Advanced Population Health Management:

Transcription

1 Advanced Population Health Management: Program success with Care Management & Data Analytics Daniel J. Elliott, M.D., MSCE, FACP Medical Director Christiana Care Quality Partners and Christiana Care Quality Partners ACO Innovations in Care Delivery Conference March 23 24, Christiana Care Health System 2 3 1

2 4 The challenge: 20,000 employees and dependents Rising Healthcare Costs 5 Christiana Care Quality Partners Clinically Integrated Network (to be) 2500 providers ~400 employed FY14 Build network FY15 First year of operation Christiana Care Health Services Christiana Care Quality Partners Board of Managers Christiana Care Clinical Chairpersons & Medical Leadership Quality Improvement Committee* Credentialing* Clinical Operations Committee* Reimbursement Committee* Governance and Leadership* 6 2

3 Core Focus JOB #2 Lead the Transformation to Value based care in our community JOB #1 CCHS Employees and Dependents Identify and Work collaboratively as a Network Developing Shared Infrastructure Defining and Understanding Quality and Cost Determine Clinical Pathways for Improvement Highest Value Care Best Place to Be a Doctor or a Patient 7 Network Performance How are we evaluated by Patients, employers, and payers? High Performing Network Better Health Better Healthcare Lower Costs Cost PMPM Utilization Unit Price KEY FACTORS Network Performance Care Management Patient Activation Benefit Design Utilization Management New treatments Quality HEDIS metrics Patient Satisfaction 8 Partnership with GHP/xG TPA PBM Care Management Population Health Analytics Quality Utilization/Cost 9 3

4 Physician Engagement CM Principles Provider alignment functionally embedded with practices Providers must have confidence in Care Managers Easy and reliable communication path and platform Electronic + verbal Introduce data that is panel specific that incorporates multiple data sources Identify patients through automated risk stratification and provider identification Dual clinical focus Intensive CM support for High Risk Prevention/Health Maintenance Tailor patient engagement approach to the patient based on characteristics, skills, literacy, etc. Partnership among multiple CM resources eliminate redundancy 10 Care management program Care Management XG People: 9 Care Managers Embedded and Telephonic CM; Increase visibility Process: Standardized operational infrastructure to support the CM team, medical home meetings, provider roster reviews and a CM platform. Technology: Predictive Modeling, identification of chronic and acute conditions; Staff also have access to the main EMR platform. Care management services Acute and Chronic condition focus Improving P4P quality metrics Integration of CM with employee Wellness program Care management interventions Medical home participation Transitions of Care ED activities 11 Identifying Employees/Families for Care Management Trigger Event* Chronic Condition* Risk Score* Referral including Hospital Admission** Care Management Team * Supported by claims data ** Includes Geisinger best practices 12 4

5 Approach to physicians In person meetings Prepared template Patient roster with key data elements Quality Data PFV Partnered with our practice reps Primary Care Pay for value program Acute/Chronic HEDIS measures Preventive HEDIS measures Medication Management Pharmacological Care Medication Adherence 13 Physician Feedback 14 Care Management Referrals 15 5

6 16 Data Analytics and Engagement Biweekly analytics meetings In person gatherings Dashboard Balanced scorecard 17 Commercial Covered Lives High level Findings between FY14 and FY15 Utilization Reductions 19% Acute Admissions/1000* 27% Med Surg Admissions/1000** 46% Med Surg 1 Day Stays/ % ALOS 30% Readmissions/1000 6% ED Visits/1000 Shifts to Other Settings 23% Ambulatory Surgery/ % Observations/1000 * Acute admissions omit Skilled Nursing and Rehabilitation admissions; as well as behavioral health ** These are medical and surgical admissions only and exclude behavioral health, maternity/deliveries, SNF and LTC 18 6

7 Year 1 Performance PMPM 19 Overview of Cost and Use 20 High cost Cases 7 people with claims > $500K 21 7

8 Pharmacy For every 1% shift to generic, there is a potential savings of $861K ($3.75 pmpm) FY16: 12% increase in pharmacy, 85% related to specialty costs Example of Statins Scripts (#) Spend ($) Generic 13,500 82,000 Brand 1, , Peer Group Summary Counts By Peer Group Family Practice Internal Medicine Pediatrics TOTAL TINs Physicians TINs By Peer Group 133 Total Physicians By Peer Group 418 Total Family Practice 60 45% Internal Medicine 43 32% Family Practice % Internal Medicine % Pediatrics 30 23% Pediatrics 81 19% 23 Results by Measure Overall Peer Group + Measure Numerator. Denominator. Rate%. Preventive Health 3,784 4, % Adolescent Immunizations % Breast Cancer Screening 1,122 1, % Cervical Cancer Screening 2,528 3, % Childhood Immunizations % Acute/Chronic Illness 1,568 2, % Children With Pharyngitis % Diabetes Eye Exam % Diabetes HbA1c Screening % Diabetes LDL C Screening % LDL Screening After Cardiovascular E % Medication Management % Acute Bronchitis % Asthma Appropriate Meds Usage % Grand Total 5,498 7, % By Peer Group Peer Group + Measure Numerator. Denominator. Rate%. Family Practice 3,192 4, % Preventive Health 2,210 2, % Adolescent Immunizations % Breast Cancer Screening % Cervical Cancer Screening 1,578 2, % Childhood Immunizations % Acute/Chronic Illness 905 1, % Children With Pharyngitis % Diabetes Eye Exam % Diabetes HbA1c Screening % Diabetes LDL C Screening % LDL Screening After Cardiovascular Event % Medication Management % Acute Bronchitis % Asthma Appropriate Meds Usage % Internal Medicine 2,040 2, % Preventive Health 1,418 1, % Adolescent Immunizations % Breast Cancer Screening % Cervical Cancer Screening 914 1, % Childhood Immunizations % Acute/Chronic Illness % Children With Pharyngitis % Diabetes Eye Exam % Diabetes HbA1c Screening % Diabetes LDL C Screening % LDL Screening After Cardiovascular Event % Medication Management % Acute Bronchitis % Asthma Appropriate Meds Usage % Pediatrics % Preventive Health % Adolescent Immunizations % Breast Cancer Screening % Cervical Cancer Screening % Childhood Immunizations % Acute/Chronic Illness % Children With Pharyngitis % Diabetes Eye Exam % Diabetes HbA1c Screening % Diabetes LDL C Screening % LDL Screening After Cardiovascular Event % Medication Management % Acute Bronchitis % Asthma Appropriate Meds Usage % Grand Total 5,498 7, % 24 8

9 Bonus Payout By Group Top 40 Detail $0 $20,000 $40,000 $60,000 $80,000 $100,000 Christiana Care Health Services $93,520 Pediatric Associates $30,230 Brandywine Pediatrics $23,532 Delaware Pediatrics $20,817 First State Pediatrics $11,669 Total Care Physicians PA $11,529 Just Kids Pediatrics $9,927 Stoney Batter Family Med Assoc $8,398 Mill Creek Pediatrics $7,345 First State Medical Associates $7,235 Family Practice Associates PA $7,138 Trinity Medical Associates PA $6,383 Brandywine Medical Associates $5,877 Delaware Modern Pediatrics $4,530 Rebecca Jaffe MD & Associates $4,427 Premier Pediatrics $4,347 Bear Internal Med. & Ped., PA $4,001 Quality Family Physicians PA $3,961 Family Medicine at Greenhill $3,944 Delaware Medical Associates $3,706 William D Funk MD PA $3,696 Delaware Family Care Assoc. $3,690 Francis Mase, MD, PA $3,652 Premiere Physicians PA $3,532 Pike Creek Pediatric Associate $3,491 Internal Medicine Associates $3,488 Middletown Family Care Associates $3,241 Irene Szeto MD $2,830 Family Care Associates $2,789 Newark Pediatrics $2,777 Case Family Practice and Sports Medicine $2,739 Delaware Medical Group LLC $2,669 Progressive Health of Delaware $2,632 United Medical Clinic $2,591 Mill Creek Medicine $2,482 Hockessin Family Medicine LLC $2,377 James Fierro MD $2,266 Wilmington Medical Associates $2,150 Maria Lazar MD $2,109 McReynolds & Associates PA $2,011 All Others $46,031 $7,681 Actual Bonus Earned Bonus Not Earned $30, groups in other $464K total bonus potential over 114 groups $376K payout to 105 groups $88K not earned as bonus $94K payout to CCHS 25% of total bonus payout Of the 114 groups, 63 groups (55%) received 80% or more of potential payout 9 groups received $0 payout All but 1 had less than 5 attributed members Top supplemental data submitter 25 Bonus Payout Summary By Ranges Earned Bonus Summary 100% % 99% 100% 80% 40 89% % of Total Groups 60% 30 40% 20 51% 65% 16 76% Groups 58 Groups (51%) Earned $1k or less 20% % 0 1 8% $0 bonus Less than $1k $1k $2k $2k $3k $3k $5k $5k $10k $10k $50k More than $50k # of Groups Total % of 26 Lessons Learned Challenging to establish network for Population Health Successful relationship with GHP/xG has been critical Care Management keys to physician engagement Shared goals/incentives Provide valuable information, communicate easily Relevant, palpable support Challenges of panel size Population health analytics Core analytics with flexibility for ad hoc reporting Patient outreach strategies Direct outreach (phone, inpatient) Tailor approach based on characteristics, skills, literacy, etc. Engagement with providers 27 9

10 A New Paradigm Bull noticed Marcus portrait and felt a sudden stab of sadness. Boy, oh boy, he missed the good old days when life was simpler and when faster, stronger, and more efficient had been enough. 28 Confidential property of xg Health Solutions, Inc. Re creation or delivery to another party in any format is strictly prohibited. 29 EXTRA SLIDES 30 10

11 Why does CCQP exist? Declining FFS Reimbursement SGR Repeal HDHP/ Consumer Price Sensitivity CMS Drive to VBP (50% through alternative models by 2016; 85% of FFS with quality/value by 2016) Value Based Care Transformation Emerging Technologies (Telehealth) 31 Era of Changing Reimbursement: Need for Population Health Management Capabilities Fee for Service Pay for Performance Bundled Payments Shared Savings Total Cost of Care/Capitation Clinical & Financial Risk Population Health Capabilities Transactional & Episodic Care Longitudinal Episodic Care: Limited Risk Longitudinal Care: More Risk Full Risk 32 Population Health Management Programming 5% of Americans Account For Half of the Nation s Health Care Spending High Cost Patients 1% Catastrophic Illness 4% 5+ Chronic Conditions 45% of Americans have at least one chronic disease 81% of all hospital admissions Rising Risk Patients 20% 2 4 Chronic Conditions At Risk Patients 25% 1 Chronic Condition 15% At Risk for developing A chronic condition Healthy Patients 35% No ongoing physical health needs Prioritizing Population Health Interventions, The Advisory Board Company. Clinical Risk Social Risk Behavioral Risk 33 11

12 * For those groups with a CAVE efficiency score and with a CCQP P4V rate over 50% 100% All CCQP Peer Groups * Quality Measures & Efficiency Less effective More effective CCQP Rate 90% 80% 70% 60% 50% Cave Efficiency Score More efficient Less efficient 34 Primary Care 35 Ambulatory Surgery closer look The majority of the increase (+30%) is related to screening, scopes/biopsies and back problems. Ambulatory Surgery Visits per 1000 Illness Category FY13 FY14 FY15 HMK GHS Total Total Trend Factors influencing health care % Diseases of female genital organs % Benign neoplasms % Spondylosis; intervertebral disc disorders; other back problems [205.] % Upper gastrointestinal disorders % Diseases of the urinary system % SUBTOTAL % All Other % Grand Total % 36 12

13 Utilization Comparison: CCQP v. Non CCQP Despite the higher risk in FY15, the CCQP population has lower risk adjusted rates of utilization for all highlighted metrics except PCP visits Metric FY13 FY14 FY15 Attrib Attrib % Attrib Attrib % Attrib Attrib % CCQP Non CCQP Difference CCQP Non CCQP Difference CCQP Non CCQP Difference Trend between FY15/FY14 Attrib Attrib CCQP Non CCQP Avg. Members 8,821 5, % 9,210 6, % 10,532 5, % 14.4% 7.5% Risk Score % % % 3.8% 0.0% Inpatient Med/Surg Admits per % % % 33.7% 29.5% Readmits per % % % 49.1% 18.9% Obs Visits per % % % 44.1% 109.8% Outpatient/Professional ER Visits per % % % 9.8% 13.6% Discretionary ER Visits per % % % 4.0% 7.1% Hi Tech Rad Svcs per % % % 12.9% 0.6% Well Visits per % % % 7.6% 1.5% PCP Visits per , , % 1, , % 1, % 14.7% 11.3% * All utilization numbers are risk adjusted Additional detail on key measures by payer is included in the Appendix 37 Inpatient Experience All key inpatient utilization measures fell between FY14 and FY15. Acute admissions, which exclude SNF and Rehabilitation*, dropped by almost 20%. Med Surg admits, a subset of Acute Admissions, fell 27%. Med Surg admits are the admissions considered most amenable to medical and care management programs and make up 47% of all acute admits. Key Measures of Inpatient Utilization Post Program Pre Program Performance Performance Inpatient Measures FY14/13 FY15/14 FY13 FY14 FY15 Trend Trend Acute Admits/ % % Med Surg Admits/ % % ALOS % % Med/Surg 1 Day Stays/ % % Med/Surg Readmits/ % % Med/Surg Readmit Rate 9.6% 10.8% 11.4% 10.1% 6.0% Observations/ % % Acute Admissions by Type Acute Admits/1000 FY15 Acute Admissions by Type Admits/1000 % of Total Medical Surgery % Mental Health/Substance Abuse % Newborns % Obstetrics % Total Acute % * The volume of Rehabilitation and SNF admissions in FY15 represented 0.5 admits/1000 for each, or 1 admission/1000 total. 38 CIN Key Attributes 1. Electronic Interfaces and Clinical Coordination 2. Reimbursement Structures That Promote Greater Value 3. Application of Evidence based Guidelines 4. Data Analytics and Performance Improvement 5. More Selective Clinician Participation Criteria 6. Payor Contracting 39 13