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Improving Lives through Innovation & Payer/Provider Collaboration

Improving Lives through Innovation & Payer/Provider Collaboration. 53%. Ruthie’s Story. Do you feel optimistic about the future?. 69%. Do you feel optimistic about the future?. 92%. Have you participated in enjoyable activities with friends or family in the last month?.

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Improving Lives through Innovation & Payer/Provider Collaboration

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  1. Improving Livesthrough Innovation &Payer/Provider Collaboration

  2. 53%

  3. Ruthie’s Story

  4. Do you feel optimistic about the future? 69%

  5. Do you feel optimistic about the future? 92%

  6. Have you participated in enjoyable activities with friends or family in the last month?

  7. Inpatient BH Costs 22 people, 12 months • Pre: $376,416 • Post: $145,914

  8. Results • 50% reduction in behavioral health admissions • 55% reduction in 30 day readmissions • 58% reduction in 90 day readmissions • 63% reduction in PMPM costs for behavioral health inpatient (with 12 months in pilot) • Optimistic about future: 69.2%        92.3%        • Activities with family/friends 61.5%        80.8%  • Living independently      42.3%        57.7%   

  9. Perspectives on Managed Care Mission Business Cultural

  10. Key Ingredients to Success • Addressing Challenges • Overcoming Barriers • Finding Potential Partners • Readiness to Collaborate • Problem Identification

  11. The Triple Aim Reduced Cost Patient Experience of Care Population Health Outcomes

  12. Finding the sweet spot Clinical Opportunity Economic Opportunity Administrative Opportunity

  13. Where is the overlap? • The Triple Aim

  14. What Payers Want to Know How will you help solve our problem? Use of Evidence Based Practices How do you measure outcomes? • Client satisfaction • Readmissions • How do you know someone is ready to leave care? HEDIS scores (7 day follow up) Integration between medical and behavioral Internal monitoring of utilization management

  15. What Providers Want to Know What are the payer’s business problems? Will the payer share data? How big a priority is this? Invested in the collaboration? Are they moving toward a shared risk mindset? How much do they care about the lives of the people in their plans? Will the payer consider alternate payment arrangements?

  16. What are the possible barriers you see?

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