Successful Population Health Management Through Analytics

Transcription

1 Successful Population Health Management Through Analytics A Town Hall Event by the C&BI Population Health-Accountable Care Task Force July 1, 2015

2 HIMSS Town Hall Series This is an informal public meeting that gives the members of a community an opportunity to get together to discuss emerging issues and to voice concerns and preferences for their community.

3 Today s Event: Population Health Management: Success Through Analytics Town Hall speakers: Joseph M. Taylor CEBS, RHU, HIA Vice President - ACO Practice Leader FluidEdge Consulting jtaylor@fluidedgeconsulting.com Moderator: John Middleton, MD, MS Diplomate, Clinical Informatics, ABPM VP/CMIO, SCL Health System john.middleton@sclhs.net

4 Progression of Alternative Payment Models Risk Fee For Service P4P Shared Savings Episode Payment Global Payment/ Full Risk Direct contract with local employers Providing insurance Provider Accountability

5 Risk-Based Contracting Takes Population Health Management to the Next Level CMS is expanding alternative payment models Payors and health systems are as well While this can be profitable, if not done well, it can be disastrous 5

6 Expanding Alternative Payment Models In 2014, 20% of Medicare s $417 million payments were through alternative payment models CMS set the goal of increasing the payments through value-based payment models to 30% by 2016 and 50% by 2018 They also proposed that by 2016, 85% of all Medicare FFS payments have a component that is based upon quality or efficiency of care - which will increase to 95% by

7 Expanding Alternative Payment Models Tandigm Health Signs Landmark Agreement with Holy Redeemer Health System and Innovative Wellness Alliance Posted Date: 2/4/2015 Tandigm Health, Holy Redeemer Health System, and Innovative Wellness Alliance(IWA) today announced a landmark agreement to improve the delivery of quality healthcare, reduce costs, and enhance patient satisfaction. Under the agreement, more than 75 primary care physicians from IWA, a physician-led, patient-centered organization, along with Holy Redeemer s extensive network of inpatient, outpatient, home health, and long-term-care services, will collaborate with Tandigm Health and its growing network of primary care physicians. The deal marks Tandigm Health s first cooperative arrangement with both a clinically integrated network of primary care physicians and a health system that provides a full continuum of health care services. The agreement will be effective March 1, Trinity forms risk-based partnership January 15, 2015 By Zack Budryk Trinity Health is continuing its trend of acquisitions, forming a risk-based accountable care partnership with Heritage Provider Network. Livonia, Michigan-based Trinity Health this week announced a partnership with California-based Heritage Provider Network (HPN), Healthcare Finance News reports. The partnership, called Trinity Health Partners, will operate in multiple markets and link HPN's 37,000 physicians with Trinity's 86 hospitals. As part of the arrangement, the two organizations will establish new models to coordinate several services, including primary care, high-risk clinics, post-acute care and hospitalist services. "This joint venture allows us to rapidly expand our capabilities to contract with payer-partners for fullrisk, capitated arrangements that will result in better health, better care and lower costs in the communities we serve," Richard J. Gilfillan, M.D., president and CEO of Trinity Health, said in a statement. "This approach is a key part of our strategy to build a people-centered health system." 7

8 Analytics Enable the Risk Needs Hierarchy Achieving the Triple Aim Risk factor stabilization & reduction Optimize Patient Functioning Measures: CMS, Payer & Patient Patient OWNS their care Co-developed personalized care plans The educated, compliant & self-managed patient Daily task achievement The coordinated care team Understanding patient behavior between visits Targeted management (MTM, readmission, ED, end of life, etc.) Chronic conditions, behavioral health & case management Population & patient based campaign management Dashboards: Patient, Care Coordinator & Physician Clinical program measurement, evaluation & evolution Risk identification and population based stratification Data governance Integrate unstructured & patient preference data Integrate lab, radiology & HIE data Connect all ACO EMRs and payer data sources Incentive compensation program alignment Determine process & results measures Mutually beneficial contracting Mission, Vision and Purpose

9 Data Integration and Analytics & Actionable Information ACO s Internal Data (EMRs and Financial) Traditional Payer Data HIE Data Patient Preference Data Predictive Modeling, Clinical and Business Intelligence Patients Stratified for Care Management Programs 9

10 Analytics & Actionable Information Empowering Care Coordination Health Promotion Health Education Single & Multiple Chronic Conditions Discharge Planning Case Mgmt. End of Life Optimizes Payer quality measures for low acuity patients Enables Patient Centered Care Management, Acute Stay, Post Acute and Full Risk Management Including UM

11 Demonstrating Value Value = (Clinical Outcomes + Patient Satisfaction) / (Price x Utilization) Clinical Outcomes Care Gaps Confirmed and Closed Medication Optimization & Possession Ratio Clinical Value Improvement SF12 Rates Risk Factor Improvement CMS and Payer Measures Clinical Outcomes Patient Satisfaction Patient Satisfaction Surveys Patient Engagement Care Program Participation Rates Patient Activity & Compliance Between Visits Leakage Rates and Market Share Improvement CMS and Payer Measures Patient Satisfaction Price and Utilization Price and Utilization Total Medical PMPM Medical Trend Total Rx PMPM Admissions/1000 Images/1000 ER, Urgent Care Usage Site of Service Management Readmission Rate Reduction CMS and Payer Measures 11

12 Vendor Evaluation Weight (1-10) Vendor 1 Vendor 2 Vendor 3 Vendor 4 Vendor 5 I. General II. Technical III. Integration / Data Feeds IV. Reporting - Quality, Costs, Outcomes, Physician Performance V. Care Delivery and Coordination VI. Physician Compensation/ Incentive Management VII. Patient Engagement VIII. Risk Management and Predictive Modeling IX. Notes Overall Score:

13 Concluding Thoughts Value-based contracting is here Data & analytics are ESSENTIAL for success Understand your business model and needs No ONE vendor can DO IT ALL!!! Focus on goals and results Collaboration is not for sissies, but it is critical!!!

14 Town Hall Discussion What are the top 3 actions an organization should do to be successful in riskbaring contracting for population health management (PHM)? What is the most difficult step, barrier, or problem to address in analytics for PHM that should be addressed as an health care organization begins its efforts? What has been the most difficult thing to do for the majority of the organizations once into the effort? How long does it take the typical organization to become reasonably competent in analytics to support its PHM program? What are 2-3 areas that typically are known to be difficult for an organization to accomplish? What are some suggestions for or examples of how to overcome those challenges? What are some of the characteristics of IT and analytics tools for a successful PHM program? Where are the members of the Town Hall in their PHM journey? How do organizations determine their PHM goals and results? And what does the end look like? 14

15 Next Steps Let s continue the conversation and learning Blog posts Key findings and take-aways Articles

16 FY15 C&BI Leadership Information Committee Chair: JD Whitlock, MPH, MBA, CPHIMS Vice President, Clinical & Business Intelligence Mercy Health Population Health-Accountable Care Task Force Co-Chairs: William Beach, MBA, MLA, PhD Jennifer Jackson Regional Director, Regulatory Readiness, Northern Region, Senior Director, IT Population Health Data Solutions St. Joseph Health System Banner Health Community Co-Chairs: Michael Brooks, BS, MBA, CPHIMS Specialist Leader Deloitte Consulting LLP Mike Berger, PE, CPHIMS Chef Analytics Officer Affinity Health Plan HIMSS Community Organizers Staff Liaisons: Shelley Price, MS, FHIMSS Director, Payer & Life Sciences, HIMSS Nancy Devlin Senior Assoc., Payer & Life Sciences, HIMSS

17 C&BI Committee Members J.D. Whitlock, MPH, MBA, CPHIMS* -- Chair Vice-President, Clinical & Business Intelligence Mercy Health Cheryl Bowman, CPHIMS Data Manager University of Wisconsin Hospital and Clinics Michael Brooks, BS, MBA, CPHIMS, FHIMSS* Specialist Leader Deloitte Consulting LLP Robyn Chatman, CPHIMS, FAAFP, MD, MPH Physician Healthbridge Teresa Gocsik, MS, CRNA, CPHIMS* Associate Principal Aspen Advisors Michael Kurliand, MS, RN* IS Strategy Consultant Children's Hospital of Philadelphia Sharon Lynn Morley, RN/CNS Client Manager Humedica Arthur Panov, MPH, CPHIMS* HIT Architect IBM Stuart Rabinowitz, MBA, BC Director Federal Markets - Channel Partners Socrata Maxine Rand, DNP (c), MPA, RN- BC, CPHIMS* Director, Clinical Education, Practice & Informatics Kaiser Permanente Chester H Robson, DO, FAAFP Medical Director, Clinical Programs and Quality Walgreen Co. Wolf Stapelfeldt, MD* Chairman, General Anesthesiology Saint Louis University Medical Center

18 C&BI Task Force & Community Chairs Community Co-Chairs Data and Analytics Task Force Co-Chairs Michael Brooks, BS, MBA, CPHIMS, FHIMSS Specialist Leader Deloitte Consulting LLP Mike Berger, PE Chief Analytics Officer Affinity Health Plan Raj Lakhanpal, MD, FRCS, FACEP CEO SpectraMedix Carol Muirhead, MBA Computer Science Faculty, Wyoming Northern Community College District Gillette College, Gillette, Wyoming Population Health- Accountable Care Task Force Co-Chairs William Beach, MBA, MLA, PhD Regional Director, Regulatory Readiness, Northern Region, St. Joseph Health System Jennifer Jackson Senior Director, IT Population Health Data Solutions Banner Health

19 Thank you!