network optimization: why physician quality should drive your benefits strategy
TRANSCRIPT
1 | © 2015 Grand Rounds, Inc. [email protected]
2 | © 2015 Grand Rounds, Inc. [email protected]
Our Presenters
Jacob BestDirector of Network Development
Jacob and his team are responsible for driving the relationships with Grand Rounds’
network of physicians, provider groups & health systems.
Nate FreeseDirector of Analytics
Nate is responsible for developing Grand Rounds’ approach to rating
Physician quality, predicting patient outcomes, and modeling the
cost-effectiveness of interventions.
3 | © 2015 Grand Rounds, Inc. [email protected]
Agenda
• Introduction• Network Design Trends• Innovative Ways Employers Are Optimizing
Networks • Wrap Up
4 | © 2015 Grand Rounds, Inc. [email protected]
Agenda
• Introduction• Network Design Trends• Innovative Ways Employers Are Optimizing
Networks • Wrap Up
5 | © 2015 Grand Rounds, Inc. [email protected]
Network Design Trends Over Time
Time
Net
wor
k Co
vera
ge
Very Narrow
Very Broad
1970s
HMO Era
1980s 1990s 2000s Today
PPO Era
Narrow Networks
EPOs
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38%
32%
30%Ultra-narrowNarrowBroad
Narrow Networks and EPOs – Employers and Carriers
Source: McKinsey Center for U.S. Health System Reform, Nov 2013. McKinsey & Company.
2014 individual exchange (N = 120). Pct of analyzed silver networks
Network distribution on public exchange:
Public exchanges exhibit high percentage of narrow networks
7 | © 2015 Grand Rounds, Inc. [email protected]
Coverage Restrictions for Academic Medical Centers
35% 94%vs.
Ultra-narrownetworks
Broadnetworks
Networks with Academic Medical Centers in network
Source: McKinsey Center for U.S. Health System Reform, Nov 2013. McKinsey & Company.
8 | © 2015 Grand Rounds, Inc. [email protected]
Employer Value - Narrow Networks
26% savings between narrow
network and broad offering
Source: McKinsey Center for U.S. Health System Reform, Nov 2013. McKinsey & Company.
9 | © 2015 Grand Rounds, Inc. [email protected]
So Narrow Networks Are Here, But What Do Employees Think?
10 | © 2015 Grand Rounds, Inc. [email protected]
Narrow Networks and EPOs – Consumer Perspectives
Source: Kaiser Family Foundation Health Tracking Poll, Feb 2014
Narrow and affordable
Broad and more expensive
Network Choice
51%37%
Which type of health insurance plan would you rather have?
11 | © 2015 Grand Rounds, Inc. [email protected]
Narrow Networks and EPOs – Consumer Perspectives
Source: Kaiser Family Foundation Health Tracking Poll, Feb 2014
Narrow and affordable
Broad and more expensive
Network Choice
63%23%
Of the 37% who chose narrow and affordable - What if you would not be able to visit the doctors and hospitals you usually use?
12 | © 2015 Grand Rounds, Inc. [email protected]
The Achilles Heel of Narrow Networks
• Employees think employers are only concerned with cost savings
• Patients don’t trust the quality of physicians in narrowed network
13 | © 2015 Grand Rounds, Inc. [email protected]
Agenda
• Introduction• Network Design Trends• Innovative Ways Employers Are Optimizing
Networks • Wrap Up
14 | © 2015 Grand Rounds, Inc. [email protected]
1. Direct to InstitutionNetworks
2. Customized Networks
3. Optimized and Augmented Networks
Innovative Solutions Addressing The Cost – Quality Issue
Significant Plan Change Moderate Plan Change No Plan Change
15 | © 2015 Grand Rounds, Inc. [email protected]
1. Direct to Institutions Boeing Approach
16 | © 2015 Grand Rounds, Inc. [email protected]
1. Direct to Institutions: Boeing Approach
• It is hard multi-year investment
• Needs to actually impact care to improve cost / outcomes
• Member communication is critical
Source: Boing Preferred Partnership ACO presentation, MBGH
17 | © 2015 Grand Rounds, Inc. [email protected]
2. Customized NetworksNew Alternative Payors
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2. Customized Networks:New Payers
• Strong value & outcomes
• Risk of payer and member push back
• Often look at institutional quality only
• Best suited to geographically concentrated populations
19 | © 2015 Grand Rounds, Inc. [email protected]
3. Optimized NetworksGrand Rounds Approach
20 | © 2015 Grand Rounds, Inc. [email protected]
Help patients and organizations achieve measurably better outcomesOur mission at Grand Rounds
Watch a 2 minute patient testimonial. Click here.
21 | © 2015 Grand Rounds, Inc. [email protected]
3. Optimized and Augmented Network:Grand Rounds Approach
• Diagnose the Problem with Data
• Influence Physician Choice for Doctor Visits
• Augment Network through Second Opinions
22 | © 2015 Grand Rounds, Inc. [email protected]
Accessibility of physician level quality data has grown exponentiallyDiagnose the Problem with Data
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Provider Level Data
Source: Reuters Health (Dec 2014) overviewing research Published in JAMA Internal Medicine
Selected states disclosing surgical outcomes data
CMS, medical societies, and additional states begin disclosing outcomes data
State APCDs and commercial data vendors begin selling administrative claims data
Individual hospitals and group practices begin disclosing outcomes data
23 | © 2015 Grand Rounds, Inc. [email protected]
Quality scores are based on vast, newly available datasetsGrand Rounds Physician Quality Algorithm
PatientOutcomes Training Expertise Practice
AffiliationAwards &
Publications the top
of doctors
10%7 billion clinical data points analyzed with >96%
physicians evaluated
24 | © 2015 Grand Rounds, Inc. [email protected]
Influence Physician Choices - Average Physician Quality In Orthopedics
Based on quality algorithm output for each HSA with 3+ orthopedists
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Influence Physician Choices – With Physician Quality Optimization
Based on quality algorithm output for each HSA with 3+ orthopedists
Top quality physicians achieve:• 15% lower hospital admission rates• 20–25% lower complication rates• 30–40% lower mortality rates• $1800 saved per office visit case
Optimize Network By Channeling Care
26 | © 2015 Grand Rounds, Inc. [email protected]
Augment Network Through Second Opinions
Based on quality algorithm output for each HSA with 3+ orthopedists
Remote expert opinions achieve:• 66% change diagnosis or treatment plan• 2x faster return to work• 40% removal unnecessary surgeries• $10k+ saved per case
Patient
Expert Physician
Augment Network With Expert Opinions
27 | © 2015 Grand Rounds, Inc. [email protected]
Grand Rounds Customers See Real, Immediate Impact
Talent Retention
MeasurableROI Achieved
MeaningfulPatient Impact
World-class health benefit for employees
20-25% lower complication rates
$1800 saved per visit and $10k+ per opinion
28 | © 2015 Grand Rounds, Inc. [email protected]
Agenda
• Introduction• Network Design Trends• Innovative Ways Employers Are Optimizing
Networks • Wrap Up
29 | © 2015 Grand Rounds, Inc. [email protected]
Concluding Remarks
Traditional narrow networks:
• Tradeoff between cost, coverage and quality
• Patient backlash and confusion
• Implementation pains from switching networks
Optimized and augmented network design:
• Reduced costs by focus on quality
• No patient frustration
• Current network maintained
30 | © 2015 Grand Rounds, Inc. [email protected]
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