Providence Business News Executive Roundtable
UnitedHealthcare New England Health Plan CEO
ANA STANKOVIC, M.D.
Chief Medical Officer, UnitedHealthcare of New England
JAMES E. FANALE, M.D.
President and CEO, Care New England
President, Integra Community Care Network
Nexus ACO Product Brings Better Quality and Lower Costs to Members
MODERATOR: How does UnitedHealthcare define value-based care and what is UnitedHealthcare trying to deliver and solve for its consumers, employers, and providers?
FARRELL: These programs help people lead the healthiest life possible by giving them and their doctors incentives that reward more coordinated care, and by making sure the care received is based on proven health guidelines that result in the best possible outcomes at lower costs. The most important thing to know about value-based care is that it puts the patient at the center of the healthcare experience. At UnitedHealthcare, we believe the transition to value-based care provides the best path to better health, better care and lower costs – for everyone. Value-based care is here to stay and growing. In fact, today 15+ million UnitedHealthcare members are seeking care from health professionals who participate in value-based arrangements. When done right, it helps achieve the triple aim – that is driving high quality, low cost, and better health outcomes. Through partnerships with Accountable Care Organizations (ACOs) like Integra, we achieve that triple aim by addressing what I like to call the triple threat: variation, fragmentation and consolidation in healthcare.
MODERATOR: Why have you selected Integra Community Care Network to partner with on an ACO?
FARRELL: Integra brings a coordinated high-service approach to what was often a historically uncoordinated experience in many care settings. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and costly medical errors. The coordination results in better health outcomes. Integra has developed a new approach to healthcare delivery and wellness for the region, coordinating care across many different settings, integrating the physicians and other providers of care, educating patients about their health conditions and helping them set goals to achieve the best health possible. UnitedHealthcare has been very fortunate to have a long-term relationship with Integra, and has worked very collaboratively with Dr. Al Puerini, and Noah Benedict from Rhode Island Primary Care Physicians Corporation. Together we have created an integrated model and have been able to connect in the community. It all comes down to the ability to help people live healthier lives, which is our mission at UnitedHealthcare, and Integra has proven their ability to do that.
MODERATOR: Jim, what should people in our region know about Integra?
FANALE: Integra wants our members to live their healthiest lives possible and has worked tirelessly on behalf of our network of providers to bring the best healthcare experience to the region. Integra brings together our hospitals, physicians and other providers of healthcare to improve quality, increase the satisfaction of our members, and make healthcare more affordable. At Integra, we’re focused on managing our patients across all sites of care so they can achieve the best possible outcome. We focus on all of our members, those with the greatest needs, as well as those who are healthy and want to remain that way. Also, our care model operates across all sites of care which is essential to ensure our providers work as a team. We employ various tools, analytics, and IT systems to guide us. And, most importantly, our PCPs are central to our model and drive the whole operation in a partnership with their patients.
MODERATOR: Can you explain in more detail how value-based care arrangements like this collaboration with Integra and UnitedHealthcare benefit the customer?
STANKOVIC: The average cost of healthcare for a family per year in the United States is more than $20,000 according to a 2019 survey from Kaiser Family Foundation. Point being, people are dealing with affordability issues. On top of that, they aren’t always getting quality care. NexusACO is really a strategy designed to drive better quality and better coordinated care. The ultimate goal is for the employer to have a healthier employee population, and to save on costs at the same time. With projected savings close to 15 percent compared to UnitedHealthcare’s comparable 2020 plans, and a product designed around delivering the highest quality care, this strategy and collaboration will make care more affordable for both the employee and employer.
MINICHIELLO: Value-based care arrangements hold providers of care accountable to quality, efficient use of resources, and customer satisfaction. They emphasize achieving the best possible patient health outcomes in the most cost effective manner. Integra brings a coordinated high service approach to what was often a historically uncoordinated experience in many care settings. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and costly medical errors, resulting in better health outcomes. Integra has developed a new approach to healthcare delivery and wellness for the region. Our goal is to help people receive more personalized and better coordinated care, which will significantly enhance their ability to live healthier lives. UnitedHealthcare has been a long-time supporter of the value our primary care providers can bring to coordinating care and thereby better controlling costs. UnitedHealthcare has been very supportive of our patient centered approach.
MODERATOR: Stephen, how many members and how much spend does UnitedHealthcare have under Value-based Care nationally and locally in Rhode Island?
FARRELL: When you think about value-based care, you have to think of it in several different arrangements: primary care physician incentives; bundling episodic payments; and then the more comprehensive Accountable Care Organizations. When you think of UnitedHealthcare nationally, you think of commercial and group insurance, Medicaid and Medicare. When you tie all that together, we are servicing about 21 million members under value-based care arrangements nationally and that equates to about 77 billion dollars’ worth of total payment under value-based care, based on 2018 data. In Rhode Island, almost 90 percent of medical spend is on value-based care arrangements.
MODERATOR: Are there certain medical specialties that UnitedHealthcare focuses on, with respect to the delivery of value-based care?
STANKOVIC: If you focus on what’s core for an Accountable Care Organization, it’s making sure the primary care physician and specialists drive the care, while making sure we strengthen the personal connection between these physicians and the consumer. We want to simplify the interactions through technology, whether that’s by integrating different systems to give that primary care physician or specialist a full view of that patient’s care, or allowing them to provide the right care at the right time. When you tie the interactions together through technology to share actionable data, you empower the physicians and improve the consumer experience, and that’s what I think we’ve created here with Integra.
MODERATOR: Jim, how about Integra? Are there specific categories that are the biggest focus when it comes to value-based care?
FANALE: Integra wants our members to be healthy and we position ourselves to be a partner in their health. Integra coordinates care across many different settings, integrates the physicians and other providers of care, educates patients about their health conditions and helps them set goals to achieve the best health possible, and frequently prompts patients to schedule important preventative screenings.
MODERATOR: Stephen, how is your vision of this ACO collaboration different from what’s been offered to customers in the past?
FARRELL: Historically ACOs have been an arrangement between the provider and the health plan, and it was kind of a behind-the-scenes arrangement. NexusACO is different in that it really pulls together all the interested parties: the provider, the patient, the health plan and the employer. It coordinates care in a better way. Everyone involved has a stake in the game, and the process is much more visible to all parties. We now have the patient working closer with providers, providers working closely with each other and the health plan, employers working with their employees to offer a plan that promotes better health, and the employees working with their PCP to coordinate their care. At the end of the day, the doctors and insurance company are supporting each other by re-aligning incentives to help the consumers, resulting in a better consumer experience that puts the consumer at the center.
MODERATOR: Is there a proven track record that demonstrates that ACOs perform better than non-ACOs?
STANKOVIC: Yes, there is. Commercial ACOs perform better than non-ACOs on 87 percent of the most common quality measures that we monitor. And ACOs have been proven to have fewer hospital admissions as well as fewer emergency room visits. The top ten percent of ACOs closed 76% percent of the care opportunities identified for patients and had 14% fewer ER admissions than non-ACOs, according to UnitedHealthcare’s 2018 report, “How value-based care is improving quality and care.”So this translates into better health for the patient, better care for the patient, as well as lower cost for both the patient and the employer.
MINICHIELLO: To add to that, we see the difference every day. In building our ACO, we have found that we are bringing our providers together in meaningful ways we’ve never thought possible. We frequently discuss how the roles and systems we’ve created within our ACO have boosted our performance considerably. Our quality performance continues to improve each year and we’ve created a team based approach that has been very well received by our members. The care we provide is also more efficient. Most importantly, the positive feedback we receive from our patients and their families has been very rewarding.
MODERATOR: How does Integra create and integrate its technology to offer integrated care?
FANALE: We have purchased and implemented systems and partnered with other health information technology organizations to integrate our care. We have adopted electronic health records across our network, and leveraged the Rhode Island Quality Institute’s health information exchange. We have also invested in a great deal of training and education for our provider network on the use of these tools.
MODERATOR: How does UnitedHealthcare share data with providers to impact clinical outcomes?
FARRELL: We receive data from laboratory, pharmacy and medical claims, and we package that information for our physicians so that they can identify gaps in care, like those already mentioned, to help close those gaps. It helps them compare themselves to their peers. The other thing that we do is share real-time data that includes ER visits and discharge summaries from the hospital to help us activate our care coordination program. This approach also helps us share critical information with both physicians and hospitals so they can help prevent further ER visits.
MODERATOR: If you look to the future, what do you see being offered in collaboration with Integra and UnitedHealthcare?
FARRELL: Any time you have the provider and the health plan collaborating, it’s a great environment for innovation. We intend to use NexusACO as an innovation test tube and means to focus on continued improvements for all parties involved. One example is that we’re working with new technologies to tackle specific issues we see crop up, like over-utilization of emergency departments. We’re already considering a product called Dispatch Health, which brings the emergency room to the patient, for those patients that are high utilizers. Working closely with providers like Integra will help us to continue identifying areas that can be improved upon, and to come up with innovative ways to make the health care experience better.
FANALE: We want to engage our members in new and innovative ways to partner with them. We want them to understand all of the benefits of being a member of Integra and UnitedHealthcare, and to see all the value in having a relationship with one of our local primary care providers. So much more can be achieved if we can successfully bring together all the resources within our organizations in order to partner with our members. We want to make healthcare work better for everyone.
MODERATOR: Does anybody else have anything to add?
MINICHIELLO: It is a privilege to serve our members throughout Rhode Island. We welcome the opportunity to partner with our members to achieve the best care experience and health possible. We’ve been successful but will continue to work tirelessly to bring innovative care approaches to them. We have many new programs being introduced over the next year. We are very appreciative of the partnership we have with UnitedHealthcare.
FARRELL: An important part of our mission – helping people live healthier lives – involves working with high-performing providers like Integra to coordinate better care and address some of the overarching healthcare issues facing consumers and employers. Having providers and health plans working closer together is a step in the right direction towards solving the affordability crisis while also achieving that triple aim I referenced earlier– driving high quality, low cost, and better health outcomes.
MODERATOR: Thank you all so much for participating in this round table discussion.