Maximizing Network Opportunities. March 22, 2018

Transcription

1 Maximizing Network Opportunities March 22, 2018

2 Our vision Better cost controls CREATE networks tailored to each market s unique needs and competitive cost structure HEALT H TRIPLE AIM Better experience CONNECT individuals with tools and information to engage them in finding the right providers and the right care Maximizing new market opportunities to make health care more affordable are foundational to helping our members live healthier lives. Better health COLLABORATE with providers to share data and insights to support consistent, high-quality clinical outcomes

3 The move to value-based care Current (traditional) care ACO (value-based) care Fee for Service provider payment Lack of technology and incentives for physicians to proactively coordinate patient care Data and analytics are not routinely shared Care delivery Care coordination Data and information Pay for Value and increased risk sharing Physicians empowered by technology, data and access to UnitedHealthcare programs Analytics provide a full picture of a member s health risks, care and enhance efficiency Costs climb without corresponding health improvements Costs New shared focus with care providers to manage health care costs and quality Complicated health care system confuses and frustrates members Member experience ACO providers provide trusted support in navigating the system

4 The Value-Based Care Spectrum Fee for Service Performance-Based Bundled Payments Accountable Care Programs Level of Financial Risk Degree of Clinical Integration Pay for volume Performance-based contracts Primary Care incentives Episode-based payments Accountable Care Organizations Capitation Sharing savings and/or risk

5 The Move to Value-Based Care How do we advance health care through a new kind of relationship with providers? $36.8B $45.6B $64.5B $12.1 $16.5 $22.2 $23.2 $27.3 $31.9 $2.5 $5.9 $5.3 Performance-based Condition-specific/Bundled payments Accountable care

6 Our value-based status today Impacting over 16 million members 1 110,000 physicians 1 >1,100 hospitals 1 >1,000 Accountable Care Agreements 2 Performance-based % Improvement in Early Elective Deliveries (EED) 6.0% decrease in both ER Escalations to Inpatient A:E ratio and in Potentially Avoidable Admissions Bundles & Episodes 34% reduction in medical cost savings for cancer therapy pilot 4 >25% Orthopedics COE Savings per Bundle 5 (Hip and knee replacements, lumbar, spine and disc procedures) Accountable Care 8-12% Medical cost advantage vs. market % increase in preventative cancer screenings 14% lower ER visits 1 Estimated counts across all lines of business as of December 2017; 2 Includes shared savings, shared risk, full risk, capitation, and medical home contracts across all lines of business as of Dec. 2017; 3 Commercial Hospital PBC programs as of Dec. 2017; 4 Savings provided by UHC Oncology team Dec. 2014; 5 Orthopedics OCE performance, ; 6 Savings provided by UHC Health Care Economics as of Q4 2016

7 Initial results of value-based initiatives COST CONTROLS 18% savings UnitedHealth Premium Program 1 HEALTH 11% fewer Hospital admissions for commercial ACO clients 2 EXPERIENCE 9% reduction In inpatient length of stay for ACOs 2 1. Incremental savings between UnitedHealth Premium Tier 1 physicians and non-unitedhealth Premium Tier 1 Providers, 2013 UnitedHealthcare Network (Par) Commercial Claims analysis for 159 markets ACO results across all UnitedHealthcare lines of business. Rates are based on historical information and are not a guarantee of future outcomes

8 Expanding our flexible product portfolio UnitedHealthcare networks are configured for the needs of specific populations and cost strategies BROAD ACCESS TIERED PLANS CENTERS OF EXCELLENCE NEXUSACO TM TIERED PRIMARY CARE CENTERED PRIMARY CARE CENTERED AND NARROW NARROW 843,006 health care professionals 2-8% Savings 10-20% in episode savings Up to 15% projected savings 3-5% Savings 3-8% Savings 2-5% Savings Largest single health plan network Members are incented to use physicians who will deliver the best value: a broad virtual narrow network Episode of care payment with clinical support for both pre and post event (transplant, kidney, maternity, orthopedics, cancer) Members choose primary care physician and are incented to use ACO physicians and hospitals who have set goals for quality and outcomes Primary care physician helps to navigate referrals and care needs Combining primary care centered with narrow, high-value network Choices within defined, narrow, high-value network driven by local market dynamics National Plan designs that provide incentives or reduced deductibles/cost sharing for seeking care from identified health and service providers are referred to as High Value Networks. Customer level potential savings of High Value Networks will be a function of plan design, geographic mix, service mix, the proportion of total spend currently associated with non-tier 1 providers, and the extent to which that current spend is redirected to Tier 1 providers. Savings estimates relate to UnitedHealthcare s book-of-business results. All figures and estimated savings represent historical performance and are not a guarantee of future savings. Meaningful benefit design differentials needed to achieve the upper bound of savings. Quality and cost-efficiency based on national standards and local benchmarks. (As of May, 2016) Local

9 Maximizing the opportunity of ACOs COST CONTROLS Reduce avoidable admissions Reduce non-emergent ER visits HEALTH Improve high-risk Patient care Improve access to care EXPERIENCE Eliminate costly duplications and improve efficiencies Collaborate for member satisfaction

10 Accountable Care Organizations Commercial Business as of January 2018 WA NH VT ME CA AK OR NV ID AZ UT MT WY CO NM ND MN WI SD IA NE IL MO KS OK AK MS LA TX NY MI PA OH IN WV VA KY NC TN SC AL GA FL RI CT NJ DE MD DC MA Baseline Shared Savings / Shared Risk ACOs ACOs with baseline and NexusACO / CharterACO contracts Notes We have over 100 commercial ACOs contracted today. Over 25 of these groups are also participating in our ACO product models, which span 20 markets in 12 states. Baseline ACOs are embedded in our networks and accessible to all members in these products, but do not involve promotion or tiering *We have over 90 commercial ACOs contracted today and expect to have close to 100 by the end of HI

11 A new level of collaboration to help ACOs be successful Shared savings and shared risk arrangements Quality measures incentives ACO Activation Teams provide local support Population health risk assessments Optum Link Electronic Gateway reduces administrative costs New product designs built on ACO chassis

12 Activation team supports success of each ACO relationship Local ACO Team coordinates the overall relationship Day-to-day clinical transformation consultant who prepares and leads ongoing clinical meetings. Holds weekly calls with the practice to collaborate on process. Health care economics supports contract negotiation, analytics and ongoing reporting. There are ACO HCE dedicated staff in each region. Market medical director is the primary clinical executive for collaboration with the ACO clinical leadership. Includes ongoing engagement with the Practice CMO and Clinical Transformation Consultant. ACO ACO account manager coordinates our ACO relationship management and provides roster and member attribution management.

13 Maximizing the opportunity of bundled payments and episodes COST CONTROLS Bundled and episodic payments deliver significant savings HEALTH Shorter length of stay and fewer admissions and readmissions EXPERIENCE High member satisfaction with experience

14 Evolution of Centers of Excellence (COEs) Bariatric Resource Services Cancer Resource Services Cancer Support Project Congenital Heart Disease Resource Services Neonatal Resource Services Reproductive Resource Services Spine and Joint Solution Transplant Resource Services

15 Centers of Excellence roadmap Spine and Joint Seattle Los Angeles San Diego Portland Bay Area San Bernardino Colorado Springs Phoenix Cleveland Pittsburgh Providence Chicago NNJ/NYC Columbus Philadelphia Denver Indianapolis Cincinnati Washington Kansas City DC Raleigh/Durham St. Louis Oklahoma City Charlotte Greenville Dallas Minneapolis Atlanta Boston Hartford Austin San Antonio Houston Tampa South Florida Current Contracted Centers of Excellence Planned expansion markets Markets and timing are subject to change. This representation is not a commitment that all markets will available by the targeted go live date.

16 Cancer Episode of Care roadmap Participating Groups Advanced Medical Specialties Miami, FL Cancer Specialists of North Florida Jacksonville, FL Center for Cancer and Blood Disorders Fort Worth, TX Denver, CO Cincinnati, OH Dayton, OH NJ/MD locations Dayton Physicians LLC Northwest Georgia Oncology Centers, P.C. Ohio Hematology Care Dayton, OH Marietta, GA Cincinnati, OH Forth Worth, TX Tulsa, OK 150 sites throughout TX and SW OK Memphis, TN Marietta, GA Jacksonville, FL Regional Cancer Care Associates Rocky Mountain Cancer Center Texas Oncology NJ and MD locations Denver, CO 150+ sites throughout TX and SW OK Miami, FL The West Clinic Memphis, TN Tulsa Cancer Institute Tulsa, OK

17 Oncology episode payment program strategy $33M treatment savings for 810 patients in the pilot* Rewards physicians for improved quality and reduction in total cost of cancer Separates oncologist s income from drug sales Builds a learning system to identify best practices for cost and quality Retains oncologist income at present levels (may reduce revenues) Ends oncologist dependence on drug selection for practice survival Identifies and rewards best practices and consistent, evidence-based care UnitedHealthcare launched a 3 year episode payment pilot focused on oncology services that rewards participants for best treatment practices and better health outcomes. Results were published in The Journal of Oncology Practice.* Participants The West Clinic, Memphis Northwest Georgia Oncology Centers, PC, Marietta Center for Cancer and Blood Disorders, Forth Worth Advanced Medical Specialties, Miami Dayton Physicians LLC, Dayton Changing Physician Incentives for Affordable, Quality Cancer Care: Results of an Episode Payment Model, The Journal of Oncology Practice, July, 2014, Lee Newcomer; M.D.; Bruce Gould, M.D; Ray D. Page, D.O., Ph.D..; Sheila A. Donelan, M.S. and Monica Perkins, Ph.D.

18 Expanding access with lower cost options COST CONTROLS UnitedHealth Premium physicians are identified for quality outcomes and cost efficiencies HEALTH Virtual Visits expand access anywhere, anytime for non-er care EXPERIENCE Quality and cost data integrated into provider and condition search

19 Helping our members make informed decisions Premium Care Physician TIER 1 Look for the new UnitedHealth Premium symbol to identify doctors and facilities, individually recognized for quality and cost efficiency. +87,000 Primary Care Physicians +46,000 Specialists 80% of costs Influenced by 16 specialties and 47 subspecialties Our new provider search on our consumer portal, myuhc.com, offers more cost effective options for members to choose from. Members search for: Convenience Clinics Urgent Care Virtual Visits 200% more often than hospitals* Tier 1 indicates physicians and facilities where the member will receive the highest value, including Premium Providers and facilities and ACOs. Includes: Primary Care Physicians Specialists Hospitals Adding Oncology in 2017 *myuhc.com provider monthly search metrics from April, 2015 to August, 2016

20 UnitedHealth Premium We take every opportunity to identify for our members the UnitedHealth Premium Care Physicians who have been recognized for providing quality and cost efficiency* *UnitedHealth Premium Tier 1 physicians have received the Premium designation for Quality & Cost Efficiency, or Cost Efficiency and Not Enough Data to Assess Quality

21 UnitedHealth Premium performance Care and cost variation Comparison of UnitedHealth Premium Care Physicians to non-premium physicians COST VARIATION All specialties Premium Care specialists for all specialties evaluated had: CARE VARIATION Implantable cardiac device Premium Care specialists with cardiology procedure episodes had: CARE VARIATION Lumbar Fusion Procedures Premium Care specialists with orthopedic procedure episodes had: 18% Lower costs between a Premium Tier 1 physician and a non-tier 1 physician 22% Lower average complication rates 16% Fewer average redo procedures 16% Lower average complication rates 24% Fewer average redo procedures Savings estimates based on UnitedHealthcare's 2013 analysis in 154 markets. Figures are based on book-of-business results and represent the national average expected cost differential between Premium Care Physicians and non-premium Care Physicians for entire episodes of care. Actual savings achieved will vary by customer depending on geographic availability and customer-specific service mix. All figures and estimated savings represent historical performance and are not a guarantee of future savings.

22 Current and Future Collaborations COST CONTROLS Shared risk contracts and data sharing for greater efficiencies HEALTH Greater clinical integration and outcomes goals EXPERIENCE Creative plan designs and use of technology to simplify member experience

23 New dynamic collaboration with top health systems Every aspect of health care is changing: We are using this opportunity to work strategically with 100 top health systems to help drive innovation. New relationship management teams with executive sponsors to identify aligned objectives and strategic opportunities Sharing our national data and perspective to collaborate in regional and local opportunities Exploring new opportunities for innovation across UnitedHealthcare, Optum and these health leaders

24 Our vision Our efforts to make health care more affordable are foundational to helping our members live healthier lives. HEALTH Reduce medical costs and medical trend Deliver best quality outcomes Improve population health and patient experience CREATE COLLABORATE CONNECT networks tailored to each market s unique needs and competitive cost structure with providers to share data and insights to support consistent, quality clinical outcomes TRIPLE AIM individuals with tools and information to provide them access to quality care COST CONTROLS HEALTH EXPERIENCE