Transforming Health Care Delivery
One of Society’s Most Pressing Issues
20% 30% $1.6T
of US GDP
by 2025
of health care cost
is waste
wasted cost
by 2025
Wide Variation in Utilization/Treatment Rates of PSA Screening for Males
65+
Prostatectomy per 1,000 male Medicare
beneficiaries 75 & under with prostate cancer
480 Munster, IN
72 Tulsa, OK
Rates of Cardiac Stenting
29x regional variation
Back Procedures
4% Lebanon, NH
58% Miami, FL
87% ↑ Nat. avg.
Wyoming
58% ↓ Nat. avg.
Hawaii
Wide Variation in Price for Same Service
$0
$10,000
$20,000
$30,000
$40,000
ACL Repair Knee Arthroscopy
Louisville
4X 3X
$0
$10,000
$20,000
$30,000
$40,000
ACL Repair Knee Arthroscopy
San Francisco
3X 3X
$0
$10,000
$20,000
$30,000
$40,000
ACL Repair Knee Arthroscopy
Columbus
5X 6X
$0
$10,000
$20,000
$30,000
$40,000
ACL Repair Knee Arthroscopy
New York
5X 4X
HOSPITAL ASC
Wide Variation in Site of Service Cost
Urgent Care and Walk-In
Clinics
ASCs
Practice-Based Imaging
Emergency Room
Inpatient Surgery
Hospital-Based Imaging ~50% less
60-70% less
~50% less
Independent Physician Hospital-Employed Physician ~60% less
Lower Cost Alternative Hospital-Based Lab ~70% less
Resulting in Above Average Costs – Below Average Outcomes
Longevity vs. Cost
76
78
80
82
84
86
88
0 2 4 6 8 10
Life E
xpe
cta
ncy
Health Care Cost per Capita ($K)
Source: The Journal of the American Medical Association
Health Care Spend (% of GDP)
0%
5%
10%
15%
20%
19
60
19
63
19
66
19
69
19
72
19
75
19
78
19
81
19
84
19
87
19
90
19
93
19
96
19
99
20
02
20
05
20
08
20
11
OECD Average U.S. over Average
If We Eliminated Wasted Cost by 2025
We could more than double
the current level of funding for public education
We could increase our investment in
clean energy by 5x
We could increase global aid to
developing countries by 58x
TRADITIONAL
FEE FOR SERVICE
VALUE-
BASED CARE
Visit length 15 min. 45 min.
Panel size 2,000+ <500
Preventative care Less More
Referrals Patient-directed Tightly
coordinated
Reimbursement Volume x Rate Outcomes
Utilization Volume Evidence
Revenue Rate Risk
99% PATIENTS IN 4+ STAR PLANS
82 PATIENT NPS
30% LOWER TOTAL
COST OF CARE*
50%+ REDUCTION IN
COST TREND
*relative to fee-for-service Medicare
Achieving the Triple Aim through Value-based Care
Achieving the Triple Aim through Value-based Care
Physician leadership
Evidence-based clinical programs
High-value ancillary services
Alignment with health plans
Consumers Served
>14M >37K Clinics
1.1K Payers
80 Aligned Physicians
LEADING CLINICAL RESEARCH
“BENCH”
STANDARD CARE MODELS
“BEDSIDE”
Grounded in Physician-Led
Clinical Governance
FULFILLING THE
TRIPLE AIM
Powerfully Integrating Evidence-Based Medicine
Embedded in Culture
Integrated into Workflow and
Point of Service
Aligned Incentives
Improved Outcomes
Better Patient Experience
Lower Total Cost of Care
OptimalCare Applied Broadly
Gleason & prostate cancer active
surveillance
Colon polyp
surveillance
Barrett’s screening
Epidural steroid
injections
Nuclear stress test for stable CAD
Vertebro-plasty
84% 28% 68% 47% 94% 54%
CONTRACTED PHYSICIANS &
PARTNERS
Lab
Pathology
MEDICAL
GROUPS
Home Health Care
Skilled Nursing Facilities
Pharmacy
Home Infusion
Urgent
Care Ambulatory
Surgery Centers
House Calls
Local Care Delivery Ecosystem
Behavioral Health
Powered by Data & Analytics
Nevada Market Example
36 Locations
6 Urgent Care Centers
375+ Providers
2 Surgery Centers
16 Specialty Departments
7 Convenient Care Locations
99.6% 80% generic RX
substitution rate
telehealth users
directed to lower
site of care
20% 12.5% better HEDIS
measurements
lower health care cost
for PCP patients
Hospice
and
palliative
care
Tele-health
Conven-
ient care
Urgent
care
Online
visits Mobile
medicine
Provider
network
OB/GYN
and Peds
Lifestyle
centers
Integrated EMR and care coordination
Primary
and
specialty
care
Nevada Market Example
New Jersey Market Example
21 Neighborhood Care Centers
14 Surgery Centers
210 Physicians
11% lower inpatient
hospital admits/1000
35% lower ER
visits/1000
lower total
PMPM cost
50%
Massachusetts Market Example
$0 $2,000 $4,000 $6,000
Reliant
Umass Medical Center
Lahey Health
Beth Israel Deaconess Care Org.
South Shore Health System
Boston Medical Center
Partners HealthCare
Variation in Spending Among Mass. Providers
500 providers
320K patients served
90% OF EMERGENCY
ROOM
SERVICES AT
ASC HOPD
Example: Total Cost of Rotator Cuff Surgery
2x 10% OF THE COST
Urgent Care Surgical Care
High Value Ancillary Services
A Transformative Model of Care
BETTER
QUALITY
IMPROVED
EXPERIENCE
MEANINGFULLY LOWER
TOTAL COST OF CARE