Minnesota High Tech AssociationMinnesota High Tech Association

June 23, 2010June 23, 2010June 23, 2010June 23, 2010

HealthPartners MissionHealthPartners Mission

To improve the health of our members, patients and

2

our members, patients and the community.

HealthPartnersHealthPartners

• Consumer-governed, not-for-profit

• Health plans, medical group, hospitals

• Health and dental plans– 1.25 million members

The Health of a defined population

To simultaneously optimize…

HealthPartners ApproachThe Triple Aim

44

The Experience of the individual Per capita Cost for the population

How are we organized? How are we organized? Members / Patients / Community

Medical

Dental

Health Plan

Medical & Dental ClinicsPharmacies

Hospitals- Regions- Westfields

Care Delivery

Research Foundation

FoundationsContracted Networks

- Medical- Specialty- Hospital- Pharmacy- DentalDental

Pharmacy

Health Promotion

- Westfields- Hudson

Home Care & HospiceRiverway ClinicsNorth Suburban ClinicsN. St. Paul Transitional CareCentral MinnesotaPNBC

Institute for Medical Education

(IME)

Philanthropy

Administrative support such as: Legal, IS&T, Communications, HR & Finance

- Dental

Strategic Partnerships

- ICSI- MNHIE- MNCM- Other WI partnerships

Health Care Reform

• Coverage for 35-40 million more Americans• Insurance practices/requirement for coverage• Health care changes• $1 trillion price• $1 trillion price• Tax increases (50%)• Medicare cuts (50%)

Real Health Care Reform

• Support healthy life choices• Coordinated care/focus on that triple aim!• Payment reform to support value• Use health information technology to improve

resultsresults• Measure and publicly report quality and cost• Partner with consumers in making choices –

health, care, cost, quality• Adopt innovate approaches that add value • Reduce administrative burden

Support Healthy Lifestyles

• Healthy living = longer life and better quality of life.

Also, lower health care costs.

• Four lifestyle behaviors could impact 25% of health care costs:– Healthy diet (5 servings fruits/vegetables/day)– Regular exercise– Not smoking– Moderate alcohol use/avoiding risky use

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

No Data <10% 10%–14%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1987

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1988

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1989

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

No Data 10% 10%–14%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 2001

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Source: CDC Behavioral Risk Factor Surveillance System

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 2003

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 2004

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 2005

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 2007

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. AdultsBRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: CDC Behavioral Risk Factor Surveillance System

Adherence to Healthy Lifestyle Behaviors and New Disease

High Blood

Pressure Cholesterol Cancer Back Pain

Heart

Disease Diabetes

Difference in 2-year incidence of new disease between peoplewho adhere to 0 or 1 and 3 or 4 healthy behaviors (%)

33

-15 -17

-24

-43 -45

-66

Source:HealthPartners Health Assessment database, 2007

Change health care itselfCoordinated care/triple aim

focusfocus

• Proactive• Prevention focused• Chronic illness care coordinated• Templates, tools and teams• Templates, tools and teams

35

38%

0.946

0.966

0.986

1.006

Tot

al C

ost

Inde

x

25%

33%98%

97%

90%

95%

100%

TRIPLE AIM: HealthTRIPLE AIM: Health--ExperienceExperience--AffordabilityAffordability

HealthPartners ClinicsHealthPartners Clinics

0.91050.906

0.926

0.946

4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09 4Q099%

17%

85%

90%

% patients with Optimal Diabetes Control *

* controlled blood sugar (per ICSI guideline A1C changed from < 7 to < 8 in 1st quarter 2009), BP & cholesterol, AND

daily aspirin use, AND non-tobacco user

% patients “Would Recommend” HealthPartners

Clinics

Total Cost Index

(compared to statewide average)< 1 is better than network average

1.00

0.9400

0.9500

0.9600

0.9700

0.9800

0.9900

1.0000

1.0100

Total Cost Index

AffordabilityAffordability: (Statewide): (Statewide)HealthPartners ClinicsHealthPartners Clinics

0.91

0.9000

0.9100

0.9200

0.9300

0.9400

4Q04

1Q05

2Q05

3Q05

4Q05

1Q06

2Q06

3Q06

4Q06

1Q07

2Q07

3Q07

4Q07

1Q08

2Q08

3Q08

4Q08

1Q09

2Q09

Total Cost Index

Total Cost Index (compared to statewide average)< 1 is better than network average

Total Cost of Care

• A method to measure the overall performance of a medical group relative to other groups.

• Includes all costs associated with treating a patient’s condition:–Professional, facility inpatient and

outpatient, pharmacy, lab, radiology, any other ancillary services

38%

20%

25%

30%

35%

40%

Optimal Care Percent

Health: (Optimal Diabetes ControlHealth: (Optimal Diabetes Control-- Total)Total)HealthPartners ClinicsHealthPartners Clinics

9%5%

10%

15%

4Q04

1Q05

2Q05

3Q05

4Q05

1Q06

2Q06

3Q06

4Q06

1Q07

2Q07

3Q07

4Q07

1Q08

2Q08

3Q08

4Q08

1Q09

2Q09

3Q09

4Q09

Optimal Care Percent

% Patients with Optimal Diabetes Control * *controlled blood sugar, BP & cholesterol (per ICSI guidelines A1C changed from < 7 to < 8 in 1st quarter 2009)daily aspirin use AND non-tobacco user

Saves 364 Hearts, 68 Legs & 625 Pairs of Eyes Each Year

97%

98%

80%

90%

100%

Percent

Experience: (Would You Recommend)Experience: (Would You Recommend)HealthPartners ClinicsHealthPartners Clinics

50%

60%

70%

2Q06

3Q06

4Q06

1Q07

2Q07

3Q07

4Q07

1Q08

2Q08

3Q08

4Q08

1Q09

2Q09

3Q09

4Q09

Percent

Measure: % of HPMG patients surveyed who answered “Yes, definitely” and “Yes, probably” to "Would you recommend this office to your family and friends?"

38%

0.946

0.966

0.986

1.006

Tot

al C

ost

Inde

x

25%

33%98%97%

90%

95%

100%

TRIPLE AIM: HealthTRIPLE AIM: Health--ExperienceExperience--AffordabilityAffordability

HealthPartners ClinicsHealthPartners Clinics

0.91050.906

0.926

0.946

4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09 4Q099%

17%

85%

90%

% patients with Optimal Diabetes Control *

* controlled blood sugar (per ICSI guideline A1C changed from < 7 to < 8 in 1st quarter 2009), BP & cholesterol, AND

daily aspirin use, AND non-tobacco user

% patients “Would Recommend” HealthPartners

Clinics

Total Cost Index

(compared to statewide average)< 1 is better than network average

Payment Reform to Support Value

• Take the emphasis off fee-for-service• Pay for value (triple aim)• Move to Total Cost of Care approaches• Re-evaluate fee-for-service weights and

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• Re-evaluate fee-for-service weights and payment levels

Leveraging Technology

• Use the electronic medical record to improve care

� Disparities Initiative� H1N1 Outreach

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� H1N1 Outreach• Online patient services: 221,000 patients

(10.5 millions test results)• m.HealthPartners.com (already 10,000 per

month)

Partner with Consumers

• Decision support – better information about care choices

• Measure and publicly report quality and costcost– Minnesota Community Measurement– www.HealthPartners.com: Cost

Comparison Tools• Support healthy choices

Reduce Administrative Costs

• Reduce administrative burdens– Paperless Plan – No paper Explanation of

Benefits necessary– Electronic Enrollment– Electronic Enrollment– Online billing, payment and record

maintenance– Electronic provider payment

�Electronic claims submission – 90%�Auto adjudication – 85%

HealthPartners Advantage

• Consumer-governed, not-for-profit status

• Low administrative costs 5.4%++

• Responsible margin 2.3%___________

Better value for customers

Real Health Care Reform

We’ll advocate for it.We’ll be an example of it