Population Health and Wellness: 2 Stories from Cleveland Clinic. Elizabeth Sump Senior Director, Health Policy Cleveland Clinic
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1 Population Health and Wellness: 2 Stories from Cleveland Clinic Elizabeth Sump Senior Director, Health Policy Cleveland Clinic 1
2 2 population health stories Cleveland Clinic Employee Health Plan Cleveland Clinic Medicare Shared Savings Plan 2
3 Employee Health Plan & Mission Selfinsured 52,000 employees 98,000+ covered lives $410M Book of Business To ensure that our employees receive high quality evidence-driven health care that includes both prevention and treatment at a sustainable cost to the employee and the organization. 3
4 Employee Health Challenges Build a Culture of Wellness Support Healthy Life Style Choices Promote Personal Responsibility Use Accurate Objective Data Control Costs 4
5 Tools Active Outreach/Care Coordination Care and Support Programs Financial Incentives Bully Pulpit 5
6 Resources 6
7 Caregiver Wellness EHP Employees ( ) and EHP Employees + Spouses ( ) 60% 2016 Goal: 55% 50% 40% 30% 20% 10% 27% 34% 50% 52% 51% 53% 51% 0% 9% Dec 2009 Dec 2010 Dec 2011 Dec 2012 Dec 2013 Dec 2014 Dec 2015 Dec 2016 Percent of Unique Employees and Spouses with Diabetes, Hypertension, Asthma, Hyperlipidemia or BMI >27 enrolled in Care Management 7
8 2009 vs Change in Utilization, Cost and PMPM (Medical and Pharmacy Claims) 50% 44.5% 40% 30% 29.3% 20% 14.2% 14.2% 10% 0% -10% -20% -11.6% EHP Metrics EHP vs. Milliman Benchmark Utilization Unit Cost PMPM Median PMPM Milliman EHP primary members only; claims paid through November, 2016 PMPM normalized for ASC Grouper, PBB and 09/01/2010 rate change Includes pharmacy CMS subsidy, rebates and internal savings PBB = Provider Based Billing ASC = Ambulatory Surgery Center Milliman median commercial benchmark 8
9 Pre vs. Post Care Management Enrollment Utilization Trend 1. Number of employees: Diabetes 1,945; HTN 2,510; Asthma 2, Non-normalized PMPM; claims incurred through 3Q16 and paid through 11/2016 9
10 Average Weight Gained or Lost by EHP Population by Healthy Choice Participation 0.0 Not In Healthy Choice In Healthy Choice ,603 4,747 15,399 5,931 16,493 6,608 16,422 7,211 16,115 6,699 Sources: Wellness database; Weight data from COACH, Epic, Fitness centers Weight data collected and aggregated with Ingenix Reports Number of Members in Yellow 32
11 Estimated Percent of Tobacco Users EHP Employees and Spouses by Year 12% 10% 9.9% 9.6% 9.7% 9.5% 8.5% 8.4% 8% 8.5% 8.0% 7.8% 7.5% 6.5% 6.7% 6.3% 6% 6.2% 6.4% 6.0% 5.4% 4% 5.2% 2% 0% 2,464 2,707 2,908 3,407 3,605 3,309 3,430 3,242 2, # of Confirmed Smokers Confirmed Smoking % Max % (if no data = smoker) Sources: Clarity; Optum One CDR Maximum Percent : Assumes that members Not Asked are smokers 11
12 Trended EHP Paid PMPM by Quarter (Medical and Pharmacy Claims) $520 $470 $420 $370 $320 $270 $220 Annual Trend = 7.5% Annual Trend YTD 2016 = 2.6% Annual Trend YTD 2016 = 0.5% Q2 04 Q3 04 Q4 04 Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12 Q1 13 Q2 13 Q3 13 Q4 13 Q1 14 Q2 14 Q3 14 Q4 14 Q1 15 Q2 15 Q3 15 Q4 15 Q1 16 Q2 16 Q3 16 Q1 04 to Q4 09 PMPM Expon. (Q1 04 to Q4 09 PMPM) Q1 10 to Q3 16 PMPM Expon. (Q1 10 to Q3 16 PMPM) EHP primary members only ; claims paid through 11/30/16; Data Sources: EHP Warehouse, HCTA, EHP Financial Summary PMPM normalized for ASC Grouper, PBB, 09/01/2010 rate change and rate exception (April 2012 March 2013) Includes pharmacy CMS subsidy, rebates, internal savings and error adjustment PBB = Provider Based Billing ASC = Ambulatory Surgery Center 12
13 Estimated Cumulative Savings by Bending the Trend Since 2010 $200 $183,000,000 Cumulative Savings (in Millions) $150 $100 $50 $0 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12 Q1 13 Q2 13 Q3 13 Q4 13 Q1 14 Q2 14 Q3 14 Q4 14 Q1 15 Q2 15 Q3 15 Q4 15 Q1 16 Q2 16 Q3 16 -$50 13 Source: EHP Financial Summary; claims paid through November, 2016
14 Cleveland Clinic Medicare ACO Medicare Shared Savings Program Upside only 4,000+ Cleveland Clinic hospitals, employed physicians and select Independent PCPs CCMACO is at risk for ~ 65,000 beneficiaries Medicare Fee-For-Service Jan 1, 2015 Dec 31, 2017
15 Medicare ACO Shared Savings Model Historic Benchmark Adjusted Benchmark Beneficiary Expenditure Savings
16 Key Care Model Transformations Patient centered medical home Care coordination Post-acute network Readmissions Care paths Population health analytics Teamwork
17 2015 Results n = 62,600 Beneficiaries $10,110 $9,659 Target 2015 Spend Best performing 1 st year MSSP ACO Nationwide 6 th best performance of all MSSP ACO s
18 Performance Drivers Inpatient 12% Skilled Nursing 21% 30-day All Cause Readmission 6%
19 Top Quartile Quality Performance 90th Heart Failure Ischemic Vascular Disease All Cause Readmissions Tobacco Screening Falls Screening 80th Diabetes Coronary Artery Disease Hypertension Breast Cancer Screening Colorectal Screening Pneumonia Vaccination
20 80,000 70,000 Total Medicare Shared Savings Program(MSSP) Beneficiaries Number of 2016 beneficiaries 8.1% higher than ,675 60,000 54,431 56,830 60,021 62,582 50,000 40,000 30,000 20,000 10, Q2016
21 70,000 MSSP Membership by Enrollment Type 60,000 50,000 47,463 52,545 57,419 43,865 42,146 40,000 30,000 20,000 10, Disabled Declines Likely due to Medicaid Expansion 7,9568,477 8,344 7,867 7,308 Aged/Dual Declines due to MyCare Ohio program 3,6813,813 End Stage Renal Disease Disabled Aged/Dual Aged/Non-Dual 3,587 1,586 2, Q2016
22 3,000 Utilization Rates 2,580 2,500 2,350 2,000 1,500 1,634 1,558 1, Short Term Hospital Discharge Skilled Nursing Facility or Unit Utilization Days Emergency Department Visits Emergency Computed Tomography Department Visits that (CT) Events Lead to Hospitalizations Magnetic Resonance Imaging (MRI) Events Q2016
23 20.00 Ambulatory Care Sensitive Conditions (Discharge Rates Per 1,000 Beneficiaries) Chronic Obstructive Pulmonary Disease or Asthma Congestive Heart Failure Bacterial Pneumonia Q2016
24 900 Post Acute Utilization Rates Day All-Cause Readmissions Per 1,000 Discharges 30-Day Post-Discharge Provider Visits Per 1,000 Discharges Q2016
25 Lessons Learned Communication is Key! - Employers are extremely effective at delivering wellness messaging Incentives work - Make it meaningful for the audience Cost and quality cannot be considered independently of each other 25
26 ` Every Life Deserves World Class Care 26
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