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