© Oliver Wyman

WHAT WE DO

HOW OLIVER WYMAN’S

HEALTH & LIFE SCIENCES TEAM TRANSFORMS CARE WITH INNOVATIVE PATIENT‐CENTRIC MODELS

1

© Oliver Wyman

• Developed the five-year strategic plan to become a population health manager and manage the risk for patient populations

• Designed care models to help our client manage its high-risk, dual eligible population, congestive heart failure, and oncology patients

• Deployed clinical models using experts from our clinical team to implement newly written policies and procedures, improve coding and documentation, redesign office space, develop patient marketing materials, and more

• Developed organizational structure for client’s Accountable Care Organization (ACO), supporting identification of new executive/leadership roles and recruitment efforts

• Built Management Services Organization (MSO) and served as core strategic advisor

• Client focused on transforming its entire organization from a high-value fee-for-service provider to a key market leader in value-based care, leveraging strong regional and national payer relationships

• Highly competitive market with significant M&A activity

• Oliver Wyman completed the five-year strategic plan for our client to become a population health manager and has supported ongoing efforts over the past several years to implement key recommendations

Oliver Wyman approach Client situation

Multi-Specialty Physician Organization Oliver Wyman team developed and implemented comprehensive strategic plan to transform entire organization to value

2

© Oliver Wyman

Multi-Specialty Physician Organization Oliver Wyman team developed and implemented comprehensive strategic plan to transform entire organization to value

• Negotiated all payer contracts to risk, including becoming a Medicare ACO under the Medicare Shared Savings Program (MSSP)

• Multiple care models (e.g., duals, congestive heart failure, oncology) enabled negative trend on MSSP, 76% Medical Loss Ratio on Medicare Advantage contracts

• Significantly reduced hospital bed days and patient admissions from prior year • Launched a new MSO to provide custom enablement services to other transforming provider

customers; secured significant outside funding to drive growth in MSO

Key impacts achieved

3

© Oliver Wyman

• For Concierge Medicine: Reviewed internal survey data from phase I, profiled competitor offerings - including potential electronic medical record partners - detailed solution features/stacks, developed initial market revenue potential and associated client capture, and outlined immediate next steps

• For Employer Sponsored Clinics: Estimated the market opportunity by clinic type, profiled competitor offerings - including partner archetypes - developed potential solution stacks based on ER needs, developed initial market revenue potential and associated client capture, including solution pricing models

• For Caregiver Support: Outlined market hassles and underlying needs, determined initial solution features/bundles, and modeled three value capture models based on end user

• Our client is currently in the process of entering the market with a Patient Centered Medical Home (PCMH) solution targeted at physician groups interested in moving toward a value-based model in the mid-term

• While the primary focus is continued PCMH market expansion, our client has identified a series of extension opportunities to reinforce or supplement the core PCMH offering: – Concierge Medicine – Employer Sponsored Clinic – Caregiver Support

• Oliver Wyman was asked to evaluate the market opportunity related to each of these offerings, develop initial solution features/stacks, and develop initial financial projections to support continued market development

Oliver Wyman approach Client situation

Market Opportunity Assessment of Patient Centered Medical Home Oliver Wyman assessed the expansions related to concierge medicine, employer sponsored clinics, and caregiver support

4

© Oliver Wyman

Market Opportunity Assessment of Patient Centered Medical Home Oliver Wyman assessed the expansions related to concierge medicine, employer sponsored clinics, and caregiver support

• For each of the three identified expansion opportunities: – Profiled overall market size and opportunity – Profiled competitive landscape and associated capabilities – Developed detailed solution features and recommended solution stacks – Built models to estimate revenue potential and client capture for 2012–2015

• Identified synergies and key challenges across expansion opportunities given PCMH business and capabilities

Key impacts achieved

5

© Oliver Wyman

• Conducted a market assessment of any assets in the community and county that could be leveraged in caring for these patients who often have psychosocial and socioeconomic issues, in addition to their chronic conditions

• Designed a care model with an extensivist clinic to address the top utilizers

• Engaged various stakeholder organizations in discussions on how to collaborate in a way that creates accountability and ownership for the patient (vs. the “old” model where patients often fall through the cracks)

• Created an economic model to analyze the financial impact of chronic care delivery, including investments and value-based arrangements

• The market leading provider touches a number of the Medicaid patients in its county (including dual eligibles who are covered under Medicare and Medicaid) and runs a pilot program to care for “super utilizers” – those who use the most services and are the highest-cost patients

• The program gained the attention of the State, whose primary objective is to develop solutions that address the rapidly increasing trend in State Medicaid healthcare spend (almost 6% year over year)

• The client needed to develop a program that would address the State’s upward trend and be economically viable

Oliver Wyman approach Client situation

Chronic Care Model Development Oliver Wyman developed a Chronic Care Model for a provider group to address an unsustainable growth trend in Medicaid expenditures

6

© Oliver Wyman

Chronic Care Model Development Oliver Wyman developed a Chronic Care Model for a provider group to address an unsustainable growth trend in Medicaid expenditures

• Designed a Chronic Care Model that integrates the physical health, behavioral health, and social support services available across organizations, supported by Medicaid Managed Care contracting

• Recommended a strategy that centered around an extensivist clinic run by the provider client that could integrate and optimize existing services in the community

• Developed a proposal (presentation and written) to be submitted and reviewed by the State for consideration

• Provided support in initial conversations with managed care organizations regarding value-based contracts based on the Chronic Care Model’s economics

Key impacts achieved

7

© Oliver Wyman

• Oliver Wyman played a central role in advancing the high intensity care model by: – Leading program economic modeling – Guiding clinical and operational

model development • Oliver Wyman drove alignment among

client stakeholders by: – Facilitating cross-functional meetings to

address program objectives throughout the design process

– Teeing up and documenting key executive decisions

• Facilitated payer-provider collaboration to develop an actionable care model

• A regional health insurance plan with strong market share sought to launch a high intensity care model for a high-acuity Medicare Advantage population

• The high intensity care model was designed as part of an effort to reduce healthcare spend and improve outcomes for high-risk, polychronic patients

• The client needed to address key program design elements, including clinical model and interventions used, funding, launch logistics, and bid impact

Oliver Wyman approach Client situation

High Intensity Care Model Development Oliver Wyman helped a large, regional health plan launch a provider-delivered high intensity care model for Medicare Advantage members

8

© Oliver Wyman

High Intensity Care Model Development Oliver Wyman helped a large, regional health plan launch a provider-delivered high intensity care model for Medicare Advantage members

• Aligned client stakeholders around key program objectives and decisions

• Helped client identify and work through clinical and operational program design hurdles

• Illustrated the program value for Medicare Advantage business unit planning and Centers for Medicare & Medicaid Services bid development

• Aided in provider socialization and funding negotiation discussions

Key impacts achieved

9

© Oliver Wyman

• Oliver Wyman worked with 5 CCGs to: – Profile target patient segments,

developing a detailed understanding of their needs, including the size of target patient segments and the prevalence of long-term conditions in these segments

– Benchmark the expected reduction in activity from implementing new care models

– Model the financial impact of introducing new care models within each of the CCGs

• A Central Policy Body is facing an impending budget crisis, with growth in spend significantly outstripping expected budget increases

• Incremental change has been insufficient to control costs and a lack of coordination can mean that the quality of care delivered to the sickest patients is poor

• With this in mind, the Central Policy Body and a number of Clinical Commissioning Groups (CCGs) are looking to pilot new models of care designed to provide a much more coordinated, patient-centric approach and to significantly increase the volume of preventative care

Oliver Wyman approach Client situation

Patient-Centric Care Models Oliver Wyman helped a Central Policy Body to understand the potential for new patient-centric models to transform the delivery of healthcare

10

© Oliver Wyman

Patient-Centric Care Models Oliver Wyman helped a Central Policy Body to understand the potential for new patient-centric models to transform the delivery of healthcare

• These models of care have the potential to reduce the cost of the sickest patients by 15–20% through a significant reduction in secondary care

• This equates to a 5–10% reduction in total secondary care spend which comprises over half of the CCG’s budget

Key impacts achieved

11

© Oliver Wyman

• Oliver Wyman defined the IOCP care model that the client would be deploying with provider partners

• Our team assessed the client’s existing capabilities to identify any gaps required to successfully deploy the care model and any areas of enhancement and investment needed to fill those gaps

• We developed the blueprint and execution roadmap for building out the client’s solution for providers and estimated the resulting revenue opportunity (including financial impact for provider partners)

• Our client was a division of a major US insurance company that was building out care management

• The group identified the provider-driven care management activities as the near‐term priorities with the greatest impact and savings potential

• The client selected a care management solution for an intensive outpatient care program (IOCP) model as an initial pilot due to its patient reach and ability to impact cost and quality

Oliver Wyman approach Client situation

Intensive Outpatient Care Program Development Oliver Wyman supported a health enablement company in developing a care management solution to support physicians

12

© Oliver Wyman

Intensive Outpatient Care Program Development Oliver Wyman supported a health enablement company in developing a care management solution to support physicians

• Oliver Wyman identified opportunities for our client to build out its existing capabilities for a care management solution in order to partner with providers

• We developed an initial set of pitch materials that the client could use for initial meetings with providers

• Our team developed a care model that would be deployable and scalable for our client and providers, and where its solution would be applicable to other care models

Key impacts achieved