BUT IF WE HAVE SHARED OBJECTIVES AND WE ESTABLISH SOME COMMON GUIDING
PRINCIPLES OF HOW WE WORK TOGETHER, IT’S AMAZING WHAT TWO ORGANIZATIONS COME AT ANY POINT AND
BUILD, WE STARTED WITH MODELS THAT WERE ATTRIBUTE BASED I CALL THEM PASSIVE MODELS.
SO IN THE BACKGROUND PAYORS AND PROVIDERS ARE WORKING TOGETHER TO MANAGE POPULATIONS
BUT GUESS WHO’S NOT ACTIVELY INVOLVED, WHO’S ACTIVELY NOT INVOLVED IN THIS?
TYPICALLY THE CONSUMER OR THE PURCHASER OF HEALTHCARE AND FOR ORGANIZATIONS THAT WE HAVE
WORKED WITH, OVER TIME SOME OF THEM SIX AND SEVEN AND EIGHT YEARS NOW WHO HAVE COMMON
STRATEGIC OBJECTIVES ABOUT MANAGING POPULATIONS AND CHANGING THE WAY HEALTHCARE IS DELIVERED
FOR THE BETTERMENT OF THE COMMUNITY, WE ACTIVELY GO TO MARKET WITH THEM AND WE OFFER PRODUCTS
IN THE MARKET WITH THOSE PROVIDERS. SO THAT’S A CHANGE.
WE’VE SEEN THAT AS A GAME CHANGER IN TERMS OF THE CULTURAL TRANSFORMATION AND WHAT IT
TAKES TO CREATE REAL CHANGE IN BOTH PAYOR AND PROVIDER.
WHAT DO I MEAN BY THAT. I MEAN THAT NOW, OUR PROVIDER PARTNERS SIT
AT THE TABLE WITH PURCHASERS AND START TO UNDERSTAND HOW HEALTH CARE IS BUNDLED AND
PURCHASED AND DELIVERED AND THEY BRING THAT BACK INTO THEIR OWN ORGANIZATIONS AND THINK
ABOUT HOW THEY SERVE THEIR COMMUNITIES OVERALL AND WHO THEY’RE ACTUALLY SERVING AND WHAT’S
IMPORTANT TO THE MEMBERS OF THE COMMUNITY THAT THEY’RE SERVING.
JUST A FEW QUICK NUMBERS. WE HAVE ABOUT 800 – NOT ABOUT, A LITTLE OVER
800 VALUE BASED CONTRACTS ACROSS THE COUNTRY. YOU SAY SEE A LOT OF DIFFERENT COLORS UP HERE
OR SHADES OF BLUE AND THIS GOES TO WHAT I SPOKE ABOUT EARLIER, HEALTHCARE AND DELIVERED
DIFFERENTLY IN EACH LOCAL MARKET. NOW THIS REPRESENTS STATE BY STATE BUT AS
WE ALL KNOW AND I AM FROM CHICAGO, SO CHICAGO IS A VERY DIFFERENT PLACE THAN CAIRO, ILLINOIS
I DON’T KNOW IF YOU’VE EVER BEEN THERE BUT THEY HAVE A SOUTHERN ACCENT WHICH IS SURPRISING
TO ME AS A CHICAGO AN. SO VERY DIFFERENT MARKETS AND WE HAVE TO HAPPENED
AND ADAPT TO EACH OF THESE DIFFERENT MARKETPLACES MEANING THE COMMUNITIES AND THE PROVIDERS
WHERE THEY ARE. LET’S TALK A BIT ABOUT CONSUMERS.
SO FUN THAT’S WE JUST HEARD ABOUTWELL, CCO IS A LITTLE TOUGHER TO WORK WITH.
COMPLETELY AGREE WITH THAT SO THINKING ABOUT DESIGNS THEY JUST TAKE THEM INTO HMO AND PPO
BECAUSE WE WORK ACROSS COUNTRY, WE SEE MUCH MORE PPO BASED PLAN DESIGN DEMANDED FROM THE
MARKETPLACE THAN HMO ALTHOUGH HMO MAKES ALL THE SENSE IN THE WORLD FOR ANY OF THESE VALUE
BASED CONTRACTS. THIS ISN’T ABOUT A PLAN DESIGN.
THIS IS ABOUT AN APPROACH, THOUGH SO WE’RE ALWAYS ASKED HOW IS THIS NOT JUST THE OLD
HMO DAYS. SO JUST A FEW QUICK POINTS ON CLARIFICATION
OF HOW IT’S NOT. WE’RE MUCH BETTER AT ANALYZING AND UTILIZING
DATA AVAILABLE ACROSS THE CONTINUUM OF THE HEALTHCARE SYSTEM SO WE CAN EARLY IDENTIFY
AT RISK PATIENTS AND WE CAN OUTREACH FOR THEM PROACTIVELY AND IT DOESN’T HAVE TO BE FROM
THE PAYOR AND THAT’S WHAT WE HEARD FROM THE PAYOR AND IT SHOULDN’T BE FROM THE PAYOR,
I’LL TELL YOU IF AETNA CALLS MY OWN HOUSE, I MIGHT NOT ANSWER IT BUT IF DR. WONG MY PHYSICIAN
CALLS MY HOUSE OR HIS OFFICE CALLS MY HOUSE, I WILL PICK IT UP IN A HEART BEAT.
THERE’S A MUCH MORE PERSONAL RELATIONSHIP THERE THAN CONSUMER TO PAYOR.
SO A COUPLE THINGS THAT ARE DIFFERENT, I KNOW THAT WE LOOK AT THE ELEMENT OF QUALITY NOW
AND YOU JUST HEARD ABOUT THAT. IT’S NO DIFFERENT AT AETNA.
IT’S NO DIFFERENT IN MANY OF THE FEDERAL AND VAL AND STATE BASED PROGRAMS AND HOW WE INCORPORATE
QUALITY INTO EVERYTHING THAT WE DO AND I WOULD WOULD SAY THERE THAT THE VERY GOOD NEWS IS
THE MORE CONSISTENT WE ARE AS PAYORS, WHETHER IT’S FEDERAL, STATE OR LOCAL LEVEL, THE MORE
CONSISTENT WE ARE IN HOW WE INCORPORATE QUALITY AND HOW WE DEFINE QUALITY.
THE EASIER ANY OF THESE PROGRAMS WILL BE TO ADMINISTER AND THIS IS HOW WE REDUCE ADMINISTRATIVE
WASTE WITHIN THE HEALTH SYSTEM WHEN WE DON’T ASK PROVIDERS TO MONITOR AND PERFORM AGAINST
A BUNCH OF DIFFERENT METRICS. THEY DON’T NEED A SEPARATE AETNA ORIGINAL
A SEPARATE SIGMA MA OR SSP SET OF MEASURES, THE MORE WE CAN CONSOLIDATE WHAT WE BELIEVE
QUALITY IS FROM INDUSTRY AND INCORPORATE THAT INTO MODELS THAN WHAT IT IS FOR THE HEALTHCARE
ROUGH ATOM VIEDERS. A LITTLE BIT ABOUT HOW PATIENTS ARE BENEFITING
BUT THIS GOES BEYOND PATIENTS AS WELL. IT GOES INTO THE COMMUNITY HOW WE’RE ALL BENEFITING
FROM THESE MODELS. SO WHAT ARE WE SEEING IN THESE MODELS?
HAD WHAT ARE THE RESULTS ACROSS THE BOARD? SO IN THE 2014 PERFORMANCE HERE, THESE ARE
SOME OF THE KEY STATISTICS IN MED RICKS THAT WE’RE TRACKING AND SAW AND I WILL SAY THAT
AT SOME LEVELS INCREASES YOU’RE ALWAYS GOOD AT WHAT YOUR BOSS LOOKS AT?
SO WHEN WE SELECT MEASURES TO HONE IN AND ON AND WE WORK TOGETHER ON INITIATIVES TO
IMPROVE THEM, THE RESULTS ARE AMAZING. SO THE GREAT NEWS ABOUT WORKING WITH ORGANIZATIONS
ALONGSIDE THEM YEAR – OVER – YEAR OVER YEAR AND ITERATING ON THE MODEL IS NOW WE HAVE
A GREAT FOUNDATION TO START WITH AND WE START TO EXPAND WHAT WE’RE WORKING ON TOGETHER,
WHAT METRICS WE’RE LOOKING AT. TOTAL COST OF CARE IS OF COURSE WHAT WE LOOK
AT. WITH THE QUALITY COMPONENTS INCORPORATED INTO
ALL OF THAT. THAT’S VERY DIFFICULT FROM A TACTICAL REALITY
PERSPECTIVE, TO GET A HOLD ON AND SAY WHAT DO WE DO TO IMPROVE THAT SO WE PICK VERY SPECIFIC
INITIATIVES AND MEASURES TO IMPROVE QUALITY IN THE TOTAL COST OF CARE SO HERE YOU WILL
SEE THE INCREASED GENERIC DISPENSING AND THIS IS ONLY IN THE TOP FOUR DRUG GROUPS THAT WE
HONED IN ON, INCREASE BY 10%. IMPACTIBLE SURGICAL ADMITS PER THOUSAND WHICH
IS HARD FOR ME TO SAY, FAST, THAT-THAT-THAT DECREASE BY 14% AND I’M NOT AN ACTUARY BUT
I WILL TELL YOU THESE ARE MATERIAL NUMBERS AND THEN OVERALL REDUCTION IN MEDICAL COST
VERSUS THE REST OF THE MARKET WHERE THE REST OF THE MARKET WAS WAS OVER 8 PERCENT, THOSE
ARE MEANINGFUL NUMBERS. A LITTLE BIT ABOUT EXPERIENCE, SO THE CONSUMER
EXPERIENCE IS VERY IMPORTANT IN ALL OF THIS. CONSUMERS WILL CONTINUE TO VOTE IN SOME RESPECTS.
I THINK I HEARD IT REFERRED TO IN AN EARLIER SESSION CALLED TO AS ATTRITION, WHAT WHATEVER
THAT IS, WHETHER IT’S A FETERAL PROGRAM OR STATE PROGRAM OR A PRIVATE PROGRAM, WE HAVE
TO UNDERSTAND WHAT CONSUMERS ARE DEMANDING AND HOW THEIR LIFESTYLES ARE CHANGING OVER
TIME AND WORK TO MEET THAT. SO WE LOOK AT BOTH PRODUCTIVITY AND AND WE
LOOK AT HEALTH STATS AND THE TWO ARE HIGHLY INTERRELATED SO IF HEALTH STATS ARE COSTING
OUR EMPLOYERS ALMOST $1700 PER EMPLOYEE PER YEAR THAT’S A NUMBER WE CAN WORK ON TOGETHER.
SO PROVIDER, PAYOR TOGETHER ON BEHALF OF THE COMMUNITY THAT’S A NUMBER WE CAN WORK ON TOGETHER
SO INSTEAD OF MISSING HOURS OF WORK, DRIVING BACK AND FORTH THIS LAB TO THAT LAB, LET’S
MAKE IT EASIER. LET’S INSURE THAT WE HAVE ELECTRONIC INTERFACE
SO THAT IN THESE MODELS THE PATIENT DOES NOT HAVE TO GO BACK AND FORTH ALL THE TIME.
EMPLOY THERE’S A ONE STOP SHOP WHERE THE INFORMATION IS HOUSED FOR THE PATIENT.
AND IT’S LITTLE THINGS LIKE THIS THAT SOUND LOGICAL AND I THINK THE AVERAGE CONSUMER THINKS
IT’S SOMEHOW HAPPENING IN THE BACKGROUND AND THIS OTHER PART OF THE SYSTEM AND HEAVEN FORBID
HAVE SOMETHING HAPPEN OR DEVELOP A CHRONIC CONDITION.
WE DON’T WANT TO REALIZE ALL OF IS GOING ON SO WE WORK HARD FOR OW PROVIDER PARTNERS ON
SEEMING LOW SMALL ITEMS THAT MAKE A DIFFERENCE BUT IMPROVE PRODUCTIVITY THAT ADDRESS THE
CONVENIENCE ASPECT OF HEALTHCARE THAT THEY’RE DEMANDING.
AND THAT ALSO LOOK AT OVERALL QUALITY OUTCOMES. TALK ABOUT WHAT WE WERE.
SO ALL OF THIS TRANSITION AND I’LL USE ALL THE BUZZ WORDS HERE, MAYBE ALL IN ONE SENTENCE
WHEN WE TALK ABOUT MOVING FROM A FEE FOR SERVICE MODEL TO A VALUEBASED MODEL, IT IS A JOURNEY,
IT IS A TRANSITION AND NOT EVERY ONE WITHIN THE ENTIRE HEALTHCARE SYSTEM IS IN THE SAME
PLACE AT ANY GIVEN POINT IN TIME SO OUR APPROACH IS TO HAVE DIFFERENT MODELS FOR THOSE THAT
ARE IN DIFFERENT PARTS OF THE JOURNEY. AND IT’S NOT JUST TO THROW A CONTRACT TO SAY
THAT’S OUR MODEL FOR YOU, THAT’S HOW WE ASSESSED YOU.
GOOD LUCK, IT IS, LET’S WORK TOGETHER. THIS IS WHERE WE HAVE ASSESSED YOU.
WHERE DO YOU THINK YOU ARE ALONG WITH YOUR JOURNEY, DO YOU THINK THIS WILL BE THE MODEL
THAT HELPS PROPEL YOU FORWARD IN YOUR OWN JOURNEY.
WE WILL SIT ALONGSIDE YOU AND HELP YOU AND WE LIKE TO SEE YOU GO TO THE NEXT MODEL BY
XPERIOD OF TIME AND BY THE WAY AS WE GO LONG THIS JOURNEY WILL WE INCORPORATE WHAT WE LEARN
FROM YOU INTO OUR NEW MODEL. SO ON THE FAR LEFTHAND SIDE, YOU SEE WHAT’S
BEEN A ROUND FOR A WHILE, DIFFERENT PAY FOR PERFORMANCE MODELS, PC MH MODELS, ATTRIBUTION
BASED MODELS AND NOW WE MOVE INTO THE NEW REALM.
AND THE NEW REALM AND HOW DO WE WORK ALONGSIDE PARTNERS TO DO WHAT I TALKED ABOUT EARLIER
TO GO TO MARKET TOGETHER. LET TO FIND HIGHLY FINANCIALLY ALINED, BOTH
OF US TOGETHER TO BE ALIGNED IN OUR STRATEGIC OBJECTIVES AND HOW WE WANT TO BETTER OUR COMMUNITIES
TO, THE HEALTH STATUS OF OUR COMMUNITIES TOGETHER, HOW CAN WE DO THAT?
SO ON THE FAR RIGHT SIDE YOU WILL SEE THE PROGRESSIVE MODELS WHEN YOU THINK ABOUT FINANCIAL
ALIGNMENT AND SHARED RISK AND THAT’S BRINGING PRODUCT TO MARKET TOGETHER WITH PROVIDER PARTNERS
AS WELL AS FULL ACTIVITY SHARED JOINT VENTURES. I THINK WE TALKED ABOUT ALL THIS ABOUT THE
DIFFERENT PHASES AND HOW WE WANT THIS FOR ALL AND IN THE INTEREST OF TIME I’LL SUM THIS
UP BY SAYING ACCELERATING PERFORMANCE OVER TO THE RIGHT IS WHERE WE WANT TO BE AND WE’RE
NOT ALWAYS THERE AND WE ARE OKAY WITH THAT. IT’S OKAY TO HAVE PROVIDER PARTNERS WE’RE
WORKING WITH THAT ARE STILL WORKING TO DEVELOP A CLINICALLY INDEPENDENT NETWORK OR WORKING
ACROSS THEIR INTEGRATED DELIVERY SYSTEM TO COMMUNICATE.
WE’RE OKAY FACILITATING THAT WITH THEM AND BEING ON THE GROUND WITH THEM AND HELPING
THEM DO THAT SO THAT WE CAN MOVE ALL THE WAY TO THE RIGHT AND ACCELERATE PERFORMANCE ACROSS
COSTS AND QUALITY AND THE MEMBER EXPERIENCE.>>ALL RIGHT, QUICKLY, I WANT TO LEAVE YOU
WITH THE THOUGHT OF WHAT WE HAVE TODAY AND HOW WE THINK THE FUTURE CAN BE AND THE FUTURE
THAT WE’RE WORKING TOWARD ON A DAILY BASIS AND THIS ISAETNA AND THE PROVIDERS WE WORK
WITH AS L. TODAY WE HAVE OF COURSE A VERY PROVIDER CENTRIC MODEL AND WE HAVE THIS PAYOR
LEG CARE MANAGEMENT MODEL AND YOU HEARD HOW WE’RE WORKING TO CHANGE THAT SO THAT WE’RE
THINKING ABOUT THE CONSUMER IN THE MIDDLE. WHO IS THE CONSUMER CONSUMING THE HEALTHCARE
SERVICES THAT’S WHAT’S IN THE MIDDLE OF THE THINKING WE HAVE ABOUT OUR FUTURE STRATEGIES
AND APPROACHES AND WHAT WE BRING TO MARKET. WE ALSO BELIEVE THAT AS WE JUST HEARD AS WELL,
PROVIDER LED CARE MANAGEMENT, SO, LITERALLY CARE IS PROVIDED AND MANAGED BY THOSE THAT
SHOULD BE PROVIDING HEALTHCARE, NOT FROM ANENTITY LOOKING AT IT BUT FROM A 30,000FOOT LEVEL
AND CALLING INDIVIDUALS. SO FOR PEOPLE, RIGHT?
THINK ABOUT THE PEOPLE THAT WE SERVE. RIGHT NOW WE HAVE A SICK PERSON MODEL, WE
HAVE A HIT AND MISS ON CARE ACCORD NATION. WE ABSOLUTELY DON’T WANT THAT TO BE FUTURE.
WE ARE WORKING TOWARD TOTAL POPULATION MODELS THAT ARE PRIMARY CARE LED, WE ALSO KNOW THAT
ENGAGING THESE INDIVIDUAL MEMBERS SIT’S IMPORTANT TO KNOW THAT THEY ACCESS TECHNOLOGY.
I DON’T EVEN HAVE IT ON ME, I TYPICALLY HAVE IT ON ME MY SMART PHONE TELLS ME EVERYTHING.
I DON’T HAVE TO BE 17 OR 18 YEARS OLD TO BE AN ADDITION TO MY SMART PHONE.
IT TELLS ME EVERYTHING I NEED SO THINKING OF WAYS TO IMPROVE ENGAGEMENT IN OUR OWN PERSONAL
HEALTH THROUGH TECHNOLOGY. SO, WE’REWE SEE THAT ABSOLUTELY IN THE PICTURE.
AND THEN DATA DRIVEN DECISION MAKING WILL CONTINUE TO HEAR ABOUT THAT AND I’M VERY HAPPY
AS A MEDICAL ECONOMIST AND EXTREMELY HAPPY WE CONTINUE TO HEAR ABOUT THAT BECAUSE IF
WE ARE NOT MAKING DECISIONS BASED ON DATA WE’RE MISSING THE ENTIRE CONCEPT OF THE VALUE
OF WHAT WE CAN DO WITH POPULATION HEALTH INFORMATION. I WANT TO THANK YOU FOR THE TIME TODAY.
I ESPECIALLY WANT TO THANK OUR HOST BECAUSE AS WE WALK INTO, TALK TO PROVIDER ORGANIZATIONS
ABOUT HOW WE CAN WORK, TO MOVE FROM FEE FOR SERVICE TO A VALUE BASED MODEL TO BETTER SERVICE
OUR COMMUNITIES AND CREATE HEALTHIER COMMUNITIES IT’S GREAT TO HAVE PARTNERS AT BOTH THE FEDERAL
AND STATE LEVEL WHO ARE WORKING TOWARD THE SAME OBJECTIVES.
IT DEFINITELY HELPS WITH THE PROVIDER COMMUNITIES AS WELL AND IT HELPS THEM ENGAGE MUCH FASTER.
[ APPLAUSE ]>>TERRIFIC, THANK I BRIDGET AND ANDREA FOR
THE GREAT BACKGROUND. I AM SAY AS I’M A PHYSICIAN AND A PRIMARY
CARE DOCTOR BY TRAINING ORIGINALLY, I WAS LOOKING FORWARD TO THIS SESSION AND TO LINK
IT BACK TO THE EARLIER SESSION WHEN WE HEARD ABOUT THE MARKETPLACE ISSUES IN PARTICULAR
ABOUT THE NUMBER ONE THING THEY THINK ABOUT WHEN THEY’RE CHOOSE SUGGEST ON PRICE AND AFFORDABILITY
SO CLEARLY VERY MUCH ON THEIR MIND AND THEN VUBSLY FOR THE FOLKS WHO ARE COMPETING FOR
THEIR BUSINESS, THEY WANTFOLKS WANT TO BE COMPETITIVE ON PRICE.
SO CLEARLY WORKING IN A WAY WITH YOUR PROVIDERS ON HOW TO GET AFFORDABILITY BACK TO THE CONSUMER
IS VERY CRITICAL FOR THE OVERALL SUCCESS OF THE MARKETPLACE SO I WAS EXCITED TO HEAR ABOUT
HOW YOU BOTH ARE IN DIFFERENT WAYS THINKING ABOUT THAT.
CLEARLY MASSACHUSETTS HAS HAD A MUCH LONGER RUN ROOM FOR DOING SOME OF THESE AND SO EXCITED
TO HEAR ABOUT YOUR DEEPER EXPERIENCE. WHAT I WANTED TO START WITH IN TERMS OF QUESTIONS
AND I KNOW A LOT OF FOLKS MAY BE THINKING THAT OUT THERE, IS HOW DO YOU START THE JOURNEY
WITH SOME OF THE PROVIDERS AND WHAT HAVE BEEN SOME OF THE LEARNINGS YOU’VE COME AWAY WITH
IN HOW YOUYOU APPROACH THOSE, YOU MENTIONED AT THE END WHERE YOU’RE SAYING THERE’S REALLY
A LOT OF OOH LIENMENT COMING TOGETHER, NOT JUST SPEAKING AT A MARKETPLACE OF BUSINESS
BUT REALLY ACROSS A HEALTHCARE SYSTEM IN MOVING FOLKS FORWARD AND CAN YOU TALK ABOUT MAYBE
SOME OF THOSE TRENDS AND HOW THAT HAS CHANGED THE DYNAMIC OF TALKING TO YOUR PROVIDERTHIS
JOURNEY.>>I CAN CERTAINLY START.
I THINK IT WAS 2010, 2011 WE WERE INSIDE AETNA, I CALL IT AN INCUBATOR TEAM TRYING TO THINK
ABOUT HOW WE COULD ENABLE HELP PROVIDERS IN IN INEVITABLE JOURNEY.
AND WHAT DID THAT MEAN? AND WOULD THE PROVIDER COMMUNITY BE RECEPTIVE
TO THAT? AND I WOULD SAY THAT OUR EARLY CONVERSATIONS
WERE WITH ORGANIZATIONS WHO WERE PLANNING TO AT LEAST APPLY FOR THE PIONEER PROGRAM.
SO THOSE ORGANIZEINIZATIONS WE KNEW WERE LIKE MINDED IN SOME SHAPE OR FORM AND HONESTLY
WE DIDN’T HAVE A SET MODEL WE SAT DOWN WITH THEM TO TALK ABOUT.
WE TALKED ABOUT HOW WE COULD GO THROUGH THIS JOURNEY TOGETHER AND WHAT WOULD THAT LOOK
LIKE AND THOSE PARTNERSHIPS HELPED US FORM. HOW WE COULD THEN GO TO THE NEXTI WOULDED
SAY THE NEXT SET OF POTENTIALLY LIKE MINDED PROVIDERS AND IT WAS AETIN,A KNOCKING ON PROVIDER
DOORS AT THIS POINT IN TIME AND A LOT OF CLOSED DOORS AS WELL.
LOVE WHAT YOU HAVE TO SAY BUT WE DON’T SEE THAT WORKING FOR USES.
LOVE WHAT YOU HAVE TO SAY, WE’RE NOT READY YET.
OKAY, WE’LL COME BACK, IF IF THERE’S ETERNAL OPTIMISM, I HAVE IT, AND IT’S PERSONALLY SOMETIMES
KIND OF SILLY BUT NOW WE’RE TALKING EIGHT YEARS LATER OR SIXEIGHT YEARS LATER IN SOME
CASES BUT NOW THEY KNOCK ON OW DOOR AND SAY, HOW CAN WE WORK WITH YOU.
WE LIKE WHAT YOU’RE DOING. THE WE SEE THAT THIS WORKS.
AND THE CONVERSATIONS SOMETIMES ARE DIFFICULT BECAUSE WE MAY ACCEPT THAT YOU AS AN ORGANIZATION
AREN’T AS READY AS YOU THINK YOU ARE, BUT WE WILL BE SPECIFIC ABOUT WHAT WE BELIEVE
AND YOU CAN BELIEVE IT OR NOT, BUT CALL US WHEN YOU THINK THESE ARE IN PLACE.
AND WE’LL HELP, WE’LL WORK WITH YOU.>>SO ON THE MASSACHUSETTS SIDE, A LITTLE
BIT BEFORE THE PIONEER AND ACTUALLY THE CONVERSATIONS WE STARTED HELPED THEM TO DECIDE TO JOIN PIONEERS.
SOPHISTICATEDY WE HAD QUITE A FEW MASSACHUSETTS BASED PROVIDERS FELT LIKE THEY WERE QUITE
READY FOR PIE O NEARS SO THEY HAVE THE BIGGEST CONCENTRATION AND I WOULD ARGUE THAT THE EARLY
CONVERSATIONS HELPED INFORM THAT AS WELL. BUT I DO THINK THAT IN THESE TWOTHE EARLY
DAYS BEFORE PIONEER, I THINK THERE WERE PROBABLY TWO, AT LEAST TWO QUESTIONS COMING FROM PROVIDERS
SO THE FIRST THEN THEY WANT TO GET OFF THE TABLE WAS THIS IS NOT HMO 101 AGAIN, RIGHT?
AND WE’RE NOT GOING TOAND HUGE VOLUME AND THEN YOUIT’S JUST NOT THAT, RIGHT?
AND WE SPENT A LOT OF TIME SAYING THIS IS NOT A RATE CUT.
WHAT WE’RE TRYING TO DO IS CHANGE THE TRAJECTORY OF WHERE THIS IS GOING AND IN THAT PLACE FIND
WAYS TO GET IT DOWN AND TO ADDRESS THE WEIGHT OVER TIME OR ADDRESS THE OVERUSE OVER TIME
AND WE SPENT A LOT OF TIME SAYING, WE ARE GOING TO START YOU WHERE YOU ARE AND LET’S
IMPROVE WHERE YOU ARE FROM HERE. NOT HEY WE HAVE A DEAL FOR YOU AND WE WILL
CUT OUR RATES. THE SECOND THEN THEY FELT STRONGLY ABOUT WAS
QUALITY, BECAUSE THE HMOs DIDN’T HAVE THAT AND WHEN WE TALK TO THEM ABOUT THE QUALITY
AND THE THINGS THEY COULD MEASURE, IT FELT REALLY TACTICAL AND TANGIBLE TO THEM SO THEY
FELT LIKE OH AND IT WAS NOT A COMPETITION, IT’S AN OBLIGATIONS ABSOLUTE COMPARISON.
YOU HAVE TO DO BETTER THAN YOURSELF. AND YOU WILL GET SCORED ON THAT SO YOU DON’T
HAVE TO DO BETTER THAN SOMEONE ELSE, THAT JUST FELT REAL SO THE COMBINATION OF HELPING
WITH THE REMETABOLISM EMBUSKERMENT HERE AS WELL AS HAVING THEM WORK ON THINGS THEY REALLY
WANT TO WORK ON AS CLINICIANS REALLY HELPED JUMP START THE CONVERSATION AS REAL TACTICAL
THINGS THEY COULD SEE THE MOMENTUM BUILDING FROM AND THAT’S WHERE THE LEARNING STARTED.
>>THAT’S TERRIFIC. AS A PHYSICIAN, THAT RESONATES WITH ME PROFESSIONALLY
AND MANY OF MY FELLOW PHYSICIANS WANT TO KNOW HOW TO CARE FOR THEIR PATIENTS AND WHEN YOU
GIVE THEM TOOLS TO DO THAT, WHICH IS THE CONNECTION POINT HERE IT’S NOT JUST PUSHING A CONTRACTOR
ACROSS THE TABLE, IT TRULY IS WHAT YOU’VE BEEN TALKING ABOUT THE PARTNERSHIP THAT ALLOWS
FOR THE INCREASE OF QUALITY BUT WITHIN A DIFFERENT PAYMENT STRUCTURE THAT ALLOWS THEM TO DO DIFFERENT
THINGS, FOCUS ON DIFFERENT THINGS AND UTILIZE DATA, AND I DON’T KNOW IF IF YOU CAN TALK
TOTHAT’S THE POINT, I WANT TO MAYBE IF YOU CAN HIT ON NEXT WHICH IS, I THINK MAYBE YOU’RE
THINKING ABOUT, THOSE ARE THE THINGS THAT WILL MAKE A PROVIDER READY.
CAN YOU TALK A BIT MORE ABOUT WHAT ARE THOSE THINGS, IS IT DATA AND THEIR ABILITY TO USE
DATA TO IMPROVE CARE? WHAT ARE THE THINGS THAT YOU ARE LOOKING FOR
THAT WOULD SAY HEY, THEY’RE READY ORAND CAN MOVE ON.
>>SO IT’S A HIGHER ORDER THAN BEING ABLE TO ANALYZE AND UTILIZE INFORMATION THAT’S
AVAILABLE. WE LOOK AT ORGANIZATIONAL ALIGNMENT, GOVERNMENT
STRUCTURE, MANAGEMENT PROCESSES AND SO WHAT DO I MEAN BY ORGANIZATIONAL ALIGNMENT?
OH IS THERE A POPULATION HEALTH GROUP THAT’S PART OF THE ORGANIZATION THAT SITS WAY OFF
TO THE SIDE, THEY DON’T HAVE A SEAT AT THE BOARD AT ALL?
THEY DON’T HAVE AANY SUITE LEVEL REPRESENTATION BUT THEY’RE A PILOT PROJECT OUT THERE?
THAT’S PROBABLY NOT A HIGHLY ALIGNED ORGANIZATION AROUND VALUE BASED PAYMENT MODELS BECAUSE
IN THE END THIS IS ABOUT A CULTURAL TRANSFORMATION. IT IS ABOUT LITERALLY ESTABLISHING NOW OPERATING
MODELS AND IT WON’T HAPPEN OVERNIGHT. WE COMPLOATLY UNDERSTAND THAT.
BUT WE CAN START TO SEE HAVING EXPERIENCE OVER TIME HOW IMPORTANT THE ORGANIZATIONAL
ALIGNMENT IS, AROUND THE TRANSITION BASED VALUE MODELS.
SO THIS IS A CRITICAL ELEMENT WE THINK YOU WILL.
I THINK YOU’RE NOT QUITE READY, HOW CAN WE HELP YOU GET READY SO WE CAN BE SUCCESSFUL.
THE.>>I COULDN’T AGREE MORE WITH THE ORGANIZATIONAL
ALIPEMENT AND WOULD SAY IT HAS TO START FROM THE HIGHEST LEVEL OF THAT ORGANIZATION AND
SHE HOW IT PLAYS OUT. I ALSO THINK WE LOOK AT THEIR OWN ENGAGEMENT
WITH US. THERE’S JUST A LOT OF POCKETS OF EVIDENCE
OF WHETHER OR NOT THEY’RE UTILIZING THE DATA AND IN THOSE INSTANCES THAT’S WHY WE HAVE
THE QUARTERLY CONVERSATIONS, THAT’S WHY WE’RE TRACKING TO SEE, THE DROPPING OFF, YOU LOOK
AT THE SUPPORT GROUPS AND MAKE SURE THERE’S ADEQUATE PARTICIPATION BECAUSE I THINK THOSE
ARE PIECES OF EVIDENCE WELL ORIGINAL NOT THERE’S AN ALIGNMENT.
BUT FUNDAMENTALLY, HOW IT GETS DONE IS REALLY SPECIFIC AND WHAT’S BEING FOCUSED ON IS REALLY
SPECIFIC. SO IT GETS INTERESTING ON HOW YOU TRANSLATE
THE ALIGNMENT VERSUS THE HOW. BUT IT REALLY DOES HAVE TO BE FEELING OF COMING
FROM THE TOP.>>THANK YOU.
SO I’M GOING TO INVITE FOLKS FROM THE ROOM IF THERE ARE QUESTIONS TO COME TO THE MICROPHONE
AND REMIND FOLKS ONLINE TO SUBMIT QUESTIONS AT CISIO UPDATES @CMS.HHS.GOV.
>>SO I HAVE A QUESTION FOR YOU WHICH IS WE SPENT THE FIRST PART OF THE TIME TALKING ABOUT
THE MARKETPLACE TYPE XUOF THE MERES AND WHAT THEY LOOK LIKE, THE UNINSURED, ET CETERA.
AS YOU THOUGHT ABOUT THESE MODELS YOU HAD FOR FOR QUITE A FEW YEARS NOW ARE THERE ANY
CHANGES, TWEAKS, ADJUSTMENTS MAKING IN PAYMENT, HOW YOU MANAGEMENT WHAT YOU DO IN LIGHT OF
THESE CUSTOMERS NOW COMING IN?>>SO I’LL START IN MASSACHUSETTS SINCE WE
HAD A GOOD CHUNK OF THE POPULATION WELL IN ADVANCE OF WHEN THESE MODELS CAME IN SO WE
WERE LEARNING ABOUT THE FORM AS WE WERE BUILDING THE 2009 CONTRACTS SO THERE WAS A NICE ALINEMENTMENT
THERE, I WOULD SAY IT’S NOT DIFFERENT, IT’S JUST A DIFFERENT CONCENTRATION OF THOSE MEMBERS
AND THE REPORTING IS THE SAME AND WE REALLY DON’T TREAT THE SEGMENTS ANY DIFFERENTLY.
THIS IS A TOTAL POPULATION BASED CONTRACT. IN THE EARLY DAYS OF THE CONTRACT, THERE WAS
A LOT OF QUESTIONS ABOUT THE SOCIOECONOMIC DIFFERENCES OF WHERE THE PRACTICES ARE AND
WE’VE BEEN SUPPORTING IT WITH DATA AND SOME OF THAT CAME OUT EVENT IN THE CONVERSATION
TODAY. BUT I WOULD SAY, IT’S JUSTIS A DIFFERENT CONCENTRATION
OF WHAT IS A GENERAL ISSUE IN THE MARKET.>>I WOULD COMPLETELY AGROW WITH THAT AND
EMPHASIZE IT’S EXTREMELY IMPORTANT, I TALKED TO THAT A LITTLE BIT TOUCH OFFICE OF DIVERSITY
IT, IT’S EXTREMELY IMPORTANT TO REMEMBER THAT THE PROVIDER ORGANIZATIONS WHO ARE LEADING
THESE TRANSITIONS TO VALUE BASED CARE, THE MORE UNIFIED WE COULD MAKE THEIR OVERALL APPROACH,
THE BETTER AND INCORPORATE ALL OF THE ELEMENTS THAT ARE CRITICALLY IMPORTANT TO THE DIFFERENT
SEGMENTS OF POPULATIONS THAT ARE UNDER THEIR MANAGEMENT.
>>THANK YOU.>>SO BIGET MAKEBRIDGET MAKE CAN YOU TALK
ABOUT THESE GRAPHS AND TALK ENDTOEND ABOUT ONE OF THOSE VENTURES COULD LOOK LIKE.
SO I’LL GIVE YOU AN EXAMPLE OF A RECEIPT ONE THAT WE PUBLICLY ANNOUNCED, I THINK TWO WEEKS
AGO NOW IN DALLAS TEXAS, OR TEXAS HEALTH RESOURCES. WE STARTED WORKING WITH THEM ALL THE WAY TO
THE LEFT OF THAT GRAPH ON PAID FOR PERFORMANCE AND THEN WE WORKED WITH THEM AS WE HAD AN
ATTRIBUTION BASED MODEL WITH THEM AND THIS IS YEARS OF WORKING TOGETHER.
SO AGAIN, EMPHASIZING THIS IS A JOURNEY OVER TIME AND THEY TURNED TO US NOT IN THE VERY
FAR PAST AND ASKED WELL, WE WOULD LIKE TO BETTER SERVE OUR COMMUNITY MUCH MORE PROACTIVELY.
WE’RE THINKING OF BUILDING OUR OWN HEALTH INSURANCE PLAN: WE WERE A TRUSTED ENOUGH PARTNER
THAT THEY TURNED TO US AND SAID WHAT DO YOU THINK OF THAT.
WHAT ARE THE PIT FALLS OF THE HEALTH INSURER, WHAT ARE THE PIT FALLS THERE WE SHOULD THINK
ABOUT AND WE SHOULD WATCH OUT FOR. AND THEY EMBARKED UPON THEIR OWN JOURNEY OF
GOING THROUGH THEI’LL SAY STRATEGIC PLANNING AND DECISION MAKING.
THIS WAS A GOOD IDEA FOR THEM OR NOT? AND IF IT WAS A GOOD IDEA WHYHOW WOULD WE
DO IT. IF IF IT’S NOT A GOOD IDEA.
HOW DO WE ACTIVELY PARTICIPATE AND BETTERING TO SERVE OUR COMMUNITY FROM A HEALTH PERSPECTIVE
AND SO, A LOT OF STRATEGIC PLANNING WENT ON IN THE BACKGROUND WITH THEM AFTER INITIAL
CONVERSATIONS AND THEY CAME BACK TO US AND SAID, WELL WOULD YOU LIKE TO EMBAR UPON THIS
JOURNEY WITH US? IF SO WHAT WOULD THAT LOOK LIKE?
WE WOULD LIKE TO BE FINANCIALLY ALIGNED WITH YOU IN THIS JOURNEY AND UNDERSTAND YOU’LL
BE RIGHT HERE IN THE LOCAL COMMUNITY ALONGSIDE US BUILDING A BETTER AND HEALTHIER COMMUNITY
TO INNOVATE WITH US ON WHAT WE CAN OFFER IN THE MARKET TO HELPHELP US WITH THE FINANCIAL
MANAGEMENT ASPECT AND THE HEALTH PLAN ADMINISTRATIVE CONCEPTS AS WELL.
>>THANK YOU. ANOTHER QUESTION.
>>THANKS. I APPRECIATE WHAT YOU BOTH SAID ABOUT LOOKING
AT VALUE AND IONIZATION NOVATION AND LOOKING AT PULL POPULATION BUT SOME PEOPLE BACK WE’VE
HEARD FROM PROVIDERS SPECIFICALLY FOR THE MARKETPLACE PRODUCTS IN SOME STATES ARE THESE
ARE FOLK WHO IS HAVE BEEN UNDER INSURED OR UNINSURED IN THE PAST.
MANY RECEIVED SUBSIDIES AND LOWER INCOME RATE AND THERE’S NOT ENOUGH INCENTIVES THERE.
IT’S REALLY NOT WORTH IT FINANCIALLY TO SPEND TIME FOCUSING ON THESE INDIVIDUALS SPECIFICALLY?
HOW DO YOU ADDRESS THAT FEEDBACK FROM PROVIDERS?>>I GUESS I WOULD SAY WE HAVE CREATED ENOUGH
FINANCIAL INCENTIVES TO TRY TO HELP WITH THE VALUE EQUATION WHERE WE THINK THERE IS A VALUE
PROPOSITION SO A LOT OF IT HAS TO DO WITH WHERE IS THE OPPORTUNITY AND WOO CAN WE ALIERN
ON THE OPPORTUNITY AND REALLY EVALUATE IT THE SAME WAY BECAUSE I THINK IN A LOT OF INSTANCES
THERE’S A FEELING OF DIFFERENT POINTS OF VIEW AND STARTING POINTS AND SO, A LOT OF THE DATA
SHARING HELPED BRIDGE THAT GAP AND IN SOME INSTANCES TWEAKING OF WHAT IS IMPORTANT SO
MAYBE CHANGING WHAT YOU FOCUS ON TO BE MORE SPECIFIC TO THOSE SPECIFIC ISSUES AND THEN
EFFECTUALLY GET PASS THAT AND GET ON A RAMP. BUT I DO THINK THERE MIGHT BE DIFFERENT VIEWS
OF WHERE THE STARTING POINT IS. I KNOW IN MASSACHUSETTS WE HAVE A GOOD CHUNK
OF MEMBERS THAT FALL INTO THAT CATEGORY AND OVER TIME YOU CAN POINT TO A BUNCH OF POPULATION
IN IN THE COMMERCIAL BUSINESS AND GO THAT’S REALLY NOT THAT DIFFERENT THAN THIS AND IT’S
A MATTER OF STARTING THE CONVERSATION AND THEN EVENTUALLY CONVERGING TO THE SAME PLACE.
>>YEAH, I WOULD SAY, AGAIN, A COMPREHENSIVE APPROACH TO TO VALUE BASED MODELS AND IT’S
NOT ABOUT SELECTING A PARTICULAR POPULATION BECAUSE THAT’S WHAT YOU WOULD LIKE TO TO WORK
ON, IT IS ABOUT THE ENTIRE COMMUNITY AND THE REAL QUESTION IS, HOW DOES THIS POPULATION
FIT INTO THE MODEL YOU HAVE TODAY? CAN IT?
CAN YOU BE SUCCESSFUL WITH IT AND CAN WE BE SUCCESSFUL WITH IT AND LIKE THAT THAT’S A
VOICE WHERE YOU MIGHT SAY YOU MIGHT NOT BE QUITE READY FOR THIS QUITE YET BUT LET’S TALK
ABOUT YOUR NEEDS AND WHAT YOUR REAL CONCERNS ARE SO THAT WE CAN INCORPORATE THAT INTO HOW
YOU BUILD YOUR INTERNAL MODEL FOR VALUE BASED CARE.
>>AND THEN ALSO ADD TO THE QUESTION THAT LINKED TO THE EARLIER SESSION WE HAD WHEN
CONSUMERS WHO WERE NEWER TO THE SYSTEM NEED TO SEE THE VALUE OF THEIR INSURANCE AND CAN
YOU IMAGINE AS A PROVIDER OR HOSPITAL OR PERSON OR DOCTOR WHO THOSE MAY HAVE BEEN YOUR UNINSURED
PATIENTS COME NOTHING, THE EMERGENCY ROOM DOOR BEFORE, BAD DEBT, ET CETERA THAT I WOULD
SAY AS A PROVIDER YOU WANT TO MAKE SURE YOU’RE SHOWING YOUR VALUE AS THE PROVIDER.
THAT THEY SEE THE HIGH QUALITY CARE THAT THE PROVIDER IS PROVIDING AND WANT TO MAKE SURE
THAT THE CONSUMER SEES COVERAGE AS SOMETHING THEY WANT TO HAVE AND MAINTAIN FOR THEIR LIFETIME
NO MATTER WHAT’S HAPPENING IN THEIR LIFE. SO I THINK THERE ARE A LOT OF NEW INCENTIVES
HERE IN THE MARKETPLACE FOR FOLKS TO WANT TO FOCUS ON THIS POPULATION AND THEN JUST
TO YOUR POINT, TAKE THEM INTO EVERYTHING THEY’RE DOING ACROSS THEIR ENTIRE SPECTRUM OF BUSINESS
AND THE WAY IN WHICH THEY WANT TO JUST DELIVER GOOD CARE ACROSS ALL OF THEIR PATIENT POPULATIONS.
SO ANY OTHER QUESTIONS IN THE AUDIENCE, I KNOW WE ARE KEEPING EVERYONE FROM LUNCH SO
THANK YOU SO MUCH BRIDGET AND ADRIANA FOR COMING IF ARE A GREAT SESSION.
[ APPLAUSE ]>>SO WE WILL BREAK FOR LUNCH.
THERE ARE SUGGESTIONS IN YOUR PACKET OF PLACES YOU MIGHT WANT TO GO GRAB FOOD AROUND HERE.
IF YOU GO UPSTAIRS TO THE CAFETERIA, THERE ARE FOLK WHO IS CAN ESCORT YOU UP THERE AND
WE WILL SEE YOU BACK HERE AT 1:30. 1:30 HERE.
THANK YOU SO MUCH. [PROGRAM IS ON LUNCH BREAK ]

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