kimberly higgins mays vice president, advisory services ... · advancing population health kimberly...
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Advancing Population Health
Kimberly Higgins Mays
Vice President, Advisory Services
Accountable Care Solutions from Aetna
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Aetna’s values drive ACS strategy
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About ACS from Aetna
• Leveraging 160 years of experience and expertise
• Collaborating with providers to help them in the transition to value-based care delivery models
• Delivering technology and services that fill gaps in provider readiness for accountable care
• Providing ongoing support through a collaborative approach
• Delivering results
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A broader definition of accountable care
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Choluteca bridge
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After Hurricane Mitch 1998
Where we focus transformation
• Governance & Leadership • Growth • Competitive differentiation
Technology Transformation
Business Transformation
Clinical Transformation
Strategic Transformation
• Organizational effectiveness • Network Management • Revenue & cost management
• Clinical integration • Patient care delivery • Care Management • Patient & family engagement • Clinical value analytics &
performance improvement
• Business architecture • Application architecture • Information architecture • Integration architecture • Infrastructure architecture
Facilitate clinical engagement across sites of care and across providers, building consensus, shared care guidelines, and evidence based best practices.
Care Management
Patient Care Delivery
Clinical Integration
Patient & Family Engagement
Clinical Value Analytics &
Performance Improvement
Help providers increase the efficiency and consistency of care, and to transform care delivery from reactive, episodic, treatment oriented care to proactive management of patients and populations
Develop integrated, innovative care management models that coordinate care across and between settings and connect care teams to enable management of patients and populations
Creatively develop approaches that proactively involve patients and families in their care and create affinity between the patient, their family and the delivery system
Identify opportunities, for improvement of variations in care, drive change, measure results, and quantify impact
Clinical Transformation Key Attributes
Strategic Transformation
Business Transformation
Clinical Transformation
Technology Transformation
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Goals for clinical transformation
Goal Result
Increase patient “keepage” Reduce “leakage
Attract new patients Grow our patient base
Reduce the cost “to” care Reduce operating costs
Reduce the cost “of” care Reduce medical costs
Improve the outcomes of care Quality and performance improvement
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Population health in Medicare: It’s not simple
• 2 Primary Care MDs
• 5 Specialists
• 4 Sites of Care
Data Creation
•EMR Documentation
•Coding
•Enablement documentation
Data Collection and normalization
•HIE
•Chart Audits
•EDW ingest
•Claims submission
Reporting
•Query creation
•Report Writing
•Patient Identification
•Predictive Modeling
Analysis
•Interpret results
•Identify drivers
•Prioritize opportunities
Performance Improvement
•Present results
•Identify interventions
•Tests of change
•Scale the work
•Embed into workflows
Measurement
•Scorecards
•Benchmarks
•Value Analytics
How to Drive to Results
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Sample clinical transformation program: Readmission prevention
• Discharge planning
• Follow up visit scheduling
• Med Rec
• Patient Education
• Self Management Plans
• Follow up action plans
• Appointment availability
• PMCH
• Clinic care teams
• Triage lines
• Follow up care protocols
• Standard assessments
• In-network referrals
Clinical Integration
Care Delivery
Care Mgmt.
Patient and Family
Engagement
Report baseline data by site Identify patients at risk Develop PI interventions Measure results
Value Analytics and Performance Improvement
Reduced Cost
Reduce Inpatient
costs
Efficient Care Management
staffing
Improved Quality
Improved readmit
rate score
Care process consistency
metrics
Improved patient
experience
Improved pt. satisfaction
Return visits to network
Integrated Program Results Across Goals
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Our results
* for Medicare Advantage Patients
Thank you
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