oregon pebb board presentation · 2017. 10. 17. · oregon pebb board. october 17, 2017....
TRANSCRIPT
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OREGON PEBB BOARD
October 17, 2017
Presenters:Janet O’Hollaren, Interim President, Northwest, Kaiser Foundation Health Plan and HospitalsRahul Rastogi, MD, Vice President and Chief Operating Officer, Northwest Permanente, P.C.Keith Bachman, MD, Oregon PEBB Medical Director
Bdatt.5
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MANAGING/DECREASING
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THE KAISER PERMANENTE DIFFERENCE
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Care without delayRight place. Right care. Right time.
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INPATIENT SERVICES
Evidence:• Kaiser Permanente Northwest has decreased
readmission rate by 21% over the last 3 years and further reductions in 2017
• Value-based contracting with non-KP hospitals
Future initiatives/focus:• Proactive presurgical management • Decreasing patient days in hospital • Avoiding readmission
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Program resources:Integrated health record
Telehealth
Behavioral health integration into primary care
Controlling outpatient utilization
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OUTPATIENT
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2015 2016 DIFFERENCEEmail Encounters 222,717 227,266 4,549 emailsTelephone Visits 56,859 75,322 18,463 visitsVideo Visits 0 694 649 visits
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ACCESS IMPROVEMENTS THROUGH TELEHEALTH
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Tracking
Evidence-Based Protocols and Prescribing
Dispensing and Patient Education
Formulary
STRATEGICPURCHASING
BENEFITDESIGNS
Our end-to-end approach to
managing drug costs and utilization
Program/Resources:• Fully integrated pharmacy with care
delivery
Evidence:• Mail Order Initiative saved nearly $1
million in 2016 • Drug Utilization Action Team saved $25.5
million in 2016• Opioid Use Improvement program results
in cost savings and safety
Future• Continued focus on specialty drug
management• Mail order use
PRESCRIPTION DRUGS
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ECONOMIC STABILITY
NEIGHBORHOOD AND PHYSICAL EDUCATION
EDUCATION FOODCOMMUNITY AND SOCIAL CONTEXT
HEALTH CARE SYSTEM
HEALTH OUTCOMESMortality, Morbidity, Life Expectancy, Health Care Expenditures, Health Status, Functional Limitations
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SOCIAL DETERMINANTS OF HEALTH
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Evidence:Team-based model proactively following the highest risk members
Navigators address social determinants of care and link community resources
We’re tracking 25 financial measures and projecting savings of $6.8 million over 2 years
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DIRECT CARE MANAGEMENT ACTIVITIES TO COMPLEX/HIGH-COST PEBB MEMBERS AND EFFECTIVELY MANAGING HIGH-COST CLAIMS
Team-based, physician-led
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We continuously monitor and evaluate our services to help ensure high-quality, cost-effective care for our members
Evidence:• Market leading for HEDIS®
Improving quality and utilization among PEBB members
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HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
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PRIMARYCARE DELIVERY
SPECIALTYCARE DELIVERY
Behavioral Health Consultants, Navigators, Health Coaches
Triage, Emergency Psychiatric Services, Rapid Access to Mental
Health, Solutions Team
Mental Health Team: Psychiatrist, Therapist, Group Therapists, Nurse
Case Manager, Case Managers, Peers
Brief Interventions, Skills, Education
Treatment Interventions and Programmatic Responses
• Assess• Determine Acuity• Begin Treatment
Utilization Management
Consult Liaison
Brookside Center
Triage Emergency Psychiatric Services
Behavioral Health
Consultant
Primary Care Physician
Self Referral
Emergency Department
Specialty Care
Team-Based Care/Exceptional Needs Care Coordinator/Other
PATIENT START
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Evidence:• Co-locating behavioral health specialists in the PC setting • Ongoing PHQ9 screening in primary care• AUDIT tool used in ER and PC• Rapid Access and Solutions team positively impacting
urgent care needs
IMPROVING BEHAVIORAL AND PHYSICAL HEALTH INTEGRATION
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Meeting/exceeding the target of spending at least 12% of total medical expenditures on primary care
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Date PaidPrimary Care Claims as % of Total Paid Claims
2015 16.2%2016 17%
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To the Public Employees’ Benefit Board for your continued partnership and collaboration…
To our PEBB members for allowing us to serve…
Thank you!