Total population health management 2.0. An innovative approach to delivering healthcare in a reformed environment

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Total population health management 2.0. An innovative approach to delivering healthcare in a reformed environment"

Transcription

1 Total population health management 2.0 An innovative approach to delivering healthcare in a reformed environment

2 Total Population Health Management (TPHM) is a fresh and innovative approach to healthcare services delivery designed to address the clinical and lifestyle management needs of an entire population. Included are efforts to improve a member s clinical status, identify and support at-risk members, and maintain the status of healthy members. While the idea of effectively managing an entire population is not new, the Affordable Care Act and the move to value-based payment bring emphasis back to the management of the total population to foster future success of health plans and Accountable Care Organizations. Three key takeaways 1. A renewed focus on members who are most likely to be impacted through engagement will lead to improved clinical and financial outcomes. This represents a departure from the traditional concentration on the most expensive members in a population. 2. New skills and technologies are required to fully leverage the unprecedented volumes of federated data gathered and distributed by electronic medical records, social media, mobile apps and other sources. 3. Turning massive amounts of consumer data into personalized and actionable segmentation strategies is the key to successfully managing the health of a growing and diverse population. 1 ExlService Holdings, Inc

3 The state of healthcare It is well documented that health status in the United States continues to decline at a rapid rate. Illness prevalence rates within employers are on the rise, with one of every two working-age adults diagnosed with a chronic condition. Additionally, the employee turnover rate for those with a protracted state is much lower than those without a condition, which exacerbates the risk burden of employers and health plans. In younger generations, the trend doesn t seem to get better. Obesity has more than doubled in children and quadrupled in adolescents over the past 30 years, according to the Journal of the American Medical Association. In 2012, more than a third of children and adolescents were overweight or obese. Meanwhile, healthcare costs continue to increase. Last quarter costs were up 9% and the increases aren t slowing down anytime soon. These factors, along with numerous others, have created a perfect storm. All eyes are on the healthcare industry. Consumers and healthcare professionals alike are looking for answers. And, it all starts with a mindset change. An impact focused mindset Currently, 3% of an employer s population is driving roughly 50% of the total healthcare costs. Each year a member s annual cost is expected to increase by 3% due to aging. The healthcare community has historically focused its efforts on this group because of the anticipated return on investment. Unfortunately, the financial impact of a member s clinical risk is not a variable that can be easily impacted by factors the employer or health plan can control. In contrast, the clinical risk of each member can be greatly reduced when the member is properly engaged in care management and feels empowered to close the gaps in clinical care. This engagement can take many forms but often includes maintaining the current health status of a member, actively preventing a chronic disease, or treating a current condition to appropriate level of evidence-based medicine. This is a complete mindset change for many health plans and employers because it expands the attention to include the totality of the population they serve. It is no longer in their best interest to focus only on the few who drive the majority of the expenses. A renewed concentration on maximizing resources by engaging the segment of the population that is most likely to be impacted is the key to improving clinical and financial outcomes. 2 ExlService Holdings, Inc

4 New data, new skills Making this mindset change truly impactful requires the collection of new data on a different subset of the population, possibly from new sources. Health plans need to begin to take advantage of what emerging data sources like electronic medical records, mobile apps, social media, wearable technologies, and others have to offer. These sources, along with the more traditional ones, will increase the volume of data that needs to be acquired, aggregated and managed efficiently. The ability to stratify this data and draw action-orientated conclusions from it is imperative in building the proper engagement plans and strategies. Traditionally, patients were looked at from one dimension, their health status, falling somewhere on the graph from healthy to terminally ill. Lifestyle risk, clinical risk and duration have since been included in the risk analysis. Care management providers need to begin to look at an additional dimension as well: the likelihood of the patient to engage. The personal nature of the data being captured by new multimedia channels has made this analysis possible. The ability to drive member engagement has been the bane of the care management and wellness industry. Without incentives or disincentives, typically less than one in four members targeted for engagement actively participates. One of the main reasons for this lack of engagement is the healthcare industry s lack of leadership in developing and deploying segmentation strategies to engage and influence members behaviors. Healthcare continues to lag behind other industries, like retail and banking, in using external resources to segment and understand its members. Rectifying this will require deep analytic skill sets that do not currently exist in abundance within the healthcare industry. This is an area where health plans can rely on third parties, or professionals from other industries, to understand best practices and implement the proper tools and technologies. The financial and clinical benefits associated with engaging members at all levels of health are the future of the healthcare industry. Getting insights and measuring ROI The Affordable Care Act (ACA) and other recent regulations and policies have created an environment in which providers will increasingly be measured and reimbursed by the quality of care they provide and the impact they have on their entire populations. The principal motive behind these changes is to move away from fee-forservice based payment, which rewards quantity, to value-based payment, which focuses on clinical outcomes. 3 ExlService Holdings, Inc

5 As healthcare reform continues to evolve, there will be significantly less member turnover than seen historically due to enrollment in exchanges and market consolidation. This too forces health plans to concentrate efforts on lifestyle behaviors of total populations to better manage long-term risks, not merely the short-term risks of the sick. Analytics will play a vital role in gaining insight and determining success for health plans moving forward. The opportunities to utilize analytics throughout the stratification and engagement process are endless. For example, a use case could include one or more of the following: Identify trends related to risk Further segment and stratify a population Calculate the likelihood of a member or group to engage Optimize clinical resources through constant validation of engagement strategies Predict impactability of a member or group Determine engagement best practices for a member or group Recognize progress in clinical and financial outcomes Track sustained improvements in outcomes Developing metrics that are actionable and then structuring them in a value chain helps create a cause and effect analysis. This helps to precisely pinpoint the breakdown in the process so a corrective action can be taken without interrupting the parts of the strategy that are working. Bottom-line impact Given the complexity of healthcare, there is skepticism about the attribution of the savings from lower than expected trend. A year-overyear analysis will show that for most employers prevalence rates have been increasing about 2% year over year. Within two years, and very possibly within one year, the proof point of success will be the slowing in the employer s prevalence rates of members with a chronic condition. Ultimately, the prevalence rate will flatten out, and potentially even decrease. Assumed cost of $3,600 per member per year for a group of 100,000 employer basedmembers (commercial) Expected annual cost for the group is $360M Assuming an 8% annual trend, the expected cost increases by $28.8M year over year A net reduction in trend of 2% (3:1 ROI) results in an annual savings of $7.2M, per 100,000 members See Table 1 entitled Prevalence Rates by Year with and without Population Management in the appendix of this paper. 4 ExlService Holdings, Inc

6 Table 1: Prevalence rates by year with and without population management 50% Prevalence rates by year 45% 40% With TPHM Without TPHM 35% Estimated Estimated Estimated 5 ExlService Holdings, Inc

7 EXL Triple Play EXL is uniquely positioned to offer integrated and modular solutions to meet the industry s changing and growing needs. Our care management technologies, clinical operations teams and analytics experts can help with data acquisition and aggregation strategies, techniques to successfully stratify the data, innovative channels for engagement and more. We are the first in the industry to provide and integrate all three solutions and, by design, enable them to benefit from the strength of the other solutions. The technology CareRadius integrates data from multiple sources and shares it among health plans, practitioners and members in real time. Its holistic view of the member enables personalized care plans, the ability to make timely decisions, and earlier interventions to improve health outcomes. The experts Our 1,200+ clinical staff and URAC Core Certified programs can enhance your organizations professional capacity management through the use of global clinical talent and analytics expertise. When clinical resources are scarce, internal resources must be focused on the highest-priority initiatives that impact quality outcomes and the bottom line. in data management, reporting, analytics and predictive modeling that provide actionable insights. TPHM Value Chain Healthcare analytics Our team of clinicians, behavioral economists, statisticians, and segmentation experts can help address rapidly evolving needs. We specialize 6 ExlService Holdings, Inc

8 Platform Clinical Operations Analytics Table 2: Total Population Health Management Value Chain Who is eligible? What is the risk of the population? Eligibility CareRadius Eligibility is determined upstream from the application and reviewed by staff prior to executing enrollment, authorization, review or appeals Identification CareFind Risk may be determined by cost and frequency of procedures/hospitalizations by condition; level of compliance with treatment or psycho-social barriers to care Mixed media modeling to optimize prospective enrollees Existing risk engines can be leveraged using EXL analytics, or EXL can develop customized solutions Who should be targeted for the program? Stratification CareFind Condition-specific high utilizers, multiple provider encounters, specific Rx and/or clinical metrics EXL segmentation models will determine who can be impacted clinically and likely to actively participate in the program; risk transfer arbitrage opportunities can also be built into the model Who is enrolled in the program? Engagement CareRadius Members who are ready to commit due to issues identified above with support of integrated providers and care managers EXL can leverage, marketing, segmentation, and work force management techniques to optimize participation What is the clinical progress of members? Outcomes CareRadius Improvement in medication compliance, clinical metrics; reduction in provider encounters; program participation; portal access and use Biometric, risk score and gap closures are constantly measured to determine changes in clinical status; initial progress will be seen in these analyses rather than claim amounts What is the return on the program? Financial Savings CareRadius/ CareFind Reduction in overall expenses associated with identified conditions Medical savings will be calculated using the industry leading approach which creates a credible control group 7 ExlService Holdings, Inc

9 EXL (NASDAQ: EXLS) is a leading business process solutions company that looks deeper to drive business impact through integrated services and industry knowledge. EXL provides operations management, decision analytics and technology platforms to organizations in insurance, healthcare, banking and financial services, utilities, travel, and transportation and logistics, among others. We work as a strategic partner to help our clients streamline business operations, improve corporate finance, manage compliance, create new channels for growth and better adapt to change. Headquartered in New York and in business since 1999, EXL has more than 22,800 professionals in locations throughout the U.S., Europe and Asia. EXLservice.com GLOBAL HEADQUARTERS 280 Park Avenue, 38th Floor, New York, NY T: F: UK SALES OFFICE 6 York Street, London, W1U 6PJ, United Kingdom T: F: INVESTOR RELATIONS Jarrod Yahes ExlService Holdings, Inc. Phone: United States United Kingdom Czech Republic Romania Bulgaria India Philippines Malaysia

Analytics strategies to improve corporate travel management

Analytics strategies to improve corporate travel management Analytics strategies to improve corporate travel management Innovative travel management companies (TMCs) are finding ways to apply analytics to improve and enhance the corporate customer experience. While

More information

Avoiding readmissions

Avoiding readmissions Avoiding readmissions The power of predictive analytics to cut the cost of hospital stays For years, hospitals and health plans have been looking for ways to identify and remove inefficiencies in care

More information

TACKLING POPULATION HEALTH MANAGEMENT with Worksite Wellness & Community Outreach

TACKLING POPULATION HEALTH MANAGEMENT with Worksite Wellness & Community Outreach TACKLING POPULATION HEALTH MANAGEMENT with Worksite Wellness & Community Outreach APRIL 2015 THE PRESIDENT S MESSAGE Daniel T. Yunker Why do we need population health management in the health care delivery

More information

Guide to Population Health Management

Guide to Population Health Management Guide to Population Health Management presented by the Healthcare Intelligence Network Note: This is an authorized excerpt from the Guide to Population Health Management. To download the entire guide,

More information

ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT

ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT ACCOUNTABLE CARE ANALYTICS: DEVELOPING A TRUSTED 360 DEGREE VIEW OF THE PATIENT Accountable Care Analytics: Developing a Trusted 360 Degree View of the Patient Introduction Recent federal regulations have

More information

Population health management:

Population health management: GE Healthcare Population health management: Navigating successfully from volume to value In the new world of value-based care and risk-sharing compensation, success will depend on how well provider organizations

More information

Analytics for ACOs Integrated patient views

Analytics for ACOs Integrated patient views Analytics for ACOs Integrated patient views What s at stake? Level-setting Overview The healthcare environment is changing and healthcare organizations have challenging decisions to make. With the dramatic

More information

Fifth Annual Wellness in the Workplace Study: An Optum Research Update

Fifth Annual Wellness in the Workplace Study: An Optum Research Update Fifth Annual Wellness in the Workplace Study: An Research Update Fifth Annual Wellness in the Workplace Study: An Research Update In the whirlwind of change engulfing the health care industry, employers

More information

ICD-10 Advantages Require Advanced Analytics

ICD-10 Advantages Require Advanced Analytics Cognizant 20-20 Insights ICD-10 Advantages Require Advanced Analytics Compliance alone will not deliver on ICD-10 s potential to improve quality of care, reduce costs and elevate efficiency. Organizations

More information

Identifying High-Risk Medicare Beneficiaries with Predictive Analytics

Identifying High-Risk Medicare Beneficiaries with Predictive Analytics Identifying High-Risk Medicare Beneficiaries with Predictive Analytics September 2014 Until recently, with the passage of the Affordable Care Act (ACA), Medicare Fee-for-Service (FFS) providers had little

More information

2014 Health Care Changes Ahead Survey

2014 Health Care Changes Ahead Survey September 2014 2014 Health Care Changes Ahead Survey Emerging Factors Influencing Employer-Sponsored Health Care Benefits Executive Summary Plan sponsors face a highly complex health care benefit environment

More information

Population health management:

Population health management: 3M Health Information Systems Population health management: A bridge between fee for service and value-based care Balancing multiple payment models Although 85 percent of healthcare reimbursement is currently

More information

NCQA INCLUDES ODS PROGRAM IN NATIONAL QUALITY LEADERSHIP PUBLICATION

NCQA INCLUDES ODS PROGRAM IN NATIONAL QUALITY LEADERSHIP PUBLICATION NCQA INCLUDES ODS PROGRAM IN NATIONAL QUALITY LEADERSHIP PUBLICATION The National Committee for Quality Assurance (NCQA) invited ODS to submit a case study for publication in its Quality Profiles: The

More information

NOUS. Health Management. Importance of Population. White Paper INFOSYSTEMS LEVERAGING INTELLECT

NOUS. Health Management. Importance of Population. White Paper INFOSYSTEMS LEVERAGING INTELLECT NOUS INFOSYSTEMS LEVERAGING INTELLECT White Paper Importance of Population Health Abstract The revised healthcare regulations in US markets like the Affordable Care Act (ACA) law, the demands of providing

More information

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization

Pediatric Alliance: A New Solution Built on Familiar Values. Empowering physicians with an innovative pediatric Accountable Care Organization Pediatric Alliance: A New Solution Built on Familiar Values Empowering physicians with an innovative pediatric Accountable Care Organization BEYOND THE TRADITIONAL MODEL OF CARE Children s Health SM Pediatric

More information

HOW CARE MANAGEMENT EVOLVES WITH POPULATION MANAGEMENT

HOW CARE MANAGEMENT EVOLVES WITH POPULATION MANAGEMENT Reform and rising costs continue to push the importance of care management systems to the forefront. With the growing prominence of population health for provider organizations, provider-based care management

More information

2015 Population Health Study

2015 Population Health Study 2015 Population Health Study Population health initiatives are gaining momentum, but the industry is still in the early stages of proving strategy and vendor solution value As the emphasis on the change

More information

Optum One. The Intelligent Health Platform

Optum One. The Intelligent Health Platform Optum One The Intelligent Health Platform The Optum One intelligent health platform enables healthcare providers to manage patient populations. The platform combines the industry s most advanced integrated

More information

PALANTIR HEALTH. Maximizing data assets to improve quality, risk, and compliance. 100 Hamilton Ave, Suite 300 Palo Alto, California 94301

PALANTIR HEALTH. Maximizing data assets to improve quality, risk, and compliance. 100 Hamilton Ave, Suite 300 Palo Alto, California 94301 100 Hamilton Ave, Suite 300 Palo Alto, California 94301 helix@palantir.com www.palantir.com/health PALANTIR HEALTH Maximizing data assets to improve quality, risk, and compliance Palantir Health: Maximizing

More information

The Era Of Intimate Customer Decisioning Is At Hand

The Era Of Intimate Customer Decisioning Is At Hand A Forrester Consulting Thought Leadership Paper Commissioned By FICO Decisions Based On An Informed, Intimate, And Immediate Understanding Of Customers Are the Next Normal January 2013 Table Of Contents

More information

4.5% 2014 Digital Marketing Optimization Survey results > 4.5% Top lessons learned from the leaders

4.5% 2014 Digital Marketing Optimization Survey results > 4.5% Top lessons learned from the leaders 2014 Digital Marketing Optimization Survey results Top lessons learned from the leaders Table of contents 1: Introduction 2: Five lessons from the top 20% #1: They test to make decisions 3: #2: They put

More information

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY Table of Contents I. Introduction... 2 II. Background... 2 III. Patient Safety... 3 IV. A Comprehensive Approach to Reducing

More information

Infogix Healthcare e book

Infogix Healthcare e book CHAPTER FIVE Infogix Healthcare e book PREDICTIVE ANALYTICS IMPROVES Payer s Guide to Turning Reform into Revenue 30 MILLION REASONS DATA INTEGRITY MATTERS It is a well-documented fact that when it comes

More information

POPULATION HEALTH ANALYTICS

POPULATION HEALTH ANALYTICS POPULATION HEALTH ANALYTICS ANALYTICALLY-DRIVEN INSIGHTS FOR POPULATION HEALTH LAURIE ROSE, PRINCIPAL CONSULTANT HEALTH CARE GLOBAL PRACTICE DISCUSSION TOPICS Population Health: What & Why Now? Population

More information

Revenue Cycle Management: What s Next in Healthcare

Revenue Cycle Management: What s Next in Healthcare Revenue Cycle Management: What s Next in Healthcare FEBRUARY 2014 Table of Contents Introduction... 3 Background... 3 Study Design... 3 Common Overall Business Priorities... 4 Management Priorities...

More information

2015 Emerging Trends in Health Care Survey

2015 Emerging Trends in Health Care Survey April 2015 High-Performance Insights 2015 Emerging Trends in Health Care Survey Executive Summary The new imperative for employer-sponsored health care programs is higher performance. To qualify as high

More information

Proven Population Health Management. Faster.

Proven Population Health Management. Faster. Proven Population Health Management. Faster. At Medecision, our quest to liberate healthcare means tackling the big obstacles by connecting more data from more care teams than other population health management

More information

Apigee Insights Increase marketing effectiveness and customer satisfaction with API-driven adaptive apps

Apigee Insights Increase marketing effectiveness and customer satisfaction with API-driven adaptive apps White provides GRASP-powered big data predictive analytics that increases marketing effectiveness and customer satisfaction with API-driven adaptive apps that anticipate, learn, and adapt to deliver contextual,

More information

LionShare knows the Landscape

LionShare knows the Landscape LionShare knows the Landscape LionShare has a long-standing commitment to the health care industry. For more than 20 years we have partnered with hospitals and health systems across the country to make

More information

Patient Relationship Management

Patient Relationship Management Solution in Detail Healthcare Executive Summary Contact Us Patient Relationship Management 2013 2014 SAP AG or an SAP affiliate company. Attract and Delight the Empowered Patient Engaged Consumers Information

More information

How we use Big Data Analytics to Create Customer and Patient Intimacy

How we use Big Data Analytics to Create Customer and Patient Intimacy How we use Big Data Analytics to Create Customer and Patient Intimacy About Evariant The leading provider of a CRM platform based on a centralized healthcare data hub, analytics, and communications engine.

More information

HOLISTIC PERFORMANCE MANAGEMENT: A FAST-GROWING NECESSITY IN APJ

HOLISTIC PERFORMANCE MANAGEMENT: A FAST-GROWING NECESSITY IN APJ HOLISTIC PERFORMANCE MANAGEMENT: A FAST-GROWING NECESSITY IN APJ IMPROVING THE END-USER EXPERIENCE DRIVES COMPETITIVE ADVANTAGE IN ASIA-PACIFIC/ JAPAN As business in nearly every industry becomes increasingly

More information

Accountable Care: Implications for Managing Health Information. Quality Healthcare Through Quality Information

Accountable Care: Implications for Managing Health Information. Quality Healthcare Through Quality Information Accountable Care: Implications for Managing Health Information Quality Healthcare Through Quality Information Introduction Healthcare is currently experiencing a critical shift: away from the current the

More information

Reconciling the Great Healthcare Consumer Paradox: Are consumers willing to change to get what they want?

Reconciling the Great Healthcare Consumer Paradox: Are consumers willing to change to get what they want? Reconciling the Great Healthcare Consumer Paradox: Are consumers willing to change to get what they want? 2 The Affordable Care Act (ACA) will introduce approximately 51 million people to the individual

More information

Explore the Possibilities

Explore the Possibilities Explore the Possibilities Seize the Moment 2013 HR Service Delivery and Technology Survey Executive Summary Report 2 towerswatson.com Explore the Possibilities Seize the Moment Table of Contents What the

More information

Population Health Management: A New Business Model for a Healthier Workforce INNOVATIONS 2 SOLUTIONS

Population Health Management: A New Business Model for a Healthier Workforce INNOVATIONS 2 SOLUTIONS Population Health Management: A New Business Model for a Healthier Workforce INNOVATIONS 2 SOLUTIONS Population Health Management: A New Business Model for a Healthier Workforce POPULATION HEALTH MANAGEMENT:

More information

QUICK FACTS. Catholic Health Initiatives Collaborates with TEKsystems to Update its Aging Fleet of IT Equipment to Achieve Meaningful Use

QUICK FACTS. Catholic Health Initiatives Collaborates with TEKsystems to Update its Aging Fleet of IT Equipment to Achieve Meaningful Use [ Healthcare, Technology Deployment ] TEKsystems Global Services Customer Success Stories Client Profile Industry: Healthcare Revenue: Approximately $9.8 billion (FY2012) Employees: Approximately 78,000

More information

Performance Driven Customer Engagement

Performance Driven Customer Engagement Performance Driven Customer Engagement Concentrix Corporation President Chris Caldwell Japan Concentrix K.K. President Toshiyuki Namiki 2014 Concentrix Corporation Agenda 1. Breaking New Ground through

More information

Health Plan Quality Monitoring

Health Plan Quality Monitoring Health Plan Quality Monitoring Andrew L. Naugle, MBA Patty Jones, RN MBA BACKGROUND Section 1311(b) of the Patient Protection and Affordable Care Act of 2010 (ACA) detailed the intent of the federal government

More information

ACO Toolkit. Face-To-Face Care Coordination Services & Comprehensive Cloud-Based IT Solutions. 1.800.720.2578 e q h s. o r g

ACO Toolkit. Face-To-Face Care Coordination Services & Comprehensive Cloud-Based IT Solutions. 1.800.720.2578 e q h s. o r g ACO Toolkit Face-To-Face Care Coordination Services & Comprehensive Cloud-Based IT Solutions 1.800.720.2578 e q h s. o r g 2014 eqhealth Solutions, Inc. All rights reserved. All other trademarks designated

More information

Healthcare Data Management

Healthcare Data Management Healthcare Data Management Expanding Insight, Increasing Efficiency, Improving Care WHITE PAPER This document contains Confidential, Proprietary and Trade Secret Information ( Confidential Information

More information

The Primary Health model: A collection of population health solutions & services

The Primary Health model: A collection of population health solutions & services The Primary Health model: A collection of population health solutions & services Creating health care alignment with an employer-driven network The United States spends more money on health care than any

More information

Aon Hewitt Health & Benefits Consulting

Aon Hewitt Health & Benefits Consulting Aon Risk Solutions Aon Hewitt Health & Benefits Consulting Better Health. Better Results. Risk. Reinsurance. Human Resources. Empower Results Game-Changing Strategies to Achieve Better Results As population

More information

Rhode Island s Development of a Pediatric Health Home

Rhode Island s Development of a Pediatric Health Home Introduction Rhode Island s Development of a Pediatric Health Home The Affordable Care Act (ACA) affords states an opportunity to establish a health home, an innovative care delivery model in Medicaid

More information

Your guide to UnitedHealthcare

Your guide to UnitedHealthcare Your guide to UnitedHealthcare Face the future with confidence The benefits environment remains challenging. Uncertainty reigns as a wave of new regulation sweeps across the industry. Costs continue to

More information

The UnitedHealthcare Diabetes Health Plan Better information. Better decisions. Better results. Agenda

The UnitedHealthcare Diabetes Health Plan Better information. Better decisions. Better results. Agenda The UnitedHealthcare Better information. Better decisions. Better results. 1 Agenda Market Health Trends- declining health status and increase disease prevalence Optimal Decisions and Opportunity for Improvement

More information

The Benefits of End-to-End Card Processing: Effective, Efficient and Secure

The Benefits of End-to-End Card Processing: Effective, Efficient and Secure The Benefits of End-to-End Card Processing: Effective, Efficient and Secure by Bryce Teater December 15, 2015 a whitepaper prepared by www.dpath.com (800) 633-3841 Introduction The process of issuing payment

More information

December 23, 2010. Dr. David Blumenthal National Coordinator for Health Information Technology Department of Health and Human Services

December 23, 2010. Dr. David Blumenthal National Coordinator for Health Information Technology Department of Health and Human Services December 23, 2010 Dr. David Blumenthal National Coordinator for Health Information Technology Department of Health and Human Services RE: Prioritized measurement concepts Dear Dr. Blumenthal: Thank you

More information

Redefining Customer Analytics

Redefining Customer Analytics SAP Brief SAP Customer Engagement Intelligence Objectives Redefining Customer Analytics Making personalized connections with customers in real time Making personalized connections with customers in real

More information

Health Earnings Beyond Simple Incentives

Health Earnings Beyond Simple Incentives t h e w e b i n a r s e r i e s SM Health Earnings Beyond Simple Incentives Participants Jeff Viviano, Sr. Manager, HR Operations, Benefits & Payroll, Welch Allyn Thomas Flynn, Principal, Mercer Health

More information

GLOBA MAGAZINE. By Les C. Meyer, MBA and Ronald Parton, MD, MPH

GLOBA MAGAZINE. By Les C. Meyer, MBA and Ronald Parton, MD, MPH Gentlemen, Start Your Engines! By Les C. Meyer, MBA and Ronald Parton, MD, MPH In the eyes of a CEO, businesses create jobs, innovate, manufacture and provide the services that drive economic growth. Yet

More information

The Evolving Nature of Accountable Care. Results from the 2015 ACO Survey

The Evolving Nature of Accountable Care. Results from the 2015 ACO Survey The Evolving Nature of Accountable Care Results from the 2015 ACO Survey BACKGROUND Accountable care organizations (ACOs) are voluntary networks of healthcare providers that have agreed to work together

More information

STRATEGIES FOR A SUSTAINABLE WELLNESS PROGRAM. Sue Blankenhagen and Jennifer Piliero May 9, 2014

STRATEGIES FOR A SUSTAINABLE WELLNESS PROGRAM. Sue Blankenhagen and Jennifer Piliero May 9, 2014 STRATEGIES FOR A SUSTAINABLE WELLNESS PROGRAM Sue Blankenhagen and Jennifer Piliero May 9, 2014 Agenda Key Industry Trends Elements of a Successful Wellness Program Five Strategies to Develop a Sustainable

More information

Response to Serving the Medi Cal SPD Population in Alameda County

Response to Serving the Medi Cal SPD Population in Alameda County Expanding Health Coverage and Increasing Access to High Quality Care Response to Serving the Medi Cal SPD Population in Alameda County As the State has acknowledged in the 1115 waiver concept paper, the

More information

For healthcare, change is in the air and in the cloud

For healthcare, change is in the air and in the cloud IBM Software Healthcare Thought Leadership White Paper For healthcare, change is in the air and in the cloud Scalable and secure private cloud solutions can meet the challenges of healthcare transformation

More information

The new revenue cycle imperative: A data-driven approach to minimizing risk and optimizing performance

The new revenue cycle imperative: A data-driven approach to minimizing risk and optimizing performance The new revenue cycle imperative: A data-driven approach to minimizing risk and optimizing performance An Experian Healthcare white paper Shifting reimbursement, evolving payment models and growing regulatory

More information

NG Healthcare Payers June 10 th 12 th, 2015 JW Marriott Miami, Florida Day One June 10 th. Day Two June 11 th

NG Healthcare Payers June 10 th 12 th, 2015 JW Marriott Miami, Florida Day One June 10 th. Day Two June 11 th NG Healthcare Payers June 10 th 12 th, 2015 JW Marriott Miami, Florida Day One June 10 th 16:30 18:00 Roundtable 1: Split-Streams Track 1: Healthcare becoming a Digital Business Track 2: Transformation

More information

A Guide to Employer-Managed Care: On-Site Clinics and Wellness Centers

A Guide to Employer-Managed Care: On-Site Clinics and Wellness Centers A National Insurance Services White Paper A Guide to Employer-Managed Care: On-Site Clinics and Wellness Centers 2013 National Insurance Services of WI, Inc. Health cost increases prove unsustainable The

More information

Social Media: A Platform to Increase Sales and Visibility

Social Media: A Platform to Increase Sales and Visibility www.niit-tech.com Social Media: A Platform to Increase Sales and Visibility Prachee Gupta NIIT Technologies White Paper CONTENTS Introduction 3 What is Social Media for Insurers 3 Engaging on Social Media

More information

A Population Health Management Approach in the Home and Community-based Settings

A Population Health Management Approach in the Home and Community-based Settings A Population Health Management Approach in the Home and Community-based Settings Mark Emery Linda Schertzer Kyle Vice Charles Lagor Philips Home Monitoring Philips Healthcare 2 Executive Summary Philips

More information

THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD?

THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD? UNDER THE MICROSCOPE NOVEMBER 5, 2013 THE ACCOUNTABLE CARE ORGANIZATION (ACO) TRAIN IS LEAVING THE STATION: ARE YOU ON BOARD? ISSUE. A 2006 Institute of Medicine report ( Performance measurement: Accelerating

More information

PSYCHIATRY IN HEALTHCARE REFORM SUMMARY REPORT A REPORT BY AMERICAN PSYCHIATRIC ASSOCIATION BOARD OF TRUSTEES WORK GROUP ON THE ROLE OF

PSYCHIATRY IN HEALTHCARE REFORM SUMMARY REPORT A REPORT BY AMERICAN PSYCHIATRIC ASSOCIATION BOARD OF TRUSTEES WORK GROUP ON THE ROLE OF ROLE OF PSYCHIATRY IN HEALTHCARE REFORM SUMMARY REPORT A REPORT BY AMERICAN PSYCHIATRIC ASSOCIATION BOARD OF TRUSTEES WORK GROUP ON THE ROLE OF PSYCHIATRY IN HEALTHCARE REFORM 2014 Role of Psychiatry in

More information

Using targeted marketing strategies to optimize healthcare plans

Using targeted marketing strategies to optimize healthcare plans Using targeted marketing strategies to optimize healthcare plans Targeted benefits communications can improve member health and lower program costs WHITE PAPER Introduction Today, organizations are finding

More information

3M s unique solution for value-based health care

3M s unique solution for value-based health care A quick guide to 3M s unique solution for value-based health care Part 2: The era of and Current trends industry changes Volume-based health care Value-based health care ICD-9 ICD-10 Inpatient care Outpatient

More information

White paper. Health care advisor. Optum. www.optum.com

White paper. Health care advisor. Optum. www.optum.com White paper Health care advisor www. Reshaping the consumer s health care experience For consumers, dealing with the health care system today can be a difficult and frustrating experience. The process

More information

The healthcare industry is changing more rapidly than ever, creating new opportunities for those who stand ready to seize them. Who are we?

The healthcare industry is changing more rapidly than ever, creating new opportunities for those who stand ready to seize them. Who are we? The healthcare industry is changing more rapidly than ever, creating new opportunities for those who stand ready to seize them. COGNIZANT AT A GLANCE In this increasingly dynamic business environment,

More information

Elevating Medical Management Services to Meet Member Expectations

Elevating Medical Management Services to Meet Member Expectations Cognizant 20-20 Insights Elevating Medical Services to Meet Member Expectations Healthcare payer organizations can lower the cost of commoditized medical management functions via better and different processes,

More information

HEALTHCARE REFORM WILL TALK SMAC

HEALTHCARE REFORM WILL TALK SMAC HEALTHCARE REFORM WILL TALK SMAC Disruptive Technologies Key to Success of Outcome-Based Delivery By Al Denis, Director www.isg-one.com INTRODUCTION The Affordable Care Act creates a powerful set of incentives

More information

Early Lessons learned from strong revenue cycle performers

Early Lessons learned from strong revenue cycle performers Healthcare Informatics June 2012 Accountable Care Organizations Early Lessons learned from strong revenue cycle performers Healthcare Informatics Accountable Care Organizations Early Lessons learned from

More information

THE NEW FACE OF CHRONIC CARE MANAGEMENT

THE NEW FACE OF CHRONIC CARE MANAGEMENT THE NEW FACE OF CHRONIC CARE MANAGEMENT By Joseph Berardo Jr., President and Chief Executive Officer, MagnaCare Introduction Over 75 percent of total health care spending in the U.S. will focus on chronic

More information

Accountable Care: Clinical Integration is the Foundation

Accountable Care: Clinical Integration is the Foundation Solutions for Value-Based Care Accountable Care: Clinical Integration is the Foundation Clinical Integration Care CoordinatioN ACO Information Technology Financial Management The Accountable Care Organization

More information

Feature. The phrase globally strategic payroll is filled with misconceptions, The Six Keys to Globally Strategic Payroll

Feature. The phrase globally strategic payroll is filled with misconceptions, The Six Keys to Globally Strategic Payroll Feature The Six Keys to Globally Strategic Payroll The Journey of High-Performing Companies in Efficiency and Innovation By John M. Gibbons, Jeitosa Group International The phrase globally strategic payroll

More information

The Factors Fueling Rising Health Care Costs 2008

The Factors Fueling Rising Health Care Costs 2008 The Factors Fueling Rising Health Care Costs 2008 Prepared for America s Health Insurance Plans, December 2008 2008 America s Health Insurance Plans Table of Contents Executive Summary.............................................................2

More information

Report on the Agency-Advertiser Value Survey

Report on the Agency-Advertiser Value Survey Report on the Agency-Advertiser Value Survey Study conducted by Ignition Consulting Group on behalf of American Association of Advertising Agencies Association of National Advertisers August 2007 Results

More information

Smart shopping with your bank Card Linked Offers and Merchant Funded Rewards The Next Generation Loyalty Program

Smart shopping with your bank Card Linked Offers and Merchant Funded Rewards The Next Generation Loyalty Program Smart shopping with your bank Card Linked Offers and Merchant Funded Rewards The Next Generation Loyalty Program Business ValueBusiness Value The Four Strategic Technology Areas The Must Haves for Competitive

More information

EXECUTIVE INSIGHTS. Quality in the Healthcare Marketplace: Becoming a Rising Star. Outlining the 5-Star Quality Ratings Program

EXECUTIVE INSIGHTS. Quality in the Healthcare Marketplace: Becoming a Rising Star. Outlining the 5-Star Quality Ratings Program VOLUME XIV, ISSUE 14 in the Healthcare Marketplace: Becoming a Rising Star A basic tenet of federal healthcare reform is promoting higher quality care and improving outcomes. One emerging strategy to achieve

More information

HEALTHCARE PAYER. Healthcare Payer. Overview

HEALTHCARE PAYER. Healthcare Payer. Overview HEALTHCARE PAYER Healthcare Payer Overview Equipped for a rapidly changing market The face of healthcare is rapidly changing. Rising costs, reforms and a newly empowered consumer base are reshaping the

More information

The Obama Administration s Record on Supporting the Nursing Workforce

The Obama Administration s Record on Supporting the Nursing Workforce The Obama Administration s Record on Supporting the Nursing Workforce Nurses are at the center of the American health system. There are more nurses in our country than any other type of health care provider.

More information

Government Risk. Modeling & Assessment

Government Risk. Modeling & Assessment Government Risk Modeling & Assessment A FRAMEWORK TO DETERMINE THE COMMERCIAL RISKS AND OPPORTUNITIES OF US HEALTHCARE REFORM By Stephen Lu, Mengran Wang, and Matthew Shindel The implementation of the

More information

The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration

The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration The 4 Pillars of Clinical Integration: A Flexible Model for Hospital- Physician Collaboration Written by Daniel J. Marino, President & CEO, Health Directions November 14, 2012 Originally published by Becker

More information

Harnessing Data to Optimize and Personalize the In-Store Shopping Experience

Harnessing Data to Optimize and Personalize the In-Store Shopping Experience Harnessing Data to Optimize and Personalize the In-Store Shopping Experience People-tracking technology, including sensors, beacons, and video cameras, combined with mobile applications, can provide an

More information

Wasteful spending in the U.S. health care. Strategies for Changing Members Behavior to Reduce Unnecessary Health Care Costs

Wasteful spending in the U.S. health care. Strategies for Changing Members Behavior to Reduce Unnecessary Health Care Costs Strategies for Changing Members Behavior to Reduce Unnecessary Health Care Costs by Christopher J. Mathews Wasteful spending in the U.S. health care system costs an estimated $750 billion to $1.2 trillion

More information

On-site medical clinics date back at least 70 years, but. Employer-Sponsored Medical Clinics: Much More Than Convenience Care

On-site medical clinics date back at least 70 years, but. Employer-Sponsored Medical Clinics: Much More Than Convenience Care Employee Benefits and Chronic Conditions Employer-Sponsored Medical Clinics: Much More Than Convenience Care Chronic diseases and their complications are typically the main health care cost drivers of

More information

T h e M A RY L A ND HEALTH CARE COMMISSION

T h e M A RY L A ND HEALTH CARE COMMISSION T h e MARYLAND HEALTH CARE COMMISSION Discussion Topics Overview Learning Objectives Electronic Health Records Health Information Exchange Telehealth 2 Overview - Maryland Health Care Commission Advancing

More information

FFor members population, both in and out of

FFor members population, both in and out of Risk adjustment: Questions everyone should be asking in 2014 Expert presenters Jay Baker, Director, Commercial Risk Adjustment, Optum Scott Howell, MD, Senior National Medical Director FFor members population,

More information

Rethinking value delivery in health plan operations

Rethinking value delivery in health plan operations IBM Global Process Services Thought Leadership White Paper April 2012 Rethinking value delivery in health plan operations The top 10 areas for consideration 2 Rethinking value delivery in health plan operations

More information

Key Indicators: An Early Warning System for Multichannel Campaign Management

Key Indicators: An Early Warning System for Multichannel Campaign Management Cognizant 20-20 Insights Key Indicators: An Early Warning System for Multichannel Campaign Management For pharmaceuticals companies, a careful analysis of both leading and lagging indicators for multichannel

More information

Reactivating Lapsed Donors: How to Use Loyalty and Philanthropic Segmentation to Optimize Donor Reactivation

Reactivating Lapsed Donors: How to Use Loyalty and Philanthropic Segmentation to Optimize Donor Reactivation Reactivating Lapsed Donors: How to Use Loyalty and Philanthropic Segmentation to Optimize Donor Reactivation Richard Becker, President, Target Analytics Business Challenge: Nonprofit organizations are

More information

How Health Reform Will Help Children with Mental Health Needs

How Health Reform Will Help Children with Mental Health Needs How Health Reform Will Help Children with Mental Health Needs The new health care reform law, called the Affordable Care Act (or ACA), will give children who have mental health needs better access to the

More information

New Business and Investment Opportunities Emerging from Population Health Management (PHM)

New Business and Investment Opportunities Emerging from Population Health Management (PHM) Stax s Perspective on Changes Driven by PHM New Business and Investment Opportunities Emerging from Population Health Management (PHM) By Natalie De Fazio, Director, Stax Inc. November 2014 New Business

More information

How Health Reform Will Affect Health Care Quality and the Delivery of Services

How Health Reform Will Affect Health Care Quality and the Delivery of Services Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care

More information

The Five Pillars of Population Health Management. Dr. Christopher Mathews Senior Vice President and Chief Medical Officer ZeOmega

The Five Pillars of Population Health Management. Dr. Christopher Mathews Senior Vice President and Chief Medical Officer ZeOmega The Five Pillars of Population Health Management Dr. Christopher Mathews Senior Vice President and Chief Medical Officer ZeOmega ZeOmega a forerunner in Population Health Management Transformation into

More information

DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I

DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I A firm understanding of the key components and drivers of healthcare reform is increasingly important within the pharmaceutical,

More information

Framework for Improving Medicare Plan Star Ratings

Framework for Improving Medicare Plan Star Ratings Framework for Improving Medicare Plan Star Ratings Designed by the Center of Medicaid and Medicare Services (CMS), the five-star rating system is a quality and performance scoring method used for certain

More information

Customer Lifecycle Management How Infogix Helps Enterprises Manage Opportunity and Risk throughout the Customer Lifecycle

Customer Lifecycle Management How Infogix Helps Enterprises Manage Opportunity and Risk throughout the Customer Lifecycle Customer Lifecycle Management How Infogix Helps Enterprises Manage Opportunity and Risk throughout the Customer Lifecycle Analytics can be a sustained competitive differentiator for any industry. Embedding

More information

Identifying and Reducing Variation in the Supply Chain

Identifying and Reducing Variation in the Supply Chain Identifying and Reducing Variation in the Supply Chain April 14, 2015 Yohan Vetteth, MBA VP of Healthcare Data & Analytics Kari Bignell Manager, Data Architecture DISCLAIMER: The views and opinions expressed

More information

Beyond "Big data": Introducing the EOI framework for analytics teams to drive business impact

Beyond Big data: Introducing the EOI framework for analytics teams to drive business impact Beyond "Big data": Introducing the EOI framework for analytics teams to drive business impact Michael Li Business Analytics, LinkedIn Nov 20, 2014 J onathan Wu raveen Neppalli Naga P Chi-Yi Kuan Business

More information

Are Traditional Primary Care Clinics a Relic of the Past?

Are Traditional Primary Care Clinics a Relic of the Past? Are Traditional Primary Care Clinics a Relic of the Past? 105/2014 INSEAD Healthcare Management Initiative www.insead.edu/hmi hmi@insead.edu Written by Ridhima Aggarwal, The Salmon and Rameau Research

More information

Social Business Analytics

Social Business Analytics IBM Software Business Analytics Social Analytics Social Business Analytics Gaining business value from social media 2 Social Business Analytics Contents 2 Overview 3 Analytics as a competitive advantage

More information

Maximizing Returns through Advanced Analytics in Transportation

Maximizing Returns through Advanced Analytics in Transportation Maximizing Returns through Advanced Analytics in Transportation Table of contents Industry Challenges 1 Use Cases for High Performance Analytics 1 Fleet Optimization / Predictive Maintenance 1 Network

More information