Growth Through Collaboration
2021–2022 Impact Report
2021–2022 Impact Report
The continued national focus on value-based care delivery models in both public and private healthcare funding programs has motivated healthcare providers to consider how these arrangements could improve quality outcomes and health equity for their patient populations. As the largest physician-led clinically integrated network in the Gulf South, partnering with like-minded providers, health systems and payers to deliver high-quality care is fundamental to our success. In 2021, we proudly welcomed 700 new physicians, and in early 2022, we welcomed three new health systems: Titus Regional Medical Center in Texas and Singing River Health System and Ochsner Rush Health in Mississippi. Our employer and payer relationships also played a key role in our expansion. Loyola University and the Archdiocese of New Orleans chose OHN as their network of choice, bringing an additional 5,800 patients into the network and enabling these organizations to improve employee health outcomes while reducing care costs for both members and their businesses.
After six years, Ochsner Health Network’s vision remains steadfast – bringing like-minded physicians together to strengthen communities and inspire patients to live healthier lives by providing the right care in the right place at the right time. Backed by the breadth and experience of Ochsner Health, we have made large strides since 2016:
• Increased covered lives in our network by 200%
• Earned $500 million in value-based revenue.
• Saved Medicare over $107 million in total cost of care through our ACO, Ochsner Accountable Care Network (OACN).
• Continually raised the bar for quality outcome metrics each year.
And we are positioned to do even more as we work toward Ochsner’s vision of improving the overall health of the state of Louisiana. This vision, Healthy State by 2030, will be a focus of OHN as we deliver programs that enhance healthcare access, and improve health equity and health outcomes.
It is our pleasure to present Ochsner Health Network’s 2021–2022 Impact Report. The following pages are a culmination of the incredible effort and accomplishments we have achieved through collaboration with our healthcare partners to extend high-quality, value-based care to patients and communities along the Gulf Coast and beyond.
On the heels of an unprecedented 2020, 2021 delivered its own set of challenges to the healthcare community. Clinics juggled high patient volumes from care delayed in 2020 because of COVID-19; severe weather events across the Gulf South threatened access to care; and the cost to deliver healthcare continued to skyrocket. Physician and care team burnout was, and continues to be, a serious challenge affecting our healthcare community. Despite these headwinds, OHN rose above and proved that we are stronger together.
As you’ll read throughout the report, our work to deliver industry-leading care management programs, powerful data and analytics tools, and access to growing patient populations is helping our partners achieve meaningful results, both clinically and financially. In 2021, we expanded Ochsner’s integrated post-acute network, adding skilled nursing facilities, home health agencies and inpatient rehab facilities throughout Louisiana and into the Mississippi Gulf Coast. This high-performing post-acute network ensures that patients living in these communities have access to high-quality coordinated care after they are discharged from the hospital. The integrated network improves health outcomes and reduces costs after hospitalization by reducing readmissions and helping patients and families navigate the continuum of care.
On behalf of our Board of Directors, we extend a hearty thank you to all our partners for helping OHN change lives.
Sincerely,
Sidney “Beau” Raymond, MD, FACP Chief Medical Officer, Ochsner Health Network Eric Gallagher Chief Executive Officer, Ochsner Health NetworkOHN brings physicians and care teams together with shared goals to:
• Improve care quality and patient outcomes
• Develop better coverage solutions for patients and employers
• Improve efficiency
• Reduce the cost of care for everyone
• Prioritize physician and care team support and well-being
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Ochsner Health Network is a clinically integrated physician network made up of over 5,500 physicians and healthcare providers across the Gulf South, focused on delivering value-based care. TX LA
• Analytic insights on patient care and provider performance
• Care management focused on patients who need extra support
• Care coordination to help patients navigate the healthcare system
• Other tools that help our providers reduce total costs and perform successfully in valuebased agreements
OHN is committed to creating a healthier region where healthcare providers and patients thrive.
OHN BY THE NUMBERS
3,500
participating OACN physicians
30+
specialists
450+
primary care physicians 200+ hospitalists 30+ urgent care physicians
Here is a sample of our quality performance on the populations we manage at OHN. We focus on controlling chronic conditions such as hypertension and Type 2 diabetes to help reduce the likelihood of heart attacks and strokes. Our preventative care efforts, such as cancer screenings that aid in earlier detection, are also a high priority.
More than 2,600 employers partnered with OHN in 2021 to provide care for their employees. These employers have chosen to offer preferential benefits to their employees who use OHN because we deliver the best possible outcomes at a better cost for their businesses.
Tier 5 Achieved
Blue Cross and Blue Shield of Louisiana (BCBSLA), the largest payer in the state, operates a quality improvement program called Quality Blue Primary Care (QBPC). As the largest provider network participating in QBPC, OHN achieved Tier 5 status in 2021 by exceeding the state’s highest performance thresholds for chronic disease care goals. Our providers earned exceptional scores in hypertension, diabetes, vascular and kidney disease care and improved the health of over 40,000 BCBSLA members in Louisiana.
In 2021, our performance resulted in care management fees for our participating primary care groups totaling:
$9.2M
At its core, value-based care focuses on connecting patients with the right care, at the right time, in the right place. OHN’s programs and resources equip physicians and their care teams to create better patient outcomes and experiences at a lower cost. Here is a look at some of the ways OHN responded to patient care needs in 2021.
The emotional and financial costs of hospital admissions are high. OHN’s post-discharge transitional care coordination (TCC) program ensures a smooth transition from the hospital to the home, thereby reducing the risk of readmissions.
The TCC program is one of several care management programs offered through OHN. It provides patients and caregivers with general education and support resources, such as programs to address housing, food or financial risks. The program also includes access to the post-discharge tracker program, where patients receive a series of texts to monitor their well-being and ensure that their needs are being met to proactively reduce the risk of a readmission. When necessary, the patient can reply to any text and connect with a member of the care team.
Over 13,000 patients were enrolled in post-discharge TCC and 1,000+ patients participated in our new post-discharge tracker, leading to a 7% reduction in readmissions for 2021. This means improved outcomes for patients and better efficiency of healthcare resources.
While making her daily phone calls to recently discharged patients, Transitional Care Coordinator Gina Brothers, RN, spoke to a patient who reported an adverse reaction to a prescribed medication used to treat high blood pressure and heart failure. When Gina compared the dose that the patient reported with the dose listed on her hospital discharge report, she noticed the patient had taken twice the amount prescribed.
Gina promptly advised the patient, who was at a doctor’s appointment, to let the staff know she wasn’t feeling well and have them take her blood pressure immediately. She then routed an urgent message to the patient’s primary care provider and cardiology staff, informed the gastroenterology department of the accidental overdose and instructed the Rapid Response team to evaluate the patient. She reviewed all medications and dosages with the patient, advised her to monitor her blood pressure and attend all future appointments, and encouraged her to call the Nurse On Call line if she had any further questions or concerns. Through the post-discharge TCC program, Brothers ensured that the patient remained safe and informed, exemplifying Ochsner Health’s core value of “Patients First.”
The COVID-19 Symptom and Surveillance Trackers were designed to support care coordination of patients who are COVID-19 positive or suspected positive. For low-acuity patients, a daily text is sent asking if the patient feels worse today than the day before. If the patient responds “yes,” a nurse care specialist reaches out to manage the patient’s care needs.
High-acuity patients are supplied with home pulse oximeters, allowing them to upload their vital signs twice daily into their electronic medical record for OHN care teams to monitor. If their vitals are out of range, a nurse care specialist reaches out to validate the vitals and to assist with their care.
“OHN played a key role in the development, implementation and optimization of these two COVID-19 trackers that enhanced our ability to deliver standardized interventions for patients throughout the pandemic,” says Mark Green, Vice President of Care Management at Ochsner Health.
In 2021, more than 60,000 patients enrolled in the tracker programs, resulting in more than 24,000 nurse calls to support patients.
Outpatient Care Management (OPCM) provides complex care management for patients identified as high risk. The program involves telephonic, in-clinic and/or in-home care management from nurse care managers, social workers and community health workers. Services include a complete assessment of the patient’s health status, social determinants of health, and ability to self-manage healthcare. In 2021, OPCM enrolled more than 2,000 patients.
Through interventions such as patient and caregiver education, care coordination and navigation, and intensive care planning to meet identified needs, OPCM achieved the following results in 2021.
In the first 60 days of Outpatient Care Management, enrolled patients experienced:
7%
5,000+ 4,000+ patients received care coordination interactions with OHN care team specialists
In the 12-month period following, Outpatient Care Management results showed:
patients used the COVID-19 Surveillance Tracker in 2021
Our 24/7 Nurse On Call advice line is instrumental in providing dependable, after-hour access that patients and clinics can rely on. By using our advice line that is URAC-certified and staffed by registered nurses, providers can be confident their patients will be directed to the most appropriate care every time.
“From a provider-recruiting standpoint, this tool is a win-win,” says Pedro Cazabon, MD, System Medical Director, Adult Primary Care. “Our clinical partners can enjoy better work-life balance because they’re taking calls less often. They can also trust their patients are being cared for using the same clinically driven protocols they themselves would use, with documentation of the call appearing in the patient’s record the next day.”
Nurse On Call handled over 125,000 calls from 38 states in 2021. More than 80% of callers avoided the emergency room, and 38,000 callers were referred to their primary care providers for care. Some of the more frequent conditions included over 2,000 expectant mothers and 3,000 patients with high blood pressure.
When physicians join our network, they gain access to our extensive population health technology and tools, powering integrated and coordinated care solutions that lower costs, deliver powerful insights, and enhance patient and physician experiences. These resources include collaboration with and support from our analytics team, creating experiences like that of Kathy Jo Carstarphen, MD, at Ochsner Center for Primary Care and Wellness.
“I work closely with OHN’s analytics team to perform financial analysis of my MedVantage Clinic,” says Dr. Carstarphen. “As a multi-intervention primary care clinic targeting the needs of patients with multiple chronic conditions and barriers to care, comparing risk, capitation and expenditure for my MedVantage patients against a controlled population receiving standard care was critical in determining the effectiveness of the clinical program in meeting its goals cost effectively.”
Embedded in Epic, Ochsner Health’s Real-Time Pharmacy Benefits (RTPB) program is a decision support tool that alerts prescribing physicians if a lower-cost alternative to a prescribed medication is available. Medication adherence increases when patients can afford the cost of their medication, and patients have already saved more than $1.8 million with this program since July 2021.
“Ochsner LSU Health Shreveport is taking full advantage of the RTPB program. With $300,000 out-of-pocket savings for patients, this program has delivered real value for everyone involved,” says AVP of Value-Based Performance Management Greg Dadlez.
Peter Seidenberg, MD, family physician at Ochsner LSU Health Shreveport, recalls how this program made a difference for his patients and his practice. “While prescribing a refill for a patient’s medication, I received an automatic notice in Epic that an equivalent, less expensive medication was available,” Dr. Seidenberg says.
“When I asked if my patient was comfortable switching to this lower-cost medicine, he was very happy and thanked me for caring about reducing his costs. This program has made a significant difference in increasing patient satisfaction in my practice.”
When St. Tammany Health System (STHS) joined OACN, it was seeking a high-performance organization steeped in efficiency and risk management. The OACN team swiftly onboarded STHS, implementing many of the proven tools and programs to help manage STHS’s patient population effectively and sustainably. Through collaboration and OACN’s expansive programs and resources, the STHS team has seen tangible benefits for its Medicare population since joining OACN in 2021, including outcomes like reduced unnecessary readmissions and decreased postacute spend.
“We learned from each other,” says Michael K. Hill, MD, Vice President – Quality and Utilization Management at St. Tammany Health System. “Through a collaborative approach with the OACN team, we were able to drive down readmissions for our Medicare population by 20% in 2021. We look forward to expanding our partnership with Ochsner Health Network to bring the benefits of value-based care to our commercial patients.”
20%
PHYSICIAN TESTIMONIALPeter Seidenberg, MD Family Physician Ochsner LSU Health Shreveport
80% of callers were able to access care outside of the ED
“From a provider-recruiting standpoint, this tool is a win-win.”
Pedro Cazabon, MD System Medical Director Adult Primary Care Ochsner Health
Employers need group health benefits that help employees become healthier, happier and more productive.
Solutions equip businesses to achieve these goals and reduce care costs. From high performance networks to telemedicine and a range of other solutions, Ochsner connects employees to the benefits of value-based care, providing a more personalized and proactive care approach to achieve the best health outcomes in a cost-effective way.
Employers that choose an Ochsner high performance network experience:
“We have purposefully coupled Ochsner’s employer strategy with our value-based care infrastructure to better manage employee populations and provide employers with the best value group health solutions in our market.
Donny Lawrence Vice President of Business Development Ochsner HealthBergeron Automotive partnered with Ochsner’s Corporate Wellness team to create a comprehensive wellness program for its employees. This program, “B-Well,” provided employees access to an online portal to earn incentives for participating in healthy activities like health screenings, a coaching program and a health education series, bringing Ochsner Health professionals on-site to present on meaningful behavior changes.
In addition to significant health improvements, Bergeron Automotive was presented with the Most Creative Healthy Business Award at the LiveWell Jefferson Healthy Business Awards.
130+
pound weight loss among participating employees
90%
enrollment in B-Well program
A local municipality in Greater New Orleans was looking for a more cost-effective group health plan that would provide its employees with access to the best care options in the area and reduce care costs. The solution was to transition employees from broad network access to a high performance network.
Bergeron Automotive partnered with Ochsner’s Corporate Wellness team to create a comprehensive wellness program for their employees. This program, B-Well, provided employees access to an online portal to earn incentives for participating in healthy activities, a coaching program and a Hello Health lecture series – bringing Ochsner health professionals onsite to present on meaningful behavioral changes.
Here are the impacts the business saw from onboarding an Ochsner high performance network with access to OHN versus a competitor:
In addition to significant health improvements, Bergeron Automotive was presented with the Most Creative Healthy Business Award at the LiveWell Jefferson Healthy Business Awards.
Within the first year, the Ochsner cohort spent $155 less per member per month (PMPM) than the competitor cohort.
Within the first two years, the Ochsner cohort spent $269 PMPM less compared to the competitor cohort.
The Ochsner cohort reduced its prescription costs with higher generic medication usage versus comparable but more expensive brand-name medication.
The evolution of value-based care has been fueled by demand for healthcare affordability. Ochsner Health Network is proud to work with some of the largest payers in the Gulf South to deliver on that demand.
Payers are an integral part of value-based care. When providers and hospitals prioritize cost-effective patient outcomes, payers can ensure that their members get the highest quality and best value care. By taking an individualized approach with each payer and offering both value-based agreements and network products that deliver low-cost, high-touch care, OHN delivers collective growth and success. Our growing value-based agreements and products with payers like Blue Cross Blue Shield (BCBS), UnitedHealthcare (UHC), Humana and Centers for Medicare and Medicaid Services (CMS) continue to deliver proven positive results for patients, employers and payers alike.
Over the past five years, BCBS, UHC, Humana and CMS have all experienced explosive growth in OHN and OACN product and program enrollees. Our total covered lives in commercial network products have increased by 160% from 2018 to July 2022. Through value-based agreements and a continuously expanding network product portfolio, including Administrative Services Only (ASO) options, OHN equips payers to provide groups and individuals with competitive healthcare insurance options that deliver high-quality care at a better cost.
Supporting payer growth and financial success through expanded value-based agreements and network products has resulted in these benefits to our payers:
228% growth in covered lives across commercial and Medicare value-based agreements since 2017
160% increase in total covered lives in commercial network products from 2018 to July 2022
Since January 2021, our ASO products have gained over
12,000 members
We collaborate with payers who value quality care for their covered members as much as we do, and this commitment drives enrollment and retention. OHN value-based agreements and network products continue to grow because enrolled members are satisfied and maintain their coverage from year to year.
Clinical insights and healthcare analytics that drive meaningful improvements to population health are especially valuable for payers.
“We can work with payers to analyze claims data within the value-based care analytics team,” says Harry Reese, Jr., Vice President and Chief Financial Officer for Ochsner Health Network. “Payers choose Ochsner Health Network to use our data and other solutions to achieve their goals.”
OHN members also have exclusive access to unique programs that reduce costs and improve care. Programs like Ochsner Digital Medicine provide members who have Type 2 diabetes and hypertension with access to personalized support to better manage their condition and achieve their health goals.
We continue to expand our network product portfolio to equip payers to meet market demand. One of our strongest innovations over the past 18 months is the collaboration with payers like BCBS, UHC and Humana to introduce products that are compatible with their ASO clients. ASO products are in high demand because they give large groups the power to insure their own medical costs and design coverage and products unique to them. Since January 2021, our ASO products have gained over 12,000 members. Through continuous development, we look forward to continued innovation, growth and success with our payer partners.
In 2021, OHN began its evolution from a “network of networks” into a single, clinically integrated network with centralized governance, programs, communication and capabilities. This structure allows our providers direct access to the tools and support they need to succeed in their shift toward value-based care.
We are grateful to our leaders for their collaboration and sound decision-making, helping OHN and OACN navigate the challenges of the last year while prioritizing the needs of our patients, providers and healthcare partners.
Scott J. Posecai
Executive Vice President, Insurance Partnerships and Treasurer, Ochsner HealthSidney H. “Beau” Raymond, MD, FACP
Medical Director
Eric Gallagher
Chief Operating Officer
Harry Reese, Jr.
Vice President and Chief Financial Officer
Mary Armstrong
Vice President of Managed Care
Philip Oravetz, MD
Chief Population Health Officer
Pictured top, left to right Louis Jeansonne, MD; Patrick Gandy; Christopher Achee, MD; Timothy Riddell, MD; Chaillie Daniel, MD; Aldo Russo, MD. Middle, left to right: Amanda Logue, MD; Phyllis Peoples; Nicole McKee, MD.2021 OHN Board Members
Warner L. Thomas
President and Chief Executive Officer
Ochsner Health
Pete November
Executive Vice President and Chief Financial Officer
Ochsner Health
Michael Hulefeld
Executive Vice President and Chief Operating Officer
Ochsner Health
Robert Hart, MD, FAAP, FACP
Executive Vice President and Chief Medical Officer
Ochsner Health
Sidney H. “Beau” Raymond, MD, FACP Medical Director
Ochsner Health Network
Sandy Badinger
Chief Executive Officer
Slidell Memorial Hospital – Slidell Division
Joan Coffman
President and Chief Executive Officer
St. Tammany Health System
Phyllis Peoples
Chief Executive Officer
Terrebonne General Health System
Chuck Daigle
Chief Executive Officer
Ochsner LSU Health System –North Louisiana
Amanda Logue, MD
Chief Medical Officer
Ochsner Lafayette General
Nicole McKee, MD
Medical Director of Integration & Quality
Terrebonne General Health System
Patrick W. Gandy, Jr., CPA
Chief Executive Officer
Ochsner Lafayette General
Louis Jeansonne, MD
Chief Medical Information Officer
Ochsner Health
Timothy Riddell, MD Family Medicine
Ochsner Health Center – Covington
Aldo Russo, MD
Gastroenterology
Ochsner Health Center – Baton Rouge
Charles James Fox III, MD Anesthesiology
Ochsner LSU Health Shreveport –Academic Medical Center
Matthew McElveen, MD
Hematology/Oncology
Slidell Memorial Hospital
Patrick Torcson, MD Internal Medicine – Hospitalist
St. Tammany Health System
Christopher Achee, MD Family Medicine Family Medicine Clinic of JALH
Chaillie Daniel, MD Family Medicine
Daniel Clinic
2021 Performance and Operations Committee
Michael David Casey, MD Slidell Memorial Hospital
Pedro Cazabon, MD Ochsner Health
Wayne Cestia, MD Independent, Acadiana Family Physicians
Herbert Druilhet Ochsner Lafayette General
Eric Gallagher, Committee Chair Ochsner Health Network
Michael Hill, MD St. Tammany Health System
Jack Khashou St. Tammany Health System
Timothy Lindsey, MD Independent, Daniel Clinic
C. J. Mayeaux, MD Ochsner LSU Health
Nicole McKee, MD Terrebonne General Health System
Fallon McManus, MD Ochsner Lafayette General
Steven Randall Ochsner LSU Health
Sidney “Beau” Raymond, MD Committee Chair
Ochsner Health Network
Sarah Roberts Ochsner Health
Wanda Robinson, MD
Ochsner Health
Ashley Stevens Slidell Memorial Hospital
2021 Network Development Committee
Karen Blessey, MD Ochsner Health
Chad Braden, MD Ochsner Health
Scott Bergeaux, MD Ochsner Lafayette General
Thomas Groves, Committee Chair Ochsner Health Network
Allen James Lacour, MD Independent, Regional Radiology
Merrill James Laurent, MD St. Tammany Health System
Richard LeBlanc, MD Ochsner Health
Matthew McElveen, MD Slidell Memorial Hospital
Nicole McKee, MD Terrebonne General Health System
Molly Mouton Ochsner Lafayette General
Philip Oravetz, MD, Committee Chair Ochsner Health
Steven Randall Ochsner LSU Health