LAS VEGAS — When Inova Health observed that Affordable Care Act initiatives for value-based care would cut 7%, or $220 million, out of the $3 billion health system’s victorious fee-for-service revenues, the northern Virginia contributor knew it required to change, stated the President and COO Mark Stauder.
“Considering through our strategic policy, we are a fee-for-service community of chiefly independent private practicing physicians,” Stauder claimed during HIMSS16. “We were an excellent fee for service; we required a latest revenue source.”
The outcome was a partnership with Aetna and the establishment of a latest health policy called Innovation Health.
From the time period of 2012 to 2014, the partnership has realized an 8-20% cost reduction per employer; 17% reduction in the number of unessential hospital days after surgery; 15% fewer hospital admissions; and 21% fewer hospital readmissions, Stauder claimed.
Despite the victory, Stauder stated that he feels the health network is still in “Population Health 101.”
“This is a complex journey that is going to take us another 5 years or more to get good at it,” Stauder claimed.
The strategic policy through the year 2020 emphasizes on population health, individualized wellness and the aggressive pursuit of personalized medicine, Stauder stated.
In the year 2012, the health network had no threat. Today it is 50%.
There are 90,000 commercial risk sufferers and the system bought a Medicaid health policy from Amerigroup of 60,000 members.
“We needed to make critical mass with covered lives and build a shared savings construct,” Stauder stated. “We are in a market with various commercial payers. We required to broaden market share.”
The objective by the year 2020 is to have a million covered lives.
Aetna offers health plan administration; claims and consumer service; analytics; technology and care management programs.
Inova offers a nationally recognized healthcare network, and more member management at the primary care level of chronic cases and lower unit prices.
Innovation Health started in the month of September 2013 and has grown to 180,000 members.
The health network’s narrow network is supplemented by the national Aetna network, he stated.
“It is about boosting the physician contributors,” Stauder claimed, asserting the requirement to get their cooperation.
Care coordinators steer members towards suitable programs and there are alerts provided if any members are in network hospitals, he stated.
For post-acute care, there are post-discharge community placement; transitional programs; and medical home for thirty days for high risk for readmission patients. The system is presently building out an advanced sickness model to involve home-based physician visits and EPIC community deployed visits.
Analytics and IT devices involve utilizing, a MyChart portable EMR patient engagement driver, a complete integrated EMR through EPIC, telemedicine; analytics for risk stratification and predictive data analytics for clinical quality.
The Aetna stage also interfaces with Epic.
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