Optum One Life Sciences

Transcription

1 Optum One Life Sciences April 15, 2015

2 Creating a profound and lasting impact on the health system Lower the cost trend > $100 billion 22 hours per day > 50% > $80 billion Unnecessary costs due to improper payments and administrative inefficiencies Time physician needs to see patients and meet recommended guidelines Portion of unnecessary clinical costs that consumers can influence Unnecessary annual spend due to low health information technology adoption Helping consumers navigate the system to make better decisions that result in the right care at the right time 24/7 online health and wellness tools to drive engagement and ultimately, better health Making health care easier, more convenient, and more affordable Drive improved patient outcomes 2

3 What is Optum One? A dynamic, software-as-a-service solution providing clinical intelligence analytics for providers to proactively manage their patient population health across the continuum of care. Overdue for a mammogram The Problem At risk for a heart attack Visited ED 5 times but missed primary care appointments The Solution Does not have a PCP Only 17% compliant with prescribed diabetes medications Organize, Identify and Stratify patients intelligently

4 Optum One Overview

5 Total Solution: An Intelligent Health Analytics Platform 3 rd Party connect

6 How are Providers Using Optum One? ACO Track progress against Measures Efficiently deploy resources against patients not meeting measures Evaluate resource utilization against clinical outcomes Code Improvement Identify gaps in coding Identify uncoded chronic patients based on clinical factors Cohort Analytics Identify clinical, demographic, and risk profiles of different disease cohorts Understand trends in polychronic patient populations Gaps in Care Identify patients who are not receiving standard care by site of care and provider Share lists daily with providers or care managers so gaps can be discussed in daily huddles and addressed in upcoming appointments Financial Risk Management Track PMPM and Per 1000 utilization Isolate risk adjusted provider variation Identify cost outliers and at-risk patients Support network management Care Coordination & High Risk Patient Management Identify actionable clinical opportunities for care coordinators Refer patients to outreach programs Support Care Coordination workflow and documentation Track outcomes of coordinated populations Physician Scorecards Quickly evaluate physician performance in process and outcomes of care Publish reports to the physician network to build a data-driven care framework Analysis of Prescribing Patterns Identify drug prescribing patterns vis-à-vis clinical outcomes Track compliance against medication protocols 6

7 Optum One Geographic Footprint Current + Projected Projected Database Statistics Patient lives 55M+ Active Clinicians 108,000+ Hospitals 500+ Clinics 4,500+ 7

8 General Screening Measures: ACO % s are much higher than Non ACO % s 70% Non ACO ACO 60% 58% 52% 50% 40% 34% 39% 46% 42% 35% 43% 30% 27% 26% 30% 30% 20% 10% 0% ACO Pt Count Non-ACO Pt Count Measure 3% 12% 7% 20% 62,227 1,689,873 5,763,086 1,676,100 6,644,714 12,160,769 6,139,243 2,921,668 1,494,717 26, ,547 2,322, ,580 2,657,739 4,647,391 2,470,122 1,209, ,659 (12) Medication Reconciliation (13) Falls: Screening for Fall Risk (14) Influenza Immunization (15) Pneumococcal Vaccination (16) Adult Weight Screening and Follow-up (17) Tobacco Use Assessment and Cessation Intervention 1% 2% (18) Depression Screening (19) Colorectal Cancer Screening (20) Mammography Screening Note: Data pulled from 40 Groups in Total, 26 ACO, 14 Non ACO

9 Create Value for Both Provider Systems and Constituents in Areas of Mutual Interest Approach: Leverage the Optum One infrastructure to integrate data from patient interactions and interventions outside the practice, while improving outcomes. Better tools to improve performance, outcomes Provider Better understand/serve their patients Better manage high risk patients Create efficiencies, improve processes Optimal impact on bottom line, costs Accelerate Innovation Life Sciences Opportunities to drive value in real world New channel to directly influence outcomes Consumer connectivity, loyalty Deeper insight - more real world data Test solutions in a data-driven ecosystem

10 Goal: Create value for providers in areas of mutual interest Opportunity: Leverage existing infrastructure to advance data-driven, digital health solutions which can inform care decisions, improve outcomes, and be measured in real world practice. Network Scale Engaged provider groups 55M+ longitudinal patient records Analytic Software Population and risk analytics platform Targeted Care- Enablement Tools Patient engagement Medication adherence Remote monitoring Patient reported outcomes CONTINUOUSLY MEASURE & TRACK EFFECTIVENESS

11 Framework Engage provider groups Identify and profile patients for outreach Educate, interact, collect data Ongoing research and measurement analytics Inform practice patterns Send data back to provider Opportunities for Continuous Improvement & Network Scale

12 Example Patient Engagement: Diabetes Targeted Interventions to Enable Better Patient Care Encourage Patients to Take an Active Role Explain Role of Medications, Treatment Options ENGAGE Survey Patients to Obtain Signs, Symptoms, Satisfaction Generate Awareness re Hypoglycemia Interactive: Ask Questions for care manager follow up Program Evaluation & Measurement for Continuous Improvement

13 Example Remote Monitoring: Diabetes Monitor Glucose Readings to Proactively Manage Patients & Identify Risk Clinicians evaluate patient activity to inform/modify treatment Patient enters blood glucose readings from home using any meter device Data sent to platform, combined with EHR for analytics, reporting Data syncs to mobile device, inc lifestyle (nutrition, exercise), vitals (e.g., weight) Program Evaluation & Measurement for Continuous Improvement

14 Real world data analytics supports population health Date-driven Quality Improvement Patient interactions / interventions Population health analytics Performance dashboards Insights Comparative benchmarks Risk ID and profiling Patient engagement Medication adherence Collaboration and dialogue Pt reported outcomes Remote monitoring Digital health innovation Action