Providing Care and Coverage: The Risks and Rewards (Rhonda Medows)

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Speaker Presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 1-3, 2017 in Washington, DC. Find out more about this forum at www.usnewshot.com.

Healthcare

1 Rhonda M. Medows, MD, EVP Population Health Providence St. Joseph Health November 2, 2017

2
Providence St. Joseph HealthProvidence St. Joseph Health
The 3rd largest not-for-profit health and services system in the U.S.

3
Mike Cotton Carladenise Edwards Mike Waters Linda Marzano
Providence
Health Plan
Physician
Services
Value Based
Care
Payer
Contracting
Population Health
Informatics
Sr. Executive
Assistant
Tammy Wintrode
PHP Health Plans
• Medicare Advantage
• Medicaid & DSNP
• Commercial/Exchanges
• ASO products:
- State Employees
- PSJH Employees
New Product Lines:
- New MA Plans
- MSO Services
PSJH Contracting with
Insurers/Payers
• Payer Contracting Strategy
• Contract negotiations:
• Regional/National Payers
• Value Based Contracting
• Risk Sharing Partnerships
• Performance Incentives
• Tertiary & Quaternary
Services Pricing Strategy
Physician Services
• Physician Recruitment
Services
• Ambulatory Clinical Quality
Coordination
• Patient Outreach for closure
of gaps in care
• Medical Group Performance
• Express Care Retail Clinics
& On Demand Services
Value Based Care
• Value Based Care
• Models of Care & UM
• Caregiver ACO Plan
• Medicare Population
Programs : MACRA, Medicare
Shared Savings Program,
Medicare Advantage
• PacMed Multi-Specialty
Group Practices, Puget Sound
• Tricare Plan: US Family
Health Plan
Population Health Informatics
• Advanced Analytics
• Predictive Modeling
• Collaboration with EPIC, HI,
Regions,
• PHI Capital & Procurement
Coordination
• Pop Health Informatics
Governance
• Government Program
Reporting
Rhonda Medows, M.D.
Karen Boudreau, M.D.
Care
Management
Enterprise Care Management
& Care Coordination
• Care Management
Performance
• Care Management Training &
Support for Practice Based
Care Coordinators
• MSO Care Management
Services for the Complex
Patients
• Medicaid Improvement
Strategy for Complex
Patients/Populations
Population Health
Deepak Sadagopan
Financial Performance
• Pop Health NOI
Improvement
• Monthly Operating Reviews
• Cost of Care Measurement
• Ambulatory Cost
Accounting
• Value Based Care
Analytics
• Long Range Plan Alignment
• Administrative Budget
Plan
• PacMed Financial Services
• US Family Health Plan CFO
Finance
Scott Combs
Updated 8.14.17Executive Vice President
Chief Population Health Officer

4
Providence Health Plans
Lines of Business – 1,087,997 managed lives
2018 Accreditations
Medicare Advantage
Clients We Serve
ASO Large Group Small Group
Individual &
Family
Medicare Medicaid MCO Providence
Preferred
Self Funded
Fully Insured
51+
Fully Insured
1-50
Federal Marketplace
Direct market
Government Sponsored
65+
Government Sponsored
<65
Workers Compensation
Preferred Provider
Organization
September
2017 Covered
Lives
277,875 103,626 68,750 95,969 52,785 36,380 375,320 77,292
Commercial Insured
Providence Health Assurance

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