Population Health Management: Advancing Your Position in the Journey to Value-Based Care

Transcription

1 Population Health Management: Advancing Your Position in the Journey to Value-Based Care Webcast Session One: An Integrated Approach to Population Health Management 11 August 2015

2 Welcome & Introductions Gregory Maddrey Director, Accountable Care Solutions Practice Leader Mark Werner, MD National Director of Clinical Consulting Thomas Graf, MD National Director of Population Health Management Anneliese Gerland Accountable Care Solutions Practice Manager 2

3 About The Chartis Group Our mission is to materially improve the delivery of healthcare in the world. The Chartis Group is a national advisory services firm dedicated to the healthcare industry. The firm is comprised of highly experienced senior healthcare professionals and consultants who apply a deep knowledge of healthcare economics, markets, clinical models, technology and organizational dynamics to help clients achieve unequaled results. ~250 Professionals Working In: Strategic and Economic Planning Accountable Care Solutions Clinical Transformation Informatics and Technology 3

4 Today s Discussion Define Population Health Management (PHM) and share how PHM models are evolving in the market Discuss how organizations can take a proactive, integrated approach to advancing their PHM strategies and capabilities Share examples and highlight key lessons learned from providers experiences in managing the health of the populations they serve 4

5 Multiple Forces Pushing Towards Structural Change Public Purchasers Private Purchasers Providers Driving increased accountability for value to providers, to: 1. Curb cost growth and bend the cost curve 2. Improve the health of individuals and groups Consumers Illustrative 5

6 Defining Population Health Management The approaches that have emerged are diverse, but many can be grouped under the umbrella of Population Health Management, which we define as the following: Population Health Management The advancement of the health of a defined or specific population through coordinated programs and activities that address medical and/or social determinants of health and are supported by an aligned payment model that rewards improvement of the population s health and the delivery of high-value care Health Population Aligned Payment Model 6

7 The Challenge for Providers PROFITABILITY PORTION OF BUSINESS Providers do not manage a single population, but rather multiple populations under varying levels of risk. In this context, providers must resolve two fundamental issues. Managing Populations under Mixed Models Illustrative Commercial: United + - Commercial: Anthem LOW (e.g., fee-forservice) Medicare FFS Medicare Advantage Commercial: Aetna ACO DEGREE OF PERFORMANCE-BASED RISK LIMITED (e.g., one-sided shared savings) Medicaid Carve-out for Chronically Ill Children MODERATE (e.g., two-sided shared savings) Direct-to-Employer Total Joint Bundle Employee Population HIGH (e.g., capitation; employees) Medicaid Medicare Pioneer ACO Taking Increased Accountability for Performance 7

8 Participant Poll Approximately what percentage of your organization s business remains in no- or low-risk contracts, e.g. FFS, P4P (select one)? Over 90% 35% 75-89% 17% 50-74% 21% Under 50% 27% 8

9 Risks for Providers Given the complexity of these challenges, providers are faced with significant risks in this evolving and uncertain landscape. 1 Managing Populations under Mixed Models 2 Taking Increased Accountability for Performance Approaching each population separately without fully considering how populations and their respective care and payment models relate to one another Pursuing PHM from a siloed view without taking into full account the interplay between clinical, financial and operating models Succeeding under a performance-based arrangement without fully understanding the drivers of success Doing little or nothing and being unprepared when the market forces the enterprise to take more accountability for performance 9

10 Participant Poll Which of these challenges, if any, has your organization experienced in the transition to PHM? (select all that apply) Populations approached separately 36% Functional, siloed approach to PHM 47% Don't understand drivers of success 27% Doing nothing or little 15% Other 7% Participants able to select all that apply so percentages will not add to 100%. 10

11 An Integrated, Iterative Approach to Population Health Management ENTERPRISE VISION FOR POPULATION HEALTH MANAGEMENT UNDERSTAND THE MARKET EVOLUTION KNOW YOUR POPULATIONS ARTICULATE YOUR VALUE PROPOSITION ALIGN ECONOMICS THROUGH PAYOR PORTFOLIO, INCENTIVE DISTRIBUTION AND RESOURCE MANAGEMENT ADVANCE CLINCAL MANAGEMENT & CARE MODELS ENGAGE PROVIDER & COMMUNITY PARTNERS SEGMENT & STRATIFY POPULATIONS PROMOTE CONSUMER ENGAGEMENT & ACCESS CREATE AND DEPLOY POWERFUL INFORMATION THROUGH TECHNOLOGY & ANALYTICS UNIFIED LEADERSHIP AND CULTURE 11

12 Lessons Learned from Providers Experiences They are starting in different places but several key lessons emerge from early successes and failures of providers managing population health. Define an enterprise vision to guide decisions on when and how to move to increased risk Balancing an understanding of the market, the population served and the enterprise value proposition Understand populations across multiple dimensions Using different segmentation and stratification techniques for various applications Take an integrated approach to meet a population s needs Securing commercial growth through a value-based arrangement Improving access and quality for an underserved Medicaid population Mature from a narrow program to a comprehensive solution Moving to the next level in PHM 12

13 1. Define an Enterprise Vision to Guide the Transition to Risk Understand the Market Evolution: How is the market expected to evolve in the coming 3 to 5 years? e.g., Healthcare financing and implications for care delivery models, capabilities requirements and reimbursement mechanisms Purchasing behaviors of population segments Competitive positions and aspirations of other providers Potential evolution of the health plan market Know your Populations: What populations do you manage today? How may the needs of these populations change over time? What will be required to maintain or deepen existing relationships with these populations? To manage the health of additional populations? Articulate your Value Proposition: How does population health management fit within the broader enterprise vision and strategy? What is your organization uniquely positioned to offer the market to disrupt the current competitive environment and create new / lasting value? 13

14 Participant Poll Has your organization defined an enterprise vision for PHM? (select one) Yes 52% No 38% Don't know 10% 14

15 2. Understand Populations Across Multiple Dimensions At different levels Leading providers understand their populations along multiple dimensions and use different definitions to direct various activities and priorities. SEGMENT & STRATIFY POPULATIONS Disease Condition / Health Status Utilization Patterns Along different dimensions Risk Factors Geography Socio- Economic Status Social Needs Preferences and Attitudes Example Definitions The Entire Population Targeted by the System All patients the system touched in the last three years All lives in a particular geography The Population of Interest Individuals admitted more than once in the past 12 months Individuals with Heart Failure Medicare beneficiaries attributed to ACO via primary care Individuals with multiple chronic conditions The Population of Intervention Patients with Heart Failure at risk for treatment non-adherence Individuals from a specific geography with multiple chronic conditions and social needs, e.g., transportation Individuals with COPD who actively seek services and information online 15

16 2. Understand Populations Across Multiple Dimensions The Population of Interest All patients with diabetes seen 1+ in 3 years The Population of Intervention Granular Quality Reporting Officebased Systematic Team Care Embedded RN Care Management Support Disease Management Education and Support Example Interventions AP or Pharmacist DM-Focused MTM Program Community Health Agent/ Social Work Support Transportation Vouchers Advanced Personalized Education and Lifestyle Change Program A. Multi-comorbid conditions B. Newly diagnosed DM C. Poorly controlled DM despite 6 months redesigned systems of care approach D. 3+ admissions in the last 6 months E. Poor visit adherence due to transportation issues All patients with DM, plus: F. Social needs G. Preference for no use of medications 16

17 3. Take an Integrated Approach to Meet a Population s Needs Securing commercial growth through a value-based arrangement Non-profit health system with 7 hospitals, ~2,500 aligned physicians Entered into a two-sided shared savings arrangement with a commercial payor to manage a population of ~150,000 lives Enterprise Vision Leadership and Culture Desired a different payor-provider relationship, sensitive to community mission Leadership broadly discussing total cost of care (TCOC) and Pioneer ACO options Aligned Economics TCOC with commercial payor, based on beating market trend by at least 0.5%; embedded within physician compensation model as a significant bonus pool associated with TCOC/quality/service/access metrics Population Segmentation & Stratification Advanced Clinical Management and Care Models Consumer Engagement & Access Provider & Community Partner Engagement Powerful Information Focused on commercial patients in high risk and high utilization categories Use of virtual care, online patient self-management tools, clinical guidelines and PCMH based care coordination Development of a single access point for all health plan and medical care needs to support healthcare triage, appointments and benefits management through one source Engaged physicians in 72 site dissemination of PCMH, regional practice management model and medical group governance model Early TCOC and utilization profiling in partnership with payor 17

18 3. Take an Integrated Approach to Meet a Population s Needs Improving access and quality for an underserved Medicaid population Safety net ACO formed as a collaboration between public health and social service agencies, several health systems, an FQHC and a health plan serving Medicaid and Medicare enrollees Assumed full-risk for Medicaid expansion beneficiaries enrolled in the plan, starting with ~10,000 lives Enterprise Vision Mission driven organization with focus on underserved populations Leadership and Culture Aligned Economics Population Segmentation & Stratification Advanced Clinical Management and Care Models Consumer Engagement & Access Provider & Community Partner Engagement Powerful Information Senior team dedicated to PHM and has focused many operational opportunities to support transformation TCOC contracting for Medicaid and early capitation programs; implemented modest scope through a provider-sponsored Medicaid plan Geographic segmentation plus risk stratification informed by healthcare utilization, physical and behavioral health conditions PCMH, care coordination models, specialized clinics for frail and complex patients and deployed community health workers Tailored engagement plans developed for high-risk individuals through care coordination model Many community service partnerships, investing in own community-based services Real time alerts to PCMH for ED visits; patient-level dashboard customized based on type of provider 18

19 4. Mature from a Narrow Program to a Comprehensive Solution Narrow Initiative Expanding Effort Comprehensive Approach Enterprise Vision Better Elderly Chronic Disease Care Every Patient Touched Total Community Care Leadership and Culture Aligned Economics Population Segmentation & Stratification Advanced Clinical Management and Care Models Consumer Engagement & Access Provider & Community Partner Engagement Powerful Information Driven primarily by primary care and health plan leaders, select specialty leaders Medicare Advantage 20% of physician comp performance-based All patients seen 1+ times in 3 years with diabetes mellitus; expanded to other chronic diseases over time Office based systems of care, team care, EHR optimization Patient portal, patient specific report cards, proxy/family electronic access Internally, primary care highly engaged, specialty care engagement varied by service line Active registry reports; granular quality, utilization reports for population of interest + Commercial (1/3 of patients) + Addition of population payment for PCPs for non-rvu work All patients seen 1+ times in 3 years + Tiered care management support, proactive outreach, outreach ATC + Additional report cards + Expansion of population using portal + Began unidirectional data tracking of community entities + Refinement of reports and expansion of measures + Expanded population of interest Increased engagement by hospital leadership + community leaders + Managed Medicaid, grant and community support All people in a specified geography + Community health agents; community agency connectivity; program trainees integrated + Portal access to physician notes; HIE access to community records (pharmacy, community hospital, private physicians) + Engagement of hospital + Active programmatic connectivity including competing hospitals, community social agencies, university programs + Expanded population of interest, with limited data on non-patients 19

20 Participant Poll Where would you characterize your organization on the PHM journey? (select one) Narrow initiative(s) 49% Expanding effort 38% Comprehensive solution 8% Don't know 6% 20

21 An Integrated, Iterative Approach to Population Health Management ENTERPRISE VISION FOR POPULATION HEALTH MANAGEMENT UNDERSTAND THE MARKET EVOLUTION KNOW YOUR POPULATIONS ARTICULATE YOUR VALUE PROPOSITION ALIGN ECONOMICS THROUGH PAYOR PORTFOLIO, INCENTIVE DISTRIBUTION AND RESOURCE MANAGEMENT ADVANCE CLINCAL MANAGEMENT & CARE MODELS ENGAGE PROVIDER & COMMUNITY PARTNERS SEGMENT & STRATIFY POPULATIONS PROMOTE CONSUMER ENGAGEMENT & ACCESS CREATE AND DEPLOY POWERFUL INFORMATION THROUGH TECHNOLOGY & ANALYTICS UNIFIED LEADERSHIP AND CULTURE 21

22 Questions??? 22

23 Upcoming Event Access additional information at 23