Operationalizing Population Health

Transcription

1 PATRICK GAUTHIER Advocates for Human Potential, Inc. Operationalizing Population Health Population-linked Service Systems Speaker Name Title Organization

2 What is Population Health? Systematic effort to improve health outcomes in sub-populations that share multiple clinical and social attributes, a given geography, and health insurance coverage Reflects the interdependence of biology, behaviors, social, cultural, economic, and environmental factors that impact wellbeing Compels healthcare and social service providers and the insurer to envision and develop organized and integrated delivery systems capable of achieving the Triple Aim

3 Goals of Population Health Management

4 Product development of population-specific solutions into a viable business consists of the following: 1. Recommending and developing solutions to fill the gaps and create more cohesive connections 2. Costing and pricing solutions 3. Building a capable and properly resourced entity to govern and manage the operations Market research designed to identify scope and nature of populations health consists of the following: 1. Estimating prevalence and incidence of specific conditions in specific populations 2. Measuring historic utilization and trends 3. Assessing full spectrum of provider accessibility and availability 4. Assessing connections and linkages between service providers and systems Supply Demand

5 Enterprise Fundamentals

6 Operationalizing Population Health Management 6 Measure Outcomes and Monitor Performance of System in Relation to Quality and Reimbursement Model 5 Manage Care and Benefits. Coordinate Care within Integrated Delivery System. Continue to Refine Risk Stratification. Data Integration Information Exchange Communication & Collaboration Care Coordination to Include Team-based Intervention Apply Evidence & Standards Partner with Service Providers Patient & Family Education Analysis & Reporting 4 Engage Patients in Treatment Planning, Treatment, and Self-Management 1 Collaborating with Partners and Payers to Initially Define Attributes of Target Population(s) 2 Identify Immediate Gaps in Care and Services and Develop Improvement Plan to Include Additional Partners/Providers 3 Predictive Modeling: Stratify Risks Based on Epidemiological Analysis of Prevalence and Historic Utilization Source: Adapted from Institute for Health Technology Transformation (2012)

7 Population Health Tools and Approaches

8 Population Health Tools and Approaches

9 Data Warehouse Solutions

10 Why Data Warehousing and Informatics? 1. Fragmented information systems 2. Redundant business processes 3. Lack of standards = Lack of visibility and reliable business and clinical intelligence

11 Connected Healthcare Supporting Population Health Community Point-of-Care Health Information Exchange Referrals and plans of care Surveillance Transactional business processes Clinical decision support Collaborative view Shared data Population Health Management Coordinated care Chronic condition management Innovation Outcomes and quality improvement Predictive modeling and risk management Financial risk management Clinical benchmarking Business Intelligence

12 Information is Power Product Development and Risk Profile Core Processes and Value-based Reimbursement Socio- Economic Data Prevalence Data Utilization Data Risk Stratification Diagnostic Data Claims Data Outcomes Data

13 Implementing Intelligence Aggregate Data Validate and Normalize Data Draw Insights from Data Mobilize Data Business process Operations Financial Outcomes Quality Reports Predictive modeling Stratification Performance management Disease/cluster-specific Assessing risks Contracting Partnerships Productivity CQI

14 Future State Analytics Architecture

15 Analytics and Reporting System Transition Analytics System Transition PEOPLE PROCESS TECHNOLOGY Skills Process Consolidation Data Analysis Training and Education Data Management Report Deprecation Tools Analytics Life Cycle Management Data Migration New Job Categories Service Request Management Tool Migration Centralization Support and Maintenance Master Data Management System Monitoring Virtual Data Integration

16 Big Data and Big Value

17 HHS National Quality Strategy 2015 PRIORITIES LEVERS

18 Payer Value Equation Public policymakers are intent on measuring the value of healthcare services and rewarding clinicians and healthcare entities that improve that value. Private payers are also shifting rapidly to pay-for-performance models, as illustrated by the work of Catalyst for Payment Reform to develop scorecards, databases, and other value-driven tools on behalf of employers and other healthcare purchasers.

19 Driving Revenue with Performance Measures Outcomes Intermediate outcomes Patient experience Access AND Availability Process improvements and efficiencies Revenue Drivers Quality bonuses Shared savings Preferred marketing

20 Provider Challenge: Managing Complexity The difficulty that providers face in transitioning from volume to value should not be underestimated Managing risk-based contracts with multiple health plans and MCOs increases the difficulty Different measures Different contracts and fee schedules/reimbursement The cost of managing this additional complexity may reinforce the trend towards consolidation and integrated delivery systems

21 Types of Measures

22 Measures Measures Measures Revenue cycle Contract performance Quality Access and availability Population risk stratification Patient experience/satisfaction Outcomes medical/clinical (symptom and functionality) Outcomes Quality of Life (QoL) indicators Utilization Productivity Cost, P&L Process

23 Population Health Measures Quality of Life (QoL) indicators Provider network adequacy Timeliness Required signatures/ releases Multi-disciplinary treatment plan/team Adherence to EBPs Transitions in care Appropriate Timely Seamless Diversion effect (savings) Access to medical detox, H&P, psychiatric evaluation, and MAT Adherence with medication

24 Quality of Life (QoL) Health-related quality of life Recovery maintenance Housing Employment Family reunification Legal issues (probation, parole, DUI, child placement, etc.) Medical/primary care Risky behaviors Resiliency

25 Access Engagement access to clinician/screening/ assessment (same day) Emergent access (24 hours) Urgent access (72 hours) Routine access (7 days) Cancellations Retention adherence to treatment Average length of stay/episode Follow-up after discharge (7 days)

26 Clinical Outcomes Assessment scores PHQ-9 BASIS 32 SF-12 and 36 CAGE, AUDIT, BDI and any other measures of diagnosis, acuity/severity, functioning, symptoms, etc. Intermittent scores Post-discharge scores at 30, 60, 90, 180, 365 days Rate of readmissions at 30, 60, 90, 120, 365 days

27 Other National Standard Measures National Quality Forum (NQF) 20 quality measures focused on behavioral health Health Related Quality of Life CDC Measures Atlas of Integrated Behavioral Health Care (IBHC) Quality Measures (AHRQ) In support of integrated care Experience of Care and Health Outcomes (ECHO) Merges Mental Health Statistics Improvement Program (MHSIP) Consumer Survey and Consumer Assessment of Behavioral Health Services (CABHS) instrument

28 Other National Standard Measures Inpatient Psychiatric Facility Quality Reporting (IPFQR) Applies to the Inpatient Psychiatric Facilities (IPF) Medicare Prospective Payment System (PPS) Hospital-Based Inpatient Psychiatric Services (HBIPS) Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Children s health care quality measures: Child Questionnaire and Children with Chronic Conditions (CCC) Supplemental Items Healthcare Effectiveness Data and Information Set (HEDIS) Set of standardized performance measures designed to ensure that purchasers and consumers can reliably compare the performance of health plans

29 Institute of Medicine (IOM) Core Metrics for Health and Health Care Progress IOM uses a four-domain framework healthy people, care quality, lower cost, and engaged people to propose a streamlined set of 15 standardized measures with recommendations for their application at every level and across sectors

30 IOM 15 Core Measures

31 PROMIS Measures Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Measure assesses global physical, mental, and social HRQoL through questions on self-rated health, physical HRQoL, mental HRQoL, fatigue, pain, emotional distress, social activities, and roles PROMIS development led by National Institutes of Health (NIH) in conjunction with Patient-Centered Outcomes Research Institute (PCORI)

32 HHS PROMIS Measures

33 Next Indicated Steps

34 Recommendations PERFORMANCE PLANNING TEAM QA Director IT Director Clinical Director Finance Director Performance Management Plan Trainer Training National Standards Researcher Database Admin. Qualifications Budget/Timeline Measures/Tools Infrastructure Analyst Data Entry

35 PERFORMANCE PLANNING TEAM QA Director IT Director Clinical Director Finance Director Performance Management Plan Trainer Database Admin. Training Qualifications Budget/Timeline National Standards Measures/Tools Infrastructure Researcher Analyst Data Entry Training and Change Management Data Warehouse Solutions (interface, analysis, reporting) and Business Intelligence

36 Recommendations Assign team to understanding population health in your market Payers and providers Integrated and organized delivery systems Target populations Goals and objectives Measures Conduct strategic performance planning Review contracts for requirements and opportunities Prepare to invest in a data warehouse, analytical and reporting tools Prepare to invest in a highly configurable Business Intelligence dashboard solution

37 Recommendations Conduct a gap analysis Identify solutions and alternatives Identify resource requirements including sufficient expertise to implement measures/tools and train staff Develop a timeline with reasonable and rational expectations Develop a budget Assign an implementation team to the implementation plan Assign project manager and additional oversight

38 Thank You To receive more information, please contact: PATRICK GAUTHIER Director, AHP Healthcare Solutions 3415 S. Sepulveda Boulevard, Suite 1100 Los Angeles, CA Phone: