supporting medical practices’management system patient acuity drug cost (ion invoices & os...

©2019 Dimensional Insight, Inc.

Supporting Medical Practices’

Transition to Value-Based Care

with Diver Platform

Cass Schaedig

Vice President, Provider Analytics

IntrinsiQ Specialty Solutions


About the speaker

▪ 30+ years in healthcare business intelligence– Employers, Facilities, Payers and Physicians

▪ Founded Trellis Healthcare (1997)

▪ Dimensional Insight (initial use in 2001, Solutions Partner 2006)

▪ Acquisitions– HealthTronics/Endo Pharmaceutical (2013)

– IntrinsiQ/AmerisourceBergen (2015)

1997

Episode of Care for Specialists 350K Lives

2006

InfoDive

21,000+ Providers

2012

Medicare BPCI

250,000 Bundles

2016

Medicare OCM +35 Practices

2019

LUGPA Benchmarking

History of Our Value-Based Care Initiatives


About Us AmerisourceBergen provides pharmaceutical products, value-driving services and business

solutions that improve access to care. Tens of thousands of healthcare providers, veterinary

practices and livestock producers trust us as their partner in the pharmaceutical supply chain.

Global manufacturers depend on us for services that drive commercial success for their products.

2018 Revenue

Growth aligned with our customers’

long-term success

$167+ B

Global Offices

Delivering a range of services to address specific, local

needs

150+

Countries with a Local Presence

Growing knowledge of market-specific healthcare

environments

50+21,000+

Company Associates

Diverse expertise all focused on improving global health

FORTUNE 500 RANK #10


Medical Practice Challenges

▪ Declining fee-for-service rates

▪ Community practices merging or

joining hospitals

▪ Transitioning to value-based care

$51.36 $74.93

Office Visit

$227.16

$119.10

CT Head/Brain

$1,522.94

$1,423.44

Knee Replacement

2001 – 2019 Medicare Fees

Example - 2019 MIPS Scoring


DispensesNucleus Inventory Management System

Patient Acuity

Drug Cost (ION Invoices &

OS Rebates)

Relative Value Units

and Fee Schedules (CMS)

Medicare

Claims Data

Regimen and

Line of Therapy

Billing/Collections(PM System)

INSIGHTS

Benchmarking

Compare productivity, revenue,

accounts receivable, payer mix,

inventory management metrics

internally within practice and

externally to other ION practices

View net cost recovery of drugs

by payer and product using actual

invoices and paid claims experience

Buy & BillGapFinder®Monitor drug dispensed to billing data

to uncover lost billing and/or

compliance issues

Oncology Care Model

Identify OCM eligible beneficiaries,

monitor 6-month episodes with cost

and utilization data, gain insight into

the full cost of care by cancer type

and patient acuity

ReferralsView the entire care path for a

patient from the point of referral

including treatment path and

reimbursement

Revenue CycleView reimbursement, zero paid,

contract performance, A/R, etc.

Use robust financial reporting for

payer negotiations

▪ Benchmarking

▪ Buy & Bill

▪ GapFinder®

▪ Oncology Care Model

▪ Referrals

▪ Revenue Cycle

InfoDive® allows practices to turn disparate datasets into actionable insights for optimal business performance


$25 Billion

Payments

125 Million

Services

7700 Providers

93 Specialties

42 Billing

Systems

InfoDive Monthly Processing Volume


InfoDive Home Page


Oncology Care Model

▪ CMMI 5 year demonstration began July 2016 (175 practices still participating)

▪ Model is designed to lower the overall cost of treating cancer– 6 month episodes, triggered by patient initiating chemo

– Inclusive of all costs (Part A, B and D)

▪ Risk model – Target prices set based on cancer type and patient acuity

– Practices receive a performance based payment (PBP) if beat the target

– Failure to earn a PBP forces practices into two sided risk or drop out

▪ CMS provides all claims quarterly to participating practices

Period Episodes

Actual

Expense

Target

Price Avg +/- Total +/-

% of

Target

%

Practice

Paid

%

Chemo

Cost

Facility

Based

Care % ER

%

Acute

Admit % SNF

Total 3,640 $32,627 $31,362 $1,265 $4,603,137 104.0% 65% 52% $5,685 38% 25% 8%

1 1,248 $32,416 $30,202 $2,214 $2,763,639 107.3% 64% 49% $6,308 40% 28% 9%

2 1,212 $33,005 $31,335 $1,670 $2,023,807 105.3% 65% 52% $5,728 39% 25% 7%

3 1,180 $32,462 $32,618 -$156 -$184,309 99.5% 67% 54% $4,981 36% 23% 7%


Drugs – Billing, Collection and Inventory Management


Delivering flexibility using DivePort


InfoDive 7.0U

ser

Inte

rfac

e • Redesign was inspired by DI Simplified Interface

• Dashboards

• Bookmarks

• User initiated password change

• Faster response time

• More than doubled metrics and dimensions available

• Lessened the need for custom reports through pick-a-metric

Bac

ken

d • Ability to publish cBases while in use

• Limiting size of PDF and Excel that can be exported

• Running production scripts to call tunnels

• Ability to efficiently replicate programming changes across projects

• Expanded use of input portlets

• Increased visibility into script status

Effi

cien

cy •Faster builds (1/3 the time)

•Fewer Files (56 in 6.4, 22 in 7.0)

•No continuation models

•Consolidate multiple models to fewer cBases

•Utilize cPlans

•Reduced number of markers by using Chart/Measures/Diver portlets

•Staff can process more accounts simultaneously


What’s next?

▪ Practice-facing enhancements

– Expanded reporting of quality of care metrics

– Provider and executive mgmt compensation benchmarks

– General ledger/practice expenses

▪ Backend/Infrastructure

– Migrate remaining models to cBases

– Email alerts for process failures and more automated data validation

– Use of enhanced server time based logging (7.1) to support auditing

and troubleshooting

– Migration from DIAL scripts to .dive files

– Evaluation of Measures Factory (7.1)


Questions?

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