mission health’s journey to accountable carethan mhp; 334 were higher (or 92%) – benchmark...

NCIOM Annual Meeting I September 25, 2017 I 1

Ronald A. Paulus, MDPresident and CEOSeptember 25, 2017

Mission Health’s Journey to Accountable Care


Our BIG(GER) Aim: To get each person, to their desired outcome, first without harm, also without waste and always with an

exceptional experience for every patient, family and team member.


MAP OF MISSION HEALTH SYSTEMWestern North Carolina 18-County Service AreaPopulation (2016): 882,581Percent over 65: 22%


27 Primary Care Clinics

Primary Care Sites


Specialty Sites

23 Specialty Care Clinics


CareScience Risk-Adjusted 30 Day Readmission O/E ( 1 = average; lower is better)

Mission Health Risk-adjusted Mortality (compared to State and Nation)

0.55

0.68

0.40

0.50

0.60

0.70

0.80

0.90

1.00

2011Q1 2011Q2 2011Q3 2011Q4 2012Q1 2012Q2 2012Q3 2012Q4 2013Q1 2013Q2 2013Q3 2013Q4 2014Q1 2014Q2 2014Q3 2014Q4 2015Q1 2015Q2 2015Q3 2015Q4 2016Q1 2016Q2 2016Q3 2016Q4

Obs

erve

d/Ex

pect

ed

Mission Mission System National NC Linear (Mission System)


0.64

0.87

0.5

0.6

0.7

0.8

0.9

1.0

1.1

2012Q1 2012Q2 2012Q3 2012Q4 2013Q1 2013Q2 2013Q3 2013Q4 2014Q1 2014Q2 2014Q3 2014Q4 2015Q1 2015Q2 2015Q3 2015Q4 2016Q1 2016Q2

Obs

erve

d/Ex

pect

ed

CareScience Risk-Adjusted 30 Day Readmission O/E (1 = average; lower is better)

Mission Mission System National NC Linear (Mission System)

Mission Health Risk-adjusted Readmissions (compared to State and Nation)


Geisinger Health System

Careworks Convenient Healthcare

Non-Geisinger Physicians With EHR

Last updated 08/18/09

Geisinger ProvenHealth Navigator SitesContracted ProvenHealth Navigator SitesGeisinger Medical GroupsGeisinger Specialty Clinics

Geisinger Inpatient FacilitiesAmbulatory Care Facility Geisinger Health System Hub and Spoke Market AreaGeisinger Health Plan Service Area 9

NCIOM Annual Meeting I September 25, 2017 I 12 12


Primary Care Council – December 2011

Thanks for your nice note and the invitation to become a member of the Primary Care Advisory Group. I would be glad to participate in that group based on your assurance that we will have a seat at the adult table, and not be an ancillary group, there for show.


Primary Care Summit – November 2012• > 100 attendees• High satisfaction


Primary Care Service Line November 2013


Clinically Integrated Network: Key ComponentsLegal Structure & Governance

Flow of Funds

Contracting

Information Technology

Physician Leadership

Infrastructure

Participation Criteria

Performance Objectives

Clinically Integrated Network

Source: Dixon Hughes Goodman and Nexsen Pruet


SWOT Summary (Mission Health/Physician Community)

• Strengths– Strong position of high quality– Relatively low cost producer of care across a very broad spectrum of

services– Excellent physician community committed to excellence

• Weaknesses– Payer mix– Somewhat late start on population health– “Hero culture” vs. systematic management– Some “mistrust” between health system and physicians


SWOT Summary (Mission Health/Physician Community)

• Opportunities – Improve fee-for-service performance via care model redesign– Create Population Health model to secure future and benefit

community• Threats

– Declining reimbursement– “Hospital” vs. “Physician” vs. COMMUNITY optimization– Major shift in competitive landscape– Someone else seizing the “Population Health Dividend”


Mission Health Partners


Network Development Timeline

Network Initiation

Network Development

Financial Support

IT Support

Quality Improvement

Payor Contracting

Demand Management

Jan Feb Mar Apr May Jun JulDec

Baseline requirements for membership Incentive payment modelingData testing Patient engagement

Develop evidence-based modelsPredictive modeling

NOI for MSSPMedicaid readiness

MSSP applicationEmployee/ commercial plan

Case ManagementConcurrent reviewProvider profilingRx management

Engage CIN consultantForm committeesDevelop governanceIdentify capital source

PCP reimbursement process

High level ROIContracting model (FFS, Cap, savings distribution)

Develop membership criteriaPCP recruitment strategy

Specialist considerationsAncillary considerationsPCP credentialing PCP contracting

Claims and clinical data capture and analysis

Form committeesDevelop governanceIdentify capital

Form committeesDevelop governanceIdentify capital

Data testing Engage CIN consultantForm committeesDevelop governanceIdentify capital source

Financial operations

Data capture mechanismData testing

Acquisition, implementation & testing in independent practicesPatient portal

2013 2014


Phase I Milestones


Year 1 MSSP Quality PerformanceOnly measure where lower is better – Poorly Controlled Diabetics


-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

2015 2016 2017

MHP Membership By Payer By Year

MSSP Mission Humana MA United MA Healthy State

59,000

72,841

90,201


One of the Lowest Total Spends Nationally

24


MSSP: Very Low Spending Benchmark…

• Of 362 ACOs (2015), only 27 (7.5%) had lower targets than MHP; 334 were higher (or 92%)– Benchmark spend/beneficiary: $22,777 (max) $10,400 (min)– MHP Benchmark spend/beneficiary: $8,047– Difference: $14,730/$2,353

• In 2015 ACOs that achieved shared savings had an average benchmark of $11,393; those that didn’t had an average benchmark of $9,986.


Results• Managed Mission Health’s self-insured medical trend: • +2.6% vs. +6.5% national trend (3.9% trend shift) • Mission Health Partners:

– Reduced Readmissions 6.2%– Decreased ED Utilization 5.8%/1,000/year among Medicare

beneficiaries • Quality among nation’s best: 2016 MSSP Quality Score 97%,

up from 95% in 2015• Saved Medicare $11.2 million and via 97.6% quality score

earned $5.3 million gain share

mission health’s journey to accountable carethan mhp; 334 were higher (or 92%) – benchmark...

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