transition chs to predictive care management with medai rnc final

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

S

Predictive Care Management for CHS Single Practitioner

S

O

Predictive Care Management for CHS Single Practitioner

S

O

A

Predictive Care Management for CHS Single Practitioner

S

O

A

P

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for CHS Single Practitioner

Predictive Care Management for Single Practitioner

Transitioning CHS Care Management to Population Stratification

Purpose of MEDai Risk Navigator Clinical for Community Health Solutions

Identify savings from TOTAL COST UNDER FORECASTED COST by Dx Categories

Identify HIGH RISK members in SCS population

Use RNC reports to demonstrate measured savings after CM engagement

Develop new programs from SCS population strata

Determine a process to move away from diagnosis trigger codes for CM

Establish a reliable ROI from the RNC data that could not have been attained prior

Transitioning CHS Care Management to Population Stratification

Identify HIGH RISK members in SCS population

Transitioning CHS Care Management to Population Stratification

Identify HIGH RISK members in SCS population

Transitioning CHS Care Management to Population Stratification

Identify HIGH RISK members in SCS population

Transitioning CHS Care Management to Population Stratification

Provide predictive analytics to identify future costs for each member

Identify members with TOTAL COST 10% GREATER than FORECASTED COST

Run a report for all members with greater than $50,000 TOTAL COST

Establish threshold dollar amount for PHARMACY FORECAST COST for example GREATER than $10,000

Determine the gap between TOTAL COST and FORECASTED COST for each SCS Shared Savings Age group

Transitioning CHS Care Management to Population Stratification

Determine gap between TOTAL COST + FORECASTED COST for each SCS Shared Savings Age group

Transitioning CHS Care Management to Population Stratification

Identify members in our SCS population that pose high risk for care

Run monthly reports for all member FORECASTED RISK INDEX > 50

Determine a threshold limit FORECASTED RISK INDEX for CM eligibility, for example any member greater than INDEX = 5 eligible for CM process

Identify our Psychiatric Disorders Group Aggregate HIGH RISK INDEX since this Group is SCS greatest Diagnostic Category

Segregate and indentify LOW RISK population strata and do not engage CM at level below 1.0 unless FORECASTED COST > $30,000

Transitioning CHS Care Management to Population Stratification

Segregate and indentify LOW RISK population strata; do not engage CM at level below 1.0

Transitioning CHS Care Management to Population Stratification

Segregate and indentify LOW RISK population strata; do not engage CM at level below 1.0

80.6%

Transitioning CHS Care Management to Population Stratification

Ability to run Comparative Analysis on several CHS clients

Within SCS service line, determine Risk Index for each Group

Monitor TOTAL COST in relationship to FORECASTED COST for each client

Compare effects of CM engagement within each SCS Group

Determine HIGH RISK Diagnostic Categories within each SCS Groups

Identify members who are predicted to have HIGH TOTAL COST that can engage CM right now

Transitioning CHS Care Management to Population Stratification

* End of Presentation *

Beginning of Predictive Care Management

August 2, 2010

Dr. Curtis J. TinsleyCommunity Health Solution of America

Office of Chief Medical OfficerOffice of Clinical Data Governance

“Transition Community Health Solutions to Predictive Care Management with MEDai Risk Navigator Clinical Suite”