The Impact Of Employer Contribution Policy On Premium Rate Setting. Group-Specific Experience: Financial And Utilization Performance

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1 Premiums: HMO Premium Rate Calculations Setting Group Renewal Premium Rates The Impact Of Employer Contribution Policy On Premium Rate Setting Group-Specific Experience: Financial And Utilization Performance Plan Targeted Premium Rate Increases Versus Actual Premium PMPM Benefits: Issues in Member Payment Responsibilities Calculating the Financial Impact Of New Benefits Or Benefit Changes Measuring the Total Cost Impact of Cost Sharing Changes Deductible Management Value Based Insurance Design: A Primer Selected Medicare Advantage Terminology Terminology of Selected Components of Health Care Change Financial: 2015 CMS Readmissions Penalties Transitioning Physicians to a Performance-Based Compensation Model ACO Lessons Learned: Revisiting the Timing of Downside Risk Tips to Survive the Transition from Volume to Value Pay-for-Success Financing: A New Vehicle for Improving Population Health? Health Plan Financial Performance Indicators Identifying Managed Care Accounting Soft Spots Start AdvancedTopics 2015, MCOL. All Rights Reserved. page 217

2 Financial Continued: Analyzing And Budgeting Managed Care Administrative Expenses Coordination Of Benefits (COB) and Third Party Liability (TPL) Recoveries Understanding Health Plan Broker Compensation Medical Loss Ratio Requirements Estimations: Tips for Mining Big Data to Tackle Privacy Concerns in Predictive Modeling Practical Predictive Analytics for Healthcare 101 Predictive Analytics Comes to Healthcare Estimating PMPMs Estimating Medicare Risk vs. Commercial HMO Indicators Estimating Member Market Share After A Contract Terminates Using Capitation Principles When You re Not Capitated Predictive Modeling: A Primer Predictive Modeling Made Simple Metrics: Big Data, Big Ethics: Ensuring Appropriate Use of Large Data Sets PPO Market Metrics Web Metrics for Health Care Organizations Health Plan Ratings and Report Cards Revenue Cycle KPIs Provider Comparisons: A Primer Administrative Operational Metrics for Health Plans Start AdvancedTopics 2015, MCOL. All Rights Reserved. page 218

3 Medical Management: Better Care for the Over Serviced: Lessons from an Ambulatory ICU Reducing Readmissions Through An Effective Nursing Program How to Use the CMS Readmissions Hospital Specific Report The Importance of Medication Management During Care Transitions Incorporating Customer Relationship Strategies into Population Health Mgmt. Architect for Health -- the Clinical Health Coach mhealth: Essential for Drug Adherence Reducing Readmissions Through the Use of Technology Getting The Patient s Perspective To Reduce Hospital Readmissions Leveraging Big Data: Identify & Communicate Risk Drivers for Readmissions Neonatal Medical Home: A Novel Post-Discharge Care Model Calculating Inpatient Days Per 1,000 Pharmaceutical Management Concepts Monitoring And Reporting Out-Of-Local Network Utilization Contact Measurement Obesity: Understanding Body Mass Index (BMI) Wellness Incentive Programs Pay for Performance Incentives Comparative Effectiveness Primer The Behavioral Risk Factor Surveillance System Provider Issues: The Pioneer ACO: A Strategy for Population Health Management Hospital-Physician Partnership Holds Key to Value over Volume Start AdvancedTopics 2015, MCOL. All Rights Reserved. page 219

4 Provider Issues continued: Is Your ACO Prepared for HIPAA? Measuring Managed Care Participating Provider Changes Traditional Capitation Concepts Medical Identity Theft Membership Issues Member Disenrollment Bulk HMO Member Transfers Measuring Service Contact Performance Consumerism Issues Calculating Consumer Out Of Pocket Costs Budgeting and Projections for High Deductible Plans and Higher Cost Sharing Reporting Consumer Driven Enrollment Customized Health Plans Price Transparency Start AdvancedTopics 2015, MCOL. All Rights Reserved. page 220

5 Advanced Topics Menu Volume 1, Issue 7 Incorporating Customer Relationship Strategies into Population Health Management by Mark Crockett, M.D. T hough recent changes in healthcare payment and delivery have brought more alignment between payer, provider and patient, the healthcare system still struggles to care for the patient as a person. The passage of the Affordable Care Act has increased focus on the continuum of care and population health, but a lack of individual patient connection remains troublesome in the quest for efficiency and effectiveness in healthcare. To close this gap, payers must understand the population as a whole, and providers must have complete knowledge of the patient as an individual. By developing a more complete and nuanced profile of their patients, both payers and providers can approach care management in a much more intimate and meaningful way. The term "Triple Aim" has been tossed around for a number of years in healthcare. Over time, the meaning has become a bit cloudy. Whether its aims are defined as customer service, profitability and competitive differentiation as is done by so many these days or hearken back to the earlier definition of experience of care, improving the health of populations and reducing per capita costs of healthcare (care, health and cost), the underlying concept remains. Through a strong relationship with their physicians, patients are willing to partner with providers, thereby improving clinical outcomes and bringing clinical and financial success to a healthcare practice. Within other industries, companies that master the customer relationship win (and keep) business. There also is plenty of proof in the healthcare world that great relationships power great results as more and more industry players are beginning to see. As the healthcare system begins to embrace the Triple Aim, with the rise of accountable care organizations and an increased focus on value-based reimbursement, a successfully implemented population health solution employing a handful of important steps can be a critical part of that process. 1. Proactive physician involvement. Let s face it; patients need to feel a bond with their physician. Developing and bolstering that relationship is extremely important in how patients choose to obtain (and adhere to) care. Care is an intimate experience and when expectations are met for service, the relationship is very powerful. When the provider is not informed and coordinated, that goodwill is wasted or worse yet, thwarted. Tackling this problem so that the relationship between providers and their patients remains strong, is paramount in achieving positive population health outcomes. Exibit 1: Physician Relationships 2. Organize strategy around the patient. More and more tools are available these days, but early adopters of resources, such as text messaging for appointment reminders and web-based appointment scheduling, will see that struggles remain. Many soon realize that there are still a lot of inbound and outbound patient calls that will keep physicians disconnected from their patients. And it certainly doesn t help matters when clinical care coordinators or those in similar positions still spend a good portion of their workday creating manual reports for physicians and retyping information into an electronic medical record. With the impending reality of value-based contracts, providers must develop patient-centric strategies to address their care gaps, streamline data flow and give all members of the care team more time with those they serve. 3. Leverage Data. By analyzing data and aligning information by patient and provider, physicians can begin to get a clearer picture of each patient s health profile. By leveraging that data, in order to identify at-risk patients and care gaps, those that coordinate care for providers are able to better distill the necessary intelligence needed to support outcomes in a world of value-based reimbursement. Keeping track of these factors also greatly increases providers ability to best allocate resources and control costs. Start AdvancedTopics 2015, MCOL. All Rights Reserved. page 380

6 Advanced Topics Menu 4. Evolve to a community care model. There is simply no substitute for knowing one s customers. For this reason, reaching out to patients and encouraging them and their families to be more involved in their own care is another vital component of the overall strategy. When providers and patients are able to more accurately keep track of patients histories, risk factors and scheduling, the efficiencies of a community care model begin to emerge. Appointments for multiple services can be scheduled in a single day, making it easier for patients to comply. Physicians better know what to schedule and what to record for patients. The data, as discussed above, then become an asset, which builds on itself and allows for a more complete picture via an electronic medical record (EMR). Though the physician is the patient quarterback, the caregivers and families of patients can now interact with and/or be informed by a patient record reinforcing the sense of shared information goals and community. 5. Take advantage of every communication opportunity. Patients care about their health. On an average day in a multispecialty practice, patients call in four times more often than they are reached via outbound calls. By treating every patient interaction as an opportunity for greater engagement, providers will be able to reduce the amount of redundant inbound patient calls and more efficiently grow their data stores. Benefiting From a Population Health Management Strategy In addition to reducing administrative workload and closing care gaps, a well articulated strategy around population health management gives providers the ability to do what they do best: take care of patients. As the reality of value-based care looms, practices have to work smarter, not harder, in order to survive and thrive in the new healthcare economy. Exhibit 2: Inbound versus outbound call volumes per day A complete system that supports the physician s oversight of patient care and takes advantage of every possible interaction is an investment in time, effort and capital but the results are significant and offer long-term benefit. Preparation for value- based care means getting healthier now. No pain no gain. Start AdvancedTopics 2015, MCOL. All Rights Reserved. page 381