Worcester Business Journal

wbjournal.com | September 28, 2020 | Worcester Business Journal 17 create and connect is critical to the success of driving value-based care, and the collaboration with Reliant has been great. MODERATOR: How is your vision of this partnership different from those that have been offered in the past? FARRELL: This partnership is different in that we are really examining and addressing a fragmented health care delivery system that delivers inconsistent and low-value care. Through the NexusACO high-performing network, our members will have a better overall health care experience, and it all starts with choosing a primary care physician for themselves and their family members, taking the guessing game out of coordinating their care. Further, the strategy aims to bring down overall costs, not just shift costs around from the employer to the employee. NexusACO should result in savings all around. STANKOVIC: To elaborate on that, the primary care physician and all of the physicians who are part of the member's care team will help the patient by providing proactive, highly attentive care. Our NexusACO members will receive timely and appropriate health care screenings and avoid the duplicate screenings that occur a lot of times when you're seeing multiple different providers in multiple different systems. Additionally, the stronger relationship between the primary care physicians and patients should help members more effectively manage chronic diseases such as diabetes, heart disease and arthritis. We think in the end, this will offer a better health care experience and better health care value for patients. FARRELL: That's exactly right. With NexusACO, we are able to deliver value to consumers and employers through better care coordination. Plan participants will partner with a PCP who helps to navigate the health care system, including specialists, hospitals and other care providers. This will also promote better health outcomes, because the plan provides access to care providers who proactively engage their patients more frequently, ensuring at-risk patients receive timely, appropriate health screenings, and helping people manage chronic diseases so they can avoid complications or more serious issues down the line. Lastly, the efficiencies associated with this kind of care model should lead to lower costs for employers as well as employees who use in-network Tier 1 care providers to coordinate their care. MODERATOR: Is there a proven track record that demonstrates that ACOs perform better than non-ACOs? STANKOVIC: Yes, there is. Our UnitedHealthcare commercial ACOs perform better than non-ACOs on 83 percent of the most common quality measures that we monitor. And members who receive care from providers participating in ACOs have significantly fewer hospital admissions and emergency room visits. The top 10 percent of ACOs closed 75% of the care opportunities identified for patients versus 56%for non-ACOs. So this translates into better health and care for the patient as well as lower costs for both the patient and the employer. MODERATOR:: How does UnitedHealthcare share data with providers to impact clinical outcomes? FARRELL: As the largest insurer in the country and part of UnitedHealth Group, we have an incredible amount of actionable data to share with our partners to improve health outcomes. What's critical here is that we have a dedicated team that works solely with Reliant to conduct predictive modeling and monitor quality and cost outcomes on a patient-by-patient basis. Our team packages that information for physicians so that they're aware of gaps in care and in a better position to help close those gaps. STANKOVIC: ACOs are very data driven, so we aim to provide daily, weekly, monthly and quarterly reports, as well as real-time reports about things like ER admissions, which is very important. The goal of sharing those reports and the rich data they contain is to help close gaps in care by doing things like reminding patients when it's time to schedule their mammogram, colonoscopy, immunizations, things that patients either wouldn't normally think about or might be putting off. MODERATOR: What are you doing to support the most commonly cited challenges in value-based programs? FARRELL: We've had a strong commitment to value-based care for many years, and today we work with more than 113,000 physicians and 1,200 hospitals in some form of a value-based relationship. These providers care for more than 17 million of our members. With so many value-based relationships, we focus on being flexible with providers and meeting them where they are in their readiness to transition to value. On a more tactical level, there is a connection among the health plan that has data, the ACO that receives that data and shares it with their providers, and the providers who are actually caring for members. The challenge is figuring out where the gaps are in this structure and addressing them. That's what we've tried to do with the NexusACO high- performing network. We've learned a lot since introducing this offering a few years ago and have applied those key learnings as we continue collaborating with Reliant Medical Group. In the end, our goal is to use a high-value network strategy to deliver more coordinated care. This makes it critical to have a primary care focus. The primary care doctor is the coordinator of all the care. They can help the patient avoid hospital admissions and make sure they have gaps in their care closed. Primary care physicians really need to be a champion in an ACO. But they can't do it alone – they need a care team behind them supporting them. That is really the crux of success with this model. MODERATOR: If you look a few years down the road, what do you see being offered from UnitedHealthcare and Reliant? FARRELL: A plan that looks similar to today's plan in terms of benefits, but that operates even more effectively, with providers working together to achieve the triple aim. Members will enjoy a less complex and vastly improved experience as a result of the health plan and the providers actually collaborating. And with everyone – the member, provider and health plan – working together towards a common goal, all with appropriate and aligned incentives, we will begin to see rate increases stabilize or perhaps even start to reverse course and thus make health care more affordable for members and employers. MODERATOR: Thank you both so much for participating in this round table discussion. S P E C I A L A D V E R T I S I N G S E C T I O N

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