Public Employers State Purchasing Committee March 1, 2010 Denise Honzel Health Leadership Task Force

The Health Leadership Task Force Initiated by the business community in the summer 2008 Goal—Develop solutions and actions to keep health care costs and premium increases closer to the CPI Sponsors: Legacy, Kaiser, ODS, OHSU, PacificSource, Providence, Regence Task Force Health Plans and Hospitals also funding 2

Health Leadership Task Force How work is being accomplished  Task Force of 27 health care leaders to review and support recommendations  Work on areas that need critical mass to get results; and they are accountable for implementation  Four work groups with 120+ members -- Value Based Benefits -- Evidence Based Best Practice -- Reimbursement and Payment Reform -- Administration Simplification 3

Health Leadership Task Force Accomplishments to Date  Completion of a value-based benefit design for the large group market  Implementing actions to address high cost imaging  Building improved efficiencies in credentialing and provider access to information to reduce costs  Moving forward on payment reforms—focused first on High Value Medical Home initiative 4

Health Leadership Task Force High-Value Medical Home Pilot  Building off the successful Boeing model  Contracted with same national expert to help guide the work; Bart McMullan chairing effort  Three committees to develop/review the model  Focus on patients with complex chronic conditions first, if successful, expand  Establish a new model of care and new payment methodology to demonstrate cost saving, improved quality and increased patient satisfaction 5

Health Leadership Task Force High-Value Medical Home Pilot-Process  Established design principles to guide the work  Developed the care model with greatest opportunity for success; focused on Triple AIM and strong concordance with State Standards  Developed evaluation components including: -- Utilization: Overall Cost, ED, Hospital -- Clinical Quality: HbA1c, LDL -- Patient Experience  Developed payment methodology: -- PMPM + FFS + p4p 6

Health Leadership Task Force Care Model: Key Elements  Access  Intensive Care Management -- Care cycle, intake process -- Support processes  Coordination -- Care transition, post ED follow up criteria  Staffing requirements --RN Care Manager  Training and Culture 7

Health Leadership Task Force High-Value Medical Home-Next Steps  Iterative process with multiple stakeholders involved  Identify high risk patients and affiliated MD  Obtain critical mass of health plans/self-funded purchasers to participate  Develop criteria to select provider groups, invite those that have sufficient volume to be evaluated  Plans/providers agree/selected to participate  Contract negotiations  Launch pilots in Q3of

Health Leadership Task Force High-Value Medical Home-Pilots  Critical elements to launch -HP/Self funded employers decision to participate -Provider Selection process -Contract negotiations  Pilot runs for 2 years  Formal evaluation will be completed at 12/24 months  Learnings will drive changes in approach  Determine expansion opportunities 9

Health Leadership Task Force Can we duplicate the results others have achieved? Business Case Illustration:  Population: top 10% of high cost individuals  Expected costs based on MEPS 2007 data--$22K/yr  If 4,000 enrollees in the pilots, total baseline costs $88M  New cost to support the model about $2M  Break even as a % of total new cost: 2.2%  If achieve 10-20% cost savings, ROI to Plans 180% to 400% 10

Health Leadership Task Force Summary  To demonstrate the success of the high value medical home in Oregon, we need multiple payers and other stakeholders to work together  We have developed models of care and payment approaches, built off experience others success and support Triple AIM  The next 90 days will be critical—need to identify the Plans/Purchasers willing to participate, the MD groups who are ready and willing to be part of the pilot, and start contract negotiations in order to launch Q3 11