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FLAACOs 2014 Conference - Shift in the Payer Movement in the Provider Space to Augment the Movement of Value Based Integrated Payments - The Evolution to Health Solutions
The document outlines the transformation within the healthcare sector, emphasizing a shift towards integrated health solutions and value-based payment models. It discusses the evolution of the delivery system, driven by healthcare reform and changing market dynamics, with an increasing focus on patient-centered care and cost reduction. Additionally, the document highlights Guidewell Health's strategic partnerships and innovative approaches to address the needs of diverse populations, particularly the Hispanic community.
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FLAACOs 2014 Conference - Shift in the Payer Movement in the Provider Space to Augment the Movement of Value Based Integrated Payments - The Evolution to Health Solutions
- 1. Shift in thePayer Movement in the Provider Space to Augment the Movement of Value Based Integrated Payments The Evolution to Health Solutions Jonathan B. Gavras, MD President, GuideWell Health September 29, 2014
- 3. How Health CareIs Changing…
- 4. A HEALTH SOLUTIONS COMPANY A leadinginnovator enabling healthy communities through new solutions that improve health outcomes and access while driving down industry costs. Integrated HealthIntegrated Health SolutionsSolutions Health InsuranceHealth Insurance market leadermarket leader InnovativeInnovative consumer servicesconsumer services DiversifiedDiversified health productshealth products and servicesand services Health &Health & health carehealth care delivery servicesdelivery services SOLUTIONS
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- 6. GuideWell Health Leadership Focused anddedicated assets to drive the strategic vision of integrated health care Focused and dedicated assets to drive the strategic vision of integrated health care Entrepreneurial and nimble approach Entrepreneurial and nimble approach Strong M&A competencies Strong M&A competencies Tight alignment to affiliated consumer company Tight alignment to affiliated consumer company Culture of innovation and execution Culture of innovation and execution Assimilation of experienced and proven talent Assimilation of experienced and proven talent Possesses Key Requirements to WinPossesses Key Requirements to Win Leverage existing successful provider models and talent Leverage existing successful provider models and talent
- 7. Marketplace Overview Health reformis changing the health delivery system. The system is being turned upside down with the power shifting from Payers and Facilities to Patients and Primary Care Physicians Provider Convergence and Consolidation in the Marketplace - PwC Characteristic` Current Delivery System Future Delivery System Focus Provider and Payer Patient Aim Price Reductions Population Cost Reduction Financial Intent Grow Volume Find Savings and Efficiencies Quality Quality Assurance Quality Dependent Payment Contracts Fragmented Agreements Single Integrated Contract Physician Focus Specialists Primary Care Physicians
- 8. Market Trends Highest proportion ofdeal activity occurred within the Integrated Delivery System Domain With almost 64% of the deal volume and close to 46% of the deal value Consumerism/ retail experienced the second highest deal volume With almost 20%, but only 1.4% of the total value Consumerism/ retail experienced the second highest deal volume With almost 20%, but only 1.4% of the total value The cost containment deal value heavily influenced by the $34B acquisition of Medco The cost containment deal value heavily influenced by the $34B acquisition of Medco Government market transactions account for only 3% of the volume, but about 14% of the deal value Health and wellness accounts for a higher volume than Government market, but only 0.5% of the total value Likely indicates some start-up activity in this domain
- 9. Market Trends Industry consolidation Industry consolidation Different environment from 1990sand 2000s Different environment from 1990s and 2000s Six deal types predominate Six deal types predominate • Seeing both large (Catholic Health East – Trinity) and local (Baptist – Bethesda) Systems • Transactions increased 18% in 2012; facilities by 60% • East and urban markets hottest • Was response to insurer consolidation • Now have separation of “have” and “have nots” of hospital systems • Revenue and operating models changing • Inpatient revenue decreasing • Need for capital • FFS to VBR • Distress • Alliances (usually local) • Adjacent markets • Bigger chassis • Big get bigger • Academic Medical Centers evolve to Academic Medical Systems
- 10. Axioms of ModernHealth Care Industry Healthcare is of local relevance to most people Reform, consumerism, health needs and cost will require variable access and price requirements Quality (and how measure) will drive a large part of health care financing Administrative cost pressure enormous with fixed MLRs There will be those that are advantaged moving forward in the marketplace A new delivery system is evolving – Blurring of provider and payer space – Non-traditional participants – “Radical” alliances – “Mosaic” of delivery system components
- 11. 3,53,5 4,6, 10, 13 4,6, 10, 13 1,111, 11 Accountable Care Organizations (ACO)s 1.Baptist Miami/AMS (Oncology) 2.NCH Healthcare (Naples) 3.BayCare Physician Partners 4.Holy Cross Physician Partners 5.H. Lee Moffitt Cancer Center (Oncology) 6.Cleveland Clinic 7.HMA Brevard 8.Orlando Health Physician Partners 9.First Coast Health Alliance (Flagler Hospital) 10.Memorial Health Network (Memorial SFL) 11.Baptist Health Quality Network (Baptist Miami) 12.Physician Health Partners at Munroe Regional 13.Advantage Health Network (Tenet) Bundled Payment Pilots 1.Mobile Surgical Services 2.Florida Ortho Institute 3.Mayo Clinic Patient-Centered Medical Homes and Similar Programs •>300 Physician Groups •>2,200 Physicians Participating Payment Innovation 22 77 88 99 1212 Payment Innovation footprint: -Population-based payment models in 52 of the 67 Florida counties -27% commercial spend and 28% Medicare spend is flowing through these models Payment Innovation footprint: -Population-based payment models in 52 of the 67 Florida counties -27% commercial spend and 28% Medicare spend is flowing through these models Hospital Pay-for- Performance •33 Hospitals Contracted on a P4P Model Medicare Collaborative Care Models (CCM) Currently 35 and expanding
- 12. Leon GuideWell Health –Current Market Presence Holly Hill, FL Volusia Largo, FL Pinellas Orange Winter Park, FL Tallahassee
- 13. • GuideWell EmergencyMedicine Doctors, LLC (GWEMD) is a non-blue branded, wholly-owned legal entity that will provide high quality, patient- centered, advanced urgent care in retail settings for those we serve in Florida • All GWEMD sites will be staffed by Crucial Care with Board Certified Emergency Physicians and will be Joint Commission accredited • By providing consumers with improved access to emergency medicine physicians, we are able to treat the right conditions in the right setting resulting in superior patient experience, quality outcomes and provider- driven medical savings Existing Vertical Strategic Entities • Serves Volusia (Daytona), Flagler, and Seminole Counties, providing coverage to 51,000 area residents • NCQA Commendable rating • STAR rating of 4.5 • A.M. Best Financial Strength rating of “A+” • Better Business Bureau rating of “A+” • Voted "Best HMO/Health Plan" for 23 consecutive years • Gold Level Worksite Wellness Award Recipient • 15 years as the areas only Healthy Kids provider • Over 35 years of service to Volusia & Flagler counties • Provides medical services to 100,000 Pinellas County residents at 5 locations • Multispecialty practice with 100 providers representing 23 specialties • Serves as a one stop medical home that leverages technology to provide comprehensive integrated ambulatory care • Expanding capabilities in population management and value based care • Participates in all lines of business with essentially all payers • Awarded CMS Medicare ACO with Walgreens • Awarded NCQA Patient Centered Medical Home Level 2 • Serves the area surrounding Tallahassee, providing coverage to more than 125,000 members • Committed to serving as a medical home, focusing on delivering evidence based care directed by Primary Care Physicians, in an effective, timely and cost effective manner • A.M. Best Financial Strength rating of “A+” • STAR rating of 4.5 • NCQA national ranking - #4 for Medicare; #16 for Commercial and #1 in Florida for both
- 14. Delivery System Strategy SupportingSegment Growth Provide vertical (owned) delivery system assets to join with virtual (financially aligned) delivery system assets in creating a mosaic of new models of care that address affordability, create a competitive advantage or close a competitive gap and brings new innovative products and services to market Virtual •Accountable Care Organizations (ACOs) •Patient Centered Medical Homes (PCMHs) •Medicare Collaborative Care Models Alignment of Vertical, Virtual and Other Healthcare Delivery Solutions Vertical Future PartnershipsFuture PartnershipsProvidersProviders Other Delivery System Solutions Consumer Engagement, Decision Support, Transparency Data, Member Rewards and Navigation
- 15. Analytics Financial Management Capability Build Connectivity 20132014 2015 2016 Core Core Integrated HealthAlliances Vertical Delivery System Future State Integrated Health
- 16. A Health CareDelivery Challenge Individual market is going to more than double in the next 3 years due to ACA. At least half of the growth comes from the uninsured. 2013 pre-ACA uninsured rate of 34% in Miami-Dade. Significant market churn within the Exchange and Medicaid and from Groups dropping coverage. The Medicare market will continue to grow due to aging baby boomers. Double digit–19% compared to 0.2% non-Hispanic White–Hispanic population growth in Florida by 2019 particularly from Central and South American countries
- 17. Hispanics Dynamic Betweenthe US and Home Country Culturally Sensitive Integrated Care in the US and “Home” Country Presents a Unique Opportunity to Serve Hispanics
- 18. A GuideWell Health Solution Strategic alliance between GuideWell and Organización Sanitas Internacional (OSI) to create a new company with the purpose of offering a culturally relevant health care delivery model for the important and growing Hispanic market Brings two leading health care brands together GuideWell: parent company to a family of forward-thinking companies focused on transforming health Organización Sanitas Internacional: leading health care business group in Latin America through companies such as Colsanitas, Medisanitas, Sanitas Venezuela, Positiva Sanitas and Medisanitas Brasil as well as a wide network of highly recognized clinics, hospitals and educational institutions
- 19. OSI Organizations Footprint Figures asat Dec. 31/2012
- 20. A GuideWell HealthSolution • Integrated medical care centered around patients and their individual health and wellness needs • Incorporating a patient’s cultural and social needs to deliver holistic and personalized care • Timely identification of health risks and charts a clinical care pathway to improve health • One stop shop conveniently located in dense Hispanic Miami-Dade areas • Extended office hours • Minimize patient wait time • An ‘in-language’ and ‘in- culture’ experience that addresses the differences in how Hispanics use and receive health care services • Welcome the entire family into the care experience since Hispanics see health as a family issue Medical Centers Value Proposition
- 21. Leon GuideWell Health – FutureMarket Presence Holly Hill, FL Volusia Largo, FL Pinellas Orange Winter Park, FL Tallahassee Miami
- 22. Geraghty said GuideWelldispatched a team to Latin America to tour Sanitas’ clinics and hospitals, and they found a high quality healthcare provider with an innate understanding of its clientele’s cultural preferences. “We were impressed with their understanding of how to treat folks,’’ Geraghty said. “They’re focused on quality. They’re focused on running efficient organizations. They’re focused on customer care. The partnership between GuideWell and Sanitas is the latest example of the growing globalization of healthcare, said Steven Ullmann, a health policy expert at the University of Miami business school. But there is also evidence, Ullmann said, that culturally sensitive healthcare can produce better outcomes for patients. “There are studies that have been done that indicate when patients are culturally comfortable with their providers that outcomes become significantly better,’’ he said.
- 23. Reach Us Jonathan Gavras Organization:GuideWell Health Phone: (904) 436 - 4365 Email: jonathan.gavras@guidewellhealth.com Website: www.guidewell.com
Editor's Notes
- #4 Product of the future: How are you changing your offerings to be better positioned to serve the health care customer?