January 11, 2016

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HEALTHCARE ROUNDTABLE

January 11, 2016

The data is absolutely clear that we're bending the cost curve materially in terms of the populations that are in those vehicles. Every quality index you can track is getting better—some significantly better, some a little bit better. The challenge is delivering in a market that really is quite efficient in its care on a lower-cost delta that's enough to result in some real successes for the systems that are doing this.

We did renew our federal one this year for three more years. We just felt like it was a worthwhile experiment. I've not made any money on it. But we didn't really go into it thinking we'd make money. It's more of the experience and the learning opportunities. You're going to see those concepts and principles that are being learned continue to be perpetuated in the healthcare system.

WEED: The Medicaid ACO has been in now since 2013. All of a sudden, overnight, we had 80,000 Medicaid enrollees. The good thing about it is it begins to align the system. So if you push the risk more to the delivery system and it's not being held by some third-party administrator, you've actually got some incentives in the right place where actual care can be impacted.

TANNER: Granger also started an ACO in 2013. Like most national ACOs, they don't make any money the first few years because you spend so much time looking at data analytics and trying to figure out how you're going to manage population health. One of the challenges is getting all the information among the various providers of care. I think some of the new initiatives that CMS is putting out by some of their risk proposals in 2017, 2018 may have a little bit more impact to ACOs in the future.

CLAWSON: A couple years ago we entered into an ACO arrangement with Humana; we have around 35,000 lives that we're managing. If we were able to track the trend of the benefit of this, the MLR is around 102 percent if you're not in the ACO and being managed within our system.

You've got to share the data, you've got to give it back to the doctors, the doctors have got to be on point to manage the population appropriately and carefully to make sure this works. But when they're managed correctly, we're able to bend that trend from 102 percent MLR to 79 percent MLR. So it is doable. And we have found some success in a very sick population, the Medicaid population.

McOMBER: Many of our physicians are participating in different ACOs and it is teaching them to manage their patients and manage risk, and teaching them to look at the patients in a different way. In addition to that, it gives them the opportunity to see all of the data. In the past they didn't have the opportunity to see the data. Now they can see how much a lab costs, how much prescriptions cost, how much their surgeries cost compared to others. And they can make decisions based on data. Where in the past you didn't make decisions based on data, you just made decisions in a vacuum basically. You made decisions based on what you thought was best for the patient, but you had no other data that you could look at.

When we look at the cost curve, they can see what is happening with their own group, with other groups, with the patients, with things that they affect in the patient's care, and they can make decisions also based on cost.

We're now in the fifth/sixth year of the Affordable Care Act. Give some examples of how you think the ACA is positively or negatively impacting Utah employers, especially small businesses. Are more or less businesses providing health insurance to their employees?

BINGHAM: There are definitely certain industries, like hospitality or restaurants, that historically have not offered coverage that are starting to offer that. It's definitely caused a dramatic shift as far as the number of hours people are working and different things from that aspect.

But I would say, at least from our clientele, they're not offering benefits because of the Affordable Care Act. A lot of it is the economy. Where the economy has continued to grow and do much better, it's about competition. So they're wanting to offer the most benefits, offer a great package to attract good talent. Yes, I'm sure there is some result of the Affordable Care Act, but I would say largely it's because of that competition that we're seeing some of these increased numbers.

CONNER: We're seeing more businesses come in to Avenue H. Our take-up rate has been pretty decent, somewhere around 18 to 20 percent each year. We’re seeing businesses that were not offering coverage before, but we're also seeing those that had coverage before and are looking for competition and a different way in which to offer those plans to their employees.

There are still some that are doing group busting, breaking up small businesses and putting them in the individual market because they can take advantage of the advanced premium tax credit and cost sharing reduction that way. That helps those people from an affordability standpoint. We do see that in the industries that are high turnover, lower pay—maybe the hospitality industry, low-end manufacturing, seasonal businesses.

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