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October 13, 2010

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... Medicaid, PPO Network, Work Comp HMO for Govt programs EPO/POS for ... modeling software Disease and case management Enlightened MD leaders ... – PowerPoint PPT presentation

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Title: October 13, 2010


1
October 13, 2010 315 415 pm Insights on
Accountable Care Organizations Jack Friedman,
Chief Executive Officer, Providence Health
Plans John Fletcher, Senior Vice President/Chief
Executive, WA/MT Region, Providence Health
Services Lead Sponsors Cogdell Spencer ERDMAN
and Davis Wright Tremaine LLP
2
  • CEO Lessons for ACOs

3
The Road to ACO
WSHA Annual Meeting October 13, 2010
  • Jack Friedman
  • Chief Executive Officer
  • Providence Health Plans

4
PHP at a Glance
  • 25 years old
  • Part of PHS
  • 380K members/800K customers
  • 1.2 billion
  • Commercial, ASO, Individual, Medicare, Medicaid,
    PPO Network, Work Comp
  • HMO for Govt programs
  • EPO/POS for commercial markets
  • Proprietary network in Oregon/SWW

5
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7
Traditional Medicare Badly Broken
  • Poor primary care access
  • Runaway utilization in unmanaged market
  • Significant regional cost variation (Dartmouth,
    Gawande)
  • Declining reimbursement
  • Boomers looming
  • Quality largely unknown

8
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10
Why is Providence Looking at ACOs?
  • FFS Medicare dying
  • FFS Medicaid untenable
  • Risk for population better than government FFS
  • All payors reducing hospital days ED visits
  • Global budgets coming
  • Prepare for commercial insurance exchange

11
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12
Essential Elements of Successful ACO
  • Strong primary care base
  • Aligned incentives
  • Kick ass medical director
  • Predictive modeling software
  • Disease and case management
  • Enlightened MD leaders

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15
Transformation work is central to our systems
strategy
Where we are headed
a connected experience of care, built
on a foundation of clinical excellence.
How we will get there
Innovate (Change the way we work)
Standardize (Elim. unnecessary variation)
Connect (Systems Structures)
A few specific initiatives
S t r a t e g y M a p
Improve Health i.e. Evidence based chronic care
mgmt i.e. Patient perception of health i.e.
Mortality / 30 day readmissions
More Affordable i.e. Premium increase at CPI
2 i.e. of Fee for Service declining i.e.
decrease in Type 1 2 ED visits
Best Experience i.e. Patient activation
measures i.e. Levels of shared decision
making i.e. Measure across continuum
How well measure success
16
Beneficiary Premiums Stable Over Time
17
Physicians Rewarded for Quality and Effectiveness
  • Physician base pay is 115 of Medicare 
  • Quality and performance incentives have increased
    payment to average 137.
  • Hospitals base pay is 100 of Medicare with
    incentives around 105.

18
Skate to Where the Puck is Going to Be
  • Vertically integrated systems best prepared for
    future
  • FFS gives way to population health management
  • Providers must be rewarded for waste elimination
  • Disease and Case management win the day
  • Paid by accountable lives, not units of service
  • MDs lead the new organizations
  •  

19
Expect to take on more financial risk and to be
held accountable, clinically and economically,
for what happens across the continuum of
carewhether we own the continuum or not.
Michael Sachs, Chairman
and CEO, Sg2
20
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21
Reflections from Mike Leavitt
  • Do You (Read Us) Understand the Scope and
    Intensity of these Reforms?
  • Can You Live on Medicare Rates?
  • Are You Preparing for Medicaid expansion
  • What Markets Will You Serve (Busses, Taxis,
    Limos)
  • What is Your Insurance Exchange Strategy
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