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Transforming Healthcare Delivery for Better Patient Outcomes

Learn about the current state of healthcare delivery in Rhode Island, the affordability gap, and how Blue Cross Blue Shield of Rhode Island (BCBSRI) is addressing these challenges. Discover the impact of BCBSRI on hospital price increases and utilization of services. Explore the transition to systems of care and the formation of coordinated care networks. Find out how advanced primary care medical homes and retail-based clinics are changing the healthcare landscape. Stay informed and ask questions about the future of healthcare delivery in Rhode Island.

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Transforming Healthcare Delivery for Better Patient Outcomes

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  1. Care Delivery in RINow,andA Look AheadMay 2015 Gus Manocchia, MD Senior Vice President & Chief Medical Officer BCBSRI

  2. Health Care Cost Growth vs. Wage Increases The Growing Affordability Gap Cumulative active employee health care costs vs. wage increase Source: Towers Watson Health Care Cost Survey 2010 (active employee data) and Bureau of Labor Statistics, seasonally adjusted data from the Current Employment Statistics Survey August to August, 2000 – 2009

  3. BCBSRI Healthcare "Pie" Surgery 9% Machine Tests 3% Hospital 38% Imaging 7% Other 6% Lab 4% Pharmacy 18% Physician 15%

  4. BCBSRI Price for Medical Services; Too High? • Regional and National Benchmarks tell us BCBSRI prices to providers on target • BCBSRI has focused on large scale price moderation with hospitals BCBSRI Impact on Hospital Price Increases Incurred: Nov 2013 – Oct 2014; Allowed Dollars; RI Residents, Commercial & Medicare Advantage Only

  5. Utilization of Services; Too High? • Regional and National Benchmarks tell us utilization is too high Blue Cross Commercial Utilization Compared to “Well Managed” Markets

  6. Primary Care Reimbursement Transition to Systems of Care

  7. BCBSRI SupportingFormation of Systems of Coordinated Care Rhode Island Today Rhode Island in 2018 Home Care Labs, Radiology, etc. Independent specialist physicians Labs & Radiology Nursing homes Hospitals Advance Primary Care Medical Home 24/7 Access Rehab: PT/OT Partnering specialists physicians Rehab: PT/OT Advanced Primary Care Medical home Hospitals 7

  8. Today’s Membership in Systems of Coordinated Care Denominator = 387K BCBSRI Members Living in Rhode Island Membership Distribution 2018 Goal: 70% of BCBSRI Members in Systems of Coordinated Care 8

  9. CTC PCMH Practice considerations: “Raise the bar” Focus on “Population Health” Higher Quality = Lower Cost … “Community” Expectations [access, cost, patient experience, etc] No More “Hamster Wheels” … How do you care for the “sickest of the sick” ? What happens when patients get outside the PCMH practice confines ?? Do you know how your practice is performing ?? Etc, etc …

  10. Retail Based Clinics CVS MinuteClinic

  11. Questions?

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