The Future of Value-Based Care in South Louisiana

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THE FUTURE OF VALUE-BASED CARE IN SOUTH LOUISIANA An executive roundtable hosted by UnitedHealthcare, joined

by Franciscan Missionaries of Our Lady Health System

H

istorically, the health care system has been organized around treating the sick and paying for volume, not value. But today health care is shifting to a model that emphasizes the importance of keeping people healthy and rewards physicians for coordinating care.

This approach, usually called “value-based care,” means creating the personal connection for the consumer—putting the patient at the center.

Value-based care can come in many different arrangements—through an incentive-based plan with primary care physicians, as a set of payments for bundled and episodic services, or in the form of an accountable care organization (ACO).

An ACO starts with high-performing network providers. And through those high-performing providers and the insurance carriers, the system becomes focused on managing a population.

UnitedHealthcare and partners like Franciscan Missionaries of Our Lady Health System work together to define appropriate quality metrics.

Then the goal becomes to manage a population according to those quality metrics to demonstrate savings and improved outcomes for the patients.

It’s about rewarding our partners in regards to value-based outcomes versus fee for service.

Earlier this year, we brought an expert panel together to discuss how the model is working in south Louisiana.

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UNITEDHEALTHCARE AND FMOLHS EXECUTIVE ROUNDTABLE FEB. 23, 2017 | 8550 United Plaza Blvd., #703, Baton Rouge, Louisiana

JOE OCHIPINTI President and CEO, UnitedHealthcare – Gulf States

Vice President, Key Account Sales and Account Management, UnitedHealthcare – Gulf States

JOHN J. FINAN, JR.

PENNY S. WALKER, M.D.

RICHARD VATH, M.D.

SCOTT WESTER

President & CEO, Franciscan Missionaries of Our Lady Health System

President, Health Leaders Network (Franciscan Missionaries of Our Lady Health System)

MODERATOR: In the health care industry today everyone’s talking about value-based care. How does UnitedHealthcare define value-based care and what is UnitedHealthcare trying to deliver for its consumers, employers and providers?

OCHIPINTI: Our shared goal with Franciscan Missionaries of Our Lady Health System (FMOLHS) is to try to help people in Baton Rouge live healthier lives. In doing so, we try to drive affordable care, increase the quality of care and improve outcomes. That’s the trifecta we’re seeking to accomplish, but health care is complex. We also continue to focus on simplifying the consumer experience.

VATH: From our perspective, we understand how people are measuring value. Now we’re creating value within our own provider network, driving the patient experience, improving outcomes and ultimately controlling costs. That’s what value-based care is all about.

FINAN: We started this journey in 2007 with the creation of a medical home in each of our communities.

From that experience in understand42

CHRISTINE O’BRIEN

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ing how the primary care physicians and providers were making a difference in care, we created Franciscan Health and Wellness Services, which is a population health company with the goal of managing the health of our team members and their families in our health benefits plan.

From 2011-2017, we’ve had only one year with a premium increase. Every other year, it’s been zero (no premium increase). So we’ve demonstrated that active management is better than passive management.

MODERATOR: Joe, you’ve alluded to alignment of values between UnitedHealthcare and FMOLHS, but why have you selected FMOLHS and Health Leaders Network to partner with on an ACO? OCHIPINTI: When I think about what UnitedHealthcare seeks to accomplish, I can’t help but think about the American health rankings that evaluate the economic status, public health, policy making and health care within each state, which are published annually. Unfortunately, Louisiana is ranked No. 49.

So, when you begin to approach the population that requires better outcomes, you start with the overall

Sr. Medical Director, UnitedHealthcare – Southeast Region

CEO, Our Lady of the Lake Regional Medical Center

delivery system. You want to look for a collaborative partner, someone who can connect with the community, and someone with the wherewithal to create an option for the member. FMOLHS is one of those partners, who help us manage the population to advance the common mission.

At UHC, we’re also fortunate to have FMOLHS as a client, so our common principles and mission align. This creates collaborative opportunities to learn together about how we improve and deliver care; this allows our members to enjoy a simpler health care experience and receive the best care available.

MODERATOR: John, what should people in our region know about Franciscan Missionaries of Our Lady Health System?

FINAN: We have served the people of Louisiana for 105 years—we’re in our 106th year of service. As a ministry of the Catholic Church, we are first about the healing ministry of Jesus Christ, but we operate in a commercial environment and it’s important that we’re successful at both. Today through our local ministries and many providers we serve

more than 40% of the state’s population, and we’re proud to be recognized for our quality, our innovation and our community leadership. We think we will be successful in our partnership with United when we’re able to reduce premiums, rather than just keep premiums from increasing as much.

Health care is local, and we really strive to deepen our relationships with patients and the communities through the work of our physicians and team members to deliver not only exceptional experiences, but also high-quality value-based care.

Our primary facilities and markets are St. Francis Medical Center, Monroe; Our Lady of the Lake Regional Medical Center here in Baton Rouge; Our Lady of Lourdes Regional Medical Center, Lafayette; St. Elizabeth Hospital, Gonzales; and Our Lady of the Angels Hospital, Bogalusa.

MODERATOR: Dr. Vath, what should people in the region know about the Health Leaders Network?

VATH: What is unique about Health Leaders Network is that we take this idea of a physician-led organization very seriously. We’ve purposely engaged physicians from the start,

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resulting in the most engaged physician group I’ve worked with in my 34 years’ experience.

We’ve spent the last 18 months educating our primary care providers who have lived in the traditional volume-based model to understand and give them the skills to work in a value-based population contract.

We started with 330 physicians and, within one year, we’ve grown to just under 700. The 330 were employees of our health system, and we were working exclusively on our own 17,000 self-insured covered lives. So we’ve gone to more than double the size of our organization, and we’ve gone from 17,000 lives to more than 100,000 under value-based contracts.

Lastly, many clinical networks and ACOs have worked on care coordination, but it’s been largely separated from the physician providers. We did it differently by connecting our nurses to the physician teams, so we have the physicians engaged very deliberately in the care coordination process.

WESTER: Our traditional business was very much transaction-based.

Patients would go to the doctor, then go to the hospital and possibly to post-acute care services. Then, the insurer would process the bills and claims. In today’s environment, we’re getting much more sophisticated to operate more on the longitudinal side of the business. It’s not just looking at one segment, but looking at the whole. The tools and work with UnitedHealthcare, with what they’re able to provide, in combination with the clinical engagement that Health Leaders Network provides ... when you marry those together, you can really change how we deliver the care system, which truly benefits the patients.

MODERATOR: Joe, how many members does UnitedHealthcare have under value-based programs nationally, regionally, and specifically in the greater Baton Rouge area?

What does that represent in total payment?

OCHIPINTI: Nationally, UnitedHealthcare has about 15 million members for whom we provide value-based care, which touches about $50 billion in spend. Regionally (Louisiana, Mississippi and Alabama), we have more than 500,000 members that are part of value-based care, which represents just under $1 billion that we’re

MODERATOR: Christine, how is your vision of an ACO product different from products that have been offered in the past?

O’BRIEN: We’re marketing the triple aim of an ACO to companies of all sizes that are seeking to manage costs for their employees. The ACO is the cornerstone of that product.

The primary care physician is conductor of the care, making sure that members receive proactive, rather than reactive care. This is a seismic shift from the transactional type of care to a quality-focused, primary care-directed product. managing. Locally, UHC has 10,000 members in the Health Leaders Network ACO and soon we’re going to include the FMOLHS employees to the ACO, so we’ll be around 25,000 members.

MODERATOR: Are there specific categories that UnitedHealthcare is focused on in delivering value-based care?

OCHIPINTI: It starts with a focus on the patient—with preventive care services. If you can create awareness of the value the screenings provide to the patient, you create ownership and get members engaged; that’s when you start to get high adoption, high utilization on important screenings.

The second category or theme is around technology. When we evaluate how we approach care, we want to leverage our technology because that allows physicians and specialists the ability for real-time data to keep that patient (member) at the middle of the care so they get the most qualitative care.

What puts all of this together is the primary care physician group.

It’s very important to build up our primary care physician group, because that’s who’s going to steer our accountable care organization.

WALKER: We consider the primary care physician the conductor of the patients and they coordinate all the care. If you don’t have a primary care-focused entity, you’re not going to be able to control costs.

MODERATOR: How many ACOs and value-based care arrangements have you implemented in Louisiana and what do you hope to achieve?

OCHIPINTI: Back to the triple aim: The goal is to drive more affordable

care, improve quality of care and provide better outcomes. In a state like Louisiana, we have the ability to create more engagement and drive more preventive care. Within Louisiana, UnitedHealthcare has about 300 value-based care payment arrangements with Quality Incentives, driving lower costs. When you look at just the ACO (the clinically integrated network with the high-performing physicians, population management, quality metrics and true shared savings), we have four at this time. Health Leaders Network and UnitedHealthcare is our most recent launch, we have Ochsner Health Network, Gulf South Quality

MODERATOR: Is there a proven track record that demonstrates that ACOs perform better than non-ACOs? VATH: We’re beginning to see success in places like Memorial Hermann in Texas, where they do remarkably well on their Medicare shared savings as an example of a large, clinically integrated network.

We carefully designed our leadership structure and our engagement of physicians because we researched who did it well and we tried to recreate that structure and that model of engaging physicians.

We’re optimistic that we’ll get there because of the engagement we have, knowledge we’ve gleaned, and the technology and data that we have.

FINAN: What the ACO does is organize the physicians in a way that they can look at comparative data and then change practice patterns to produce better results.

The ACO provides the infrastructure for that to work.

Network and Hattiesburg Clinic.

We’re excited because of the opportunity to engage statewide nonFMOLHS-owned system affiliates, while building out the partnership with Health Leaders Network.

WALKER: The old system was just paying claims and fee-for-service.

And now all of our ACOs and value-based contracts include quality metrics that are very important to improve patients’ health.

WESTER: Today, the conversation among doctors is how do we change our delivery system to be more efficient to the patient. The fundamental discussion among clinicians is how do we deliver something that has very high quality and reliability at a lower cost.

MODERATOR: How does Health Leaders Network create and integrate its technology to deliver integrated care?

VATH: We realized if we had everybody on a disparate health record that didn’t communicate with each Daily-Report.com | BUSINESS REPORT, May 23, 2017

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and gaps in patient care. The data will show if a member is missing a critical preventive screening. That’s shared with physicians and hospitals so they can close those gaps in care.

Finally, the ACOs that have been most successful have had physician champions to get primary care physicians enthused about changes in their practice patterns.

MODERATOR: If you look a few years down the road, what do you see being offered in collaboration between FMOLHS and UnitedHealthcare? other, it wasn’t going to be terribly valuable. So we made the decision very early on to look at a single community record. Ultimately, we formed a joint venture IT shop between Baton Rouge Clinic and FMOLHS, and we stood up the Epic Ambulatory Record to serve as the community record to support the clinically integrated network. It was successful beyond expectation and spread around the state so every one of our primary care providers is on a single instance of Epic.

The second thing is we’ve decided to use Epic’s embedded population health tools. This is a new space for them, and they’re learning how to do that. In the interim, we’ve relied upon third-party payers. UnitedHealthcare, through Optum, has an incredibly robust data set and analytics. We’ve begun to partner with payers to access information that was previously unavailable, but is now, to help build up the most effective care in the network. And we’ve created a small data analytics team to pore over giant data dumps that we receive. We’ve created both partnerships and infrastructure to be able to use the data appropriately.

How Value-Based Care Is Different

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MODERATOR: How does UnitedHealthcare share data with providers to impact clinical outcomes?

WALKER: We receive claims data from laboratories, mental/behavioral health providers, pharmacies and medical providers (doctors and hospitals). We’re able to package it so it’s much more readable and actionable, and then share it with physicians and hospitals so they can close gaps in care and provide more efficient care. In addition, we have real-time data on ER visits, ER discharges and hospital discharges, which we’re sharing with large physician groups and hospitals to prevent recurrence of ER and hospital admissions.

MODERATOR: What is UnitedHealthcare doing to address the most commonly cited challenges in value-based programs?

WALKER: Primary care is so important and we have a lack of primary care physicians in the state.

Primary care is the coordinator of all care for the patient and they control the quality and efficiency of care.

The second challenge is data

VATH: Looking down the road, it’s building upon the relationship. Because United has operated nationally in markets that are far more progressive, we can utilize the national set of information and knowledge to learn as we grow.

FINAN: United has been a leader in initiating discussions about partnerships. At FMOLHS, we have a long and successful history of partnerships, which allows us not only to increase scale, but also to standardize approaches. United brings incredible performance as an insurer.

Combining those skillsets allows us to design products that address the triple aim. The measure of success in this will be when premiums begin to move in the other direction.

WESTER: The average employer looks at their health care maybe once or twice a year. When faced with a premium increase, that’s when an employer focuses on health care costs.

We want to be very transparent.

We love to have conversations with employers, and also with partners like United, about what we can do to help companies and their employ-

ees to make sure we are supporting their best or optimal health status for them. We improve their outcomes and we’re very efficient for the dollars they spend.

O’BRIEN: All too often, employees look at the bottom line. Most will take the cheapest plan because they feel that’s all they can afford or they choose the most expensive plan because they think it will get them the best care possible. A regular plan has benefits and costs. With the ACO, it adds the depth that manages the care—and ultimately leads to better care and lower premiums. It gives the employer the opportunity to get more than they’ve had in the past.

OCHIPINTI: As a Fortune 6 company, UnitedHealthcare has a national presence. We can learn from other ACOs nationally, apply the learnings locally to our population here in Louisiana. So what we’re doing, which a lot of our competitors can’t even think of doing, is connecting these ACOs nationally and then in the state of Louisiana, through our ACO partners here (Health Leaders Network and FMOLHS), offer a national and local network and product. I see that evolving in the next couple of years as we progress our partnership.

FINAN: I cannot overstate the importance of these efforts. Consider that the average household income in this country is a little less than $56,000 and the average premium per family of four is about $18,000.

This reality really calls upon us to think about the need to do this differently—the need to change the way that this all works—to bring true value to the community. We can only do it through collaboration.

Consumer Experience

Care Delivery

Care Coordination

Data & Information

Costs

VALUE-BASED CARE

Consumers are at the center of the health care system, empowered with more information and support

Proactive, preventive care, with an emphasis on keeping people healthy

Physicians empowered by new technology, data and financial incentives to coordinate care

Data can be mined to identify patient health risks, improve care coordination and enhance efficiency

Insurance companies and care providers are paid based on quality and patient health improvements

TRADITIONAL CARE

Complicated health care system confuses and frustrates consumers

Lack of technology and incentives for physicians to coordinate patient care

Data trapped inside massive repositories; lack of sophisticated analytics

Costs climb without corresponding health improvements

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Reactive, transactional care delivered in response to an injury or illness