Transitioning to Value-Based Care: Care1st Population Health Model

BANNER AND CARE1ST POPULATION HEALTH MODEL Transitioning to a value based model focused on outcome measures driven by providers and engaged members

2 Care1st Health Plan Arizona, Inc BACKGROUND

3 Care1st Health Plan Arizona, Inc Banner / Care1st Medicaid Contract Global Risk sharing agreement based on total cost PMPM by risk groups for the assigned Acute AHCCCS membership (excluding NEAD population for minimum year one) October 1, 2014 Start Date Focused on 5 Banner Primary Care Physician group practices Application of population health strategies to a Medicaid population Adult and Pediatric population Members: 5,374 distributed across Maricopa County Pediatric: 2,470 Adult: 2,904

4 Care1st Health Plan Arizona, Inc Readiness Elements: April Oct 2014 Provider Team and Accessibility- Pediatric and Adult Physician Leadership- Champion Operational Resources/Upfront $ s- Dedicated Staff IT/Clinical Data- Sharing of Reports Patient Engagement- Predictive Modeling of HN/HC Shared Governance- Strategic Alignment

5 Care1st Health Plan Arizona, Inc Structure Implementation Joint Meetings: Clinical Meetings/ Monthly - Improve care delivery through higher quality care, lower inappropriate utilization, and collaboration of joint resources Administrative Meetings/ Monthly - Identify issues and opportunities for financial improvement (OON UM), Pharmacy Trends, Provider Services/ Network Credentialing, IT / receipt of required data files Quarterly Strategic Meetings/ Quarterly - Provide leadership overview of current status of financial and quality metrics outlined in the contract. Develop monitoring activities and track progress against annual strategic plan.

6 Care1st Health Plan Arizona, Inc Quality Incentive for Year 1 Pediatric Quality Measures Annual Dental Visits (ages 2-20 years) Well Child Visits (first 15 months) Well Child Visits (ages 3 6 years) Adolescent Well Visits (ages 12-21 years)

7 Care1st Health Plan Arizona, Inc YEAR ONE

8 Care1st Health Plan Arizona, Inc Status Prior to Contract Implementation Different decentralized workflows/processes Variable approaches to patient outreach Lack of knowledge of which patients were actively engaged in care management programs Lack of data Lack of staff to implement outreach Different EHR s across provider groups Lack of understanding of AHCCCS benefits

9 Care1st Health Plan Arizona, Inc Focus Work Year 1 Work flows Standardize across the multiple health clinics/health centers Improve efficiency Centralize some components Acute setting Improve care coordination/transitions of care Develop common EMR (incidental to system wide initiative) Improve reliability of PCP identification Dental Care Increase awareness and access to information Adolescent Care Strengthen outreach to patient and care givers Improve overall access to care

10 Care1st Health Plan Arizona, Inc BEST PRACTICES

11 Care1st Health Plan Arizona, Inc Improve Efficiency Remove the provider as the data collector Streamline process for patient call backs and follow ups Coordinate transition care from acute care to ambulatory care

12 Care1st Health Plan Arizona, Inc Standardized Approach Use a centralized resource Review data Collate per region, practice, provider Designate individual designated as point of contact at each clinic/health center Update bi-weekly to monthly Develop basic workflows Front office Working care gaps Messaging to patients Reporting and communicating to practices

13 Care1st Health Plan Arizona, Inc Process Work Flow for Ambulatory Setting Centralized Administrative MA Organizes, Reviews & Pushes to Practice Designated Individual within Practice Identifies Care Gaps, Utilization Concerns Reports Generated Care1st Plan of Care Instituted* Practice Team Works the Report *May prompt referral to CM

14 Care1st Health Plan Arizona, Inc RESULTS

15 Care1st Health Plan Arizona, Inc Dental: Increased Awareness Work flow in clinics/health centers Reminder every patient/every time about importance of dental care Last dentist visited easily accessible by practice Information given to patient and family Reminder cards Tri-fold dental flyer used to encourage parents to take child to dentist Results to date Tracking to hit target, likely will hit stretch

16 Care1st Health Plan Arizona, Inc Adolescent Well Care Update to Work Flows to Target Opportunity Increased focus on adolescent care Adolescent well care/sports physical letter sent to parents Providers encouraged to do Adolescent Well Care during sick visits Front office workflow created Results to date Improved, likely to hit target

17 Care1st Health Plan Arizona, Inc Well Child Visits Well Child visits (first 15 months) Tracking to exceed target Well Child Visits (ages 3 6 years) Tracking to exceed target

18 Care1st Health Plan Arizona, Inc YEAR 2

19 Care1st Health Plan Arizona, Inc Year 2: Process Changes Developing rolling 12 month quality reports By region, practice, provider Continue monthly push of Care1st quality data to practice Standardize appointment templates Add PCPs in areas of high need Transition from acute care to ambulatory care Evaluate more efficient utilization via mid-level providers Increasing patient outreach Appointments made prior to discharge More frequent appointments oPatients with multiple chronic conditions oHigh risk for ED use or hospital admissions