Premier Health’s Risk-Lives - Managing Total Cost of Care

Premier Pulse     September 2017

P-W-COM41507-Clark_105By Jerry Clark, MD, chief medical officer and president, Premier Health Group; chief medical officer, Premier Health Plans; and chief executive officer, Premier Health ACO of Ohio

Premier Health is now eight months into managing the total cost of care for approximately 22,000 traditional Medicare fee-for-service beneficiaries aligned to the “participant” providers for our Next Generation Accountable Care Organization (ACO). Premier Health understands that the current health care system in the United States is not sustainable, with it’s spiraling health care costs and with quality outcomes worse than in many developed countries. We want to be part of the solution. On a high level, we feel the answer resides in clinical transformation. That is, transforming to team-based, consumer-focused care across the continuum, with our health system working closely with providers to decrease the variation in practice that exists. In other words, taking care to a higher level.

In 2014, Premier Health Group (PHG) became the provider network and population health service for Premier Health employees and in 2015 created our own provider-sponsored health insurance plan, Premier Health Plan. In addition, PHG, as our physician hospital organization (PHO), developed payer partnerships with other health insurers. We now care for more than 60,000 “risk lives.”

More than 150 primary care providers are in the “participant” provider category for our Premier Health ACO of Ohio (the company that holds the Next Gen ACO). As with our Humana payer partnership and with our health plan’s Medicare Advantage, individual, and large group lives products, PHG provides risk stratification to identify the high-risk patients in that group and helps support the primary care provider-led care teams to manage them – with nurse care advisors, pharmacists, engagement specialists, social workers, etc. We can now marry claims and clinical data to provide insight into the total cost of care for these covered lives. Getting actionable data back into the hands of the provider to optimize care is our current focus.

Our partnership through the PHG-PHO helps us focus on this shared goal of building healthier communities by making the best use of our resources to deliver higher quality and patient experience. This requires a new level of insight, understanding, and willingness to work together – both primary care providers and specialists – to incorporate transparent, physician-specific data (both efficiency and quality) to accomplish our strategic goals. 

Back to the September 2017 issue of Premier Pulse