population management
TRANSCRIPT
In-Depth Look: Population Health
Management
August 18, 2014
Health system leaders tell us they need help with the following three things the
most:
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ALIGNMENT. Improve experience and loyalty of patients and providers, both employed and affiliated.
COORDINATION. Provide high quality care by ensuring care is coordinated, information is shared, and the patient is visible and at the center across care settings.
EFFICIENCY. Accomplish the above by better leveraging your existing financial and human capital.
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Population Health Today
100+ companies already exist to support population health, however…
Disparate Data Inputs
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…but that means it’s up to you, the client, to harvest value
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Focus on risk and value-based reimbursement
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When in reality, health systems will be balancing FFS and FFV for years
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12 Medicare Shared Savings ACOs
1.2 million covered lives
$5B Total Medical Expense
10,000+ physicians
More than 65% of the risk membership in MA
Over 25 commercial risk programs across 9 states
We help manage 8% of the at-risk lives in the country
Three Pioneer ACOs
Software alone is not the answer. We add knowledge and work…
Disparate Data Inputs
Software• Quality, Outmigration & Risk
Managers• Network facesheet • Secure messaging• Patient Communication tools• Direct scheduling
Knowledge• Patient matching
algorithms• Scheduling logic• Quality management rules• Patient outreach best
practices• Intelligent referral
management
Work• Interoperability service• Population health campaigns/gap in care
outreach• Patient scheduling for campaigns (live
operators)• Patient access services
Identify gap in care
Reach out to patients
Patient schedules
appointment
Patient reminded of appointment
During patient visit, provider
views longitudinal
patient recordProvider refers
patient to a specialist and
schedules appt
Insurance clearance,
referral-on-file, prior-auth, or
pre-certification completed
Pre-register patient and
collect patient financial
responsibility
Specialist receives secure message with
link to longitudinal
patient record
Clinical and financial results are tracked and
optimized
athenaCoordinator Enterprise is an end-to-end Care Coordination service
athenahealth sees that George needs a PCP visit
Identified through evidence-based clinical “rules” and payer-based quality programs
Identify gap in care
Identify gap in care
Reach out to patients
Patient schedules
appointment
Patient reminded of appointment
During patient visit, provider
views longitudinal
patient recordProvider refers
patient to a specialist and
schedules appt
Insurance clearance,
referral-on-file, prior
authorization, or pre-certification
completed
Pre-register patient and
collect patient financial
responsibility
Specialist receives secure message with
link to longitudinal
patient record
Clinical and financial results are tracked and
optimized
Identify gap in care
athenahealth sends George secure messages encouraging him to make an
appointmentReach out to patients
Identify gap in care
Reach out to patients
Patient schedules
appointment
Patient reminded of appointment
During patient visit, provider
views longitudinal
patient recordProvider refers
patient to a specialist and
schedules appt
Insurance clearance,
referral-on-file, prior
authorization, or pre-certification
completed
Pre-register patient and
collect patient financial
responsibility
Specialist receives secure message with
link to longitudinal
patient record
Clinical and financial results are tracked and
optimized
Identify gap in care
Reach out to patients
Patient schedules appointment
George receives a text to schedule his appointment
Patients can schedule via mobile app, online portal,
or live phone operator
Identify gap in care
Reach out to patients
Patient schedules
appointment
Patient reminded of appointment
During patient visit, provider
views longitudinal
patient recordProvider refers
patient to a specialist and
schedules appt
Insurance clearance,
referral-on-file, prior
authorization, or pre-certification
completed
Pre-register patient and
collect patient financial
responsibility
Specialist receives secure message with
link to longitudinal
patient record
Clinical and financial results are tracked and
optimized
Identify gap in care
Reach out to patients
Patient schedules appointment
During patient visit, provider views longitudinal
patient record
Dr. Calhoun uses the Network Facesheet to view information about
George from across care settings
Abnormal
Dr. Calhoun
Identify gap in care
Reach out to patients
Patient schedules appointment
Patient reminded of appointment
During patient visit, provider views
longitudinal patient recordProvider refers patient to
a specialist and schedules appt
Insurance clearance, referral-on-file, prior authorization, or pre-
certification completed
Pre-register patient and collect patient financial
responsibility
Specialist receives secure message with link to longitudinal patient
record
Clinical and financial results are tracked and
optimized
Identify gap in care
Reach out to patients
During patient visit, provider views
Network Facesheet
Patient schedules appointment
Provider refers patient to a specialist and schedules
appt
Dr. Calhoun schedules George for an ophthalmologist visit with Dr. Martin,
a provider in his health system
Dr. CalhounDr. Martin
(on different EHR)
Identify gap in care
Reach out to patients
Patient schedules appointment
Patient reminded of appointment
During patient visit, provider views
longitudinal patient recordProvider refers patient to
a specialist and schedules appt
Insurance clearance, referral-on-file, prior authorization, or pre-
certification completed
Pre-register patient and collect patient financial
responsibility
Specialist receives secure message with link to longitudinal patient
record
Clinical and financial results are tracked and
optimized
Identify gap in care
Reach out to patients
During patient visit, provider views
Network Facesheet
Provider refers patient to a specialist and schedules appt
Patient schedules appointment
Insurance clearance, referral-on-file, prior authorization, or
pre-certification completed
athenahealth identifies and ensures that the prior-auth for George’s visit is
needed and complete
Identify gap in care
Reach out to patients
Patient schedules appointment
Patient reminded of appointment
During patient visit, provider views
longitudinal patient recordProvider refers patient to
a specialist and schedules appt
Insurance clearance, referral-on-file, prior authorization, or pre-
certification completed
Pre-register patient and collect patient financial
responsibility
Specialist receives secure message with link to longitudinal patient
record
Clinical and financial results are tracked and
optimized
Identify gap in care
Reach out to patients
During patient visit, provider views
Network Facesheet
Provider refers patient to a specialist and schedules appt
Insurance clearance, referral-on-file, prior
authorization, or pre-certification
completed
Patient schedules appointment
Pre-register patient and collect patient financial responsibility
George receives financial obligation and payment options from
athenahealth representative
Identify gap in care
Reach out to patients
Patient schedules appointment
Patient reminded of appointment
During patient visit, provider views
longitudinal patient recordProvider refers patient to
a specialist and schedules appt
Insurance clearance, referral-on-file, prior authorization, or pre-
certification completed
Pre-register patient and collect patient financial
responsibility
Specialist receives secure message with link to longitudinal patient
record
Clinical and financial results are tracked and
optimized
Identify gap in care
Reach out to patients
During patient visit, provider views
Network Facesheet
Provider refers patient to a specialist and schedules appt
Insurance clearance, referral-on-file, prior
authorization, or pre-certification
completed
Pre-register patient and collect patient
financial responsibility
Patient schedules appointment
Specialist receives secure message with link to
longitudinal patient record
Dr. Martin receives a secure text about George’s visit, including access
to George’s Network Facesheet
Dr. Martin(on different EHR)
Identify gap in care
Reach out to patients
Patient schedules appointment
Patient reminded of appointment
During patient visit, provider views
longitudinal patient recordProvider refers patient to
a specialist and schedules appt
Insurance clearance, referral-on-file, prior authorization, or pre-
certification completed
Pre-register patient and collect patient financial
responsibility
Specialist receives secure message with link to longitudinal patient
record
Clinical and financial results are tracked and
optimized
Identify gap in care
Reach out to patients
During patient visit, provider views
Network Facesheet
Provider refers patient to a specialist and schedules appt
Insurance clearance, referral-on-file, prior
authorization, or pre-certification
completed
Pre-register patient and collect patient
financial responsibility
Patient schedules appointment
Specialist receives secure message with
link to Network Facesheet
Clinical and financial results of care communicated back to
providers and are tracked and optimized
Dr. Calhoun receives results of George’s visit in the network
facesheet
Dr. Calhoun receives results from George’s visit in the Network
Facesheet
Clinical and financial results are tracked and
optimized
Identify gap in care
Reach out to patients
Patient schedules appointment
Patient reminded of appointment
During patient visit, provider views
longitudinal patient recordProvider refers patient to
a specialist and schedules appt
Insurance clearance, referral-on-file, prior authorization, or pre-
certification completed
Pre-register patient and collect patient financial
responsibility
Specialist receives secure message with link to longitudinal patient
record
Clinical and financial results are tracked and
optimized
Identify gap in care
Reach out to patients
During patient visit, provider views
Network Facesheet
Provider refers patient to a specialist and schedules appt
Insurance clearance, referral-on-file, prior
authorization, or pre-certification
completed
Pre-register patient and collect patient
financial responsibility
Patient schedules appointment
Specialist receives secure message with
link to Network Facesheet
Clinical and financial results are tracked and
optimized
Secure Text Messaging to improve care coordination and network loyalty
Network Facesheet to improve care coordination and enhance quality with a unified patient record for all network providers (employed and affiliates)
Patient Access Services to guide patients to their appointment, ensure revenue is realized, and realize cost synergies
In summary…
Sequencing of threads can vary depending on your priorities
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Population Health Services to source patients, boost schedule density and improve quality scores
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Direct Scheduling to open and fill slots and to improve schedule density and satisfaction2
We’re doing it today: athenaCoordinator Enterprise is helping health systems
respond to a changing environment with leading services
HEALTH SYSTEM BENEFIT ATHENA RESULTS
• Higher compliancy rates for population health campaigns 10-25% appointment conversion rate
• Improved in-network referral rate 8-10% reduction in out-migration
• Improvement in self-pay collection rate $25M collected via online bill pay/live operator in 2013
• Improvement in schedule density 3-5% increase in schedule density
• Reduction in denials and bad debt write offs from no prior auth/referral on file
Reduced referral backlog from 21 days to 0; reduced denial rate 15%
• Reduced readmission penalties 20-40% reduction due to better care plan documentation and patient communication
• Cost synergies from co-sourcing of patient outreach and patient access Varies by health system
By leveraging athenaCoordinator Enterprise you can achieve your strategic
goals
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1. Engage patients
2. Align physicians and care teams
3. Create seamless transitions
in care
4. Optimize revenue and
efficiency
Thank you!