pankaj patel md msc senior medical director, advocate physician partners
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Obesity Symposium-Ignite the fight against Obesity: Advocate’s Approach to Population Health Management September 26 th 2014. Pankaj Patel MD MSc Senior Medical Director, Advocate Physician Partners. “Knowing is not enough, we must apply Willing is not enough, we must do”. Goethe. - PowerPoint PPT PresentationTRANSCRIPT
Obesity Symposium-Ignite the fight against Obesity: Advocate’s Approach
to Population Health Management September 26th 2014
Pankaj Patel MD MScSenior Medical Director, Advocate Physician Partners
“Knowing is not enough, we must applyWilling is not enough, we must do”
Goethe
Market Trends and Health Reform: It’s A New Day
• Pressure on Commercial Payers• Medicare Insolvency• Medical Inflation>Economic Inflation• Population Aging and Uninsured • ‘Tragedy of the Commons’
Population Health
Patient Experience Cost Per Capita
Insurers Acknowledge Difficulty in Controlling…
• Utilization of High End Imaging• Readmissions• Outpatient Trend• New Drugs & Technologies• Ambulatory Sensitive Conditions
4
Options
• Reduce Unit Price• ACO with aligned incentives to pursue ‘Triple Aim’
Pankaj Patel
Population Health
Cost Per CapitaPatient Experience
APP’s Reimbursement Model Is Shifting
6
7
Value Based Agreements
14
Contract Lives Total Spend
Commercial 410,000 $2.0 B
Medicare Advantage 33,000 $0.4 B
Advocate Employee 27,000 $0.1 B
Medicare ACO 122,000 $1.4 B
Total 592,000 $3.9 B
ACO = Accountable Care Organization
The Cost Equation to Manage Risk
Profit Revenue Cost
FFS Surgicenter Imaging PT ED visits Readmissions
VBC Appropriate Coding
Price Volume
Low CostCenters
StandardizedCare Approach
Surgicenter Imaging PT ED visits Readmissions Avoidable morbidity
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Population Health Management
Source: The Advisory Board, Population health managers, meet the three patient types central to your success, June 14, 2013
PCMH
EMR /
MU
Smart
Registrie
s
Care Guidelines
Behavioral Health
Opt.
CM
Medicatio
n Therapy Managemen
t
Post-Acute
Network
OP
Palliative Care
X X X X X X X X X
X X X X X
X X X X X
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Evolution of Clinical Integration5 Performance Domains:
–Chronic Disease Care–Health and Wellness–Efficiency–Care Coordination–Patient Experience
Evolution of Clinical IntegrationPopulation Based Outcome Metric
AdvocateCare Index• Length of Stay• Admits/1000• ED Visits/1000• 30 Day Readmissions• % Days In-Network
Additional sub metric 2015 • Total cost of care
– Episode– pmpm
Evolution of Clinical Integration
Change in Incentive Payment
Incentives For All Physicians:
Move from pay for performance to pay for value contribution
Value Contribution = Performance x Volume of patients managed x Coordination of Care
factor
Advanced Analytics and Other Care Management Solutions• DART - ActiveHealth (HDMS)
• Predictive Tools– Readmission Risk - Cerner partnership– Falls Risk - Cerner partnership– Risk Stratification - ActiveHealth (HDMS)– Patient Impactability (under development)
• Total Cost of Care and Resource Use – Licensed from Health Partners
• Integrating EMRs - CareNet +
• Care Management Work Flow Tools - ActiveHealth
• Referral Management ERMA - APP
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Advancing Evidence Based Clinical Decisions
• e University CME Programs• Clinical Pathways Development / Point of Care Patient
Management Protocols• Pharmacy Academic Detailing• Learning Collaborative • Physician Office Staff Training• Patient Outreach and Education• Patient Health Coaching Program through Care
Management Program• Patient Self Management Tools
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Obesity:
• Impact on Population Health – BMI>30 results in 200-300% increase in Mortality – Increase in HTN, DM, CVD, DJD– 36% increase in Medical costs
• Gluttony or Sloth or Both– Imbalance: Energy consumed and Used– BMJ 1995 Energy consumed declining but obesity
increasing
Obesity Related Measures• 2012
– BMI Assessment• 2013 and 2014
Adults and Pediatrics– BMI Assessment and Follow Up Plan if abnormal– Exercise Assessment and Counseling
• 2015• Above Plus
– Online CME for Diabetes (includes focus on lifestyle changes and consideration of Bariatric surgery)
BCBS ACO Performance
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Value-based Agreement ResultsCommercial ACO• Cost Savings
– 2.0% Improvement in PPO cost trend (Q3 2013)– 3.1% Improvement in Combined HMO cost trend (Q3 2013)
• Quality*– HMO – 6 of 8 key metrics improved, 1 no change, 1 decreased
Medicare Shared Savings Program• Cost Savings
– 0%, Flat (Preliminary results, First 12 months, Q2 2013)
• Quality– Completely and accurately reported all 33 quality measures-100%– Estimated score 79%
Patient/Care Giver Experience 85% Preventative Health 87%
Care Coordination/Patient Safety 65% At-Risk Population 83%
*PPO Quality Data is not available due to new cohort measurement.
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Summary• Emerging payment models create a focus on
population health management
• Population health requires – A new focus on wellness and health status– A team approach