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Transcript of Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express...
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
ACCOUNTABLECAREPLATFORMDelivering distinctive value to those we serve
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Network Strategy | Delivering Distinctive Value
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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
WE ARE TRANSFORMING HOW WE PAY FOR HEALTH CARE AND HOW HEALTH CARE IS DELIVERED
We are aligning incentives across employers, consumers and care providers to achieve the Triple Aim of better health, better care and lower costs
We are transforming the delivery system to be more accountable for cost, quality and experience outcomes, helping make health care more affordable
We are paying for value through outcome-based payment models that reward care providers for improvements in quality and cost-efficiency
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Accountable Care Platform | Accountability Continuum
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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Capitation + PBC
Lev
el o
f F
inan
cia
l R
isk
Degree of Care Provider Integration and Accountability
Performance-based Programs
Performance-based Programs
Centers of ExcellenceCenters of Excellence
Accountable Care Programs
Accountable Care Programs
Shared Risk
Shared Savings
Bundled/Episode
Payments
Performance-Based
Contracts (PBC)
Primary Care
Incentives
Fee-for-Service
OUR MODULAR SET OF VALUE-BASED PAYMENT MODELS ARE DEPLOYED ACROSS THE CONTINUUM.
WE ARE ABLE TO ALIGN OUR VALUE-BASED PAYMENT MODELS WITH A CARE PROVIDER’S RISK READINESS.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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Primary care incentives,Performance-based
contracts
Shared savings, Shared risk,Capitation
(including ACO, PCMH)
Achieving specificMETRICS
Managing a specific CONDITION
Managing ENTIRE POPULATION HEALTH
Bundle/episode payments
We have value-based engagement with more than 600 hospitals, 1,150 medical groups and 80,000 physicians participating in our Accountable Care Platform.1
• 32,000+ physicians• 900+ medical groups• 575+ hospitals
• 160+ Centers of Excellence• 60,000+ physicians• 550+ medical groups• 65+ hospitals
1 Deployment statistics for executed contracts as of July 2013, net of program overlap.
Increasing level of integration, financial risk and accountability
Performance-based Programs
Centers of Excellence Accountable Care Programs
Accountable Care Platform | Deployment Snapshot
OVER $22 BILLION OF NETWORK SPEND IS TIED TO OUR ACCOUNTABLE CARE PLATFORM1
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Accountable Care Platform | Deployment Map
5
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Location of icon within state is for illustrative purposes only and is not indicative of program’s actual geographic locations within the state – many programs are state-wide. Deployment as of December 2012.
DELIVERING DISTINCTIVE VALUE ACROSS THE COUNTRY
CT
DE
DC
MA
MD
NH
NJ
RILEGEND
Performance-based Programs
Centers of Excellence
Accountable Care Programs
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Accountable Care Platform | Managing Population Health
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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
PATIENT-CENTERED MEDICAL HOMES (PCMH)
Our PCMH programs include more than 2,000 primary care physicians and 250 medical groups
On average, our commercial model in the initial launch markets, AZ, RI, OH, CO demonstrates:
Additionally, we are participating in the CMS Comprehensive Primary Care Initiative Program in Ohio, Colorado and New Jersey
4-4.5%Medical Cost
Reduction
2:1Return on
Investment (ROI)
Clinical quality results trending above program targets on 95% of all measures and delivering a 2 to 1 return on investment.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
15 ACOs Selected (Commercial, Medicare, Medicaid):
•ACO model live with 10 Accountable Care Organizations
•Participating in Dartmouth-Brookings ACO collaborative in Arizona
•Additional ACOs launched in New York, North Carolina, Northern California, Rhode Island, Colorado, Texas and Ohio
•Ongoing negotiations with ACOs in Arizona, New York, Ohio and other markets
Medicaid Accountable Care Shared Savings programs launched in several states
Accountable Care Platform | Managing Population Health
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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Our ACO model incorporates proactive population health management strategies
The objectives of our ACO model are to:•Improve population health and patient experience•Deliver the best possible quality outcomes•Reduce medical cost and medical trend
Deliver Best Possible
Quality Outcomes
Improve Population Health and Patient
Experience
Reduce Medical Costs/Trend
ACCOUNTABLE CARE ORGANIZATIONS (ACO)
We are introducing Optum capabilities to our ACO partners to provide them with the analytics and decision support solutions to manage risk and improve quality outcomes.
CT
RI
MA
DEMD
NJ
AL
ARAZ
FL
IA
IL
MO
LA
MI
MS
TN
KY
SC
PANE
NY
TX
UT
WI
VACO
MN
NC
OHIN
WV
NV
NM
ND
OK
OR
WA
GA
SD
HI
VT NH
ID
KS
DC
MEAK
CA
WY
MT
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ACCOUNTABLE CARE ORGANIZATIONS (ACO) & PATIENT-CENTERED MEDICAL HOMES (PCMH)
Palo Alto Medical Foundation
SUTTER
Palo Alto Medical Foundation
SUTTER New WEST PhysiciansNew WEST Physicians
Arizona Connected CareArizona Connected Care
CORNERSTONE HealthcareCORNERSTONE Healthcare
COASTAL MEDICALCOASTAL MEDICAL
Accountable Care Platform | ACO/PCMH Deployment Map
LifespanLifespan
WESTMED Medical Group
WESTMED Medical Group
North Shore LIJNorth Shore LIJ
ACO Model LaunchedACO Model Launched
As of 8/1/13As of 8/1/13
ACO and PCMH Models LaunchedACO and PCMH Models Launched
PCMH Model LaunchedPCMH Model Launched
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Seton Health AllianceSeton Health AllianceACO Ongoing NegotiationACO Ongoing Negotiation
ACO Model LaunchedACO Model Launched
Mount CarmelMount Carmel
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Accountable Care Platform | Proven Results
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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
SPECIFIC RESULTS
Performance-based Programs have demonstrated improved quality and cost-efficiency outcomes:
• 14% reduction in the use of non-Tier 1 prescriptions• 25% reduction in the use of non-participating laboratory services• ROI: Medical cost savings exceed incentive payout by at least 2:1
The transplant Centers of Excellence program has improved health outcomes:
• 25% decrease in the average length of hospital stays for transplants• Improved transplant survival rates at Centers of Excellence
• 3% reduction in one-year mortality for liver transplants• 5% reduction in one-year mortality for heart transplants
• 16% reduction in the incidence of transplants through application of evidence-based appropriateness criteria
Accountable Care Programs have proven results that demonstrate improved health outcomes:• 4-4.5% medical cost reduction• 17% reduction in inpatient days per 1,000• 16% reduction in emergency room visits per 1,000• 13% reduction in inpatient admissions per 1,000• ROI: Medical cost savings exceed incentive payout by at least 2:1 • Programs focused on Medicare Advantage members achieved at least a 4 Star HEDIS level on
screenings for diabetes, cardiovascular care, colorectal cancer and rheumatoid arthritis
Performance-based
Programs1
Centers of Excellence
Accountable Care Programs2
1 Primary Care Incentive Program results from RI market and national performance-based compensation program results.2 Commercial PCMH results from RI, OH, CO and AZ markets; Medicaid PCMH results from SW Arizona.
1 Primary Care Incentive Program results from RI market and national performance-based compensation program results.2 Commercial PCMH results from RI, OH, CO and AZ markets; Medicaid PCMH results from SW Arizona.