Value-based Care Strategies in Utah: Paying for Better Health Outcomes Governor’s 2014 Health Summit Afternoon Breakout Session September 30, 2014

Utah Partnership for Value-driven Health Care Who we are: A community collaborative of health care purchasers, payers, providers, and the public Mission: We seek to advance higher value health care in our community through shared strategies that address –transparency –variation in cost and quality –community approaches to improvement in health care delivery

Value in Health Care “In health care, value is defined as the patient health outcomes achieved per dollar spent.” Health Outcomes $$. Porter ME. What is value in health care? N Engl J Med 2010; 363:

Value in Health Care “Value should be the preeminent goal in the health care system, because it is what ultimately matters for customers (patients) and unites the interests of all system actors.” -Michael E. Porter, Ph.D. Porter ME. What is value in health care? N Engl J Med 2010; 363:

BETTER HEALTH What the Focus Should Be: How to Reduce Costs By Improving Health Patients Lower Costs Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

Improving Health/Reducing Costs: Prevention and Wellness Health Condition Continued Health Healthy Consumer Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

Improving Health/Reducing Costs : Avoiding Hospitalizations Health Condition Continued Health Healthy Consumer No Hospitalization Acute Care Episode Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

Improving Health/Reducing Costs : Efficient, Successful Treatment Health Condition Continued Health Healthy Consumer No Hospitalization Acute Care Episode Efficient Successful Outcome Complications, Infections, Readmissions High-Cost Successful Outcome Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

Improving Health/Reducing Costs : Is Also Quality Improvement Health Condition Continued Health Healthy Consumer No Hospitalization Acute Care Episode Efficient Successful Outcome Complications, Infections, Readmissions High-Cost Successful Outcome Better Outcomes/Higher Quality Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

ER Visits Lab Work/ Imaging Hospital Stay Health Insurance Plan Physician Practice $$ Often, We Don’t Pay for the Things That Support Value CURRENT FEE FOR SERVICE PAYMENT SYSTEMS Avoidable Office Visits Nurse Care Mgr Phone Calls $ No payment for services that can prevent utilization......No penalty or reward for high utilization elsewhere Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

How About Different Ways to Pay? Bundled Payment, Episode Payments Warrantied/ Condition-based payments Shared Risk/Shared Savings Global Payment Care Management Payment Incentivize quality and appropriate utilization Financial Risk Performance-Based Centers of Excellence Accountable Care Organization

ER Visits Lab Work/ Imaging Hospital Stay Health Insurance Plan Physician Practice/ ACO How Different Payment Might Alter the Landscape COMPREHENSIVE CARE/GLOBAL PAYMENT Avoidable $ Flexibility and accountability for a condition-adjusted budget covering all services $ Condition- Adjusted Per Person Payment Office Visits Nurse Care Mgr Phone Calls Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

Barriers to Patients’ Access to Value PATIENT Accessible PCP or Medical Home Accessible Specialist Accessible Lab/Radiology Non-Medical Support (e.g., weight loss) Lack of Transportation Multiple Days Off Work Services Unavailable or Not Affordable Information on best value service Meaningful co-pay, deductibles Do not promote cost- conscious choice Information not available Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform Lack of ability to navigate

Providers Will Need Alignment to Allow Focus on Better Care Payer Provider Payer Patient Better Payment System A Better Payment System B Better Payment System C Even if every payer’s system is better than it was, if they’re all different, providers will spend too much time and money on administration rather than care improvement Adapted from Harold Miller, Center for Healthcare Quality and Payment Reform

Utah Payment Reform Initiatives: Public and Private Medicaid ACO implementation Patient-centered Medical Home initiatives Provider and plan preparation for Accountable Care or Shared Savings Direct contracting with providers by private and public employers Payer, state, and community-led efforts to measure and share pricing and quality performance Onsite work clinics developed by providers

Panelists Linn Baker, CEO, ARCHES Health Plan Chuck Norlin, Chief of the Division of General Pediatrics, University of Utah Gina Pola-Money, Director, Utah Family Voices Scott Barlow, CEO, Central Utah Clinic, Provo, Utah

Q and A Write a question on a 3X5 card on the table Take it to one of designated staff persons

Next Steps Contact to continue the dialogue with the Utah Partnership for Break begins at 2:45pm Sessions resume at 3:00pm