Inova Health creates new health plan, population health strategy

LAS VEGAS -- When Inova Health saw that Affordable Care Act initiatives for value-based care would cut 7 percent, or $220 million, out of the $3 billion health system's successful fee-for-service revenues, the northern Virginia provider knew it needed to change, said President and COO Mark Stauder.

"Thinking through our strategic plan, we are a fee-for-service community of chiefly independent private practicing physicians," Stauder said during HIMSS16. "We were a great fee for service; we needed a new revenue source."

The result was a partnership with Aetna and the creation of a new health plan called Innovation Health.

From 2012 to 2014, the partnership has realized an 8-20 percent cost reduction per employer; 17 percent reduction in the number of unnecessary hospital days after surgery; 15 percent fewer hospital admissions; and 21 percent fewer hospital readmissions, Stauder said.

Despite the success Stauder said he feels the health system is still in "Population Health 101."

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"This is a difficult journey that's going to take us another five years or more to get good at it," Stauder said.

The strategic plan through 2020 focuses on population health, individualized wellness and the aggressive pursuit of personalized medicine, Stauder said.

In 2012, the health system had no risk. Today it's 50 percent.

There are 90,000 commercial risk patients and the system purchased a Medicaid health plan from Amerigroup of 60,000 members.

"We wanted to build critical mass with covered lives and build a shared savings construct," Stauder said. "We're in a market with many commercial payers. We needed to broaden market share."

The goal by 2020 is to have a million covered lives.

Aetna provides health plan administration; claims and customer service; analytics; technology and care management programs.

Inova provides a nationally recognized healthcare system, and more member management at the primary care level of chronic conditions and lower unit costs.

Innovation Health began in September 2013 and has grown to 180,000 members.

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The health system's narrow network is supplemented by the national Aetna network, he said.

"It's about empowering the physician providers," Stauder said, emphasizing the need to get their cooperation.

Care coordinators steer members towards appropriate programs and there are alerts given if any members are in network hospitals, he said.

For post-acute care, there are transitional programs; post-discharge community placement; and medical home for 30 days for high risk for readmission patients. The system is currently building out an advanced illness model to include home-based physician visits and EPIC community based visits.

Analytics and IT tools include using, a fully integrated EMR through EPIC, a MyChart portable EMR patient engagement driver, telemedicine; analytics for risk stratification and predictive data analytics for clinical quality.

The Aetna platform also interfaces with Epic.

Twitter: @SusanJMorse