rowdmap health datapalooza innovation showcase
TRANSCRIPT
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Hi,I’mLaura!
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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.
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
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
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.
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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
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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