it solutions for fee for value reimbursment and population health management
DESCRIPTION
This presentation highlights some key considerations when building or integrating IT solutions for the emergent payment models evolving in Health Care. Population risk stratification, identifying patients to target for high success rate interventions, and tracking physicians adherence to evidence based medicine using key performance indicators are covered at a high level.TRANSCRIPT
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TECHNOLOGY CONSIDERATIONS FOR VALUE-BASED PAYMENTS
John SqueoLazer Focus AdvisorsFind us on LinkedIn
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1% of U.S. population consumes20% of ALL HEALTH CARE DOLLARS
Source: National Institute of Health Care Management 2012
CHALLENGES WE FACE
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1% of U.S. population consumes20% of ALL HEALTH CARE DOLLARS
Source: National Institute of Health Care Management 2012
Total expenditure on healthcare:per capita per year: $7,960
Source: Organization for Economic Co-operation and Development on global health issues: Michael B. Sauter, Charles B. Stockdale, 24/7 Wall St. , 2012 - Countries that spend the most on health care, NBCNEWS.com, http://www.nbcnews.com/business/countries-spend-most-health-care-618241
Expenditure as percent of GDP: 17.4 percent
CHALLENGES WE FACE
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HEALTHCARE REFORM
#1 Biggest Issue – Financial Challenges
#2 Biggest Issue – Healthcare Reform Implementation
#3 Biggest Issue – Patient Safety & Quality
2011 Results - Biggest Issue Facing Hospital CEOs
Source: American College of Healthcare Executives, Annual Poll – Top Issues Confronting Hospitals: 2012
Annual Survey American College of Healthcare Executives
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HEALTHCARE REFORM
#1 Biggest Issue – Financial Challenges
#3 Biggest Issue – Healthcare Reform Implementation
#2 Biggest Issue – Patient Safety & Quality
2012 Results - Biggest Issue Facing Hospital CEOs
Source: American College of Healthcare Executives, Annual Poll – Top Issues Confronting Hospitals: 2012
Annual Survey American College of Healthcare Executives
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TRENDS TOWARD VALUE-DRIVEN HEALTHCARE
• Hospital Readmissions– Hospital DRGs 1% in 2013 3% by 2015• Medicaid DSH cuts - $18.1Billion 2014 – 2020 (Pres. Obama
proposed delay to 2015)• Value-Based Purchasing• 70% - Core Measures: Heart Failure, Acute Myocardial Infarction
(AMI), Pneumonia & Surgical Care• 30% - HCAHPS score: Patient Satisfaction
• Physician (SGR) Sustainable Growth Rate – 27%
Reduced Reimbursements CMS & Commercial Carriers
• Accountable Care – Provider Risk Acceptance & Shared Savings• Bundled payment for episodic care
Global Payments Innovations – CMS & Carriers
• Payers setting up Accountable Care Organizations• Hospital Systems offering health insurance on public Health Insurance
Exchanges (HIX)
Payer/Provider Convergence
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HHS & IL HFS INNOVATION MODELS
HHS & ONC BEACON COMMUNITIESHIE - HEALTH INFORMATION EXCHANGES
SEMANTICAL INTEROPERABILITY
MASTER PROVIDER INDEXES MASTER PATIENT INDEXES CONSENT MANAGEMENT &
RECONCILIATION
ILLINOIS - Care Coordination Programs CCE - Seniors and Persons with Disabilities CCMN - Children with Complex Health Needs MMAI - Medicare-Medicaid Alignment Initiative ICP - Integrated Care Project and Integrated
Care Expansion
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ACO – ACCOUNTABLE CARE ORGANIZATIONS
BUNDLED PAYMENTS FOR CARE IMPROVEMENT
PRIMARY CARE TRANSFORMATION
MEDICAID & CHIP POPULATION INITIATIVES
DUAL ELIGIBLES INITIATIVES
PAYMENT & SERVICES DELIVERY MODEL ACCELERATION
BEST PRACTICE ADOPTION INITIATIVES
CMMI INNOVATION MODELS
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ACCOUNTABLE CARE SIMPLIFIED
Year 1 Attributi
on
Year 2
Year3 Shared Savings
ACOCMS or Other
PayerACO
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ACCOUNTABLE CARE SIMPLIFIED
Year 1 Attributi
on
Year 2
Year3 Shared Savings
ACOCMS or Other
PayerACO
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ACCOUNTABLE CARE SIMPLIFIED
Year 1 Attributi
on
Year 2
Year3 Shared Savings
ACOCMS or Other
Payer
Risk Score
Profiling
Chronic Disease
Monitoring
ACO
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ACCOUNTABLE CARE SIMPLIFIED
Year 1 Attributi
on
Year 2
Year3 Shared Savings
ACOCMS or Other
Payer
Risk Score
Profiling
Chronic Disease
Monitoring
Care Coordination
Pre & Post Acute Care
ACO
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THE OPPORTUNITY
Managed Care and Value-Based Care has provided us the privilege and responsibility to
Never Discharge a Patient.
We can dedicate our efforts to help them grow, contribute and then age with dignity.
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TRANSFORMATIONS IN HEALTHCARE DELIVERY
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TRANSFORMATIONS IN HEALTHCARE DELIVERY
MOVEMENT AWAY FROM CENTRALIZED FACTORIES OF
CAREHospital
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TRANSFORMATIONS IN HEALTHCARE DELIVERY
MOVEMENT AWAY FROM CENTRALIZED FACTORIES OF
CAREHospital
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TRANSFORMATIONS IN HEALTHCARE DELIVERY
MOVEMENT AWAY FROM CENTRALIZED FACTORIES OF
CAREHospital
CONSUMER DRIVEN HEALTH CARE
Source: http://www.nytimes.com/interactive/2013/05/08/business/how-much-hospitals-charge.html
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COMPACT RADIUS OF PATIENTS/COMMUNITY DEFINED PAYER MIX
TRANSFORMATIONS IN HEALTHCARE DELIVERY
HOSPITAL PATIENT CAPTURECURRENT STATE
MOVEMENT AWAY FROM CENTRALIZED FACTORIES OF
CAREHospital
CONSUMER DRIVEN HEALTH CARE
Source: http://www.nytimes.com/interactive/2013/05/08/business/how-much-hospitals-charge.html
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TRANSFORMATIONS IN HEALTHCARE DELIVERY
SILVER TSUNAMI – Seniors Aging In Their Homes
78 Million Baby Boomers turned 65 in 2011 9 out of 10 seniors want to stay in the home they
retied in
Source: AARP survey
REDUCED HOSPITAL READMISSIONSREDUCED HOSPITAL (LOS) LENGTH OF
STAY
+
__________________________________________
MOVEMENT AWAY FROM CENTRALIZED FACTORIES OF
CAREHospital
CONSUMER DRIVEN HEALTH CARE
Source: http://www.nytimes.com/interactive/2013/05/08/business/how-much-hospitals-charge.html
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TRANSFORMATIONS IN HEALTHCARE DELIVERY
SILVER TSUNAMI – Seniors Aging In Their Homes
78 Million Baby Boomers turned 65 in 2011 9 out of 10 seniors want to stay in the home they
retied in
Source: AARP survey
REDUCED HOSPITAL READMISSIONSREDUCED HOSPITAL (LOS) LENGTH OF
STAY
+
__________________________________________
EXPANDED RADIUS OF PATIENTSEXPANDED PAYER MIXBIG DRIVE TIME TO REACH PATIENTS
MOVEMENT AWAY FROM CENTRALIZED FACTORIES OF
CAREHospital
CONSUMER DRIVEN HEALTH CARE
Source: http://www.nytimes.com/interactive/2013/05/08/business/how-much-hospitals-charge.html
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PATIENT ACTIVATION TRIGGERS
Driving change…from a distance
Source: Southcentral Foundation, “The Trust for Health Excellence’s Better Health Initiative”
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PATIENT ACTIVATION TRIGGERS
Driving change…from a distance
Source: Southcentral Foundation, “The Trust for Health Excellence’s Better Health Initiative”
Influence the RIGHT PEOPLEat theRIGHT TIMEat theRIGHT PLACEby theRIGHT METHOD
USE PATIENT OUTREACH TO
R4
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SHIFTING FOCUSPRE & POST ACUTE AND HOME SETTINGS
REDESIGNING PRIMARY CARE
Source: Southcentral Foundation, “The Trust for Health Excellence’s Better Health Initiative”
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PATIENT-CENTERED MEDICAL HOMES
Looking “in” on the patient Looking “out” to the Health Care Environment
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PATIENT-CENTERED MEDICAL HOMES
Looking “in” on the patient Looking “out” to the Health Care Environment
Patient-centered medical homes (PCMH) – Not necessarily a “place” rather a central point from which assistance is provided to navigate the fragmented healthcare system Source: Oliver Wyman, Tom Main & Adrian Slywotzky
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PATIENT PORTAL E-CONSULTS
HEALTH PLAN CO-PAYs All Metallic plans on Public Health Insurance Marketplace & SHOP Exchanges
DIRECT PAYMENT FOR E–CONSULTS RANGE - $50 - $100
NO CLAIMS ADJUDICATION NECESSARY
CONVENIENCE OF ACCESS DRIVES PATIENT ENGAGEMENT
STEERS ADOPTION OF ELECTRONIC PATIENT PORTAL USAGE
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1990s MANAGED CARE ALL OVER AGAIN?OR DIFFERENT THIS TIME?
PAY FOR PERFORMANCE
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1990s MANAGED CARE ALL OVER AGAIN?OR DIFFERENT THIS TIME?
PAY FOR PERFORMANCE
EHRs Capture the discrete data electronically
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1990s MANAGED CARE ALL OVER AGAIN?OR DIFFERENT THIS TIME?
Clinical Integration within IDNsClinical Registry Data – Reviewed by Physicians providing the
careICD-9/10 & HCPCS from PMS and CPT/DRG Diagnosis from EHR
PAY FOR PERFORMANCE
EHRs Capture the discrete data electronically
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1990s MANAGED CARE ALL OVER AGAIN?OR DIFFERENT THIS TIME?
Clinical Integration within IDNsClinical Registry Data – Reviewed by Physicians providing the
careICD-9/10 & HCPCS from PMS and CPT/DRG Diagnosis from EHR
Payer incentives to providersPQRS, Tiered Narrow Networks, Core Measures, ACOs
PAY FOR PERFORMANCE
EHRs Capture the discrete data electronically
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CLINICAL METRIC REGISTRIES
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The year 2048
333333
SOME UNNERVING STATS
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100% of Americans could be overweight or obeseSource: AHRQ US Government Agency for Healthcare Research and
Quality
The year 2048
333333
SOME UNNERVING STATS
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100% of Americans could be overweight or obeseSource: AHRQ US Government Agency for Healthcare Research and
Quality
The year 2048
% of patients take All their meds% of patients take Some of their meds% of patients take None of their prescribed meds Costing Americans $46 Billion in avoidable acute facility admissions
Source: NY Times referencing Standberg, L.R., Drugs as a Reason for
Nursing Home Admissions, American Health Care Journal
333333
SOME UNNERVING STATS
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Financial Savings Potential from Medication Adherence
Chronic Condition Savings Per Patient per Year
Congestive Heart Failure – CHF
$7,823
Hypertension $3,908
Diabetes $3,756
High cholesterol $1,258Source: CVS Caremark Research Partnership: Advancing Adherence & the Science of Pharmacy Care, Volume 2. Page 5www.cvscaremarkfyi.com/sites/all/themes/cvs_theme/11-CVS-346-NPC_2012_compendium_final_web.pdf
IF WE JUST TOOK OUR MEDICINETHE MONEY WE COULD SAVE
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Financial Savings Potential from Medication Adherence
Chronic Condition Savings Per Patient per Year
Congestive Heart Failure – CHF
$7,823
Hypertension $3,908
Diabetes $3,756
High cholesterol $1,258Source: CVS Caremark Research Partnership: Advancing Adherence & the Science of Pharmacy Care, Volume 2. Page 5www.cvscaremarkfyi.com/sites/all/themes/cvs_theme/11-CVS-346-NPC_2012_compendium_final_web.pdf
IF WE JUST TOOK OUR MEDICINETHE MONEY WE COULD SAVE
We need to leverage New Methods to PROMOTE HEALTHY HABITS!
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BASICS OF HABITS
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BASICS OF HABITS
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“As the rats were learning, the reinforcement signal goes away, because you really don’t need it”
Source: Dr. Ann Graybiel, MIT: Brain rhythms arekey to learning New study from MIT neuroscientists finds that brain waves shift frequency as a new task becomes routine.Anne Trafton, MIT News Office, November 27, 2011
BASICS OF HABITS
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“As the rats were learning, the reinforcement signal goes away, because you really don’t need it”
Source: Dr. Ann Graybiel, MIT: Brain rhythms arekey to learning New study from MIT neuroscientists finds that brain waves shift frequency as a new task becomes routine.Anne Trafton, MIT News Office, November 27, 2011
BASICS OF HABITS
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HABITS TAKE THE PLACE OF CONSCIENCE DECISION
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HABITS TAKE THE PLACE OF CONSCIENCE DECISION
Back out of Driveway
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HABITS TAKE THE PLACE OF CONSCIENCE DECISION
Drive to WorkBack out of Driveway
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HABITS TAKE THE PLACE OF CONSCIENCE DECISION
Drive to WorkBack out of Driveway Get to the Office
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Realize you CAN’T REMEMBER the actual trip itself. As if in a Trance
HABITS TAKE THE PLACE OF CONSCIENCE DECISION
Drive to WorkBack out of Driveway Get to the Office
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Process of Emotional Eating Can be a similar experience
Realize you CAN’T REMEMBER the actual trip itself. As if in a Trance
HABITS TAKE THE PLACE OF CONSCIENCE DECISION
Drive to WorkBack out of Driveway Get to the Office
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Cues Routines Rewards
HABITS BECOME HARD WIRED
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Cues Routines Rewards
HABITS BECOME HARD WIRED
AUTOPILOT
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NEED FOR DECISIONINFLUENCE AND
COACHING
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You better cut the pizza in four pieces because I’m not hungry enough to eat six.
~ Yogi Berra
NEED FOR DECISIONINFLUENCE AND
COACHING
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$90,000
$41,000
$236
COST BREAK DOWNAverage Annual Healthcare
Spend in USAPer Person
1% OF INSURED
50% O
F
INSURED
5% OF INSURED
Heart Disease
Diabetes
Arthritis
Asthma
Source: National Institute of Health Care Management 2012
WHAT CAN THE DATA TELL US?
COST
DRIVERS
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GET THE DATA SET - SOURCES
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Access to Discrete (Patient Identified) Claims Data of population1. ASO (Self-Funded Plan) or ACO (Entitlement or Commercial)2. HIE from Practice Management Systems or Patient Billing Systems
GET THE DATA SET - SOURCES
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Access to Discrete (Patient Identified) Claims Data of population1. ASO (Self-Funded Plan) or ACO (Entitlement or Commercial)2. HIE from Practice Management Systems or Patient Billing Systems
GET THE DATA SET - SOURCES
Clinical Data – HIE from EHR or Clinical Integration Registry
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Access to Discrete (Patient Identified) Claims Data of population1. ASO (Self-Funded Plan) or ACO (Entitlement or Commercial)2. HIE from Practice Management Systems or Patient Billing Systems
Medication Data1. Claims from ASO (Self-Funded Plan) or ACO (Entitlement or
Commercial)2. HIE from E-Prescribe system, E-Prescribe transaction hub
(Surescripts) or directly from the PBM (if permitted by plan design and regulations)
GET THE DATA SET - SOURCES
Clinical Data – HIE from EHR or Clinical Integration Registry
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AGGREGATE - MAP & ANALYZE DATA
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AGGREGATE - MAP & ANALYZE DATA
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AGGREGATE - MAP & ANALYZE DATA
OLAP/SQL
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AGGREGATE - MAP & ANALYZE DATA
OLAP/SQL
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AGGREGATE - MAP & ANALYZE DATA
RISK SCORESEpisode Risk Groups (ERGs)Episode Treatment Groups (ETGs)Hierarchical Condition Categories (HCC)
OLAP/SQL
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Advanced Predictive Model Determines “Risk Index” and Care Method
Risk/Cost Profile: Total Population
Costs
n =
Pop
ulat
ion
Size
Adju
sted
Risk
Inde
x
RISK STRATIFIED POPULATION
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Advanced Predictive Model Determines “Risk Index” and Care Method
Clinicians (PCP and Mid-Level)• Targeted at very top ranked
members who benefit from intensive intervention model by MD team
Risk/Cost Profile: Total Population
Costs
n =
Pop
ulat
ion
Size
Adju
sted
Risk
Inde
x
RISK STRATIFIED POPULATION
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Advanced Predictive Model Determines “Risk Index” and Care Method
Clinicians (PCP and Mid-Level)• Targeted at very top ranked
members who benefit from intensive intervention model by MD team
Nurse Coach• Team-based model targeted at
high-opportunity members
Risk/Cost Profile: Total Population
Costs
n =
Pop
ulat
ion
Size
Adju
sted
Risk
Inde
x
RISK STRATIFIED POPULATION
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Advanced Predictive Model Determines “Risk Index” and Care Method
Clinicians (PCP and Mid-Level)• Targeted at very top ranked
members who benefit from intensive intervention model by MD team
Core Chronic Disease Management• Program delivering disease-customized
content for disease-identified members• Standards of care and HEDIS
Nurse Coach• Team-based model targeted at
high-opportunity members
Risk/Cost Profile: Total Population
Costs
n =
Pop
ulat
ion
Size
Adju
sted
Risk
Inde
x
RISK STRATIFIED POPULATION
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Advanced Predictive Model Determines “Risk Index” and Care Method
Clinicians (PCP and Mid-Level)• Targeted at very top ranked
members who benefit from intensive intervention model by MD team
Core Chronic Disease Management• Program delivering disease-customized
content for disease-identified members• Standards of care and HEDIS
Lifestyle Coach• Members prioritized by Risk Profile severity• Coaching based on modifying lifestyle risks
that lead to increasing medical costs
Nurse Coach• Team-based model targeted at
high-opportunity members
Risk/Cost Profile: Total Population
Costs
n =
Pop
ulat
ion
Size
Adju
sted
Risk
Inde
x
RISK STRATIFIED POPULATION
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Advanced Predictive Model Determines “Risk Index” and Care Method
Clinicians (PCP and Mid-Level)• Targeted at very top ranked
members who benefit from intensive intervention model by MD team
Core Chronic Disease Management• Program delivering disease-customized
content for disease-identified members• Standards of care and HEDIS
Lifestyle Coach• Members prioritized by Risk Profile severity• Coaching based on modifying lifestyle risks
that lead to increasing medical costs
Nurse Coach• Team-based model targeted at
high-opportunity members
Risk/Cost Profile: Total Population
Self-Management (Web and Multi-Modal)• Customized via members’ participation in
the WBA, a Well-Being Plan organizes web content to serve the individual needs of the member self-managing healthy behavior improvement
Costs
n =
Pop
ulat
ion
Size
Adju
sted
Risk
Inde
x
RISK STRATIFIED POPULATION
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Advanced Predictive Model Determines “Risk Index” and Care Method
Clinicians (PCP and Mid-Level)• Targeted at very top ranked
members who benefit from intensive intervention model by MD team
Core Chronic Disease Management• Program delivering disease-customized
content for disease-identified members• Standards of care and HEDIS
Lifestyle Coach• Members prioritized by Risk Profile severity• Coaching based on modifying lifestyle risks
that lead to increasing medical costs
Surveillance• Some members may not participate in the
WBA• Via routine Claims Analysis and Predictive
Model runs, 100% of the population is continuously evaluated & re-prioritized for program intervention
Nurse Coach• Team-based model targeted at
high-opportunity members
Risk/Cost Profile: Total Population
Self-Management (Web and Multi-Modal)• Customized via members’ participation in
the WBA, a Well-Being Plan organizes web content to serve the individual needs of the member self-managing healthy behavior improvement
Costs
n =
Pop
ulat
ion
Size
Adju
sted
Risk
Inde
x
RISK STRATIFIED POPULATION
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Advanced Predictive Model Determines “Risk Index” and Care Method
Clinicians (PCP and Mid-Level)• Targeted at very top ranked
members who benefit from intensive intervention model by MD team
Core Chronic Disease Management• Program delivering disease-customized
content for disease-identified members• Standards of care and HEDIS
Lifestyle Coach• Members prioritized by Risk Profile severity• Coaching based on modifying lifestyle risks
that lead to increasing medical costs
Surveillance• Some members may not participate in the
WBA• Via routine Claims Analysis and Predictive
Model runs, 100% of the population is continuously evaluated & re-prioritized for program intervention
Nurse Coach• Team-based model targeted at
high-opportunity members
Risk/Cost Profile: Total Population
Self-Management (Web and Multi-Modal)• Customized via members’ participation in
the WBA, a Well-Being Plan organizes web content to serve the individual needs of the member self-managing healthy behavior improvement
Costs
n =
Pop
ulat
ion
Size
Adju
sted
Risk
Inde
x
Readmission Avoidance Program• Event-based rather than cohort-based• The Discharge event and the member’s relative
risk index are considered in evaluating the need for an outreach call
• Members’ transition from Hospital to aftercare are coordinated to reduce readmission likelihood
RISK STRATIFIED POPULATION
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POPULATION HEALTH MANAGEMENT SOLUTIONS
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TECHNOLOGY IS GREAT….BUT ALL THAT MATTERS IS THE
OUTCOME
Source: Marc Prensky - Digital Natives, Digital Immigrants published in 2001
Digital Natives born after 1996Digital Immigrants born prior to 1996
Digital NomadsMobile Bohemian – Mobos
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Senior Living
Community Health Advisor
Family Advocate
Health Educator
Health Liaison
Health Promoter
Outreach Worker
Peer Counselor
Patient Navigator
Health Interpreter
Public Health Aide
Social Worker
Manicurist
Hair Stylist
Gym Instructor
Personal Trainer
Meals on Wheels
Senior Centers
Support Groups
Respite Care
Integrative Medicine
AcupunctureHealing Touch
Massage TherapyGuided Imagery
Clergy
Home Health Care
Case ManagerHospital
Primary Care Giver
Rehab
LTACSNFsHospice/Palliative
Care
Nurse Navigator Pharmacis
t
Vitamin/Herb
Retailers
Cessation programs
TobaccoAlcoholDrugs
Behavioral Programs
Probation Officers
Anger Managers/Coaches
Chiropractor
OT/PT/ST
PCP/NP/PA/PCMH
Psychologist
Psychiatrist
Medical Specialists
Hospitals
Hospitalists
DME Providers
Intensivists
Dietician
Wound Care
Case Manager
Payer/ACO
Diet Coach
Medical Transport
Transitional Care Nurse
PATIENT INFLUENCE CONTINUUM
Source: Microsoft
Cosmetic surgeon
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CARE TEAM COLLABORATION SOFTWARE CONSIDERATIONS
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CARE TEAM COLLABORATION SOFTWARE CONSIDERATIONS
Case & Disease Management – Workflow Mngt & Assessments Longitudinal Care Plans & Plan Adherence
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CARE TEAM COLLABORATION SOFTWARE CONSIDERATIONS
Case & Disease Management – Workflow Mngt & Assessments Longitudinal Care Plans & Plan Adherence
Contact Information Directory
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CARE TEAM COLLABORATION SOFTWARE CONSIDERATIONS
Case & Disease Management – Workflow Mngt & Assessments Longitudinal Care Plans & Plan Adherence
Open Access platform for multitude of Caregivers
Contact Information Directory
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CARE TEAM COLLABORATION SOFTWARE CONSIDERATIONS
Case & Disease Management – Workflow Mngt & Assessments Longitudinal Care Plans & Plan Adherence
Open Access platform for multitude of Caregivers Appointment Scheduling and Coordination
Contact Information Directory
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CARE TEAM COLLABORATION SOFTWARE CONSIDERATIONS
Case & Disease Management – Workflow Mngt & Assessments Longitudinal Care Plans & Plan Adherence
Open Access platform for multitude of Caregivers Appointment Scheduling and Coordination Escalation for unacknowledged messages or results
Contact Information Directory
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CARE TEAM COLLABORATION SOFTWARE CONSIDERATIONS
Case & Disease Management – Workflow Mngt & Assessments Longitudinal Care Plans & Plan Adherence
Open Access platform for multitude of Caregivers Appointment Scheduling and Coordination Escalation for unacknowledged messages or results Nimble architecture – SOA based on Web Services
Contact Information Directory
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CARE TEAM COLLABORATION SOFTWARE CONSIDERATIONS
Case & Disease Management – Workflow Mngt & Assessments Longitudinal Care Plans & Plan Adherence
Open Access platform for multitude of Caregivers Appointment Scheduling and Coordination Escalation for unacknowledged messages or results Nimble architecture – SOA based on Web Services Middleware adapter and business logic for outreach via text or IVR.
Contact Information Directory
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CARE TEAM COLLABORATION SOFTWARE CONSIDERATIONS
Case & Disease Management – Workflow Mngt & Assessments Longitudinal Care Plans & Plan Adherence
Open Access platform for multitude of Caregivers Appointment Scheduling and Coordination Escalation for unacknowledged messages or results Nimble architecture – SOA based on Web Services Middleware adapter and business logic for outreach via text or IVR.
Contact Information Directory
HIE protocol capabilities – HL7, SNOMED, LOINC
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CARE TEAM COLLABORATION
SOFTWARE
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Web Email Text/
MobileMail
Social Communities IVRTelephonic Face-to-
FaceHome Care
REACH THE TARGET -
THE PREFERRED WAY
COACH THE PATIENT
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Web Email Text/
MobileMail
Social Communities IVRTelephonic Face-to-
FaceHome Care
REACH THE TARGET -
THE PREFERRED WAY
COACH THE PATIENT
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Web Email Text/
MobileMail
Social Communities IVRTelephonic Face-to-
FaceHome Care
REACH THE TARGET -
THE PREFERRED WAY
COACH THE PATIENT
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Web Email Text/
MobileMail
Social Communities IVRTelephonic Face-to-
FaceHome Care
REACH THE TARGET -
THE PREFERRED WAY
COACH THE PATIENT
Fall Risk
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CREATE PROVIDE TEACHA SINGLE POINT OF HEALTH NAVIGATION
Source: Oliver Wyman, The Volume-To-Value Revolution, Rebuilding the DNA of Health from the Patient in, Tom Main & Adrian Slywotzky, 2012
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TELEMEDICINE FOR “Wired Homes”
Qualcomm Life 2net
Sensors
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TELEMEDICINE FOR “Wired Homes”
Qualcomm Life 2net
Sensors
Implantable
In Vivo Glucose Monitor
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TELEMEDICINE FOR “Wired Homes”
Qualcomm Life 2net
Sensors
Implantable
In Vivo Glucose Monitor
Wearable
fitbit
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TELEMEDICINE FOR “Wired Homes”
Qualcomm Life 2net
Sensors
Implantable
In Vivo Glucose Monitor
Wearable
fitbit
Behavior Tracking
Glowcaps
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mHealth
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mHealthIn Apple App Store18,564 Medical Apps22,817 Healthcare & Fitness Apps
Source: http://148apps.biz/app-store-metrics, May 1, 2013
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mHealth
www.monitoringcare.com
TeleHealth
Integrators
In Apple App Store18,564 Medical Apps22,817 Healthcare & Fitness Apps
Source: http://148apps.biz/app-store-metrics, May 1, 2013
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mHealth
www.monitoringcare.com
TeleHealth
Integrators
In Apple App Store18,564 Medical Apps22,817 Healthcare & Fitness Apps
Source: http://148apps.biz/app-store-metrics, May 1, 2013
Telemedicine Solutions
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mHealth
www.monitoringcare.com
TeleHealth
Integrators
Data Aggregators- MDI
In Apple App Store18,564 Medical Apps22,817 Healthcare & Fitness Apps
Source: http://148apps.biz/app-store-metrics, May 1, 2013
Telemedicine Solutions
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mHealth
Case Studies
www.monitoringcare.com
TeleHealth
Integrators
Data Aggregators- MDI
In Apple App Store18,564 Medical Apps22,817 Healthcare & Fitness Apps
Source: http://148apps.biz/app-store-metrics, May 1, 2013
Telemedicine Solutions
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mHealth
Case Studies
www.monitoringcare.com
TeleHealth
Integrators
Data Aggregators- MDI
In Apple App Store18,564 Medical Apps22,817 Healthcare & Fitness Apps
Source: http://148apps.biz/app-store-metrics, May 1, 2013
Telemedicine Solutions
Trade Shows
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Incent Personal Accountability
Source: Healthways
Use Holistic Analysis to isolate ROOT of Unhealthy Habits
BEHAVIOR ECONOMICS
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Recruit Individual into Social Support Networks to foster positive peer awareness
Realign the FINANCIAL RI$K shared among Employers, Payers and Employees toward a common set of achievable goals
BEHAVIOR ECONOMICS
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CARROTS
Commitment Contract - $$ gain for meeting period goals, $$ at risk for not meeting goals
Daily Challenges – Organized daily or weekly challenges
among work peers (Biggest Loser), Pedometer competitions
STICKS
$500-$1000/yr Surcharge for non-participation in Biometric Screening
Tobacco usage – ranging around $2000/yr surcharge to Non-Hiring policies of tobacco users
TACTICS FOR HEALTHY BEHAVIORS
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HABIT CHANGING TOOLS TO WATCH
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ACHIEVABLE MISSIONS
1969 1979 1989 1999 2009 2019 2029 2039 2049
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ALL COACHING IS:
IS TAKING A PLAYER WHERE HE CAN’T TAKE HIMSELF
~ Bill McCartneyCollege Football Coach
COACHING HEALTH FOR WINNING OUTCOMESIN A PAY-FOR-VALUE ECONOMY
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Reach me atLinkedIn: John Squeo
TECHNOLOGY CONSIDERATIONS FOR VALUE-BASED PAYMENTS