Accountable Care: The Challenge of the Decade Michigan’s Premier Public Health Conference October 13, 2011 Kim Horn President and CEO Priority Health

priorityhealth.com Medical Index Projections Healthcare costs for American families

priorityhealth.com How Does This Relate to Us? There can be no doubt about the societal mandate to address these trends. Failure will destroy our economy. There can be no doubt about the magnitude of the challenges. What will be major requirements? –A major cultural change: Focus on efficient, effective use of resources vs. generating revenue –Comprehensive primary care and intensely coordinated care of complex disease across delivery systems –Relentless focus on variations in care –Moderation in pricing strategies by many

Accountable Care Strategy Partners in Performance

priorityhealth.com The foundation for accountability 1.Each and every member has a medical home 2.Patient Centered Networks (PCN) comprised of physicians and hospitals. Commitment to enable coordinated patient centered care, regardless of model. 3.Measurement of experience, quality and cost for each and every patient. Transparency and performance incentives spur continuous improvement. 4.Enabling patients to make informed decisions. 5

priorityhealth.com Enable the Triple Aim Patient Centered Networks

priorityhealth.com Plan Wide Region PCN Specialty Physician Measurement and engagement Practice

priorityhealth.com Understanding variation Group A Group B Group C Group D Group E Group F Group G Group H Group I Group J Group K Group L Group M Group N Group O Group P Group Q Group R Physician Organization

priorityhealth.com 9 The Evidence Supporting Shared Decision Making Number of Unnecessary Surgeries Can Be Decreased and the Quality of Necessary Surgeries Can Be Improved Surgical utilization varies dramatically by region (Wennberg, Dartmouth Atlas) 25% of all surgeries are unnecessary (RAND Corporation) Studies* show that “Decision Aids”: –Quality of outcomes is maintained –Patient satisfaction is improved –Overall effect: 24% decrease in surgical utilization (O’Connor et al. 2003) –Quality of outcomes is maintained *Whelan et al. 2004; Kennedy et al. 2002; Murray et al. 2001; Deyo et al. 2000; Morgan et al. 2000; Bernstein et al. 1998; Barry et al. 1997; Street et al. 1995

priorityhealth.com Member engagement Patient incentives –Benefit plans that reward appropriate health behaviors –Value-based benefits Patient education –Re-design systems of care to assure that patients receive information regarding all options available for preference- sensitive conditions and for end-of-life care Spine care—physiatrist visit Other preference-sensitive conditions End-of-life care

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Step 3 Understand I have 2 or more treatment options to consider Identify what I want to achieve through treatment Get a list of potential treatments options to discuss with my doctor View animations of surgeries and understand risks and benefits of each

priorityhealth.com Preference sensitive care: Our success is being replicated with other conditions 26% reduction in back surgeries 12% reduction in high-tech radiology 74% satisfied/very satisfied 83% seen within 10 days 87% better understood options

priorityhealth.com Evolution of Partners in Performance Patient Centered Networks (Triple Aim) Strong primary care base that assumes accountability for managing population health Living within a budget Relentless focus on elimination of variation Integration – clinical and economic alignment, collaboration Honor patient choices and values