UPMC for Life Hazem Alsahlani, Esq. - PowerPoint Presentation

UPMC for Life Hazem Alsahlani, Esq.Director, MedicareAugust 7, 2019 The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

2 Overview of UPMC Leading Academic Medical Center $ 20 B Global Health Enterprise 87,000 Employees Integrated Delivery & Financing System 40 academic, community, and specialty hospitals More than 6,000 affiliated physicians, including 4,900 employed physicians; #14 Best Hospital; #8 Best Children’s Hospital – U.S. NewsPartnership – University of Pittsburgh – #3 NIH funding3rd Largest GME program (1,900 Residents and Fellows) Health Services 3.5M Health Insurance MembersLeading market share: Medicare, Medicaid & Children’s Health, LTSS and Behavioral4 and 5 star Medicare and Commercial Ratings NCQA#1 member satisfaction in PA – J.D PowerMultiple PCORI awards Insurance Services

Growing Membership and Service Area 3 Quick facts: Largest individual HMO in PA with 26% market share Second highest individual Medicare Advantage plan in PA Over 28,000 D-SNP members Source: CMS data

UPMC Health Plan’s Approach to VBID 4 2016: Planning and application 2017: Implementation Successes, challeng es, and opportunities 2018: Data collection and analysis 2019: Program modifications and continued data analysis2020: More informed decisions

Target vulnerable population who have opportunity to improve High medical and Rx expenseHigh utilization of hospitals and medications Potential to reduce costs through interventions Ability to improve conditions and reduce complications Balance risk and reward Large enough to be relevant…yet small enough to manage and minimize potential loss Ability to influence behavior through sustained engagement Chose the combinations of CHF and Diabetes CHF and COPDCHF, Diabetes, and COPD Analytics Drove the Decision55

Goals and Guiding Principles 6 Self-management for better health, improved quality of life, and reduced medical costs Member Engagement and Education Create simple steps to identify health issues and prevent deterioration Focus on incremental changes that can be sustained Provide members with meaningful rewards and positive reinforcement Improve members’ understanding of their conditions, medication, and lifestyle choices Health Plan Resources Direct members to appropriate resources to address social determinants Integrate with Plan-wide Population Health Strategy Measure and Monitor Use data to drive interventions

VBID Model: Our Approach to Behavioral Economics7 Incremental Reward In 2017 and 2018, checks were issued upon quarterly activity completion In 2019, members are given an OTC debit card. Money is loaded onto the card upon quarterly activity completion

Administrative Goals 8

VBID Team 9

Program Measurement 10 Process Outcomes Enrollment Reduced unplanned care Participation Reduced readmissions Completion/DisengagementReduced ED utilizationTimeliness of Outreach Reduced PMPM medical costsComplaints, Grievances, and Appeals Improved medication adherenceData AccuracyIncreased member satisfactionReimbursement to membersAccuracy, timelinessAddress Stars measuresHEDIS Stars Gaps

Spark Your Health 2017 11

2018 program modifications 12 Limited time frame for modification with real time actionable changes 2018 program changes due 1.31.17 yet only implemented on 1.1.17.  Changes in program Shorten the survey and combine with the Personal health Review (PHR) Combined survey and assessment will be $50 reimbursement Expect to see higher engagement now that members know they will be receiving checks for completing activities. Flu shots will count as reimbursable activity ($25) Working to maximize program engagement and impact

Streamlined Process in 2018 13 Working to maximize program engagement and impact

Changed incentive in 2019: Over-the-Counter debit card 14 Looking to make rewards more immediate Focusing on health related items

Step 1: Personal Health Review 15 Member calls Member Services to “opt in” Case Manager calls to conduct assessment and Personal Health Review Identifies additional information related to medical and non-medical determinants of health Care Plan created in collaboration with the member

Step 2: Personalized Quarterly Activities 16 Based on PHR, CM recommends healthy activities, and the member selects activities from an approved list of options

2017 & 2018: VBID performance 17 Worked effectively Data flow Internal collaboration with all departments Some positive member testimonials Needed Attention Enrollment processEngagementIncentive

CMS Engaged RAND 18 CMS contracted with RAND to conduct onsite visits and learn more information about each participating plan’s VBID programs The interviews focused on a series of topics including: Motivation for joining VBID Rationale for the conditions selected Expectations about future VBID outcomes Financial and actuarial assumptions Application submission process and early implementation experiencesCommunication strategies with beneficiaries and providersProgram design, care management approach, and administration Challenges during early implementation

Snap Shot 19 Member Profile Total Eligible Population Overall Engagement

2019: More Informed Decisions 20 Is this the right population? Targeted population is very sick Explore other diseases or model What works? What doesn’t? 2019 changes Moved away from reimbursement checks to OTC debit cards Members do not have to have OOP cost sharing to receive rewardImmediate rewards (upon activity completion)Added activities (prescription for wellness, advanced care planning)

2020: Expanded Opportunities 21 UPMC program goals: Improve clinical outcomes Test innovations Member retention Reduce costs Permissible interventions: 1.Reduced cost-sharing for high-value services 2.Reduced cost-sharing for high-value providers 3.Reduced cost-sharing for enrollees participating in disease management or related programs4.Additional supplemental benefits (non-health related)

VBID looking ahead Timing of VBID applicationOverlap between VBID and FlexVBID hospiceContinued program evaluation (RAND) 22

Questions? 23