member centric decision management identification/stratification and consumer segmentation bluecross...
TRANSCRIPT
Member Centric Decision Management
Identification/Stratification and Consumer Segmentation
BlueCross Blue Shield Tennessee
Wednesday, September 26, 2012
General Session 3
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Profile of Medical Informatics Team
• PhD and Masters level analysts
• 100+ publications between team members
• Experienced Technical professionals in the field of healthcare with backgrounds in finance, actuarial, statistics, nursing and information systems
• External market and competitive experience including BCBST, UHC, OptumHealth, Ingenix and CIGNA
• Tenured leadership team with an average of 15+ years in the healthcare industry
• Unique skill sets and experience leveraging Health Information Exchange , EMR, and Clinical Data
SaTScan™
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Member Centric Decision Management (MCDM)
Vision: To reach the RIGHT person, the RIGHT way, at the RIGHT time, with the RIGHT message.
MCDM is:•Consumer Segmentation•Continuous Monitoring of Population Health•Personalized Approach to Consumer and Provider Outreach
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Painting the Consumer Profile Picture
Utilization Tracking• Medication Adherence• Biometric Results• Diagnostic Profiling• Health Assessment
Consumer Attributes• Demographics• Lifestyle• Geography• Risk Scores• Existing vs Prospective• Contact Preferences
Consumer Engagement• Nurse
• Health Coach
• IVR
• Mail Campaign
• Email Reminder
• Text Message
Opportunity Assessment• Risk Profile• Program Selection• Contact Prioritization• Outreach Optimization
Clinical, Financial, & LifestyleINTEGRATED DATA
• Supports Total Population Health Management Reporting
• Links consumer engagement to economic performance
• Showcases consumer behavior
• Empowers informed decision making
Anchored around the consumer
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Consumer Advisory Monitoring System (CAMS)
Offers a total population health monitoring system with the goal of understanding consumers holistically
Maximizes consumer outreach opportunities through customized solutions
Enables our business to meet people where they are and to capitalize on those teachable moments
Empowers the BCBST brand experience
Improves targeted marketing for retail sales
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Enabling a Personalized Approach to Consumer Engagement and Health Management
Personalized Messaging
Personal Health Opportunities
Clinical Program Referrals
Proactive Decision Support
Provider Engagement
The MCDM Process
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Flexing the Outreach Delivery Model to Meet the Unique Needs of Each Individual
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Jill, Age 36• BMI < 20•Potential High Risk
Pregnancy•Young Married
Engage with a Case Manager and Send High Risk
Pregnancy Mgmt Tips
Joe, Age 20
• Smoker• BMI < 20• Young Single
Engage with a Life Style Coach; recommend an on-line Health Module; send regular SMS messages to track progress
Janice, Age 54•Diabetes•Frequent Usage of the ER•Non-Compliant with Meds• BMI > 35•No Established PCP Relationship•Married with Family
Engage with a DM Nurse
Jim, Age 60•Coronary Artery Disease• Post Heart Attack•Discharge Care Plan in Place• Compliant with All Meds•BMI < 25•Empty Nester
Engage with a Letter or Email
The Importance of Segmentation
Clinical ProfileJanice, Age 54•Diabetes•Frequent Usage of the ER•Non-Compliant with Meds•BMI > 35•No Established PCP
Jackie, Age 54•Diabetes•Frequent Usage of the ER•Non-Compliant with Meds•BMI > 35•No Established PCP
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Knowing Only Half the Story
Knowing the whole story
Janice, Age 54•Diabetes•Frequent Usage of the ER•Non-Compliant with Meds•BMI > 35•No Established PCP
Jackie, Age 54•Diabetes•Frequent Usage of the ER•Non-Compliant with Meds•BMI > 35•No Established PCP
Jackie, Age 54•Suburban Style segment•Established residence•Family-centric living•Internet savvy•Employed
Janice, Age 54•Struggling Society Segment•Economically challenged•Unemployed•No access to computers•Transient
Clinical Profile
Lifestyle Segment
Knowing the Whole Story
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Leveraging Segmentation
MDCM: Empowering Integrated Health Management
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Members receive the right support at the right time
Chronic Conditions
Diabetes
COPD
CAD
CHF
Asthma
Hypertension
24/7 Acute Conditions
Injuries
Colds
Rashes
Emergency Assessment
Preference-Sensitive Conditions
Cancer
Uterine
Prostate
Back
Major joints
Low Back Pain
Healthy Lifestyles
Wellness
Prevention
Risk mgmt
Complex care
Major trauma
Cancer
Transplants
Seamlessly integrated
BCBST Continuum of SupportLeveraging MCDM Capabilities to Strategically Position our Clinical Product
Portfolio for Existing and Prospective Clients
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Pre-Sale Analytics
0.1%
2.5%
3.0%
0.8%
0.4%
0.6%
0.2%
0.1%
2.4%
1.6%
1.1%
0.2%
0.4%
0.3%
Obesity and Overweight
Diabetes
Hypertension
Coronary Artery Disease
COPD
Asthma
Congestive Heart Failure
Targeted Chronic ConditionPrevalence Rate
Prevalence Rate Book of Business Prevalence Rate
60.0%
10.0%
21.0%
54.0%
19.0%36.0%
Percentage of Members Percentage of Total Payments
Distribution of Health Status
Healthy Acute Chronic
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Non-Preventive Visit Wellness Visit
87.0%
13.0%
89.6%
10.4%
Wellness Visits and Other Office Visits
Percentage of Total Members Book of Business Percentage of Members
0%
1%
2%
3%
4%
5%
Breast Cancer
Screening
Cervical Cancer
Screening
Colorectal Cancer
Screening
Prostate Cancer
Screening
Cholesterol Screening
Wellness Screenings Compliance Rates
Percent of Members Completing Screening
Book of Business Percent of Members Completing Screening
MCDM: Empowering Pre-Sale Analytics
Chronic Conditions Prevalence Rate
Average Risk Score
Average Cost Per Patient
Book of Business Prevalence Rate
Book of Business Average Risk
Score
Book of Business Average Cost Per
Patient
Obesity and Overweight 0.06% 1.80 $4,500.00 0.14% 1.80 $4,500.00
Diabetes 2.37% 2.30 $11,500.00 2.46% 1.80 $10,000.00
Hypertension 1.63% 1.40 $1,872.00 3.00% 1.20 $1,671.00
Coronary Artery Disease 1.08% 2.10 $17,898.00 0.76% 2.10 $14,558.00
COPD 0.18% 1.80 $8,400.00 0.42% 2.00 $8,400.00
Asthma 0.42% 0.86 $5,200.00 0.56% 0.86 $4,900.00
Congestive Heart Failure 0.32% 2.50 $20,000.00 0.19% 2.50 $18,000.00
Proactive approach to assessing population health status and member profiles to enable tailored solutions for
– Clinical Program Design
– Effective Consumer Engagement
– Incentives that Drive Positive Member Behavior
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• Target members for retention• Target members at risk for leaving
BCBST• Monitoring movement to the
Exchange and Medicaid• Target members at risk for potential
access to care issues
Persona Categorization • Persona categories by Federal
Poverty Level (FPL) Welcome Empty Nesters Not so Golden Years Making Ends Meet
Distribution of Population
Identifying At Risk Populations Due to Health Care Reform
MCDM: Empowering Exchange Analytics and Consumer Marketing
• Empowers total population health management
• Brings BCBST to parity with key competitors
• Commissions a pre-sale analytics process that will highlight up-sale opportunities with existing BCBST clients and new sale opportunities with prospective clients
• Consolidates reporting and outcomes evaluation
• Positions a real-time predictive capability for alerts to consumers and providers
• Advances BCBST toward becoming a total health solutions company
• Prepares our business for retail opportunities in the individual market or exchange environment
• Streamlines dependence on vendors
Concluding ThoughtsWhy is this important to our Business?
How to Make Micro-segmentation Work
Creating and Monitoring Your Segmentation Categories
Micro-segmentation Mosaic Lifestyle Groups
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A – Power Elite: Enjoying all that life has to offer
B – Flourishing Families: Living very comfortable, active lifestyles
C – Booming with Confidence: Prosperous, established couples
D – Suburban Style: Middle-aged, ethnically-mixed suburban families
E – Thriving Boomers: Upper-middle-class African-American couples
F – Promising Families: Young couples living child-centered lifestyles
G – Young City Solos: Younger singles living active and energetic lifestyles
H – Middle Class Melting Pot: Mid-scale, middle-aged and established couples
I – Family Union: Somewhat diverse families supported by solid blue-collar jobs
J – Autumn Years: Ethnically-diverse and mature couples living gratified lifestyle
K – Significant Singles: Middle-aged singles leading active city styles of living
L – Blue Sky Boomers: Lower- and middle-class baby boomer-aged households
M – Families in Motion: Working-class families with diverse household dynamics
N – Pastoral Pride: Eclectic mix of widowed and divorced individuals and couples
O – Singles and Starters: Young singles starting out in diverse urban
communities
P – Cultural Connections: Diverse families in urban apartments and residences
Q – Golden Year Guardians: Retirees in settled residences and communities
R – Aspirational Fusion: Multi-cultural singles striving to make a better life
S – Struggling Societies: Economically challenged looking to make ends meet
High
Low
Micro segmentation Lifestyle Clusters
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Money to BurnTend to be more affluent. Like to know how a product can elevate their status and are more willing to take risks with their purchases.
Stable SpendersYoung to middle-aged individuals that tend to be driven by how to get the most “bang for their buck.” However, they are very aware of how specific brands can reflect their lifestyle and tend to gravitate towards popular logos.
American Melting PotContains members from a wide array of income levels and ethnicities. They take pride in local and American made products and like to see a reflection of family when making purchases.
Middle-of-the-Road MixersMiddle-class, diverse households and have spending habits that are just as varied. These individuals highly regard how products affect their family when making purchasing decisions.
Single SaversMostly singles living in urban areas that tend to gravitate towards discounts when spending their hard-earned money. They aren’t as concerned with the newest products, but tend to focus on those that are tried and true.
Unassigned
Micro segmentation Clinical Clusters
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Mystery MembersMajority have no claims information and missing MEDai information
Barely BothersMembers in this cluster tend to do the bare minimum when it comes to maintaining their health. This is indicated by their infrequent interactions with the health plan and their low compliance rate and motivation.
Moderate MoversThese members value convenience when it comes to making healthcare decisions. When they do seek care from a PCP they don’t always have to see the same one. Their forecasted change is cost remains stable due to their inclination for maintaining their health.
Inclined IncreasersWhile extremely motivated and compliant, these members still seek a high amount of care. They are more chronic than the average cluster and are expected to far exceed their current year cost in the next year.
Unmatched UtilizersThese members are unmatched in cost and utilization. They are likely deemed highly motivated and compliant due to the increased frequency in opportunities for care.
New MembersMembers with less than 30 days enrollment
Unassigned
Lifestyle by Clinical Cluster Analysis
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Distribution of Lifestyle Clusters for VSHP, Commercial, and Company X Populations
Low
Government
MCDM Outreach Campaign Plan
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Results of a 2012 Diabetes Call Campaign
Top 5 VSHP segments Dx:• Not very reachable• Not very impactible•Recommendation: Improve ability to contact members via phone, and consider different outreach modality, particularly for N & S (more rural segments)
Campaign Evaluation Effectiveness and Mode of Delivery Analysis
• Multiple campaigns were conducted each month as part of the MCDM process with the aim of increasing member compliance with certain evidence-based guidelines
• We analyze the effectiveness of these campaigns, both quality and cost • This information is examined by each lifestyle segment to see how our unique customers
respond differently to outreach efforts• The results of this evaluation is fed back into the process to make the analytical process
“smarter”
Call campaign outcome
Breast Cancer
Screening Call 2011
Diabetes Care Call 2011Cervical Cancer
Screening Call 2012
Eye Exam
HbA1c Testing
LDL-C Screening
Nephropathy Screening
# of members called 56,861 65,000 65,000 65,000 65,000 89,670
% of members reached 76% 67% 67% 67% 67% 68%
Conversion Rate for Reached
members 11% 6% 21% 23% 12% 3.2%Conversion Rate for Not-Reached
members 8% 5% 18% 19% 9% 2.5%Additional
Conversion Rate relative to no intervention 3% 2% 4% 4% 3% 1%
# of compliant members gained
relative to no intervention 1,253 653 1,611 1,655 1,219 409
ISM Governance Structure
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Purpose: oversee the Identification/Stratification/Microsegmentation process to set the communication strategy and to drive standardization for the enterprise.
Scope– Promote and monitor enterprise wide standardization/centralization of communication– Develop and approve annual member communication plan– Oversee the Identification/Stratification process by approving rules for the analytics
engine– Drive standardization around the ID/Strat process– Determine prioritization of communications– Review evaluations/results and make recommendations to improve the process– Approve modifications to the process based on results/strategy– Oversight of the Contact Preference process
Membership: VP Medical Informatics (Chair), CMO’s, VP Performance Measurement, VP Strategic Marketing, VP Pharmacy, VP Product Development Onlife, Director Quality, Director Operations, Director Product Strategy, Director Brand Strategy & Director Clinical Programs
Connecting Organizational Processes
Breaking Down Departmental Silos