Introducing HealthSpan Founded in 1991 Partner organization to Catholic Health Partners (CHP) HealthSpan Partners: HealthSpan Integrated Care HealthSpan Physicians HealthSpan, Inc. 30% interest in Summa Health System HealthSpan Integrated Care (HMO) HealthSpan Inc. (HMO) HealthSpan Inc. (Indemnity/PPO) Toledo Cleveland Lima Springfield Cincinnati Youngstown

The Changing Healthcare Landscape Presented by: Dr. Nick Dreher, Medical Director

Payment Reform Average US Salary vs. Health Insurance Premium From 1999 – 2009, salaries have increased 38% while premiums have increased 131% If other prices grew as quickly as healthcare costs since 1945 Dozen eggs would cost $55 Gallon of milk would cost $48 Dozen oranges would cost $134 Institute of Medicine,

Affordable Care Act and Healthcare Reform Current: Fee For Service New Model: Reward Quality Outcomes and Stewardship of Resources 4

Extreme Makeover Home Edition Team-based approach Open access Patient engagement and empowerment Data-directed quality improvement Engaged leadership Uncoordinated care Over-loaded schedule Physician and practice-centric Arbitrary quality improvement projects Lack of clear leadership and support

What is Population Health Management? Define Population Identify Care Gaps Stratify Risks Engage Patients Manage Care Measure Outcomes 6

What Is the Solution? TRANSFORMATION beyond transaction through technology to manage shared risk by connecting for our patients VALUE DRIVEN CARE 7

How Do We Improve Care and Manage Costs? Patient-Centered Medical Home (PCMH) is one way 8

Care Coordination: What Is It?  The goals of coordinated care o Ensure that patients, especially the chronically ill, get the right care at the right time o While avoiding unnecessary duplication of services AND preventing medical errors VALUE for the Patient = QUALITY/COST 9

Care Coordination  AIM o Effectively identify, manage and track results of PCMH’s high risk patient population through care coordination, patient coaching and education, application of Evidence Based Medicine, and population data analysis and reporting  Interventions o Embed Care Coordination Teams in Primary Care offices, identify high-risk patients and provide high touch to these patients 10

What Is the Goal of the ACO? 11

What Are the Cornerstones of the ACO? Evidence Based Guidelines Care Coordination Information Technology Financial Management Clinically Integrated ACO Network 12

What Are the Components of the ACO? Payer Partners  Insurers  Employers  States  CMS Core Components: People Centered Foundation Health Home High-Value Network Population Health Data Mgmt ACO Leadership Payer Partnerships A group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population. 13

Tying It All Together Integrated elements of a successful ACO Improved clinical outcomes and patient satisfaction linked to Care Coordination embedded in Patient Centered Medical Homes practicing Improvement Science Methodologies that support Population Health Management using Data Analytics across a Clinically Integrated Organization 14

Where Does Wellness Fit In? (To Date, Wellness has not Proven Sustainable Outcome Improvements for Large Populations.)  Interlinking Electronic Medical Record with Wellness Platform.  Physician participation in Wellness goals and monitoring.  Physician based treatment protocol for behaviors related to morbidity, (addiction, obesity, etc…) 15

Comments and Questions 16