rowdmap health datapalooza innovation showcase

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Page 1: RowdMap Health Datapalooza Innovation Showcase

AllcontentsareproprietarytoRowdMap,Inc.andarebeingprovidedonaconfidentialbasis.Anyuse,reproductionordistributionofthisinformation,inwholeorinpart,orthedisclosureofanyofitscontents

withoutthepriorwrittenconsentoftheCompany,isprohibited.

Hi,I’mLaura!

Page 2: RowdMap Health Datapalooza Innovation Showcase

2Allcontentsareproprietary toRowdMap,Inc.andarebeingprovidedonaconfidential basis.

Anyuse,reproduction ordistribution ofthisinformation, inwholeorinpart,orthedisclosure ofanyofitscontentswithout theprior written consent oftheCompany,isprohibited.

HEALTHDATAPALOOZARowdMap:ProvenInnovationatScale

PayersandprovidersareusingHHSdatatoidentify, quantifyandreducelow-valueservices astheymovefromFeeforServicetoPayforValuearrangements.

Healthplansandprovidersin48statesandtheDistrictofColumbiauseRowdMapandHHSdatatoreducethedeliveryofno-valuecare.

TheclientsRowdMapservescollectivelycoverthelivesofmorethan100millionAmericans.

Here’swhereHHSDataisbeingusedtomovefromFFStoValueBaseArrangements(not ‘pilot’or‘innovation’ programs)butactiveoperationalprograms.

ClientsusingHHSdataincludeNational,Regional&BoutiquePayersinMarketplace/Exchange,MA,Medicaid,

CommercialandGovernmentProgramsaswellasProviders includingPCP&SpecialtyGroups,CINs&Systems,

ACOs,Bundles &other CMMIProgramParticipants.

Page 3: RowdMap Health Datapalooza Innovation Showcase

3Allcontentsareproprietary toRowdMap,Inc.andarebeingprovidedonaconfidential basis.

Anyuse,reproduction ordistribution ofthisinformation, inwholeorinpart,orthedisclosure ofanyofitscontentswithout theprior written consent oftheCompany,isprohibited.

HEALTHDATAPALOOZALow-ValueServices:WhyYouShouldGiveaDarn

RowdMap’s Risk-Readiness® benchmarks helphealthplans,physician groups, andhospital systemsidentify,quantify, andreducedelivery ofno-value care—acentraltenetofsuccessful pay-for-valueprograms.

Over$9BinOrangeCounty, CA

$850BillionUnnecessarySpendin2014(InstituteofMedicine)

InstituteofMedicine(IOM)report,“BestCareatLowerCost,”(Sept.2012)estimatesthattheUnitedStateslost$750billionin2012.(Adjustedin2013at$800BB,2014at$850BB.)Thisisabout3%ofGDP.

No-ValueCare(30%)

NecessaryUtilization(70%)

“It’sgenerallyagreedthatabout30percentofwhatwespendonhealthcareisunnecessary.Ifweeliminatetheunneededcare,therearemorethanenoughresourcesinoursystemtocovereverybody.”

-Dr.ElliottFisher,DartmouthInstitutefor

HealthPolicy

“Biggerthanhigherprices,administrativeexpenses,and

fraud,however,wastheamountspentonunnecessaryhealth-care

services.”Injustasingleyear,upto42%ofpatientsreceive

“NoValue”Care.

- Dr.AtulGawande,DepartmentofHealthPolicyand

ManagementattheHarvardSchoolofPublicHealth&DepartmentofSurgeryatHarvardMedicalSchool

Page 4: RowdMap Health Datapalooza Innovation Showcase

4Allcontentsareproprietary toRowdMap,Inc.andarebeingprovidedonaconfidential basis.

Anyuse,reproduction ordistribution ofthisinformation, inwholeorinpart,orthedisclosure ofanyofitscontentswithout theprior written consent oftheCompany,isprohibited.

HEALTHDATAPALOOZALow-ValueServices:Broad,IncreasingInterest

RowdMap’s Risk-Readiness® benchmarks helphealthplans,physician groups, andhospital systemsidentify,quantify, andreducedelivery ofno-value care—acentraltenetofsuccessful pay-for-valueprograms.

Research EvaluatingCMS&PrivatePlanPrograms:“DotheyreduceLowValuecare?”

PopularPressReportingandProviderRankings:“Consumers are/shouldavoidLowvaluecare.”

CritiqueofFeeforService:“FFShastoomuchLowValuecare.”

RowdMapPartner

Recommendedevaluationcriteriaforvaluebasedplansfrompayers/providers

Page 5: RowdMap Health Datapalooza Innovation Showcase

5Allcontentsareproprietary toRowdMap,Inc.andarebeingprovidedonaconfidential basis.

Anyuse,reproduction ordistribution ofthisinformation, inwholeorinpart,orthedisclosure ofanyofitscontentswithout theprior written consent oftheCompany,isprohibited.

HEALTHDATAPALOOZALowValueServices:PracticeVariation

RowdMap’s Risk-Readiness® benchmarks helphealthplans,physician groups, andhospital systemsidentify,quantify, andreducedelivery ofno-value care—acentraltenetofsuccessful pay-for-valueprograms.

Theestimated30%ofmedicalexpensethatgoestono-valuecare.

Unnecessary spending drivesbilling inafee-for-serveeconomicmodel, butsuccessinpay-for-valuecomesfrommanagingandmitigatingthesepocketsofvariation.

Variation:UnwarrantedorUnexplained?Everyphysicianhasauniquefingerprint

EconomicDrillDown:ExampleUtilizationReviewandActuarialUnitCostAnalysisagainstCareIntensityCurveacrossTotalBasketofCare

Variationacrossgeographiesandwithinpracticesacrossphysicians.“Physician-Level PracticeVariation:WhoYouSeeIsWhatYouGet”BrianPowers,Sachin Jain,DavidCutler,&Ziad ObermeyerHealthAffairs,09.23.15

Definitions,researchandgeocodingbyHospitalReferralRegionalavailableviatheDartmouthAtlasforUnwarrantedVariation:www.dartmouthatlas.org

NB:Unwarranted variationrefers topractice patterns, which holdupacrosspopulations butpricing variationmayalsobeunwarranted andmarkedfluctuatesacrossinsuranceproduct andlinesandgeography.“ThePriceAin’t Right.”Cooper, Craig, GaynorandVanReenen, 2015.

Page 6: RowdMap Health Datapalooza Innovation Showcase

6Allcontentsareproprietary toRowdMap,Inc.andarebeingprovidedonaconfidential basis.

Anyuse,reproduction ordistribution ofthisinformation, inwholeorinpart,orthedisclosure ofanyofitscontentswithout theprior written consent oftheCompany,isprohibited.

HEALTHDATAPALOOZALowValueServices:IdentifiedviaPublicData

MedicareDocGraphReferralfile(PatientflowsbetweenPCPS,specialists,hospitalsandpostacutecenters)

DartmouthAtlasofHealthCare&Choosing Wisely(Decadesofresearchanddataonunwarrantedvariationbyconditionandgeographytokeepthingsapples-to-applesforcomparisons)

CMSFFSDataSets,CDCDataSets(MEDPAR,PartB,PartD,BRFSS)(Individualproviders,groups,hospitalsandpostacutecenters)

ProviderPatternIntensityProfilesandRiskReadinessforeveryprovider,hospital,postacutecenterintheUS.Allpreloaded withno IT.

OPENDATA–ParticularlypowerfulwhenpulledtogetherAffordableCareActdatatodetermineRisk-ReadinessofProviders/Networks

Page 7: RowdMap Health Datapalooza Innovation Showcase

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HEALTHDATAPALOOZARowdMap’sRisk-Readiness®Benchmarks

RowdMap’s Risk-Readiness® benchmarks helphealthplans,physician groups, andhospital systemsidentify,quantify, andreducedelivery ofno-value care—acentraltenetofsuccessful pay-for-valueprograms.

ProvidersinaMarketGroups

IndividualPhysicians

Whatisdrivingaprovider’sRisk-Readiness®?Isitprocedures,prescriptions,referralsorvisits?

Howbigisaprovider’spanel?

Howreadyisaprovidertosucceedinrisk

comparedtopeers?Byspecialty?

Withinaregion?

Fingerprintwithpracticepatternsthatmitigateno-valuecare=GreenDot

Fingerprintwithpracticepatternsthatcreateno-valuecare=RedDot

Risk-Readiness®Benchmarks