Enhance Member Experience
Puget Sound ACO Program MBGH 35th Annual Conference, April 2015
Jason Parrott l 312.544.2024 l [email protected]
Business Environment Business Realities • Emerging Competition • Partnering for Success • Supply Chain Management
Health Care Profile • $2.5B in annual spend • 500K lives covered • 48 States
Jason Parrott l 312.544.2024 l [email protected]
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Overview of the Model Preferred Partnership (ACO) • Improve Quality • Enhance Member Experience • Reduce Cost Delivery Goals • Incentive Only • Maintain Employee Choice • Simplified Approach Puget Sound Approach • Providence-Swedish Health Alliance & their partners • UW Medicine Accountable Care Network & their partners
Jason Parrott l 312.544.2024 l [email protected]
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Key Contractual Issues Improve Quality • Clinical Outcomes • Preventive Screenings • Health Status • Member Satisfaction Enhance Member Experience • Access to PCPs & Specialists • After hours care • Call Center Triage Reduce Cost • Aligned Financial Incentives • Shared Savings with Quality Gates • Medical, Prescription Drug and Behavioral Health
Jason Parrott l 312.544.2024 l [email protected]
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ACO Plan Structure Financial Incentives • Lower Employee Premiums • Higher Company Funded HSA • $0 Primary Care Office Copay • $0 Generic Drugs Plan Design • ACO Network is ‘In-Network’ • Existing Network for Ancillary • No PCP Requirement • No Gatekeeper
Jason Parrott l 312.544.2024 l [email protected]
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ACO Build Elements Member Experience • Boeing Website – Cost Models, Provider Search, FAQ • Provider Website – Provider Search, Health Records • Call Centers – Scheduling, Issue Resolution, etc. Data
• Timely delivery to ACO Partnerships with other Providers • Geographic Coverage • Balance Access vs. Care Integration Integration Opportunities • Insurance Carriers • Well Being Programs • Onsite/Near-site
Jason Parrott l 312.544.2024 l [email protected]
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Early Learnings Significant Work Effort – internal and external • Contracting • Network Configuration • Data Flow and Vendor Integration Early Communication • Provider Search Functionality • Plan Design Incentives • Member Experience • External Communication Care Transformation • Embedded Medical Home • Multi-Year Approach • Transition of ‘Centralized Programs’ (e.g. Disease Mgmt.) to ACO Jason Parrott l 312.544.2024 l [email protected]
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Jason Parrott l 312.544.2024 l [email protected]
Business Environment Business Realities • Emerging Competition • Partnering for Success • Supply Chain Management
Health Care Profile • $2.5B in annual spend • 500K lives covered • 48 States
Jason Parrott l 312.544.2024 l [email protected]
|2
Overview of the Model Preferred Partnership (ACO) • Improve Quality • Enhance Member Experience • Reduce Cost Delivery Goals • Incentive Only • Maintain Employee Choice • Simplified Approach Puget Sound Approach • Providence-Swedish Health Alliance & their partners • UW Medicine Accountable Care Network & their partners
Jason Parrott l 312.544.2024 l [email protected]
|3
Key Contractual Issues Improve Quality • Clinical Outcomes • Preventive Screenings • Health Status • Member Satisfaction Enhance Member Experience • Access to PCPs & Specialists • After hours care • Call Center Triage Reduce Cost • Aligned Financial Incentives • Shared Savings with Quality Gates • Medical, Prescription Drug and Behavioral Health
Jason Parrott l 312.544.2024 l [email protected]
|4
ACO Plan Structure Financial Incentives • Lower Employee Premiums • Higher Company Funded HSA • $0 Primary Care Office Copay • $0 Generic Drugs Plan Design • ACO Network is ‘In-Network’ • Existing Network for Ancillary • No PCP Requirement • No Gatekeeper
Jason Parrott l 312.544.2024 l [email protected]
|5
ACO Build Elements Member Experience • Boeing Website – Cost Models, Provider Search, FAQ • Provider Website – Provider Search, Health Records • Call Centers – Scheduling, Issue Resolution, etc. Data
• Timely delivery to ACO Partnerships with other Providers • Geographic Coverage • Balance Access vs. Care Integration Integration Opportunities • Insurance Carriers • Well Being Programs • Onsite/Near-site
Jason Parrott l 312.544.2024 l [email protected]
|6
Early Learnings Significant Work Effort – internal and external • Contracting • Network Configuration • Data Flow and Vendor Integration Early Communication • Provider Search Functionality • Plan Design Incentives • Member Experience • External Communication Care Transformation • Embedded Medical Home • Multi-Year Approach • Transition of ‘Centralized Programs’ (e.g. Disease Mgmt.) to ACO Jason Parrott l 312.544.2024 l [email protected]
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