the alithias transparency platform healthcare consumerism @ work confidential, alithias, inc
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Confidential, Alithias, Inc.
The Alithias Transparency Platform
Healthcare Consumerism @ Work
Alithias provides cloud based enterprise software that helps
self-insured employers and their employees save money.
Confidential, Alithias, Inc.
• Milwaukee, Wisconsin based company• >20,000,000 claim records in SE Wisconsin• The only transparency platform:– Based on a program proven to reduce
healthcare costs– That can support PPO pricing, Direct Contracts,
Reference Based Prices and Medicare Plus plans– Incorporating quality data from the Wisconsin
Health Information Organization
The Alithias Platform
Some of our clients…
4
Alithias means…
Truth In Healthcare
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Agenda
1. The Case for Transparency2. Transparency Platforms:
1. The Good2. The Bad3. The Ugly
3. What is “Quality?”4. Expected Utilization5. Making Transparency Work
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The Case for Transparency
Employees are shouldering more healthcare costs
36% of employees are enrolled in HDHPs
$6,000 - $12,000 deductibles are common
• Case Study: CEO, St. Lucrative• Challenge: Increase revenue and profit in a competitive, flat
market• Few Options
1. Raise retail prices2. Become more efficient3. Generate more revenue from your current customers
• See more patients• Increase RVUs
– See more patients– Bill more
• Health systems act like any other for profit business
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The Case for Transparency
Confidential, Alithias, Inc.
The Case for Transparency
High Deductibles
Not understanding benefit coverage for preventative care
Delaying or not seeking care
78% of respondents said they would have made a different decision had they known the cost of care beforehand. Healthsparq survey, 2015
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Transparency SolutionsThe Good, The Bad and The Ugly
Not all transparency solutions are equal
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Solutions• Most major carriers
provide some type of transparency tool– Utilization = 3% - 5%– No customization– Can’t accommodate
direct contracts– Will not support
incentives or tiered networks
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Customized to Client
Analytics SSO links to
benefits Direct
Contracts Incentive
Management Health literacy WHIO Quality
Data in WI Provider
information Utilization
Reporting Advocacy
Transparency Solutions: The Good
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Transparency Solutions: The Bad
“Average” Prices
No Locations
No Networks
No Providers
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“Total Hip Replacement”
“The Procedure Cost is the facility amount billed to Medicare for this procedure, as reported to the U.S. government. The data is publicly available from the Center for Medicare and Medicaid Services”
Transparency Solutions: The Ugly
Retail Amounts Mean Nothing
Facility Fee Only
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• Correct coding to ensure proper billing is very complex• Most transparency platforms don’t consider provider
technique• Definitions of an “episode” differ, but should include
– Physician fee– Facility fee– Anesthesia– Lab– DME– Imaging
• Fixed, bundled prices are the only way to be certain you are receiving healthcare value.
The Alithias Platform
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What About Quality?• National Hospital Ratings Systems Share Few
Common Scores And May Generate Confusion Instead Of Clarity - Health Affairs, May 2015
• National CMS Data: “Good, but…”– Metrics vs. Outcomes– No Provider specific– No ASC quality scores– Scores often incongruent with other quality evaluations
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The Truth About Quality• CMS Quality Data are not correlated to the procedures
consumers are actually SHOPPING for.– Infection Rates: Before Jan. 1, only those infections in eligible
hospital's intensive care units showed up in the Medicare database through the Inpatient Quality Reporting (IQR) program on Hospital Compare.
– Mortality Rates based on: • Acute Myocardial Infarction • COPD • Heart Failure • Pneumonia • Stroke• CABG surgery
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Quality Data Limitations
…which runs approximately two (2) years behind the current calendar year
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The Truth About Quality
• How does an intensive care unit central line infection rate have anything to do Colonoscopies, Imaging or Orthopedic procedures?
• No one is checking a website when they are having a heart attack or searches for low cost stroke care.
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Quality Scores and Reality
1) There are few standards for measuring quality
2) Comparisons across quality information providers is not helpful
3) If your local health system won’t provide basic quality information they are low quality
4) Procedure volume is the best surrogate
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Alithias Reporting: 400 employee company(Market A)
Data are for demonstration purposes only
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• Additional 2% - 8% of total medical spend– Depends on your local healthcare market– 35% of medical spend is for shoppable procedures– 30% - 50% average savings per procedure– 10% - 30% engagement or “behavior change to use
high value services”
• Effective Steerage– Serigraph
• Year 1 = 5% engagement• Year 6 = 70% engagement
Potential Savings from Transparency
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Making Transparency Work• 6 Requirements
1. Access to data (Medical, Rx)2. Adjust plan design and incentives3. Frequent and regular communications4. Fixed, bundled prices are the only way to
provide perfect transparency 5. Care Navigation support provided by an
advocate, HR or Administrator6. A BROKER to hold service providers
accountable – something Zenefits can not do!
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Results• Employees using the Alithias platform save an average of
$2,000 per procedure.
• Providers are more willing to contract directly or reduce their price in markets where transparency tools are used.
• Prices for certain procedures have dropped >30% in some markets due to consumer demand.
• Transparency is a great way to maximize the benefits of direct contracts or consumer driven plan design.
Alithias makes managing healthcare costs easy.
Ross Bjella 414 469 [email protected] www.alithias.com