lessons learned while transitioning to value-based...
TRANSCRIPT
Lessons Learned While Transitioning to Value-based CareMinnesota HIMSS, May 2019
2© 2019 CTG, Inc.
Conflict of Interest Statement
• Speaker has no real or apparent conflicts of interest to report.
3© 2019 CTG, Inc.
Learning Objectives
• Demonstrate the importance of a collaborative, unified IT and business leadership.
• List best practices that organizations can use in assessing their own organizational readiness to meet value-based contract objectives.
• Discuss practical, real-life lessons learned from the VBC journey of other healthcare organizations.
• Explain how to better position your organization to recognize maximum contract rewards as well as delivering better care.
4© 2019 CTG, Inc.
KEEPCALM
AND WAIT, ACTUALLY
PANIC!!
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Ride The Wave: Don’t be Crushed
6© 2019 CTG, Inc.
Today’s Value-Based Care TrendsNo Sign of Slowing
Sources: “The State of Value-based Care in 2019: 10 Key Trends to Know,” June 2019“Blue Cross-NC–Five Health Systems Announce Major Shift to Value-Based Care,” Healthcare Informatics, January 16, 2019
• Fee-for-service (FFS) is fading faster than predicted, accounting for only 37.2% of reimbursement; projected below 26% by 2021.
• Commercial lines, not government, are leading adoption, advancement, and innovation of VBC models and strategies.
• Medical cost savings topped 5.6% on average, with almost a quarter of respondents noting savings in excess of 7.5%.
• Blue Cross of North Carolina (BCNC) announcement in January 2019: “Within five years, BCNC has committed to having all 3.89 million customers covered under Blue Premier’s value-based care contracts. By early 2020, 50% or more of all BCNC members will have a provider who is jointly responsible for the quality and total cost of their care.”
All RespondentsReported Medical Cost
Savings from 0.1 to 7.5+%
Impact on Medical Costs from Value-Based Care Strategies
2019 Actual
5.6%Average Impact from Value-Based Care
Strategies on Medical Cost Savings
12%
18%
37%
24%
0.1-2.49% 2.5-4.99% 5.0-7.49% 7.5%+
% Medical Cost Savings%
of
Pay
ers
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Minnesota Health Care Spending: Making Progress
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Demonstrating 1.9% increase in spending in 2016
Minnesota Department of Human Services (DHS) negotiated payments to health plans for state public program (e.g., Medicaid and MinnesotaCare.
9© 2019 CTG, Inc.
What Is Value-Based Healthcare?CMS defines it like this:
“Value-based programs reward healthcare providers with incentive payments for the quality of care they give to people.”
Value-based refers to the quality of the care that patients are receiving, rather than the quantity.
It takes into account: • Access
• Price
• Efficiency
• Alignment of incentives
• Patient experience
• Proactive
• Preventative
In many cases, it is cited as one of the best ways to reform healthcare.
IndividualClinical
Expertise
Patient’s Values and
Expectations
Best Available Clinical Evidence
Improved Patient
Outcomes
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Supporting Primary Care Innovation
April 22, 2019—CMS Announces New Payment Models
The five payment model options are:
• Primary Care First (PCF)
• Primary Care First—High Need Populations
• Direct Contracting—Global
• Direct Contracting—Professional
• Direct Contracting—Geographic
Providing flat primary care visit fee and a performance-based adjustment:
• Upside: up to 50% of revenue
• Downside: 10% of revenue
Incentive to reduce costs and improve quality, assessed and paid quarterly.
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Steps in Preparing for VBC
• Assess current state and develop a roadmap of where you want to go
• Risk stratification of your population
• Identify challenges and develop solutions
• Embrace both operational and IT solutions
• Integrate CBOs
• Don’t limit to Medicaid
• Don’t forget about culture
• Go all in!
• Encourage Corporate Empathy
12© 2019 CTG, Inc.
The move toward
value-based care is
not a simple one.
It’s a journey.Sharing of Clinical
DataInteroperabilityData Analytics
Electronic Health Record
Meaningful Use
PCMH
Shared Savings
Pay-for-Performance
Value-Based Contracts
Hea
lth
care
Info
rmat
ion
Ref
inem
ent
Increased Needs for Quality Transformation and Coordination of Care
Key Enablers:
• Organizational vision
• Team concepts of care
• Technology to connect careacross continuum
Quality TransparencyPerformance Measurement
Improved OutcomesPopulation Health
Hea
lth
ou
tco
mes
alig
n w
ith
pay
men
t At-Risk Savings
Sometimes You Need a Roadmap
13© 2019 CTG, Inc.
Risk Stratification: Define Your Mission
The Need to Identify High-Risk Patients for Care Management
Goal: Risk stratify primary care population to identify patients at highest risk for morbidity, mortality, and resource utilization, and provide targeted care management to improve health outcomes and reduce costs
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Identifying Risk and Stratification
Complex
High Risk
Tertiary Prevention
Rising Risk
Secondary Prevention
Wellness and Primary Prevention
Optimum Health
Complex Treatment
MinimizeDisability
Reduce Complications
Preventative Services
To Prevent onset of disease
Disease Treatment
Supportive Health
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Operational Challenges
• It is not just about high risk!
• Access to care
• Patient engagement can be challenging
• Utilizing relationships with community
Working in a Model of Team-Based Care
• Difficult to align priorities/agendas across departments
• Incentives
• Success visualizations
Organizational Structure
• Providers need to see outcome improvements
• Staff engagement with goals
• Concerned about doing more for less
• Workflow supports FFS and sick care
Operational Challenges
Clinical Resistance
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Transformation Challenges
Operations
• Team concept
• Social determinants of health
• Patient-focused huddles
• Transitions of care
• Pre-visit planning
• Phone rerouting and shifting
• Staff analysis and addition of FTEs
• Culture shift
• Care Management
IT
• Development of new Population Health department
• New build for all CM tools
• Test and referral tracking
• Risk stratification
• Automated ADT notifications
• New success measurements
• Registries
• Quality dashboards
• Data Sources and data usage agreements
Population Health
• 25+ reports to define population
• Metrics and reporting
• Proactive reminders
• Care coordination services
• Social Work services
• Longitudinal plan of care
• Registries
• New platform for care plan management and registries
17© 2019 CTG, Inc.
Enterprise-Wide Population Health Focus Areas
Population Identification
Identification /Stratification of chronic diseases
Social determinants of
health
Race and ethnic diversity
Identified populations of
need
Tracking Care Based on Clinical
Guidelines
Patient registries
Referral and test tracking
Identifying gaps in care
Patient outreach
Preventive strategies
POC alerts
Care Across the “Medical
Neighborhood”
Connectivity and data intake from disparate sources
Integration of CBOs
Care management and
sharing of care plans
Data sharing
Remote monitoring
Delivering Care
EHRoptimization
Team-based care
Care management
CDS
POC reminders
Telehealth
Patient Self-Management
Maximizing portal use
Wearables
Community resources
Patient focus groups
Performance Monitoring
Monitoring against current
contracts
Claims integration
ROI
Visualization
Strategically aligning ROI
Maximizing ROI of Current System
Investments
Matrix of VBC measures
HCC billing
Prioritization of incentive
Patient Experience
Access to care
Same-day appointments
Coordination of care
Culture of compassion
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Dashboards and Visualizations are keyFocusing on Quality
• Standardized developmental screening at 9, 18, and 30 months
• Autism screening at 24 months
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Social Determinants of Health Screening: Why?
• We care about improved health and wellness of patients
• Social determinants of health are known to impact health
• Patients and families put trust in our relationship
VALUES
ASSUMPTIONS
BELIEFS
INCOME
SOCIAL STATUS
EMPLOYMENT AND WORKING
CONDITIONS
BIOLOGY AND GENETIC
ENDOWMENT
CULTURE
GENDER
HEALTHY CHILD DEVELOPMENT
PHYSICAL ENVIRONMENTS
EDUCATION
HEALTH SERVICES
SOCIAL SUPPORT NETWORKS
SOCIAL ENVIRONMENTS
PERSONAL HEALTH
PRACTICES
COPING SKILLS
20© 2019 CTG, Inc.
• Create a validated screening tool with providers
• Process map with operations
• Translated as appropriate to languages spoken
• Develop community resource tools on common drive
• Social Work support
Challenges with Social Determinants of HealthScreening Process
Overcoming Provider Culture: “Don’t Ask, Don’t Tell”
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Aligning Population Health and Value-Based Performance
Clinical Workflows and Processes
Improved Outcomes and ROI for Your Organization
Prioritized VBC Measures and “Dimensions of Analysis”
EHR and Technology Alignment
Community and Patient Engagement
Hospital Physicians Civic Organizations
PayersGovernment Agencies
22© 2019 CTG, Inc.
Assessment Model
Consider providing a prioritized, pragmatic strategy for a complex enterprise challenge—what you need to succeed now and in the future.
Three Viewpoints: One Solution
Population Health Analytics Framework Perspective
EHR Solution Perspective
Workflow/Clinical Perspective
VBC Contract Measures
23© 2019 CTG, Inc.
Developing Your Strategic Analysis
• Current VBC contracts
• Current government quality initiatives
• Strategy
• Governance
• Risk stratification
• Care delivery teams
• Quality program
• Care management
• Patient engagement
• Patient satisfaction
• Provider and staff satisfaction
• Access
• Measure inventory
• Desired sub-category stratifications
• Candidate data sources
• Data acquisition
• Data governance
• Data sharing abilities
Operational Assessment Analytics Assessment
• Current state of EHR to meet VBC objectives
• POC alerts
• Use of registries
• Administrative reporting and dashboards
• Population analysis
• Template use
• Order sets
EHR Assessment
Strategic Foundational Deliverables
Practical strategy for managing current VBC contracts while maximizing the use of current EHR investments, and a tactical roadmap for meeting future VBC trends
• Organizational population health governance structure
• VBC measure inventory
• Evaluation of current EHR systems investment to meet VBC
• Identification of key populations at risk and rising risk
Social determinants prominent in the population
Chronic disease prevalence
• Conceptual data model (“analytics blueprint”)
• Analytics findings and recommendations
• Long-term roadmap for population health strategies
24© 2019 CTG, Inc.
Prioritize your VBC Inventory by ROI
and Readiness
Pulling It All Together
Execution of Plan
VBC Inventory
EHR Assessment
Gap Analysis
Operations Assessment
Develop Short and Long-term
Plan
