successful population health management through...
TRANSCRIPT
A Town Hall Event by the C&BI
Population Health-Accountable
Care Task Force
July 1, 2015
Successful Population Health Management Through Analytics
HIMSS Town Hall Series This is an informal public meeting that gives the
members of a community an opportunity to get together to discuss emerging issues and to voice concerns and preferences for their community.
Today’s Event: Population Health
Management: Success Through
Analytics
Town Hall speakers:
Joseph M. Taylor CEBS, RHU, HIA
Vice President - ACO Practice Leader
FluidEdge Consulting
Moderator:
John Middleton, MD, MS
Diplomate, Clinical Informatics, ABPM
VP/CMIO, SCL Health System
Progression of Alternative Payment Models
Fee For Service
P4P
Shared Savings
Episode Payment
Global Payment/ Full Risk
Ris
k
Provider Accountability
Direct contract with
local employers
Providing insurance
Risk-Based Contracting Takes Population Health Management to the Next Level
5
• CMS is expanding alternative payment models
• Payors and health systems are as well
• While this can be profitable, if not done well, it can be disastrous
Expanding Alternative Payment Models
6
• In 2014, 20% of Medicare’s
$417 million payments were
through alternative payment
models
• CMS set the goal of
increasing the payments
through value-based payment
models to 30% by 2016 and
50% by 2018
• They also proposed that by
2016, 85% of all Medicare
FFS payments have a
component that is based upon
quality or efficiency of care -
which will increase to 95% by
2018
Expanding Alternative Payment Models
Tandigm Health Signs Landmark Agreement with Holy Redeemer Health System and Innovative Wellness Alliance Posted Date: 2/4/2015
Tandigm Health, Holy Redeemer Health System, and Innovative Wellness Alliance(IWA) today announced a landmark agreement to improve the delivery of quality healthcare, reduce costs, and enhance patient satisfaction. Under the agreement, more than 75 primary care physicians from IWA, a physician-led, patient-centered organization, along with Holy Redeemer’s extensive network of inpatient, outpatient, home health, and long-term-care services, will collaborate with Tandigm Health and its growing network of primary care physicians.
The deal marks Tandigm Health’s first cooperative arrangement with both a clinically integrated network of primary care physicians and a health system that provides a full continuum of health care services. The agreement will be effective March 1, 2015.
Trinity forms risk-based partnership January 15, 2015 | By Zack Budryk
Trinity Health is continuing its trend of acquisitions, forming a risk-based accountable care partnership with Heritage Provider Network.
Livonia, Michigan-based Trinity Health this week announced a partnership with California-based Heritage Provider Network (HPN), Healthcare Finance News reports. The partnership, called Trinity Health Partners, will operate in multiple markets and link HPN's 37,000 physicians with Trinity's 86 hospitals. As part of the arrangement, the two organizations will establish new models to coordinate several services, including primary care, high-risk clinics, post-acute care and hospitalist services.
"This joint venture allows us to rapidly expand our capabilities to contract with payer-partners for full-risk, capitated arrangements that will result in better health, better care and lower costs in the communities we serve," Richard J. Gilfillan, M.D., president and CEO of Trinity Health, said in a statement. "This approach is a key part of our strategy to build a people-centered health system."
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Analytics Enable the Risk Needs Hierarchy
• Achieving the Triple Aim
• Risk factor stabilization & reduction
• Optimize Patient Functioning
• Measures: CMS, Payer & Patient
• Patient “OWNS” their care
• Co-developed personalized care plans
• The educated, compliant & self-managed patient
• Daily task achievement
• Population & patient based campaign management
• Dashboards: Patient, Care Coordinator & Physician
• Clinical program measurement, evaluation & evolution
• Risk identification and population based stratification
• Data governance
• Integrate unstructured & patient preference data
• Integrate lab, radiology & HIE data
• Connect all ACO EMRs and payer data sources
• Incentive compensation program alignment
• Determine process & results measures
• Mutually beneficial contracting
• Mission, Vision and Purpose
• The coordinated care team
• Understanding patient behavior between visits
• Targeted management (MTM, readmission, ED, end of life, etc.)
• Chronic conditions, behavioral health & case management
Data Integration and Analytics & Actionable Information
Predictive Modeling,
Clinical and Business
Intelligence
ACO’s Internal Data (EMRs and Financial)
Traditional Payer Data
HIE Data
Patient Preference Data
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Patients
Stratified for
Care
Management
Programs
Analytics & Actionable Information Empowering Care Coordination
End of
Life
Case
Mgmt.
Discharge
Planning
Multiple Single &
Chronic Conditions
Health
Education
Health
Promotion
Enables Patient Centered Care
Management, Acute Stay, Post
Acute and Full Risk Management
Including UM
Optimizes Payer quality
measures for low acuity
patients
Demonstrating Value
Clinical
Outcomes
Patient Satisfaction
Price and
Utilization
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Patient Satisfaction • Patient Satisfaction Surveys
• Patient Engagement
• Care Program Participation Rates
• Patient Activity & Compliance
Between Visits
• Leakage Rates and Market Share
Improvement
• CMS and Payer Measures
Clinical Outcomes • Care Gaps Confirmed and Closed
• Medication Optimization & Possession Ratio
• Clinical Value Improvement
• SF12 Rates
• Risk Factor Improvement
• CMS and Payer Measures
Price and Utilization • Total Medical PMPM
• Medical Trend
• Total Rx PMPM
• Admissions/1000
• Images/1000
• ER, Urgent Care Usage
• Site of Service Management
• Readmission Rate Reduction
• CMS and Payer Measures
Value = (Clinical Outcomes + Patient Satisfaction) / (Price x Utilization)
Vendor Evaluation
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Weight (1-10) Vendor 1 Vendor 2
Vendor 3
Vendor 4 Vendor 5
I. General 3 8.23 5.55 3.90 6.95 6.89
II. Technical 10 9.59 5.74 5.62 6.15 6.80
III. Integration / Data Feeds 10 8.85 7.63 5.28 7.83 5.42
IV. Reporting - Quality, Costs, Outcomes, Physician Performance 7 9.91 8.89 6.61 6.53 5.87
V. Care Delivery and Coordination 10 7.84 4.17 7.46 9.13 7.63
VI. Physician Compensation/ Incentive Management 3 9.42 4.07 2.44 9.42 7.79
VII. Patient Engagement 7 8.70 0.31 6.08 6.44 7.58
VIII. Risk Management and Predictive Modeling 7 9.54 4.87 8.42 8.88 6.64
IX. Notes 3 8.14 4.21 6.86 8.79 8.36
Overall Score: 8.95 5.26 6.18 7.66 6.80
Concluding Thoughts
• Value-based contracting is here
• Data & analytics are ESSENTIAL for success
• Understand your business model and needs
• No ONE vendor can DO IT ALL!!!
• Focus on goals and results
• Collaboration is not for sissies, but it is critical!!!
Town Hall Discussion
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• What are the top 3 actions an organization should do to be successful in risk-
baring contracting for population health management (PHM)?
• What is the most difficult step, barrier, or problem to address in analytics for
PHM that should be addressed as an health care organization begins its
efforts?
• What has been the most difficult thing to do for the majority of the organizations
once into the effort?
• How long does it take the typical organization to become reasonably competent
in analytics to support its PHM program?
• What are 2-3 areas that typically are known to be difficult for an organization to
accomplish? What are some suggestions for or examples of how to overcome
those challenges?
• What are some of the characteristics of IT and analytics tools for a successful
PHM program?
• Where are the members of the Town Hall in their PHM journey?
• How do organizations determine their PHM goals and results? And what does
the end look like?
Next Steps
Let’s continue the conversation and learning • Blog posts
• Key findings and take-aways
• Articles
FY15 C&BI Leadership Information Committee Chair:
JD Whitlock, MPH, MBA, CPHIMS
Vice President, Clinical & Business Intelligence
Mercy Health
Population Health-Accountable Care Task Force Co-Chairs:
William Beach, MBA, MLA, PhD Jennifer Jackson
Regional Director, Regulatory Readiness, Northern Region, Senior Director, IT Population Health Data Solutions
St. Joseph Health System Banner Health
[email protected] [email protected]
Community Co-Chairs:
Michael Brooks, BS, MBA, CPHIMS Mike Berger, PE, CPHIMS
Specialist Leader Chef Analytics Officer
Deloitte Consulting LLP Affinity Health Plan
[email protected] [email protected]
HIMSS Community Organizers | Staff Liaisons:
Shelley Price, MS, FHIMSS Nancy Devlin
Director, Payer & Life Sciences, HIMSS Senior Assoc., Payer & Life Sciences, HIMSS
J.D. Whitlock, MPH, MBA, CPHIMS* --
Chair Vice-President, Clinical & Business Intelligence
Mercy Health
Cheryl Bowman, CPHIMS Data Manager
University of Wisconsin Hospital and Clinics
Michael Brooks, BS, MBA, CPHIMS,
FHIMSS* Specialist Leader
Deloitte Consulting LLP
Robyn Chatman, CPHIMS, FAAFP, MD,
MPH Physician
Healthbridge
Teresa Gocsik, MS, CRNA, CPHIMS* Associate Principal
Aspen Advisors
Michael Kurliand, MS, RN* IS Strategy Consultant
Children's Hospital of Philadelphia
Sharon Lynn Morley, RN/CNS Client Manager
Humedica
Arthur Panov, MPH, CPHIMS* HIT Architect
IBM
Stuart Rabinowitz, MBA, BC Director Federal Markets - Channel
Partners
Socrata
Maxine Rand, DNP (c), MPA, RN-
BC, CPHIMS* Director, Clinical Education, Practice &
Informatics
Kaiser Permanente
Chester H Robson, DO, FAAFP Medical Director, Clinical Programs and
Quality
Walgreen Co.
Wolf Stapelfeldt, MD* Chairman, General Anesthesiology
Saint Louis University Medical Center
2014-2015 C&BI Committee Members
Community Co-Chairs
Michael Brooks, BS, MBA, CPHIMS,
FHIMSS Specialist Leader
Deloitte Consulting LLP
Mike Berger, PE Chief Analytics Officer Affinity Health Plan
Data and Analytics Task Force
Co-Chairs
Raj Lakhanpal, MD, FRCS, FACEP CEO
SpectraMedix
Carol Muirhead, MBA Computer Science Faculty,
Wyoming Northern Community College
District
Gillette College, Gillette, Wyoming
Population Health-
Accountable Care Task Force
Co-Chairs
William Beach, MBA, MLA, PhD Regional Director, Regulatory Readiness,
Northern Region,
St. Joseph Health System
Jennifer Jackson Senior Director, IT Population Health Data
Solutions
Banner Health
2014-2015 C&BI Task Force & Community Chairs
Thank you!