CAPG | Making Medi-Cal Managed Care Work
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CAPG 2014 Healthcare Conference Making Medi-Cal Managed Care Work Speakers: - James Mason, CEO SynerMed - Kathy Hegstrom, President Advanced Medical Management - Megan North, President Conifer
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CAPG | Making Medi-Cal Managed Care Work
- 1. Making Medi-Cal Managed Care Work Advanced Medical Management, Inc. Kathy Hegstrom President Conifer Health Solutions Megan North President, Value-Based Care SynerMed James Mason President and Chief Executive Officer Presented By:
- 2. “If your plan is for 1 year, plant rice. If your plan is for 10 years, plant trees. If your plan is for 100 years, educate.” - Confucius 2
- 3. • Body text goes here – Bullet text • Sub bullet • Body text here 3Winter is Coming?!
- 4. 4No Need to Lose Your Head
- 5. So You Pick Your Path to the Throne … 5
- 6. Unfortunately, You Also Get…
- 8. Advanced Medical Management • AMM as Management Services Organization (MSO) – Independent Physician Associations – Hospitals • AMM specializes in Niche Clients with Custom Needs – Language & Cultural (Korean, Vietnamese, Arabic ) – Start-ups (single owner, specialty owners) – Unique Structures (Performance-based , Closely held) – Geographic (Rural, Hospital-centric, International) – Limited Knox Keene 8
- 9. Advanced Medical Management • AMM as Fiscal Intermediary (FI) – Government Programs • Medically Indigent • Custodial • Public Health • AMM as Contracted Claims Processing – Health Plans • Overflow during Rapid Expansion • Commercial ACO Demonstration – Hospitals • Dual Risk 9
- 10. Our Goal 10 Transforming how care is delivered while keeping physicians “whole” And engaging individuals to improve the health of populations
- 11. Our Footprint 11 Conifer VBC stats Value-Based Care Office Conifer Health – Service Centers Revenue Cycle Management Client Locations Patient Communications Client Locations Value-Based Care Client Locations Key • Service clients in more than 20 states • 300+ clients • 4+ million managed lives • $17+ billion medically managed spend Value-Based Care Office
- 12. Who Benefits from Us 12 Performing on risk based contracts and driving alignment of physicians Focus on the right population with workflow integration Personalized outreach while controlling healthcare costs Conifer Health sells its value based solutions to many of the stakeholders needed to achieve population health and we are on our way to creating linkages between them
- 13. Focusing on Impact 13 Integrates Disparate Data Identifies Individual’s Needs Drives Actions to the Care Team Provides Outcomes Feedback • Uses risk analytics and predictive modeling • Segments population by risk levels • Predicts future costs and utilization patterns • Proactively manages individuals to improve outcomes
- 14. Technology Platform to Improve Performance 14
- 15. What We Do SynerMed provides an agnostic provider network for Plans • PLANS GET – Low cost, high quality networks • PHYSICIANS GET – Advanced technology, market leverage and better economics through population health management • PATIENTS GET – More choices, high quality networks and a team approach to medicine 15
- 16. Vital Statistics • 400 FTEs • 800,000 members • Serving: • Sacramento • Fresno • Madera • Kings • San Bernardino • Riverside • Los Angeles County • San Diego County • Georgia 16 • $500 Million in healthcare spend under management • All healthcare products: • TANF • SPD • SCHIP • Medi-Medi • Medicare • Commercial
- 17. 17
- 18. Internet of Everything | Healthcare 18
- 19. 19 Back to Your Regular Programming
- 20. • SPDs Lessons Learned • Covered California – Welcome Mat Effect • MCEs • CCI Dual Demo 20The Others! Winter is Coming!
- 21. SPDs • Sicker • Pent up utilization due to lack of access • Dual and Tri DX • Homelessness or near homelessness 21 • 20% sicker than SPDs that opted into Managed Care versus those passively enrolled • Gaps in the PCP model of care • Is the delegated risk/revenue ratio appropriate?
- 22. MCEs • L1s – Who are they? • M1s – What’s the difference? 22 • We don’t know yet – hopefully by the time we speak, we will know more about utilization patterns • Is the delegated risk/revenue ratio appropriate?
- 23. Duals • High-cost, high needs patient population • 55% have 3 or more chronic conditions • 1 in 6 live in an Institution • 50% are Dual DX • Old model was fragmented, confusing and inefficient 23 • Part A • Part B • MLTSS – LTC/Custodial – IHSS – CBAS – MSSP – PACE
- 24. Duals Demo • 456,000 in 8 Pilot Counties: – Alameda – Los Angeles – Orange – San Diego – San Mateo – Riverside – San Bernardino – Santa Clara 24 • 4/1 San Mateo • 5/1 San Diego, San Bernardino/Riverside • 7/1 Alameda and Los Angeles • 1/1/15 Santa Clara
- 25. 25 Questions? This presentation is subject to copyright. Any reproduction or republication of all or part of this presentation is expressly prohibited. All other rights reserved. The names, trademarks, service marks and logos or the sponsors appearing in this presentation may not be used in any advertising or publicity, or otherwise to indicate sponsorship or affiliation with any product or service.