Tom Olenzak
Director, Independence Center for Health Care Innovation
Independence Blue Cross
Payer-Provider Partnership Mo...
Independence Blue Cross at a Glance
Medical, service, and ancillary
Medical and ancillary
Service and ancillary
Medical
Se...
• Once-in-a-generation transformation of our industry
• Convergence of economics, regulatory will, and public opinion
o Ou...
4
• Innovation in health care can’t be done alone.
• Identify and align priorities with other entities within the region a...
IBC Innovation Structure
5
We are building a culture ready and willing to embrace innovation
We scour the
landscape to fin...
We created the Center for Health Care
Innovation
6
• Penn Medicine
o Leveraging IBC’s vast databases of claim information and
Penn’s research expertise to identify new ways ...
• Team: Volpp/Asch (PIs), Troxel, Terwiesch, Mehta
• Objective: Prevent vascular events or rehospitalization in the 12 mon...
Demonstrates Enduring Adherence to
Medication Following a Heart Attack
Early Detection of Diabetes
• Who will develop diabetes in the
next 12, 18, and 24 months?
• Which diabetics have undiagno...
Incorporate broad data sources
12
Early Results
Model:
• Current models use over 1,200
features
• Area under ROC Curve = 0.79 across all
ages
Results:
• ...
13
Early Diabetes Detection: Next Steps
Implementation
• Bring algorithms in-house
• Outreach to providers
• Outreach by c...
• DreamIt Health Philadelphia
o Powered by Independence Blue Cross and Penn Medicine.
o Four-month startup accelerator.
o ...
15
STAT Medical Transport Pilot
Challenge
• IBC generates LOH lists
• Care Management works with the
Member to manage cond...
16
Other Joint Initiatives
Medical Transport
• IBC generates LOH lists
• Care Management works with the
Member to manage c...
17
Tandigm Health
IBC and DaVita Healthcare Partners have formed a new company,
Tandigm Health, that will work in tandem w...
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Payer-Provider Summit Boston 2014 - Presentation "Payer-Provider Partnership Models for Health Care Innovation" with Tom Olenzak, Director, Independence Blue Cross

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Payer-Provider Summit Boston 2014 - Presentation "Payer-Provider Partnership Models for Health Care Innovation" with Tom Olenzak, Director, Independence Blue Cross

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Payer-Provider Summit Boston 2014 - Presentation "Payer-Provider Partnership Models for Health Care Innovation" with Tom Olenzak, Director, Independence Blue Cross

  1. 1. Tom Olenzak Director, Independence Center for Health Care Innovation Independence Blue Cross Payer-Provider Partnership Models for Health Care Innovation
  2. 2. Independence Blue Cross at a Glance Medical, service, and ancillary Medical and ancillary Service and ancillary Medical Service Ancillary Potential expansion markets AmeriHealth Caritas AmeriHealth Administrators AmeriHealth Administrators AmeriHealth Caritas AmeriHealth Caritas and AmeriHealth Administrators AmeriHealth Caritas AmeriHealth AmeriHealth Caritas AmeriHealth Administrators AmeriHealth Caritas AmeriHealth Caritas PA & NJ Market Independence Blue Cross AmeriHealth AmeriHealth Administrators AmeriHealth Casualty AmeriHealth Caritas AmeriHealth Caritas AmeriHealth Caritas AmeriHealth and AmeriHealth Administrators AmeriHealth Administrators AmeriHealth Caritas and AmeriHealth Administrators AmeriHealth Caritas and AmeriHealth Administrators Serving 8.2 million people in 24 states as well as the District of Columbia.
  3. 3. • Once-in-a-generation transformation of our industry • Convergence of economics, regulatory will, and public opinion o Our core risk-based business is becoming a commodity o Product migration: fully insured to self insured to defined contribution o Transformation from payments management to care management o Our key business model is shifting: BTB to BTC • Traditional silos are breaking down, new business models are emerging. o Our core business is evolving at an accelerating rate o We are now vulnerable to new entrants and disruptive innovators Why innovation?
  4. 4. 4 • Innovation in health care can’t be done alone. • Identify and align priorities with other entities within the region and nation. • Focus on targets that eliminate waste, enhance the customer experience, and/or improve outcomes. • Work with others to reduce costly fragmentation in the market. • Seek, evaluate, and monitor new and potentially game-changing companies, technologies, and business models. We want to work with partners
  5. 5. IBC Innovation Structure 5 We are building a culture ready and willing to embrace innovation We scour the landscape to find and engage with innovative companies and technology to inform and support our growth strategy. We identify and evaluate new corporate opportunities through our Deep Dive and Tiger Team processes. We lead the effort to accelerate the development of the health innovation community in our region. We are creating a partnership with operating units and HR to design creative methods to incentivize innovative behavior We are building a network through which we are embedded in the health care, technology, and innovation communities
  6. 6. We created the Center for Health Care Innovation 6
  7. 7. • Penn Medicine o Leveraging IBC’s vast databases of claim information and Penn’s research expertise to identify new ways to keep people healthy. o Collaborated on breakthrough Medication Adherence research program. • New York University o Research collaboration between IBC and NYU to use IBC medical and pharmacy claims data to develop artificial intelligence methods for predicting members who have undiagnosed diabetes or who are at risk of developing the disease. • Also in the Region o Leading the creation of HealthShare Exchange of Southeastern Pennsylvania, the first health information exchange in our region that went live in 2012. o Exploring ways to leverage claims, clinical, and other health data to create a joint regional research asset. Early partnership effortsEarly Partnership Initiatives
  8. 8. • Team: Volpp/Asch (PIs), Troxel, Terwiesch, Mehta • Objective: Prevent vascular events or rehospitalization in the 12 months following heart attack Medication Adherence - $5mm CMMI Grant • Design: o 2 arm RCT of 1500 patients o 1 in 5 chance of $5, 1 in 100 for $100 o IF they took their meds (daily) o Social support…e.g., family gets an alert o Low personnel ratio
  9. 9. Demonstrates Enduring Adherence to Medication Following a Heart Attack
  10. 10. Early Detection of Diabetes • Who will develop diabetes in the next 12, 18, and 24 months? • Which diabetics have undiagnosed comorbid conditions?
  11. 11. Incorporate broad data sources
  12. 12. 12 Early Results Model: • Current models use over 1,200 features • Area under ROC Curve = 0.79 across all ages Results: • 590,000 members not diagnosed with diabetes by 2011 were enrolled though 2012 • Model produces probability of being diagnosed with diabetes within 24 months for every member: • 54,000 with > 0.70 likelihood • 18,000 with > 0.80 likelihood • 2,500 with > 0.90 likelihood
  13. 13. 13 Early Diabetes Detection: Next Steps Implementation • Bring algorithms in-house • Outreach to providers • Outreach by case management • Candidates for peer mentoring program Expansion of Models • Refine models • Answer additional research questions • Expand outreach capacities
  14. 14. • DreamIt Health Philadelphia o Powered by Independence Blue Cross and Penn Medicine. o Four-month startup accelerator. o $50,000 in seed funding. o Free work space and legal council o Access to industry executives and Penn & IBC data • 2013 o 10 out of 10 companies still active. o Pilots with both Penn and IBC. o 8 companies remain in the Philadelphia region. • 2014 o Currently accepting applications for the DreamIt’s 2014 class of companies. DreamIt Health
  15. 15. 15 STAT Medical Transport Pilot Challenge • IBC generates LOH lists • Care Management works with the Member to manage conditions • Transport to providers can be a significant barrier Pilot • Utilize STAT, a Dreamit Health 2013 Company, to manage transport options • Utilizing CMS grant to pay for transport • Success measured [tbd]
  16. 16. 16 Other Joint Initiatives Medical Transport • IBC generates LOH lists • Care Management works with the Member to manage conditions • Transport to providers can be a significant barrier • Utilize STAT, a DreamIt Company • CMS grant pays for transport Tele-Dermatology • Discontinuity in specialist referral process allows preventable conditions to worsen • Provides immediate access to dermatologists from PCP location • Tele-derm not reimbursed today • IBC provides payment structure Next Step: Expand the network to other providers and partners
  17. 17. 17 Tandigm Health IBC and DaVita Healthcare Partners have formed a new company, Tandigm Health, that will work in tandem with primary care physicians to deliver high-quality, affordable care • Combines traditional doctor-patient relationships with innovative tools and support • Focuses on enabling, not acquiring, primary care physicians • Provides PCPs with enabling technology including access to real time data and services such as community health workers and home care

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