Practicalities of integration - NAPC · Practicalities of integration NHS Confed June 2019 3. ... Each citizen has a health plan adapted to their needs, general condition and chronic

Practicalities of integration

Sam Jones, CEO/President, Centene UK

Supporting & enabling integration

Confidential & proprietary Incorporating:

Practicalities of integrationNHS ConfedJune 2019

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What we are:

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Investments in Spanish based Ribera Salud and a UK portfolio consisting of

SimplifyHealth, a mental health integration service, and The Practice Group, an at

scale primary care and community services provider

EUROPE

on Forbes’ Global

2000: Growth Champions List (2018)

#43

WHO WE ARE

St. Louisbased company founded in Milwaukee in 1984

48,100 employees

#51Fortune 500 (2019)

£47.2Brevenue for 2018

#210Fortune Global 500

£ 57.2 – 57.8Bexpected revenue for 2018

#49 Fortune 100 Fastest Growing Companies (2018)

WHAT WE DO

32 stateswith government sponsored healthcare programs

14.7 million patients

Medicaid(27 states)

Marketplace(20 States)

Medicare(20 States)

Correctional(14 States)

~300 Product / Market Solutions



Who we are:

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• We are proud of the NHS - we want to work as a partner to make it even better. In particular where care is fragmented we can bring the coordination and structure to support clinicians be the best they can be.

• 95% of our work support’s governments around the world provide healthcare - often to extremely deprived communities. We do this by adding value and reducing waste

• We passionately believe that the best solutions are local solutions – there is no one size fits all and each health economy or system must have its own solution

• Supporting integrated care for 14.7 million patients around the worlds means we understand the practicalities of integration from an operational not just a theoretical level

• We believe in or staff so much we have created a University to help them grow and flourish



PHM: aiming to achieve the triple aim

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The efficient and constant management over time the health needs of the population, through care coordination, disease management, preventive detection and proactive action

PHM


Confidential & proprietary Incorporating: 7

Population Health Management: Achieving the Quadruple Aim

The Main Goals of the Quadruple Aim

● Better Outcomes: improvement of health population outcomes

● Reducing Cost: achieve the goals through efficiency and lower costs per capita

● Patient Satisfaction: the quality improvement should be transmitted to the patients to increase their perception and experience

● Professional Commitment: professionals commitment is the key to achieve the 3 previous goals

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Predictive Personalised

Preventive Participatory

Population

Development of a

predictive model of the

risk associated with each

patient based on different

risk adjustment systems

Each citizen has a health

plan adapted to their

needs, general condition

and chronic diseases

Each citizen is directly

involved in their care

plans

The program includes

interventions for disease

prevention and health

promotion

Actionable Population Health Management - Predictive 5Ps model


Confidential & proprietary Incorporating: 9

Actionable Population Health ManagementLearning from International Experience

Clinical Management

WorkforceTechnology

Patient & Citizen

The Model Combines the Strengths of:

• A citizen-centred clinical management strategy

• Modern workforce management

• A cross functional information system

• The Citizens are at the heart of the model

These elements are self-reinforcing in a continuous process of improvement

Ribera Salud: Triangle of Success



Practicalities of integration:

Integration function



The right intent alone doesn’t create integration – functions and tools make it operationally happen

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Integrated care systems take a number of different forms :

• Networked

• Integrated delivery system

• Fully integrated

Fully integratedIntegrated delivery systemNetworked

• Clearly defined integrator• Manage large external provider network to

meet needs of patients• Integrator holds risk for population contracts

• Integration functions present but less clearly defined entity

• Takes form of management structure and ‘business units

• Organisation collectively holds risk

• Clearly defined integrator• Manage smaller, mostly ‘internal’

provider network• Integrator holds risk for population

contracts

In all of these systems there is a core role of integrator that conducts vital

integration functions supported by a range of tools and technologies



Alignment to Integrated Care Framework

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Enablers• Shared outcomes for system

and population• Single set of guidelines• Shared data and information

including cost and activity

Functions• Majority of functions in place• Used to monitor and embed

enablers – such as decision-support tools

Technology• Used to enhance application

of integration functions and embed enablers

• Improve access and improve outcomes



The role of integration functions in supporting care delivery

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Enablers

Integration functions

Acute

Community

Mental health

Primary Care

Social care

Population

• Functions are often delivered by a defined entity

• Allows for independence and objectivity in holding separate organisations to account on behalf of the ‘system’

• Agree guidelines and standards enable open and transparent monitoring of performance



The heart of population health management - understanding population risk to manage system

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Understand Total Individual Risk Factor (TIRF) to inform aggregate

analysis. This considers demographic, socioeconomic, and

health information.

Illustrative Utilisation Risk FactorsAssumed GN Population Distribution

(Deprivation Status based on IDACI/IDAOP)Illustrative Commissioner Spend (£ PPPM)

Non-Deprived Deprived GN Composite Non-Deprived Deprived Total GN

Under 1 M/F 0.808 1.371 0.946 5,616 1,822 7,438

1 - 5 M/F 0.234 0.645 0.335 32,603 10,537 43,140

6 - 13 M/F 0.221 0.542 0.297 51,116 16,041 67,157

14 - 17 M 0.189 0.668 0.302 11,415 3,521 14,936

14 - 17 F 0.421 0.785 0.507 10,816 3,349 14,165

18 - 34 M 0.253 0.567 0.330 81,742 26,480 108,222

18 - 34 F 0.555 1.535 0.791 78,374 24,815 103,189

35 - 44 M 0.458 1.256 0.633 38,464 10,805 49,269

35 - 44 F 0.722 1.750 0.938 35,791 9,498 45,289

45 - 64 M 1.055 1.336 1.105 74,033 16,125 90,158

45 - 64 F 1.155 1.429 1.203 71,745 15,357 87,102

65 - 74 M 1.865 3.854 2.199 26,238 5,299 31,537

65 - 74 F 1.713 2.958 1.920 27,401 5,457 32,858

75 - 84 M 2.911 4.404 3.160 14,092 2,819 16,911

75 - 84 F 2.471 3.627 2.666 17,362 3,505 20,867

Over 85 M 3.703 5.294 3.972 4,768 967 5,735

Over 85 F 3.224 4.384 3.419 8,642 1,754 10,396

Total GN 0.888 1.418 1.000 590,215 158,154 748,369

GenderAge Bands

Develop a composite (segment/cohort) view of risk factors: Understanding individual risk factors enables to understand wider risk by

segment and/or cohorts

Use risk factors to project future utilisation: An understanding of risk factors provides

ability to forecast/project expected utilisation. From this it is possible to monitor performance

to identify variation in performance



Bringing this all together - using technology to support care coordination – Jim’s story

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Frequent, comprehensive stratification of the population identifies patients who could

benefit from coordinated care

The outcome of the assessment results in a personalised care plan which is uploaded and

shared electronically

Care management teams share the care plan and work to the

same care plan with designated tasks. Patients remain part of care management until goals

achieved

Care plan delivery

Primary care

Care management

Hospital teams

Jim has multiple long term conditions including heart failure and diabetes. He is

identified as high risk.

Jim is invited to meet with the care management team to explore goals and ways to

manage his condition

Jim is able to access a copy of his care plan via the portal

Jim attends appointments with relevant professionals as agreed in care plan. Continues to have

regular meetings with care coordinator

Dedicated multi-disciplinary care management team performs personalised

assessment with patient

Assessment and Care Plan

Jim is able to access results of appointments, upload

information and contact is care team if he has any concerns or

issues

Patient portal

Patients are able to access their care plan via a patient portal. It also enables them to interact with health care professionals

digitally



Investing in people - Centene University

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• Centene University is our internal strategic tool designed to equip our staff with the technical and leadership skills they need today and in the future to reach their goals

• Includes a curriculum focused on the Healthcare industry, Core Operations, Functional skills and Leadership. It is also developing a state-of-the-art executive education center dedicated to accelerating the readiness of leaders.

• In addition, our eLearning platform, Cornerstone, gives employees 24/7 access to hundreds of educational programs, on topics such as: Leadership Development, New Supervisor Skills, Effective People Skills, Business Writing, and other department specific courses

Apex leadership model



Results



Reducing the burden on emergency admission

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Admission avoidance using digitally enabled care

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Data from Case Study: Universal Healthcare system in Spain Adopts TruCare and experiences significant improvements in quality care initiatives

Decreased time to intervention

Improved patient engagement & outcomes

Increased efficiency & lower costs£

Adapted to Ribera Salud’s EMR

Department Torrevieja Vinalopó TOTAL

1st consultations -26 % -26 % -26 %

Medical admissions -19 % -20 % -19 %

Medical stays -18 % -27 % -22 %

Hospital at Home (HaH) admissions -7 % 47 % 22 %

Hospial emergencies -18 % -9 % -13 %

Readmissions within 30 days -22 % -36 % -28 %


Samantha Jones | Chief [email protected]

Documents

Practicalities of integration - NAPC · Practicalities of integration NHS Confed June 2019 3. ... Each citizen has a health plan adapted to their needs, general condition and chronic