Transcript Presentation Template

The 12-Criteria of
Population Health Management
By Dale Sanders
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free
to share
butTwitter
we would
appreciate a Health Catalyst citation.
Follow
Us on
#TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
© 2013 Health Catalyst
www.healthcatalyst.com
Contact Information
Dale Sanders, Senior VP, Strategy, Health Catalyst
[email protected]
@drsanders
www.linkedin.com/in/dalersanders/
Carrie Ivers, The Advisory Board, Crimson Product Line
[email protected]
512-681-2383
www.linkedin.com/pub/carrie-ivers-reeuwijk/0/692/824
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
2
© 2013 Health Catalyst
www.healthcatalyst.com
Agenda
•
Dale Sanders: 35 minutes
•
•
Carrie Ivers: 25 minutes
•
•
Description of the 12 Criteria for Population Health
Data Management
Description of Crimson’s capabilities and strategy
related to the 12 Criteria
Q&A
•
We will stay online as long as it takes to answer all the
questions
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
3
© 2013 Health Catalyst
www.healthcatalyst.com
Our Philosophy
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
4
© 2013 Health Catalyst
www.healthcatalyst.com
The Supporting White Paper
Google: “12-Point Review of
Population Health Management
Companies”
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5
© 2013 Health Catalyst
www.healthcatalyst.com
Overview
Focus is on the data management of
Population Health Management
•
Not the processes of PHM, per se
•
Not on activity based costing and fixed-price (bundled
pricing) contract management– that’s a separate webinar
Purpose
•
Evaluate healthcare IT vendors and their PHM offerings
•
Develop internal strategies and roadmaps for Accountable Care
Organizations (ACO)
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Poll Question
On a scale of 1-5 where do you feel your
organization is in its Population Health maturity?
5 – Very high maturity
4
3
2
1 – Little or no maturity
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
7
© 2013 Health Catalyst
www.healthcatalyst.com
Today’s Key Takeaways
• The ROI of Population Health Management (PHM) is
still in debate
•
Investment is costly, returns are challenging
•
40% of healthcare is patient lifestyle related
•
Focus on the highest ROI areas of PHM for now
• Stratifying population risk makes no sense without a
strategy for intervention
•
And focusing on the highest risk patients might have the
lowest ROI
• No single vendor meets all PHM needs
•
You’ll need a patchwork of solutions to fill the gaps
•
“So you offer PHM, eh? OK, which parts?”
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
8
© 2013 Health Catalyst
www.healthcatalyst.com
True
Population
Health
Management
Requires a collaborative
strategy between leaders in
healthcare, politics, charity,
education, and business
Robert Wood
Johnson
Foundation,
2014
9
Population Health Management
The Ordered Checklist for Your 3-5 Year Journey
1.
Registries: Evidence-based definitions
of patients to include in the PHM
registries
2.
Attribution & Assignment: Clinicianpatient attribution algorithms
3.
4.
5.
6.
Precise Numerators: Discrete,
evidence based methods for flagging
patients in the registries that are
difficult to manage in the protocol, or
should be excluded from the registry,
altogether
Clinical & Cost Metrics: Monitoring
clinical effectiveness and total cost of
care (to the system and the patient)
Basic Protocols: Evidence based
triage and clinical protocols for single
disease states
Risk Outreach: Stratified work queues
that feed care management teams and
processes for outreach to patients
7.
External Data: Access to test results
and medication compliance data
outside the core healthcare delivery
organization
8.
Communication: Patient engagement
and communication system about their
care, including coordination of benefits
9.
Education: Patient education material
and a distribution system, tailored to
their status and protocol
10. Complex Protocols: Evidence based
triage and clinical protocols for
comorbid patients
11. Coordination: Inter-physician/clinician
communication system about
overlapping patients
12. Outcomes: Patient reported outcomes
measurement system, tailored to their
status and protocol
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
1
Precise Patient Registries
Evidence-based definitions of patients to include in population health registries
Must go beyond
ICD codes, which
are likely to miss
30-40% of the
population
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
2
Patient-Provider Attribution
Strategies and algorithms to assign patients to accountable physicians or clinicians
Generally accepted options for assigning attribution
Patient selection of
physician during
open enrollment
“Most frequently
visited” physician
over the past two
years
Random assignment
of patients to primary
care physicians in
the same geographic
area
Random assignment
of patients in an
employer group to
primary care
physicians in the
PPO or HMO
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
3
Precise Numerators in Registries
Discrete, evidence-based methods for flagging the patients in the registries
that are difficult to manage or should be excluded from PHM, altogether
Reasons why a patient may not be able to fully comply with clinical protocols
Language barriers
Cognitive inability to participate in a care protocol
Physical inability to participate in a care protocol
Economic inability to participate in a care protocol
Willing and informed refusal to participate in a care protocol, e.g. religious reasons
Medication contraindications to participating in a care protocol
Geographic inability to participate in a care protocol
Mortality (it can be surprisingly difficult to identify these patients)
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
4
Clinical and Cost Metrics
Monitoring clinical effectiveness and cost of care to the system and patient
Measure practice of medicine against these protocols
Measure the variability in care
Build dashboards around specific patients and population of patients
Must track the total cost of care for specific patients and a per-capita basis across the population
Provide quality, outcome, and cost variance feedback to physicians, risk adjusted, at the point of care
Ultimately this prepares an organization for fixed-fee contracting in a true value-based system
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
5
Basic Clinical Practice Guidelines
Evidence-based triage and clinical protocols for single disease states
Measure the practice of medicine against these protocols
Current evidence-based medicine lacks applicability outside the specific clinical trial
In the future, clinical trials’ “evidence” will be displaced by derived evidence from the analysis
of local data sourced by the EDW
In the meantime, the industry must make-do with existing evidence and guidelines
Many external commercial sources and commercial vendors
Health systems need to establish a “Clinical Practice Guidelines” governance body and select
their source(s) and processes
Start by defining clinical practice guidelines for patient cohorts and process families that offer
the highest opportunity for improvement and cost savings
High Opportunity =
(
Number of patients
In the population
) (
X
The Average Total Medical
Expenditure (TME) per Capita
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
)
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
6
Risk Management Outreach
Stratified work queues that feed care management teams and processes
Risk stratification enables an organization to analyze and minimize the
progression of a disease and the development of comorbidities
First need to stratify and monitor the registry
patients
Then develop strategies to identify and intervene
with high-risk trajectory patients
Ultimately need to profile and proactively treat
patients before becoming members of the registry
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Be Careful What You Ask For
Correlation
Patients with the highest satisfaction scores =>
• Higher rate of hospital admissions
• Prescribed more medications
Unpublished, internal data analysis; Northwestern University Medicine
Enterprise Data Warehouse, 2008
We were not the first or only organization to see this trend
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Strategies for PHM Intervention
1.
Disease management — Example: Diabetes management
programs
2.
Catastrophic care management — Example: Programs to reduce
risk for individuals with a high risk of developing conditions that lead
to catastrophic healthcare costs (e.g., cancer, brain injury)
3.
Demand management — Example: Nurse call lines
4.
Disability management — Example: Employer-sponsored
programs to reduce disability days and costs
5.
Lifestyle management — Example: Seat belt compliance
campaigns, smoking cessation programs, weight management
programs
6.
Integrated care management — Example: Programs that integrate
other types of interventions (e.g., catastrophic care
management,disease management and demand management for
cancer patients) with shared outcomes and monitoring over time
From Becker’s Hospital Review. Connie Evashwick and Ann Scheck McAlearney, at the American College
of Healthcare Executives' 57th Congress on Healthcare Leadership.
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
18
© 2013 Health Catalyst
www.healthcatalyst.com
Caution of Paradox
“…population strategies which focus on reducing the
risk of those already at low or moderate risk will often
be more effective than strategies which focus on high
risk individuals at improving population health in the
long run.”
Gordon Norman
Chief Medical Officer, xG Health Solutions
Recommended reading: Geoffrey Rose, “Sick Individuals and Sick Populations”,
International Journal of Epidemiology 1985;14:32–38.
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
19
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
7
Acquiring External Data
Access to clinical encounter data, cost data, laboratory test results, and
pharmacy data outside the core healthcare delivery organization
Contrary to current national strategy and focus, acquiring external data should
be a secondary focus in today’s market
It is geometrically more complicated to manage a patient
population beyond the core healthcare delivery organization
Start with in-house process and data quality first
Then, carefully and deliberately expand the data ecosystem
HIEs are the most visible technology associated with ACO
external data exchanges, but only address a small portion of
the data puzzles required for PHM
The “A” in M&A will shift from bricks-and-mortar acquisition to
data acquisition
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
8
Communication with Patients
Engaging patients and establishing a communication system about their care
Current solutions are fragmented and immature but will improve dramatically in
the next 3 years
Today’s typical patient engagement solution is through a
personal health record (PHR) tightly associated with a
healthcare delivery organization EMR
The future patient engagement solution will be completely
patient owned, decoupled from an EMR or single
healthcare organization
The PHR will evolve into a personal project management
system, with a combination of project management,
knowledge management and social support.
Take advantage of current PHRs, but be prepared to
jettison current PHRs for something more informative,
customized, collaborative and functionally rich
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
9
Educating and Engaging Patients
Patient education material and distribution system, tailored to the patient’s
status and protocol
Our current patient education system is hampered by the lack of highly
personalized materials and an effective distribution system
Often, today’s patients receive no education material about their condition
PHRs tend to present generic education information
• Low-income, preteen girl with type 1 diabetes
likely to receive same education material as a
middle-aged executive man
• Materials are not tailored to blend comorbid
conditions together
No certified, widely available method of evaluating material quality
Widely used vehicles like Twitter, Facebook, Zite, and Amazon have yet to be fully embraced
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
ACO vs. ACP:
Accountable Care Patient
From Eric Topol’s Twitter feed, @EricTopol
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
23
© 2013 Health Catalyst
www.healthcatalyst.com
Obesity Rates by Occupation
American Journal
of Preventive
Medicine
Volume 46, Issue
3 , Pages 237248, March 2014
Graph from The
Atlantic, March,
2014
24
CRITERIA
10
Complex Clinical Practice Guidelines
Evidence-based triage and clinical protocols for comorbid patients
Establishing protocols for comorbid patients is complicated
Few industry sources for clinical protocols for
comorbid patients
Physicians often left to build their own guidelines,
or chain individual disease treatment protocols
together
Medicare patients on average affected by at least
chronic diseases at the same time
Organizations that optimize comorbid care will be
in a strong position to differentiate themselves in
the market, both financially and clinically
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
11
Care Team Coordination
Inter-clinician communication and project coordination
We need to treat every patient as if they are at the center of a project plan
All members of a patient’s care
management team should be able to quickly
and easily see the patient’s overall project
plan, next milestones, and responsibilities
Acute encounters should show recovery
milestones and assigned people
Chronic diseases should show a lifetime
project plan for health
The ideal system would function like a
project management tool (like Basecamp)
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
CRITERIA
12
Tracking Specific Outcomes
Patient-reported outcomes measurement system, tailored to the patient’s
status and protocol
Patient-reported outcomes data is one of the most important pieces of data
missing from our ecosystem today
This is also the most culturally and
technically difficult criteria to implement
Our best efforts today is assessing patient
satisfaction, but that data falls short as an
aid for measuring actual clinical outcomes
Currently, no reasonable options exist in our
industry
A future patient-reported outcomes system
must have a closed-loop data relationship
with the EMR, and then exported to the
EDW for analytic purposes
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Vendor Evaluation and Scoring
No single vendor today offers an integrated and fully functional
population health management solution that meets all 12 criteria
How did I come up with these scores?
Personal experience as a customer of the vendors’ products
Personal experience as an executive in the company (i.e. Health Catalyst)
Conversations and interviews with current and past customers of the vendors’ products
Market reports from, and conversations with, industry analysts at KLAS, Chilmark, IDC,
Gartner, and the Advisory Board
Publically available information on the vendors, including their own case studies, white
papers, on-line product demos, and product information
Conversations with current and past employees of the vendors
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Focus on the framework & criteria,
not the scores
Score these and other vendors
yourselves
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Vendor Evaluation and Scoring
First tier evaluation scores
Crimson
Explorys
Health
Catalyst
Lumeris
Optum
Humedica
Phytel
Premier
Average
Score
Criteria #01:
Precise
Patient Registries
5
5
9
3
3
3
3
4.4
Criteria #02:
Precise
Patient Attribution
5
5
8
5
6
5
5
5.6
Criteria #03:
Precise Numerators
in the Patient
Registries
0
0
5
0
0
0
0
.7
Criteria #04:
Clinical and
Cost Metrics
7
7
9
6
5
4
5
6.1
Criteria #05:
Basic Clinical
Practice Guidelines
0
0
0
3
5
5
0
1.9
Criteria #06:
Risk Management
Outreach
1
0
0
5
7
5
0
2.6
Sub-Total
18
17
31
22
26
22
13
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Vendor Evaluation and Scoring
Second tier evaluation scores
Crimson
Explorys
Health
Catalyst
Lumeris
Optum
Humedica
Phytel
Premier
Average
Score
Criteria #07:
Acquiring
External Data
0
5
6
0
4
2
7
3.4
Criteria #08:
Communication with
Patients
0
0
0
4
5
6
0
2.1
Criteria #09:
Educating and
Engaging Patients
0
0
0
2
3
4
0
1.3
Criteria #10:
Clinical and
Cost Metrics
0
0
0
0
0
0
0
0.0
Criteria #11:
Complex Clinical
Practice Guidelines
0
0
0
0
0
2
0
0.3
Criteria #12:
Tracking Specific
Outcomes
0
0
0
0
0
0
0
0.0
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Asset Allocation and Timing
Recommended asset allocation as the market and organization evolve and
mature in population health management
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Asset Allocation and Timing
Recommendations
• Build a population health management roadmap
• Start as soon as possible with the first six criteria while the latter six
develop in the market
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Poll question
Who do you think will be the most capable to meet
the data management requirements of Population
Health Management?
EMR vendors
Analytic Specialists
A combination of both
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
34
© 2013 Health Catalyst
www.healthcatalyst.com
Conclusion
Key points to remember
• Follow the lead of the IDNs which have been practicing PHM for years
• Reference this presentation and the CCHIT framework when developing
an organizational strategy and evaluating vendors for PHM
• NQF has a new PHM initiative… keep an eye on that
• There is no single vendor that can provide a complete PHM solution
today
• Sequencing is important. Focus on the first six criteria over the next
three years while the context evolves
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Other Population Health Resources
Click to read additional information at www.healthcatalyst.com
The Evolution of Care Management to Population Health Management
This covers the evolution of the care management market to the population health management, the data needs for effective
population health management, and population health business models
Why the Solution to Population Health Management Woes Isn’t an EMR
Healthcare systems are struggling to figure out how to shift to a value-based model and remain competitive. This will require
hospitals to identify and reduce waste in three categories: the variation in 1) the care that is ordered, 2) how efficiently that care is
delivered, 3) in care delivery that causes preventable complications .Clearly, EHRs aren’t the answer.
The Best Way to Prioritize Your Population Health Management Efforts
Effective population health management starts with clearly defining a subset or cohort of patients and determining on which clinical
processes to focus improvement efforts. The Health Catalyst Key Process Analysis (KPA) application determines the highest
variation and highest resource consumption by integrating and analyzing clinical and financial data.
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Other Population Health Resources
Click to read additional information at www.healthcatalyst.com
Case Study: Using Data and Reporting in Population Health Efforts
How a healthcare system went from manually pulling together reports with varying data to having near real-time data that one
executive says, "enables our care coordinators to drive preventive care and ultimately lower our population health costs"
Case Study: Using Advanced Analytics to Manage Primary Care Population Health
Population health management is largely being driven by the 5 percent of the population accounts for 50 percent of healthcare
costs. Being able to identify these patients, provide high-quality care and reduce their utilization is a pressing goal for many of
today’s primary care providers (PCPs). Learn how one organization used health care analytics to meet this challenge.
Implementing a Successful Population Health Management Strategy
A White Paper by Dr. David Burton
Based on 25 years of experience, first as a senior executive at Intermountain Healthcare and later as the Chairman of the Board of
Health Catalyst, Dr. Burton shares his in-depth learnings about how to systematically implement population health management in
a long-term, sustainable way.
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com
Crimson
Population Health
In Pursuit of Value
Combining Precise Population Risk Analytics with Robust Care Management Support
©2013 The Advisory Board Company • advisory.com
The Advisory Board Helps You
Transition to Value-Based Care
350+
accountable care
projects across
45 states
Build the Provider Network
Optimize Network Performance
• Achieve clinical integration
• Engage physicians in performance
improvement
• Deliver targeted outreach to
high-value physicians
• Reduce cost and care variation
• Reduce referral leakage
• Improve quality
75+
Clinical Integration
programs
developed
Crimson Population Health
Analytics and workflow technology enabling
health systems to manage the clinical and
financial outcomes of defined populations.
45M+
Research
lives in population
health benchmark
database
Consulting &
Talent Development
Transform Care Delivery
• Prioritize at-risk patients
100%
NCQA PCMH
recognition for
50+ members
©2013 The Advisory Board Company
• Surface care gaps and intervene
• Coordinate care across the
continuum
Technology
Manage Financial Outcomes
• Develop strategy for payment
transformation
• Negotiate risk-based contracts
• Manage contract performance
advisory.com
The Business Case for Change
Diverse Motivations for Population Health
Strategic Benefits of Transformation
Clinical Advantage
Financial Advantage
Align financial incentives with
mission
Move away from faltering fee-forservice economics
Support investments in
better health
Capture greater share of
premium dollar
Market Advantage
Attract market share of
lives
Secure attractive
purchaser contracts
Source: Health Care Advisory Board interviews and analysis.
©2013 The Advisory Board Company
40
advisory.com
Two Plausible Transition Paths
Enabling Financial Success from Population Health Management
Migrating to a Value-Based Business Model
Leading with Care
Transformation
• Invest quickly
• Prove concept
Care
Transformation
• Obtain value-based
payment
Leading with ValueBased Contracts
• Meet payer demands
for risk
• Secure share
• Adapt care model
Payment Transformation
Source: Health Care Advisory Board interviews and analysis.
©2013 The Advisory Board Company
41
advisory.com
Extremely Challenging to Execute Successfully
Four Critical Success Factors, Many Hurdles Along the Way
Achieve Data Transparency to
Manage Utilization
•
Hard to arm physicians with information due to
limited transparency provided by payers
•
Difficult to link and reconcile disparate data sets
using data warehouse solutions
•
Internal clinical and financial systems constrains
visibility to utilization inside organization
1
CFO
Focus Interventions on Highest
Prioritized Opportunities
3
2
•
Lack of integration between analytical and
workflow tools prevents effective execution
•
Difficult to quickly identify and engage the
appropriate resources for each intervention
•
Limited ability to bring together timely clinical
and financial risk data for clinicians at the point
of care
4
CMO
Measure Impact of Interventions and
Continuously Improve
Prioritize Patients at Highest
Risk of Poor Cost and Quality Outcomes
•
•
•
Predictive analytics required to forecast outcomes
with accuracy not a core competency of EMR,
financial system vendors, or providers
•
Difficulty linking cost and utilization data
hinders ability to track and trend PMPM costs
•
Data complexity prevents routine analyses with
frequency required for course correction and
continuous improvement
•
Difficulty connecting productivity of care
managers to outcomes and return on
investment
Lack of robust benchmarks prevents identification
of actionable opportunities based upon gap to
benchmark
Limited visibility into psycho social factors
©2013 The Advisory Board Company
42
advisory.com
Managing Three Distinct Populations Essential to Profitability
Third-Party Information Valuable But Should Not be Sole Determinant in Segmentation Strategy
Cigna
Financial Analysis Indicates Necessity
of Managing Rising-Risk Patients
HighRisk
Patients
5 Year Margin Projection by Risk Management Level
5%; complex
Baseline,
no
management
by risk level
BCBC
(3.0%)
Managing
high-risk only
Rising-Risk Patients
Aetna
Managing
high-risk and
rising-risk
patients
15-35%; may have conditions
not under control
(4.9%)
UHC
Low-Risk Patients
Humana
(9.7%)
60-80%; any conditions minor,
easily managed
Source: Health Care Advisory Board interviews and analysis.
©2013 The Advisory Board Company
43
advisory.com
The Crimson Population Health Solution
Hardwiring a Critical Feedback Loop
New Insights Achieved by Marrying Clinical Data with Total Cost and Utilization
Prioritize Population-level
Improvement Opportunities
Population Risk Management
+ Care Management
Workflow + Care Gap
Analysis
• Who are my highest-risk patients?
Functionalities Achieved
through Platform Integration
Linking clinical values
with claims data
Enables multivariate
analysis of utilization,
claims and clinical values
for superior population
health management
Population analytics
at the point of care
Integrates populationlevel risk analytics with
point-of-care clinical
workflow tools,
enabling prioritization
of high-risk patients for
targeted interventions
©2013 The Advisory Board Company
• Which diagnoses are contributing
most to avoidable utilization?
Evaluate Effectiveness of
Interventions
Proactively Manage
Individual Patient Health
• Did these interventions reduce
avoidable utilization?
• Are these patients receiving
recommended care?
• Were our medical homes successful
in decreasing PMPM costs?
• What interventions would decrease
avoidable utilization?
44
advisory.com
BEST-IN-BREED
DATA ANALYTICS
INSIGHTS TO
SUPPORT:
Tailored Data Acquisition Approach
POPULATION RISK
MANAGEMENT



Risk-based contract performance
management
Avoidable utilization identification
Population risk stratification
•
•
•
Risk contract modeling
Population utilization
benchmarking
Predictive risk algorithms
NETWORK
MANAGEMENT



Physician relationship analytics
•
Severity-adjusted physician
performance benchmarks
Charge normalization
Total market referral analysis
•
•
CARE
MANAGEMENT



Network leakage analytics
Cross-continuum physician
performance management
•
•
•
REAL-TIME RISK
IDENTIFICATION
Medical home support
 Instant patient risk assessment
Patient compliance tracking
 Inpatient and ambulatory clinical
risk surveillance
Patient outreach and
engagement
 Intervention impact tracking
Multi-source evidence-based
care guidelines
Point-of-care workflow tools
Customizable measure sets
•
•
•
Real-time clinical predictive
analytics
Natural language processing
Automated chart review
ADVISORY BOARD COMPANY DATA EXTRACT
SOURCE
SYSTEMS
HOSPITAL DATA WAREHOUSE
Patient
Accounting System
©2013 The Advisory Board Company
Hospital
Clinical System
Practice Management
System
45
Ambulatory
Clinical System
Medical/Rx
Claims Processor
Third-Party
Lab System
advisory.com
Common Data Approaches Failing to Deliver a Complete Solution
Payer Solutions
Strengths
•
•
Deficiencies
×
×
×
×
Data Warehouses
Data spanning care settings and
delivery network
Expertise managing population risk
•
Conflict of interest when handling
data from other payers
Limited to claims data
Lack of experience with clinical data
Lack of experience with provider
performance analytics, operations
×
•
×
×
×
EMRs / Clinical Systems
Availability of clinical and financial
data spanning care settings
Flexibility of analysis
•
Data and analytics not accessible to
clinician end user
Potential challenges linking data
Difficult to integrate analytics into
clinical workflow
Lack of benchmarks
×
×
×
×
•
×
Physician and clinician familiarity
and engagement with systems
Detailed clinical data
Not total market
Lack of financial data
Siloed by care setting
Difficult to extract, aggregate data
for analysis
Challenges with alert fatigue
Hallmarks of a Best-Practice Population Health Management Solution
COMPREHENSIVE
VISIBILITY
• Cross-continuum data
• Total market data
• All payer data
• Clinical and financial data
©2013 The Advisory Board Company
INSIGHT-DRIVING
ANALYTICS
WORKFLOW
SUPPORT
• Clinical and financial
predictive analytics
• Analytics embedded in
point-of-care work routines
• Customizable performance
benchmarks
• Designed to engage
providers
• Continuous measurement
• Accessible across care sites
46
advisory.com
The Crimson Advantage
Data-Driven Insights Enable Proactive and Comprehensive Care
Consolidated Data
From Multiple Sources
Unparalleled Care
Transformation Support
Analytics Fueled by
Research and Insight
Manage Total Cost and
Quality of Key Populations
Payer and Employer Data
-
Medical Claims
-
Prescription Drug Claims
-
Eligibility Files
• 25+ years of experience researching
best practices and identifying areas
of opportunity for providers
-
HRA and Biometric Data
• Provider-centric user interface
•
• Consolidated view of financial and ,
clinical performance; robust and
customizable benchmarks
Hospital Data
-
• Extensive cohort services
-
Office-Based PMIS
-
CPT2 Codes
-
Office-based EMR
-
Lab Systems
-
E-Prescribing Systems
-
Direct Entry
45M+
©2013 The Advisory Board Company
Lives in utilization
benchmark database
• Leading provider of utilization / cost
benchmarks and actuarial analytics
to the health care industry
• Benchmarks customizable by
geography, plan design,
demographics; powered by a
database of 45M lives, 2.5B claims
• Proprietary clinical and financial
modeling tools
$2M
Potential savings
across 1,000 lives
200+
47
•
Improve Individual Patient
Health
•
ADT messages
Physician Practice Data
•
Identify areas of inappropriate
utilization, low compliance to manage
network performance
Risk stratification algorithms to identify
high priority patients requiring timely
intervention
Measure, manage interventions
Evidence-based care
guidelines and prompts
Address all levels of patient risk
through automated alerts, triggers and
care plan development
• Standardize care manager activities
regardless of payer contract or care
model to improve overall patient
outcomes
• Increase patient panel size through
robust prioritization and automated
assignment of tasks across entire care
team
Hardwire
Physician
Intervention
•
•
Point-of-care workflow tools to
maximize efficiency, effectiveness of
patient encounters
Proactively identify care gaps using
multi-source guidelines,
customizable rules engine
6M
Lives contracted for
care management
advisory.com
Beyond the Technology
Providing Extensive Support to Ensure Member Success
Unparalleled Services and Resources for Crimson Members
Hands-On Support
Dedicated Advisors
Serve as educator, analyst and counsel identifying care
variation, advising on goals and tactics to drive results.
Business Analysts
Dedicated technical talent who works closely with IT staff,
testing data files and formats to ensure seamless site
launch and maintenance.
Progressive Peer Network
Annual Performance Summit
Seminal event gathers the entire Crimson cohort to
celebrate achievements, share best practices, and
highlight successful member case studies.
National Webinars
Educational intensives focused on current research
topics or member case studies including live
discussion with Crimson experts and peers.
Additional Services for Crimson Members
Crimson Executive Partners
CXO Affinity Groups
Our most respected executive talent
will partner with your leadership team
to ensure that our support continually
serves your organizational strategy.
The EPs bring clinical training,
consulting experience, and proven
industry depth.
Leaders from across The Advisory
Board gather with members in our
offices or via webinar to problem-solve
addressing market and regulatory forces
and overcoming implementation
challenges as providers migrate toward
accountable care.
• Patient-Centered Medical Homes
Clinical Consultants and Coaches
• Bundled Payments
• Shared Savings
• Clinical Integration
Our Medical Directors and Nurse
coaches provide insight on how best
to improve clinical workflow and
leverage data transparency across the
collaborative care team
Clinical Advantage Product
Advisory Council
30+ Years of Best-Practice Research
The industry leader for health systems in search of
research and insights on the implications of value-based
payments and accountable care. Current library includes:
• Medicare Shared Savings Program Rulebook
• Succeeding Under Bundled Payments
• Playbook for Clinical Integration - Building the
Performance-Focused Physician Network
• Blue Print for the Medical Home
©2013 The Advisory Board Company
Program Managers
Our proven project managers serve as a
single point of contact managing your
technical deployment and ensuring
continual implementation progress.
48
Participation throughout the year in
exclusive meetings with Crimson leaders
of product management. These
sessions provide an opportunity to
preview planned enhancements ahead
of Crimson peers, as well as contribute
to the near-term product roadmap, and
next-generation product capabilities.
advisory.com
A Proven Record Supporting Population Health Management
140+
At-risk populations supported
by Crimson
2.1M+
Number of lives managed
using Crimson
45M
Lives in population health
benchmarking database
500K+
Cost and quality profiles for
over 500K physicians
112+
Payers sending data to Crimson
5 of 5
Payer types supported: Medicare,
Medicaid, Medicare Advantage,
Commercial, Self-Insured
A Sampling of Population Health Management Partners
About Memorial Hermann Physician Network:
• Clinically integrated network of Memorial Hermann, a
9 hospital system in Houston, Texas
• Over 2000+ physicians and 850 independent
practices
• At risk for 60K employee, commercial, Medicare lives
Medicare Shared Savings
Participants
Depth and Breadth of Expertise
About MissionPoint Health Partners:
• Clinically integrated network of St. Thomas
Health of Acension Health in Nashville,
Tennessee
• Four major hospitals, over 100 outpatient
locations and 1200 physicians participating in
network
•About
At risk
for 40KHealth
Medicare
and local employer
Covenant
Partners:
lives
• Clinical
integration program of Covenant Health
System in Lubbock, Texas
• Network of 150 employed. 150 independent
physicians
• Hospital Efficiency Contract for 30K admissions to
Covenant Health System, fully at risk for 9K+ lives
Groundbreaking Technology Capabilities and Assets
•
•
•
•
•
•
•
Cross-continuum analytics that provide insight into opportunities for improvement by physician, patient and population
Risk stratification algorithms with proven predictive superiority
Seamless link between population-level analytics and care management work flow to support direct management of high-risk patients
Exclusive access to Milliman MedInsight’s customizable benchmarking database of over 2.5B claims and 45M lives
Evidence-based guidelines and measures proactively identify gaps in care to facilitate physician and care team workflow
Supports tracking for all 33 Medicare ACO metrics and Group Practice Reporting Option submission for identified patients
Continuous innovation: member-driven changes , 10 new technology releases per year
©2013 The Advisory Board Company
49
advisory.com
For Additional Information, Infographics and Research visit the following
link:
www.advisory.com/research/resources/posters/accountable-for-progress
You can also email [email protected]
©2013 The Advisory Board Company
50
advisory.com
Thank You
Next Educational Webinar
The Path to Shared Savings With Population Health Management Applications
Laser Focused on Finding Waste, Defining and Monitoring Populations, Accountable Care
Organizations and Health Systems Alike Will Learn About The Success of One System Who
Reduced Heart Failure Readmissions
Date: Wednesday, April 9th
Time: 1:00-2:00 PM ET
Presenter: Eric Just, VP, Technology; Kathleen Merkley, VP, Clinical Engagement
By Failing to Prepare, You Are Preparing to Fail
Laying the Foundation for Sustainable Change and Success
Date: Wednesday, April 16th
Time: 1:00-2:00 PM ET
Presenter: John Haughom, MD, Senior Advisor, Health Catalyst
Register at http://healthcatalyst.com/
Follow Us on Twitter #TimeforAnalytics
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
© 2013 Health Catalyst
www.healthcatalyst.com