Transcript Patient centered primary care (PC2)

Health Care
Strategy Update
Dr. Harlan Levine
Executive Vice President
Comprehensive Health Solutions
Customer concerns
Employers
Individuals
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Heath
Quality
Affordability
Accessibility
Productivity
Convenience
Innovation can increase engagement
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Challenges in the health care system
Ranks last or next-to-last on:
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Quality
Access
Efficiency
Equity
Healthy lives*
Lack of infrastructure to
support demands
Escalating costs
Variation in quality and safety
Fragmented system
Primary care shortage
Aging population & increased
chronic diseases
*The Commonwealth Fund – June 2010
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$700B in waste across U.S. system
Key sources of waste1
% of total medical cost
that is waste
Admin and system inefficiencies
4-6%
Provider inefficiencies and errors
3-4%
Lack of care coordination
1-2%
Unwarranted use
11-21%
Preventable conditions and avoidable care
1-2%
Fraud and abuse
5-8%
-30%
Our aspiration is to reduce 50-70% of waste or 15-20%
of medical cost out of the system over time.
1 Thomson Reuters, 2009 White Paper, Where Can $700
Billion In Waste Be Cut From the US Healthcare System
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Responsibility to act
Anthem’s strengths are uniquely positioned…
Commitment to
Quality
Deep
Local Presence
Comprehensive
Care Management
Services
National Scale
Payment
Innovation
…to drive disruptive, but positive change in the system.
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On-going efforts
Improve Outcomes
& Affordability
Provider
Collaboration
Member
Engagement
• Integrated Wellness
Solutions
• Value Based
Reimbursement
• Decision Support
Tools
• Member Steerage
• Patient Safety First
• Clinical Messages
• Improved Targeting
• Gap in Care
Messaging
• Telemedicine
• Condition Care
Programs
• Mobile Messaging
• Administrative
Simplification
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Wellness offerings
Current
Fragmentation
Member portal
Future
Integration
Engagement tools
Optional solutions
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High cost condition management
Pre-Authorization
& Registry
Data Analytics
ClinicalEngine
Integrated High
Cost Condition
Management
Provider
Reimbursement
& Incentives
Care
Management
Integrated technical solutions, disease
specific data and clinical expertise
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Leveraging AIM’s platform
AIM’s Platform of Specialty Benefit Management Solutions
Diagnostic Imaging
Radiology
Cardiology
Imaging
Shopper
Clinically Appropriate
Oncology*
Medical
Oncology
Radiation
Therapy
Specialty
Drugs
Sleep Apnea*
Medical
Benefit Drugs
Diagnosis /
Treatment
Future Member Engagement Capabilities
Safe
Affordable
* Solution currently in development.
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Consumer oriented health solutions
Increased collaboration and innovation must align to improve
outcomes and affordability
Informed Consumers
Value Based Payment
 Find ER alternatives
 Distinction Centers
 Increased nurse interaction
 QHIP
 Cost and quality
transparency
 P4P
 ACOs
 Mobile health solutions
 Bundles
 Patient-Centered
Medical Home
 PC2
Data Exchange and Supporting Technology
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Patient centered medical home pilot results
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Primary care physician support
“…to use health information
technology to increase efficiency,
enhance patient safety and improve
the quality outcomes of our
healthcare delivery…”
– John Bender, MD, FAAFP
“… am truly now becoming part of a
team that provides that care that I’ve
always wanted to provide” ... “The model
of the Patient Centered Medical Home …
is going to save primary care — it’s
going to save healthcare in this country.”
“…It really saved my career.
…. The Patient-Centered
Medical Home model gave
me a blueprint for the first
time in 25 years of how family
physicians should be running
their practice …”
– R. Scott Hammond, MD,
Westminster Medical Clinic
– David Nuhfer, MD,
Family Practice Associates
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Patient centered primary care (PC2)
Reward Value
Patient-centered
care model that
rewards improvements
in quality outcomes
and affordability
Share Information
Patient-Centered Primary Care
Align Care
Improve Access
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Media coverage
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PC2: Helping primary care deliver value
PC2 will support
primary care clinicians
in all delivery settings,
but prioritize those in
independent settings
Critical Mass
Peer Alignment
Expanded
Access
Practice Extenders
Facilitated Access
Data Analytics
Guidelines
Patient Volume
Gain Sharing
Telemedicine
Decision Support Tools
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Future innovation
Advanced tools and technology like Watson will make clinical
decision making more efficient and effective
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More media coverage…
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Anthem and employers: Powerful partners
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