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OREGON PEBB BOARD
October 17, 2017
Presenters:Janet O’Hollaren, Interim President, Northwest, Kaiser Foundation Health Plan and HospitalsRahul Rastogi, MD, Vice President and Chief Operating Officer, Northwest Permanente, P.C.Keith Bachman, MD, Oregon PEBB Medical Director
Bdatt.5
MANAGING/DECREASING
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THE KAISER PERMANENTE DIFFERENCE
Care without delayRight place. Right care. Right time.
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INPATIENT SERVICES
Evidence:• Kaiser Permanente Northwest has decreased
readmission rate by 21% over the last 3 years and further reductions in 2017
• Value-based contracting with non-KP hospitals
Future initiatives/focus:• Proactive presurgical management • Decreasing patient days in hospital • Avoiding readmission
Program resources:Integrated health record
Telehealth
Behavioral health integration into primary care
Controlling outpatient utilization
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OUTPATIENT
2015 2016 DIFFERENCEEmail Encounters 222,717 227,266 4,549 emailsTelephone Visits 56,859 75,322 18,463 visitsVideo Visits 0 694 649 visits
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ACCESS IMPROVEMENTS THROUGH TELEHEALTH
Tracking
Evidence-Based Protocols and Prescribing
Dispensing and Patient Education
Formulary
STRATEGICPURCHASING
BENEFITDESIGNS
Our end-to-end approach to
managing drug costs and utilization
Program/Resources:• Fully integrated pharmacy with care
delivery
Evidence:• Mail Order Initiative saved nearly $1
million in 2016 • Drug Utilization Action Team saved $25.5
million in 2016• Opioid Use Improvement program results
in cost savings and safety
Future• Continued focus on specialty drug
management• Mail order use
PRESCRIPTION DRUGS
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ECONOMIC STABILITY
NEIGHBORHOOD AND PHYSICAL EDUCATION
EDUCATION FOODCOMMUNITY AND SOCIAL CONTEXT
HEALTH CARE SYSTEM
HEALTH OUTCOMESMortality, Morbidity, Life Expectancy, Health Care Expenditures, Health Status, Functional Limitations
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SOCIAL DETERMINANTS OF HEALTH
Evidence:Team-based model proactively following the highest risk members
Navigators address social determinants of care and link community resources
We’re tracking 25 financial measures and projecting savings of $6.8 million over 2 years
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DIRECT CARE MANAGEMENT ACTIVITIES TO COMPLEX/HIGH-COST PEBB MEMBERS AND EFFECTIVELY MANAGING HIGH-COST CLAIMS
Team-based, physician-led
We continuously monitor and evaluate our services to help ensure high-quality, cost-effective care for our members
Evidence:• Market leading for HEDIS®
Improving quality and utilization among PEBB members
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HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
PRIMARYCARE DELIVERY
SPECIALTYCARE DELIVERY
Behavioral Health Consultants, Navigators, Health Coaches
Triage, Emergency Psychiatric Services, Rapid Access to Mental
Health, Solutions Team
Mental Health Team: Psychiatrist, Therapist, Group Therapists, Nurse
Case Manager, Case Managers, Peers
Brief Interventions, Skills, Education
Treatment Interventions and Programmatic Responses
• Assess• Determine Acuity• Begin Treatment
Utilization Management
Consult Liaison
Brookside Center
Triage Emergency Psychiatric Services
Behavioral Health
Consultant
Primary Care Physician
Self Referral
Emergency Department
Specialty Care
Team-Based Care/Exceptional Needs Care Coordinator/Other
PATIENT START
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Evidence:• Co-locating behavioral health specialists in the PC setting • Ongoing PHQ9 screening in primary care• AUDIT tool used in ER and PC• Rapid Access and Solutions team positively impacting
urgent care needs
IMPROVING BEHAVIORAL AND PHYSICAL HEALTH INTEGRATION
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Meeting/exceeding the target of spending at least 12% of total medical expenditures on primary care
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Date PaidPrimary Care Claims as % of Total Paid Claims
2015 16.2%2016 17%
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To the Public Employees’ Benefit Board for your continued partnership and collaboration…
To our PEBB members for allowing us to serve…
Thank you!
