transition chs to predictive care management with medai rnc final
TRANSCRIPT
![Page 1: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/1.jpg)
![Page 2: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/2.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 3: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/3.jpg)
Predictive Care Management for CHS Single Practitioner
S
![Page 4: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/4.jpg)
Predictive Care Management for CHS Single Practitioner
S
O
![Page 5: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/5.jpg)
Predictive Care Management for CHS Single Practitioner
S
O
A
![Page 6: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/6.jpg)
Predictive Care Management for CHS Single Practitioner
S
O
A
P
![Page 7: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/7.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 8: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/8.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 9: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/9.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 10: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/10.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 11: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/11.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 12: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/12.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 13: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/13.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 14: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/14.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 15: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/15.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 16: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/16.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 17: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/17.jpg)
Predictive Care Management for Single Practitioner
![Page 18: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/18.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 19: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/19.jpg)
Predictive Care Management for CHS Single Practitioner
![Page 20: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/20.jpg)
Predictive Care Management for Single Practitioner
![Page 21: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/21.jpg)
Transitioning CHS Care Management to Population Stratification
Purpose of MEDai Risk Navigator Clinical for Community Health Solutions
Identify savings from TOTAL COST UNDER FORECASTED COST by Dx Categories
Identify HIGH RISK members in SCS population
Use RNC reports to demonstrate measured savings after CM engagement
Develop new programs from SCS population strata
Determine a process to move away from diagnosis trigger codes for CM
Establish a reliable ROI from the RNC data that could not have been attained prior
![Page 22: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/22.jpg)
Transitioning CHS Care Management to Population Stratification
Identify HIGH RISK members in SCS population
![Page 23: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/23.jpg)
Transitioning CHS Care Management to Population Stratification
Identify HIGH RISK members in SCS population
![Page 24: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/24.jpg)
Transitioning CHS Care Management to Population Stratification
Identify HIGH RISK members in SCS population
![Page 25: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/25.jpg)
Transitioning CHS Care Management to Population Stratification
Provide predictive analytics to identify future costs for each member
Identify members with TOTAL COST 10% GREATER than FORECASTED COST
Run a report for all members with greater than $50,000 TOTAL COST
Establish threshold dollar amount for PHARMACY FORECAST COST for example GREATER than $10,000
Determine the gap between TOTAL COST and FORECASTED COST for each SCS Shared Savings Age group
![Page 26: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/26.jpg)
Transitioning CHS Care Management to Population Stratification
Determine gap between TOTAL COST + FORECASTED COST for each SCS Shared Savings Age group
![Page 27: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/27.jpg)
Transitioning CHS Care Management to Population Stratification
Identify members in our SCS population that pose high risk for care
Run monthly reports for all member FORECASTED RISK INDEX > 50
Determine a threshold limit FORECASTED RISK INDEX for CM eligibility, for example any member greater than INDEX = 5 eligible for CM process
Identify our Psychiatric Disorders Group Aggregate HIGH RISK INDEX since this Group is SCS greatest Diagnostic Category
Segregate and indentify LOW RISK population strata and do not engage CM at level below 1.0 unless FORECASTED COST > $30,000
![Page 28: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/28.jpg)
Transitioning CHS Care Management to Population Stratification
Segregate and indentify LOW RISK population strata; do not engage CM at level below 1.0
![Page 29: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/29.jpg)
Transitioning CHS Care Management to Population Stratification
Segregate and indentify LOW RISK population strata; do not engage CM at level below 1.0
80.6%
![Page 30: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/30.jpg)
Transitioning CHS Care Management to Population Stratification
Ability to run Comparative Analysis on several CHS clients
Within SCS service line, determine Risk Index for each Group
Monitor TOTAL COST in relationship to FORECASTED COST for each client
Compare effects of CM engagement within each SCS Group
Determine HIGH RISK Diagnostic Categories within each SCS Groups
Identify members who are predicted to have HIGH TOTAL COST that can engage CM right now
![Page 31: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/31.jpg)
Transitioning CHS Care Management to Population Stratification
![Page 32: Transition CHS to Predictive Care Management with MEDai RNC Final](https://reader036.vdocuments.net/reader036/viewer/2022070601/587f65c51a28ab9b398b5d71/html5/thumbnails/32.jpg)
* End of Presentation *
Beginning of Predictive Care Management
August 2, 2010
Dr. Curtis J. TinsleyCommunity Health Solution of America
Office of Chief Medical OfficerOffice of Clinical Data Governance
“Transition Community Health Solutions to Predictive Care Management with MEDai Risk Navigator Clinical Suite”