For more information contact: Slideshare@marcusevans.com Presentation delivered by Michael Krusen, Director, Network Management, Health Partners Plans at the ACO Payer Leadership Summit Spring 2015 held in Las Vegas, NV

1. Health Partners PlansHealth Partners Plans
Challenges and SolutionsChallenges and Solutions
in the
Ch i L dChanging Landscape
of Healthcare

2. WHO IS HEALTH PARTNERS PLANS
• Locally owned by 5 leading Philadelphia hospital systems
• Began in 1985Began in 1985
• Bucks, Chester, Delaware, Montgomery, Philadelphia counties
• Medicaid, Medicare, CHIP lines of business
• 200k members across all lines of business• 200k members across all lines of business
• 650 employees

3. OUR NETWORKOUR NETWORK
• 44 Hospitals
500 A ill id• 500 Ancillary providers
• 5500 PCPs, specialists, allied health practitioners
The above network includes:
• Small independent practitionersSmall independent practitioners
• Large health system practices
• All federally qualified health centers (FQHC)
CRNP• CRNPs
• PAs

4. OUR MISSIONOUR MISSION
Our mission statement stands behind everything we do.
• To manage our business to exceed expectationsTo manage our business to exceed expectations
• To operate with respect and dignity in all relationships
• To continually improve the health outcomes of our members

5. OUR COMPETITIONOUR COMPETITION
LARGEREGIONALAND NATIONAL PLANS

6. ACCOLADESACCOLADES
• Ranked #1 Medicaid health plan in Pennsylvania by NCQA• Ranked #1 Medicaid health plan in Pennsylvania by NCQA
• Ranked #20 Medicaid health plan in the country by NCQA
• Ranked #3 best large place to work in Delaware Valley

7. 2014 PROVDIER SATISFACTION2014 PROVDIER SATISFACTION
Using The Myers Group to administer the tool:
• 79.2% - Overall satisfaction with plan compared to 65.9%
across TMG Medicaid book of business
88 1% ld d HPP t th id d t• 88.1% would recommend HPP to other providers compared to
80.5% across TMG Medicaid book of business

8. OUR PCP MAKE UPOUR PCP MAKE-UP
• 215 PCP Tax IDs (TIN) with members assigned to them across
all 4 lines of businessall 4 lines of business
– 40 of those TINs manage 78% of our members
– 18 of those TINs manage 61% of our members
– 7 of those TINs manage 45% of our membersg

9. ALIGNED NEEDSALIGNED NEEDS
Access
Data
Provider Payer
Data
Quality
Revenue
S ti f tiSatisfaction
Volume

10. BUILDING A PARTNERSHIPBUILDING A PARTNERSHIP
The relationship between provider and payer is more critical now
than ever in our industry.
• Local/State/Federal IncentivesLocal/State/Federal Incentives
• Medicare STARS
• HEDIS
NCQA• NCQA
Provider support and buy-in are necessary for payers to come out
winners in these areas.

11. BUILDING A PARTNERSHIPBUILDING A PARTNERSHIP
HPP has developed a collaborative approach to building these
partnerships.
• 9 Network Account Managers
• Quarterly meetings with senior leadership
• Medical Practice Advisory Committee (M PAC)• Medical Practice Advisory Committee (M-PAC)
• Advisory Board

12. Q lit & D tQuality & Data
Quality will come with lots of data………
I b i bl• It must be actionable
• It must be acted upon
• It must be focused and targetedg
– Too much data will be overwhelming and not actionable
– Providers must know how to respond to the data and what the incentive
will be if they respond to it

13. Q lit & D tQuality & Data
Quality is not just about outcomes
It is also about how that care is reported to the payer.
ICD9
CRITICAL
CPT4

14. S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?
Quality Care Plus PCP Incentive Program
S d i J l 2012• Started in July 2012
• 100 Members on Panel
• Panel must be open to new membersp
• Percentile ranked against peers
• Rankings below 50th percentile in any given measure receive
no compensationno compensation
• QCP compensation accounts for 17% of total PCP annual
compensation
TIN d i l l d• TIN and site level report cards

15. S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?

16. S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?
Quality Care Plus PCP Incentive Program
Thi l l h d h i hThis program completely changed the way we engage with our
PCP network
– Completely refocused our provider relations staffp y p
– Routine meetings with senior level staff
– Competition within provider groups and outside provider
groupsgroups
– Connected with “the person who cares about the money”

17. S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?
New Provider Portal
C E iCurrent Environment
• Using a virtually unknown provider portal vendor
• Only payer in our market using this vendory p y g
• Limited functionality
• Requires separate login
• Dissatisfied usersDissatisfied users

18. S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?
New Provider Portal
N E iNew Environment
• Move to Navinet
– Every other payer in our market is on NaviNet
• Listened to provider partners feedback
– Single sign-on for all payers
– Broad range of functionality
New NaviNet Open platform– New NaviNet Open platform
• Impressive user interface

19. S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?
NaviNet & Risk Adjusted Rates
B ildi f i li i ll k i dBuilding new functionality to systematically work missed
diagnosis code opportunities
– From manual paper process to electronic interactive process
– Communicates potentially missed diagnosis codes and missed
appointments
– Users can update diagnosis codes and submit back to HPP, generating a
l i th h th N iN t f ti litclaim through the NaviNet functionality

20. S Wh t did HPP d ? Wh t d i ?So….What did HPP do? What are we doing?
NaviNet
E h i h i Gi i h h h dEnhancing the user experience…Giving them what they need:
• Care Gap Reportsp p
• Full suite of authorizations
• Claim Reconsiderations
• ADT information (still in planning)ADT information (still in planning)

21. N iN t t ith t iNaviNet – not without issues
HPP initiated this with an aggressive timeline
• Need to impact risk adjust rate scores
• Need to move to a platform that was being used heavily in the
community
• Need to provide enhanced functionality not available on
current portalcurrent portal
This all lead to:
• Unrealistic expectations
• The unknown of a new platform – trying to work out the
d t ildetails
• Other pressing priorities

22. SSummary
• The landscape of health care is changing rapidly – we all knowp g g p y
this
• Collaborative payer/provider relationships are critical to keep
the pace full engagement must be committed on both sidesthe pace – full engagement must be committed on both sides
• Creative and out of the box approaches work
• Get to the person who cares about the money!!
• Don’t recreate the wheel, but be on the cutting edge when it
makes sense
• Listen to your providers – they have good ideasy p y g

23. Q tiQuestions