Insight to Value-Based Care and A Joint Venture Case Study. Whitney Courser SVP, Sales and Marketing

Transcription

1 Insight to Value-Based Care and A Joint Venture Case Study Whitney Courser SVP, Sales and Marketing WCourser@nuehealth.com

2 Meet NueHealth 22-year-old, privately held, nationally trusted healthcare partner and gateway to valuebased care Partner with Health Systems and Physicians to develop Ambulatory Centers for 58 Excellence (ACE) and hyper specialty facilities ~$828M 2017 consolidated revenue 27.2% 2017 net income 41 Orthopedic capable centers ~$4,833 ~171K/183K Revenue per case 2017(a)/2018 projected case volume Delivers customized services and risk readiness programs that reward high quality

3 Surgical Healthcare is Changing $572 billion spent annually on surgical care $912 billion projected spend annually on surgical care. Currently, only 14% of procedures are done in an ASC, where costs are 45% less.

4 The Reasons Behind the Change Consumerism Purchasers of healthcare are expecting the transition to high-quality value-based care Lower-Cost Sites of Service Providers are seeking alternative ways to generate revenue, protect professional fees and drive down expenses Shift of Risk Payors are shifting financial risk to providers Value-Based Care Payment systems are transitioning to value-based payments

5 Consumerism High Deductible = Financial Burden Patient Defined Value Changes Self-Diagnosis and Referrals User Experience

6 High Deductible = Financial Burden Deductible have increased by 256% between Salaries have only increased by 9% Consumerism Employers could save $56M with low cost steerage Consumers deductibles and premiums decrease as a result Copyright 2018 NueHealth

7 Patient Defined Value Changes Value is defined differently by providers and patients Consumerism

8 Self Diagnosis and Referrals Consumers are doing their own research and self treating In the US, 38% of adults are choosing non-traditional methods of treatment Implementing healthy living with organic foods and physical activity This practice weakens physician relationships with patients User Experience Technology is empowering consumers. When polled, 25% of patients said they would wait less than a minute for help creating a need for virtual consulting Consumers want services and providers in their neighborhoods where they live and want to know what services cost Consumerism

9 Lower Cost Sites of Service Technology Adaptation Expansion of Covered Procedures Care Management

10 Technology Adaptation Advances in technology promote shift to lower-cost sites of service Payers expect reduced readmissions Patients expect improved outpatient care reducing hospitalizations Site Of Service

11 Expansion of Covered Procedures Expansion of TJR Program and Spine Site Of Service

12 Shift of Risk Phase 1 No Risk Phase 2 Shared Risk Phase 3 Up & Downside Risk Quality incentive to provide care in the appropriate site of care Quality gate Care pathways & bundles Care Navigation Risk Shadowing Outcomes Reporting The same components as Phase Two Full financial risk

13 Transformation From Fee for Service to Pay for Value Pay for Value Fee for Service 2015 Shift of Risk Time 202 0

14 Three Viable Paths for Delivery Shift of Risk

15 Value-Based Care Payors Are Transitioning Spends $52 billion (roughly 45% of total spend) through value-based care Runs more than 45% of its medical spend through some form of value-based care model 43% of payments are currently tied to a shared savings programs By 2018, plans to tie 90% of all fee-for-service payments to a specific quality metric

16 60% of Fortune 500 companies are currently using or planning to use value-based centers of excellence, narrow networks or systems by the end of Value-Based Care

17 We Understand The Challenge Better care. More savings. Greater patient experience. Physicians Care Surgical Hospital Why Decreasing professional fees and overall reimbursement Health systems threaten independence, aim to employ surgeons Driving patient satisfaction and superior patient outcomes in lower cost setting How Through ownership the surgeons were able capture the facility fee to offset declining professional fees Development of Physicians Care Surgical Hospital gave the physician owners a voice in how healthcare would be delivered in their market Direct contracting with the payors for more appropriate site of service will continue the shift to value-based contracts today

18 Physicians Care Surgical Hospital Case Study physician owners and management company 6 bed hospital 5 OR Open October physician owners and management company 12 bed hospital 5 OR 17 physician owners and management company 2 health systems 1 mega ortho group Campus ASC under development

19 Physicians Care Surgical Hospital Today Remains a Tier 1 facility for physicians and heath system partners that the payors demand as an alternative to high cost/high overhead large hospitals Physicians Care Surgical Hospital is positioning itself for prospective bundles and risk readiness where all cases benefit in the site of service shift differential Awards Healthgrades Outstanding Patient Experience Award 2017, 2016, 2015 Healthgrades America s 100 Best Joint Replacement Healthgrades 5 star Hip Replacement Healthgrades 5 star Total Knee Replacement Highest profit margin in Pennsylvania for all hospitals 2015, 2016, 2017 (pending)

20 Better Care. More Savings. Increase case volume and financial performance Improve outcomes and patient satisfaction Respond to consumer-driven trends Prepare for financial risk Maximize top and bottom-line revenue Thrive don t just survive in the value-based model Change is not coming it s here. Trust NueHealth to put healthcare back into your hands. Right where it belongs.

21 THANK YOU 22