achieving success under - optum€¦ · analytics on medi-cal er traffic and mssp opportunity...

Achieving Success Under Evolving Financial Models: Leveraging Data and Analytics to Improve Outcomes

Ann Boynton

DIRECTOR OF CARE SERVICES AND INNOVATION

UC DAVIS HEALTH

A NA LY TICS

Erik Johnson

PRACTICE LEAD

OPTUM ADVISORY SERVICES

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Only level 1 trauma for both adult & pediatric for inland Northern California. 33 counties covering a 65,000-square-mile area north to the Oregon border and east to Nevada.

ER visits 80,574 Faculty & academic 1,526

Clinic/office visits 908,542 Residents & Fellows 933

Admissions 34,763 Students 1,009

Observation days 7,188

Staff 11,310

UC Davis Health 625-bed multispecialty academic medical center & designated Public Hospital


Geographic overview


Regional landscape

4 hospital systems Very few non-aligned physicians

Heavy HMO and MA penetration Kaiser controls ~60% of county HMO market

UCDH Hospital discharges Government payers dominate

• 38% Medi-Cal

• 35% Medicare

Primary care clinics Almost exclusively commercial and Medicare


Academic research supports the community

.UC Davis Children's Hospital nationally ranked pediatric hospital with more than

120 physicians in 33 pediatric subspecialties

.UC Davis MIND Institute devoted to finding treatments and cures for

neurodevelopmental disorders such as autism

.UC Davis Alzheimer’s Disease Center

.UC Davis Comprehensive Cancer Center one of only 41 National Cancer Institute-designated

comprehensive centers nationwide

.A pioneering telehealth program gives remote, underserved communities access to academic

specialty and subspecialty care

.Clinical and translational research in cancer, neurosciences, regenerative medicine, infectious

disease, among others


Current contracting overview

• MSSP Track 1 (started January 2018)

• Anthem Commercial ACO

• HMOs – including some total cost of care agreements and full risk

~ 75k lives in some kind of value-based contract


Savings generally misaligned to investment

Fixes in health care are challenging and results are slow to materialize

Can take years to discover an innovation doesn’t result in expected benefit

Preventive measures important, but return may be years away

Investment in prevention for the future and immediate problems = increased cost now

Management of FFS patients generally uncompensated


Market is everything

.Dense concentration of health systems

.History shows adverse selection even in commercial plans

.Generally poorer health outcomes compared to the rest of the state


Building capacity to manage at-risk

Tools People Process


Assess existing and emerging issues

.Analytics on Medi-Cal ER traffic and MSSP opportunity before applying

.Evaluation of our pricing against other commercial in health plan target areas

.Care disparity between teaching and non-teaching clinics


Building foundational analytics

.Rising risk and future high cost claims potential

.Disease specific cost and utilization analysis to identify intervention opportunities

.Registries for ambulatory care management

.Utilization patterns

.HCC analytics

Analysis focuses on value-based contracts

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achieving success under - optum€¦ · analytics on medi-cal er traffic and mssp opportunity...

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