Population Health Analytics. Ruth Rose Vice President, Clinical Technology Cigna

Transcription

1 Population Health Analytics Ruth Rose Vice President, Clinical Technology Cigna

2 We Have a Common Enemy - Disease 86% of American adults will be obese by in 4 working adults smoke or use tobacco 1 of every 3 American children born after 2000 will develop diabetes by age 50 Each year, over $33 billion in medical costs and $9 billion in lost productivity due to heart disease, stroke and diabetes are attributed to poor nutrition 60% of employee absences are related to psychological issues and job stress In 2015, annual per capita health care expenditures will exceed $15,000 For the first time in U.S. history, this generation of children may live shorter lives than their parents

3 Key Trends Impacting the Health Care Delivery System Pressure On Provider Revenue Leads to Changes in Practice Organization Outcomes- Based Incentives Require New Business Models Big Data and Technology Demand Rapid Change & Innovation Evolving Financial Roles of Employers and Consumers Create Challenges & Opportunities Changing Consumer Profile Necessitates More Personalized & Customized Care Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna 3

4 Transforming Care Delivery Takes Time At least six components Physician leadership and culture Health information technology Aligned incentives: Success requires aligned MD comp Comparative effectiveness and available evidence Quality improvement collaboration by peers and across system Training multidisciplinary teams across the continuum

5 CONNECTING CARE = BETTER HEALTH, AFFORDABILITY AND EXPERIENCE Cigna and likely all payors - will maximize the relationship between customers and health care professionals to ensure the most effective care in the right setting at the most affordable price. Exchanging actionable information Aligning health goals and motivating change Engaging customers and health care professionals Cigna will meet the goals set by HHS, including 90% of payments in valuebased arrangements and 50% of payments to organizations in alternative payment models by the end of Customer CONNECTED CARE Health Care Professional Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna

6 Tomorrow Connected Care The Vision: Next Gen Access enables Cigna to serve as the connected care orchestrator and facilitate a better health experience across the care continuum. Retail/ Convenience Care Local Community A CONNECTED CARE DELIVERY NETWORK Expanded network of convenience care partners Curated digitally-enabled providers and technology Data connectivity Value-based reimbursement Customer network activation Providers/ Facilities CUSTOMER Home Key Digital In-person Telehealth Urgent Care Centers Work/ Employer Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna

7 Population Health Analytics

8 DATA AGGREGATION ANALYTICS CARE COORDINATION and POPULATION HEALTH Eligibility Adjudicated Claims Provider Data Add l Data TBD Other HIE s Other Payors Registries 3 Payor Administrative, Claim and Physicain Clinical Data Actionable and population information CONNECTIVITY Clinical Data Distribute actionable information to care coordinator via portal with 360 view of patient; distribute population information to practice administrator via portal for population improvement and risk management Share individual actionable information with physician via EMR Integration of claim and clinical data to improve actionable information 2 1 Enhanced Portals EMR Patient Patients and Family Providers Hospital Systems / 3 rd Parties Care Coordinators Practice Admins Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna

9 Web Portals Connectivity and Data Exchange HIEs Care Collaboration Business Architecture and Capabilities To enable collaboration in population health management, enabling capabilities to connect, exchange data & information and engage with physicians (and patients) is required Intake Physician / Patient Clinical Lifecycle Primary Care Specialists Ancillaries Pharmacy Diagnose Treat Capture Demos Treat Validate Coverage Prescribe & Refer Auth Services Care Planning Collect Cost Share Discharge Planning Coordinate Follow Up Remind Support Consult Monitor Chronic Assess History Quality / HEDIS ID Gaps in Care Adherence Polychronic Triple Aim Examine Utilization & Costs Targeted Populations Labs / Tests Service Inpatient/ Outpatient Facilities Patient Workup Early Detection Wellness / Prevention High Cost Episodic Reduce Costs Improve Quality Enhance Services Telecom In-Person Physician Collaboration Capabilities For each use case, health plans must Health Data Assets acquire and structure the required data Medical Claims RX Claims Other Claims EMR Clinical Data Analytics and Insights to create data-driven insights Gaps in Care Risk Modeling 360 Pat View Programs and Workflow Integration determine points of interaction and approach Clinical Programs Services Provider Engagement Channels through the most effective channels Telephonic Web Portal Cust. Service Alerts Medical Mgmt. Lifestyle / Social Panel / Registry Fin. Risk Mgmt. CIS / EMR Mobile In-office

10 What Is the Problem Significant manual work processing gaps and transition of care opportunities Even with portal, growing B2B interoperability and data availability, still a significant use of manual delivery of data that is inefficient. Lack of automated efficient twoway communication that the standards do not enable Gaps in current use case scope that do not yet enable value based use cases. Most use cases are care delivery centric

11 Simply, What We Want to Accomplish.. Exchange Useful Information At low cost..with minimal impact on workflow.. Aligned with value based programs

12 Let s Pilot!

13 Let s Pilot! Now remember, we WANTED to work together.

14 The End of a Long Journey All of that time and effort to achieve this Not inspiring for doing all that hard work!

15 Process Learning and a Few Opinions If you ve done one physician integration, you ve done one physician integration Mapping to HL7 CCD formats is hard There is not a reasonable way to maintain state of discrete exchange between partners e.g. mapping a result to a prior request for information The exchange models are all single-patient-at-a-time. There is not a method to share a list of patients that require attention Process to retrieve requested information is still document based and requires an explicit request and fetch by the EMR user. Looking forward to upgrades to enable discrete data We must learn to answer the questions providers need, not just impose what we think

16 TECHNOLOGY and INTEROPERABILITY IMPLICATIONS

17 The Great Baltimore Fire 1904

18 Challenges Definition All in population health capabilities needed Connectivity Data Aggregation Analytics Mgmt. Services Care Coordination Multiple channels to connect workflows using transmission standards (e.g. HL7) A set of tools that allows clinical and administrative data from many sources to be translated and stored in the usable format Actionable information and reports to assess performance against triple aim targets Network Benefits Services provided to enable successful risk management Administrative and Risk Platforms Process Change Workflow tools that will allow a care plan to be shared across multiple entities and share work tasks across the continuum Customer Engagement Tools that offer transparency to customers clinical data and care plan as well as tools to help with education and engagement In spite of HITECH and MU, still very difficult and not repeatable. Movement to private HIE patterns Difficult to aggregate claim/admin and clinical info accurately Variety: - MA vs. Commercial - Quality vs. Cost/Util Content: - Risk adjustment - Measures Changing process is hard, sometimes need 3 rd party help or trusted relationships And Diffculty of divvying results Few standards or capabilities that enable task sharing across stakeholders State of the art 2015: telephone and EMR: opportunity to step up Digital revolution is both a blessing and a curse, because of the number of options. Customer control is nascent. But it s coming!

19

20

21 How Long Will It Take? It s taken 30 years to implement widespread, efficient, administrative transactions though a common set of standards 1980 s 1990 s 2000 s 2010 s Multiple flat file formats, customized connectivity NEIC formed, movement towards ANSI HIPAA rule, ANSI Standard, CAQH rules CAQH rules extend beyond HIPAA Getting Started Industry alignment Standards Operating efficiency Is clinical exchange on a similar path?

22 What Will It Take Massive events Significant financial opportunities Industry, government, consumer interests aligned Friends Commitment

23 Q&A