Population Health Data Initiatives at University of Iowa Health Care. December 2, 2015 Mark Henrichs, AVP Finance

Transcription

1 Population Health Data Initiatives at University of Iowa Health Care December 2, 2015 Mark Henrichs, AVP Finance 1

2 Overview of UI Hospitals and Clinics 732 bed, state-owned facility Over 33,000 acute admissions and approximately 935,000 ambulatory patient visits in FY15 57,293 emergency visits 7 Adult Specialties ranked by US News and World Report in top 50 9 Pediatric Specialties ranked by US News and World Report in top staff physicians and dentists 1,904 nurses 755 resident and fellow physicians 1,599 volunteers 2

3 University of Iowa Business Intelligence Budget / Accounting / HR Flex budget reporting fixed/variable staff, supplies/implants, etc Operational BI UHC/FPSC Benchmarking Scheduling & capacity, room turns, etc Cost Accounting/Decision Support Reimbursement modelling, cost accounting, service line financials, etc Population Health Analytics Initially claims data driven Move to enrich with clinical data via EHR 3

4 Population Health Scale University of Iowa Health Alliance Created over 2 years ago in response to changing environment value-based contracts, narrow network products, etc. UIHA provides scale for value based contract / population health efforts, while independent. Together we become the third big clinical system in Iowa. 4

5 UIHA ACO Management Structure CEO Chief Population Health Officer Chief Clinical Officer COO CFO General Counsel QI Director TBD Care Director Program Coord. Accounting Compliance Officer Project Manager Care Manager Training Contract Business Health Solutions Accounting * Direct Reporting Relationship to the ACO Board Data Analytics Contract Chapter Care Mgmt. UIHC IT Contract Oversight - Optum Contract Actuary TBD Analyst Analyst Genesis Mercy CR Wheaton Network/ Credentialing Contract - TBD Great River Payer Contracts TBD Marketing/Comm./ Legis. 5 5

6 2016 Value Based Contracts In 2016, estimated 150,000 covered lives in UIHA ACO Value-Based Contracts Contracts with risk for Quality and Total Cost of Care Benchmarks Medicare Shared Savings Program (MSSP) Track 1 Application pending for UIHA ACO for 1/1/16 Potential move to Next Gen for 2017 Wellmark ACO Employees Medicare Advantage Medicaid Managed Care Organizations (MCOs) TBD New contracts with other payers - TBD 6

7 Quality Measures Detail Patient/Caregiver Experience Care Coordination / Patient Safety Preventive Health At Risk Population Medicare ACO (MSSP) CMS Measures Getting Timely Care, Appointments, & Information How Well Your Doctors Communicate Patients Rating of Doctor Access to Specialists Health Promotion and Education Shared Decision Making Health Status/Functional Status Risk Standardized, All Condition Readmissions (L) ASC Admissions: COPD or Asthma in Older Adults (L) ASC Admission: Heart Failure (L) EHR Incentive Payment Medication Reconciliation Falls: Screening for Fall Risk Influenza Immunization Pneumococcal Vaccination Adult Weight Screening and Follow-up Tobacco Use Assessment & Cessation Intervention Depression Screening Colorectal Cancer Screening Mammography Screening Blood Pressure Screened in Past 2 Years Diabetes who Met all the Criteria HbA1c in Poor control (>9 %) (L) Hypertension whose BP < 140/90 IVD LDL control < 100mg/dl IVD who use Aspirin Beta-Blocker Therapy for LVSD Coronary Artery Disease Medicare ACO Wellmark & IWP VIS Measures Breast Cancer Screening Colorectal Screening Well Child Visits Birth to 15 Months Well Child Visits 3-6 Years of Age Primary & Secondary Domain Potentially Preventable Readmissions 30 Day Discharge 3 Chronic Care Visits Chronic & Follow Up Care Domain Potentially Preventable Admissions Potentially Preventable ED Visits Tertiary Prevention Domain PCP Visits Physician Visit Continuity of Care Measure Continuity of Care Each Domain Weighted 25% 58 Possible Points Wellmark & IWP All Domains Combined for Complete VIS Score = Percentile Rank Against Network 7

8 Defined Urgent/Short Term & Long Term Strategies Urgent = Six Months Full/Accurate Coding Drives risk adjustment and risk stratification Analytics Optum Necessary for most strategies Build Network Provider Agreement Care Coordination Training, Workflow, Consistency Increased scale Referral Management Adherence to models/improved info coordination Performance Management Physician Reporting and Management Quality Improvement Financial/Shared Risk Distribution Models Longer Term > Six Months Patient Centered Medical Home models Care Redesign/Transformation Shared Decision making Care Coordination Enhancements Patient Engagement Utilization Management Specialist Engagement Continued improvement of Urgent priorities 8

9 Key Tools Used 9

10 Key Metrics Utilization Metrics (per 1,000) ED Visits, Imaging, Inpatient, SNF Financial Metrics Per Member Per Year Spend Spend by Service Line Out of Network Utilization Quality Metrics GPRO/PQRS Metrics Commercial Value Based Contract Metrics Risk CMS-HCC Dropped Rate 3M CRG Grouper Status Jumper All Metrics -Institution -Clinic -Provider -Patient Level 10

11 Population Impact The Goals of the Triple Aim Affect the Entire Health System Key Metrics Can be Applied to Most of the Layers within the Health System Health System Patient Self-Care Key Focus is on the Microsystems Disease Cohorts Service Lines Procedure Bundles Clinical Groups Pediatrics, Cardiovascular etc. Caregiver Microsystem Mesosystem Macrosystem Environment 11

12 Information Reporting Cycle Calculation & Validation Process New Measures Are Manually Developed & Reviewed by End Users & Analysts Analyst Develop Automated Validation Post Review Reporting Methods Excel Generated Dashboards Tableau Generated Dashboards Hosted Online for Users to Review Allows for Users to Drill & View Underlying Data Future State Optum Reports Validation Process Automated Validation Reporting & Calculations Manual Validation Generated Reporting 12

13 Required Data Claims Data to Generate Accurate Spend & Risk Stratification Electronic Medical Record for Quality Measures Custom Reference Files Algorithms EIN/TIN Reference Table Service Line Crosswalk CPT/HCPCS Code Grouping Berenson-Eggers Type of Service (BETOS) CMS-HCC Grouper 3M Clinical Risk Grouper Chronic Condition Grouper Provider Attribution 13

14 Tool Utilization Concurrent Patient / Financial Management Spend Utilization is Monitored as Close as Possible (Claims Lag) Intervention is Taken on Patients to Lower Spend Utilization Rates are Monitored by Service Line & Patients Patients with High Rates are Reviewed & Followed Retrospective Analysis Historic Data is Used to Calculate Impact of Intervention Strategies Predictive Patient & Financial Management Risk Stratification Methods are used to Predict Future Spend, Readmission Potential, and Future Admissions 14

15 Outcomes & ROI Outcome Improvements Utilization & Spend Reduction Spend and Utilization have Remained Flat Compared to Benchmarks Quality Improvement Tool ROI Quality Scores for GPRO and Commercial Contracts have Exceeded Targets by 5% in the Last Year UIHC is Currently Undergoing Implementation of the Optum Tool Investment in Other Tools has Been Insignificant 15

16 Available Data Prior to Optum Claims Data Wellmark Medicaid Iowa Wellness Plan Medicare Shared Savings Plan Data Elements Inpatient/Outpatient All Locations CPT, ICD9/10, NDC, Rev. Codes, Procedure Codes, DRG To Be Announced 16

17 Available Data Optum EMR Outbound Billing Custom Extracts Payer Claims Chapter Data Extract Optum Database Generated Reports Modules Patient Registry Risk Analysis Population Analytics 17

18 Optum Selection Three Modules that Support Triple Aim Population Analytics Quality Focus Risk Analytics Spend Focus Population Registry Patient Focus Allows the Sharing of Information Across Partners Creates Longitudinal Medical Record Combines EMR & Claims Data Multiple Risk Stratification Tools Selection Process Generated a Request for Proposal Reviewed 12+ Vendors ***Go Live March 1,

19 Utilization Report 19

20 Quality 20

21 Demographics 21

22 Spend Analysis 22

23 Admin Report Sample Spend Trend TOTAL 8,600 8,500 8,400 Spend Trend Compared to Risk Adjusted Target 8,300 8,200 8,100 Savings 8,000 7,900 7,800 7,700 7,600 PMPY Risk Adjusted Target 23

24 Proposed Coding Improvement Work Flow Patient Encounter Claim Processing Newly Assigned Physician Education & New Patient Wellness Visit Target High Utilizing Aged Population & Automate Scheduling Continuously Assigned BPA Will Track Captured HCCs Missed HCC Report Created Work Que for Coder Review Non Coded HCCs Available at Time of Encounter Missed HCCs Scheduling Care Coordinator Follow Up 24

25 Coding Dashboard 25

26 Forecasted Results HCC Analysis MSSP 80% 2015 UIHC Projected HCC Rate 80% 2016 UIHC Projected HCC Rate & Savings Payment 70% 70% 60% 60% Dropped HCCs 50% 40% 30% 20% 10% 20% Actual Current Rate 30.58% Budget Dropped HCCs 50% 40% 30% 20% 10% 15% 0% 0% UIHC TARGET UIHC TARGET CY 2016 CY 2015 (RUN RATE) HCC DROP RATE - PROJECTED 20% 15% HCC DROP RATE TARGET 20% 15% SAVINGS PAYMENT - 800,000 Must Exceed MSSP Threshold % % Assumes No Change In PMPY 26

27 Quality GPRO Reports Optum Example 27

28 Optum Example 28

29 Results and Next Steps 29