Providing value @ your fingertips: integrated care in your back pocket

Daniel Hommes
Adriana Centeno
Welmoed van Deen
Natalie Duran
Alberto Montilla


What to do about the "Three Trillion Dollar" health care crisis? Today, over 70% is spent on management of chronic diseases and the number is growing. The Affordable Care Act finds its stakeholders unprepared: Patients see their premiums and co-pays rise; Providers have difficulties shifting from Fee-for-Services to Quality Payments; and Payers are pressured to enter ACO’s but only few have been successful so far. Pure capitation looms which will accelerate further the downward spiral of quality of care without really solving the problem.

In 2012, a small group of UCLA providers pioneered a brand new approach for chronic disease management: Value-Based Health Care. A prototype chronic disease was chosen (Inflammatory Bowel Diseases) and care focused solely on increasing Patient Value and lowering Provider Costs. The Value Quotient (vQ) was introduced which quantifies patient value and its associated provider costs. In addition, the vQ identifies annual goals for improvement for both patients and providers. Definitions for Patient Value were developed by patients and providers. The definitions include continuous measurements of disease control, quality of life, and (work) productivity. In addition to optimizing medical care, patient value was further enhanced by education and wellness programs. Mobile applications for both patients and providers were developed and patented, measuring health outcomes, navigating patients though their care using highly coordinated care pathways, while utilizing the available educational and wellness programs. In addition, the process of care delivery was transformed in cost effective and standardized care incorporating eHealth, task differentiation and predictive modeling. The prototype outcomes proved spectacular: high patient satisfaction and marked cost reductions that were mostly associated with a decrease in utilization and a de-escalation of disease severity.

Next, payers were contracted and access to claims databases was established. In addition to a detailed analysis of medical procedures, pharmacy use and disease severity, predictive modeling allowed personalized risk assessments and predictions for future health expenditures. This allowed us to continue to build disease specific value-based insurance designs necessary for Risk Sharing Agreements. Based upon payer input, we identified the top 20 of most costly disease areas and started to model them with UCLA experts into similar designs as our prototype. The first Shared Risk Models with payers and employer groups are currently completed and will be executed in the second half of 2015.

This presentation will provide an introduction into the principles of Value-Based Health Care and demonstrate the long term outcomes for a prototype chronic disease. In addition, results in Patient Reported Outcomes (PROs) and Patient Experience will be shared, along with Provider benefits from strong decision support and performance enhancement. Lastly, sustainability through value-based insurance designs will be presented with real time contracting examples. In summary, the audience will get a glimpse at the current seismic shift from Fee-for-Services to Quality Payments.

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