UnityPoint Health – Berryhill Integrated Healthcare Services 11/16/2018 UnityPoint Health – Berryhill Integrated Healthcare Services NAMI of Iowa Conference Aaron November 16, 2018

About the Presenters Aaron McHone, MBA 11/16/2018 About the Presenters Aaron McHone, MBA Master degree in Business Admin from Iowa State University Executive Director of UnityPoint Health-Berryhill Center ACO Executive Sponsor for UnityPoint Health – Fort Dodge Senior Leader of UnityPoint Health –Fort Dodge Father of 3; Husband of 1 Aaron

Why I got into Healthcare 11/16/2018 Why I got into Healthcare

Agenda Introduce UnityPoint Health and UnityPoint Health-Berryhill 11/16/2018 Agenda Introduce UnityPoint Health and UnityPoint Health-Berryhill Define Value Based Care Models (ACO) Discuss the impact Value Based Care models have on individuals with severe mental illness. Q & A Aaron and Kari

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Value Based Contracting Medicare Advantage 11/16/2018 Strategy: Use our network to provide exceptional care delivery in an efficient manor. Payor Strategy: Value Based Contracting Medicare Advantage Large Employer Health Insurance Aaron

Definition of Value Based Care and Accountable Care Organization (ACO) 11/16/2018 Definition of Value Based Care and Accountable Care Organization (ACO) Aaron

Value Based Care Payment Model 11/16/2018 Value Based Care Payment Model Aaron

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ACO Performance 11/16/2018 Aaron https://www.unitypoint.org/filesimages/Accountable%20Care%20Section/AccountableCareValueReport.pdf

ACO vs. Fee for Service MCO Contract 11/16/2018 ACO vs. Fee for Service MCO Contract Similarities: Both “Manage the Care of Beneficiaries” Both involve utilization targets Both seek to lower health care claim costs Managed Care Organizations: Top down approach Competition among healthcare providers Designed to remove revenue from healthcare providers Accountable Care Organizations: Bottom up approach Teamwork among healthcare providers Designed to remove internal cost from healthcare providers Aaron

11/16/2018 Aaron Data published by Medicaid and CHIP Payment and Access Commission (MACPAC) Study published in 2015 (Data from 2011 Medicaid data) https://www.macpac.gov/wp-content/uploads/2015/06/Behavioral-Health-in-the-Medicaid-Program%E2%80%94People-Use-and-Expenditures.pdf

We spend less on mental health treatment than we do for treatment of other chronic conditions. Mental health inflation is lower than that of other healthcare conditions

11/16/2018 The National Association of State Mental Health Program Directors studied comorbid health conditions for patients with behavioral health conditions (2006) Integrative Psychiatry also conducted a study to show the average years of life lost for various diseases and behaviors. As you can see Major Mental Illness results in a lower life expectancy than smoking, obesity, cancer, etc. Aaron https://www.nasmhpd.org/sites/default/files/Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf

UnityPoint Health - Berryhill Center 11/16/2018 UnityPoint Health - Berryhill Center Aaron

UnityPoint Health - Berryhill Center 11/16/2018 UnityPoint Health - Berryhill Center Named after our first Medical Director Dr. Leroy Berryhill Accredited Community Mental Health Center & Licensed Substance Use Disorder Facility, and Primary Care Clinic Primary Care clinic & CLIA Waived Lab Joined UnityPoint Health in 2008 SAMHSA PBHCI Grantee; Cohort 8 55 Employees; 3 Psychiatrists, 6 ARNP’s, & 14 therapists 18% of our budget is from Grants

Heath B, Wise Romero P, and Reynolds K Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions. March 2013

Example of IHH Success – Berryhill Decline in Emergency Room Visits 11/16/2018 Example of IHH Success – Berryhill Decline in Emergency Room Visits 722 enrolled IHH Patients Average Emergency Room Visit Charges: Hospital- $1,880 Physician-$398 Results (Oct 16-April 17 compared to Oct 17-April 18) - Average reduction of 23 Emergency Room visits per month. - Average reduction of $52,394 in billed ER Charges per month. - Average reduction of $628,728 in billed ER Charges per year. Aaron

11/16/2018 Example of IHH Success – Berryhill Decline in Inpatient Hospitalizations & Readmissions 722 enrolled IHH Patients Average Hospital Visit Charges: Hospital- $26,972 Physician- $1,690 Results (Oct 16-April 17 compared to Oct 17-April 18) -Average reduction of 2 hospitalizations per month. - Average reduction of $57,324 in billed charges for Hospital Stays per month - Average reduction of $687,888 in billed charges for Hospital Stays per year Aaron

Example of IHH Success – Berryhill Improvement in LDL Cholesterol 722 enrolled IHH Patients. Sample Size was 287 random patients. 180 patients had two values (baseline LDL and performance LDL). Results - 57% (103) of the patients had improvements in LDL Cholesterol - For all patients with two values the average LDL went from 103 to a therapeutic level of 92. - For the 57% of patients with an LDL improvement the average LDL went from 115 to a therapeutic level of 79. *The LDL goal is less than 100. Improvement in Hemoglobin A1C 722 enrolled IHH Patients. Sample Size was 147 random patients. 80 patients had two values (baseline HgbA1C and performance HgbA1C). Results - 27% (22) of the patients had a baseline A1C over 8.0. - 27% (6) patients with an A1C over 8.0 were able to decrease their A1C to less than 8.0 *The Hemoglobin A1C goal is less than 7.0.

UnityPoint Health - Berryhill Center 11/16/2018 UnityPoint Health - Berryhill Center Strategy Integration with Medical Providers and Community Service Agencies Increased Access to Behavioral Health Services Children and Family Services Be the Employer of Choice

UnityPoint Health - Berryhill Center 11/16/2018 UnityPoint Health - Berryhill Center Integration: Joined UnityPoint Health Integrated Health Home Shared Behavioral health and physical health Electronic Health Record Bi-lateral Colocation including Lab Health and Wellness Classes Pharmacy Integration Substance Use Disorder Services ED Integration

UnityPoint Health - Berryhill Center 11/16/2018 UnityPoint Health - Berryhill Center Access:

UnityPoint Health - Berryhill Center 11/16/2018 UnityPoint Health - Berryhill Center Access: Telehealth Rural Strategy Transportation Recruiting/Training No Pre-appointment Walk ins welcome Follow up after Inpatient and ED Encounters Community Education Resource

UnityPoint Health - Berryhill Center 11/16/2018 UnityPoint Health - Berryhill Center Children’s Services: School Directed School based care Parent Child Interaction Therapy Parenting Educational Groups Specialized treatment modalities incorporating team based learning

UnityPoint Health Questions & Answers 11/16/2018 CEO Search Update Recruitment Update? EMS Relationship with City of FD and FDFD? Hospice - Home/Dr. Swisher update? K9 Program (15-minutes @ 10:15) – Mark   Simulation Lab Talking Points (provided by Carol)

UnityPoint Health - Berryhill Center 11/16/2018 UnityPoint Health - Berryhill Center Aaron McHone, MBA (515) 574-8380 (515) 574-9843 mobile aaron.mchone@unitypoint.org

11/16/2018 Thank You