INDUSTRY PERSPECTIVES ON FUTURE TRENDS IN POPULATION HEALTH

ROHAN D’SOUZA

SHALEEN DUTTA

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"Health outcomes of a group of individuals, including the distribution of outcomes within the group."-Kindig and Stoddart, 2003-IOM Roundtable on Population Health

What is Population Health?

Fee for Service vs. Value Based Care

RVU RVUCPT

HEDISPCMHPQRS

Fee for Service vs. Value Based Care

Fee for Service vs. Value Based Care

Define Measure Analyze Improve Control

Define what VBB program your organization will participate in and its stakeholders

Number of patients eligible, current infrastructure and barriers to success

Quality Measures, and Shared Savings thresholds.

Enroll ‘Moving Risk’ and high risk patients in Care Management Programs

Use Predictive Models, Transitions of care alerts, and patient engagement to build a model of sustainability

Five Step Approach to Nailing the Switch

Define

Measure

AnalyzeImprove

Control

Five Step Approach to Nailing the Switch

CMS MSSP

Shared Savings

Medicare Advantage

PCMH

HEDIS

Bundled Payment

DSRIP

CCM

What Road to take?

Understand Your Population

Tagging Patients

eClincialWorksPopulation Health Solutions

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Cohort Management

Building Cohorts

• Build a solid IT infrastructure• Integrate care delivery across facilities• Measure outcomes and cost for every patient• Move towards bundled payments for care coordination• Expand excellent services across geography• Organize into integrated practice units

The Shift to Value Based Care

*Oct, 2013 Harvard Business Review – Michael Porter and Thomas Lee. ‘The Strategy that will fix healthcare

• Build a solid IT infrastructure: CCMR• Integrate care delivery across facilities: ACO• Measure outcomes and cost for every patient: HEDIS/CQM• Move towards bundled payments for care coordination: CCM• Expand excellent services across geography: TELEMED• Organize into integrated practice units: PCMH

The Shift to Value Based Care

*Oct, 2013 Harvard Business Review – Michael Porter and Thomas Lee. ‘The Strategy that will fix healthcare

eClinicalWorks CCMR

An ACO is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. At the heart of each patient's care is a primary care physician.

What is an ACO?

+ +

What is an ACO

Beneficiaries or patients

Quality Measure:HEDISCMS STARImprove performance based on Per Member Per Year Cost threshold

What is an ACO

MSSP Landscape

eClincialWorksPopulation Health Solutions

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1 out of 3 Medicare Patients

eClinicalWorks MSSP Landscape

ACOs: Over 8M lives covered

eClinicalWorks MSSP Landscape

ACO’s with NO

Shared Savings

ACO’s with Shared Savings

All 2014 ACO’s

No Conditions Coded Some conditions coded and with Poor Specificity

All Conditions coded appropriately

76 years Female 0.468 0.468 0.468Medicaid Eligible 0.177 0.177 0.177DM w/vascular 0.181 0.608

Vascular disease 0.324 0.645

CHF 0.395

Disease interaction 0.204Total RAF 0.645 1.15 2.497Base Rate $800 $800 $800

PMPM Payment $516 $920 $1,997.6Annual Payment $6,192 $11,040 $23,971.2

Medicare HCC Coding

Measure Outcomes and Cost

Context- CCM

70% Deaths 67% Chronic Patients

93% of Spending98% Hospital Readmissions

Financial & Human Cost of Chronic Conditions

Key Benefits

• Automation of workflow

• Consent Management

• Faster recruitment of patients • Easy to use and Integrated Care Planning

• Time Tracking

• Automatic Claim Generation

eClinicalWorksPopulation Health Solutions

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• “The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.” (www.ncqa.org)

• Key Objectives of a Medical Home: Personal physician / holistic care for patients Coordinated and planned care for chronic & preventive conditions Patient and family involvement Eliminate redundancies, measure and improve practice performance

Patient Centered Medical Home

eClinicalWorks PCMH Solutions

• NCQA® pre-validated Vendor for Auto Credits

• Get Up to 82 Points towards your recognition by using eCW

– 32.12 Auto Credit Points

– 48.375 additional guaranteed workflow points

– Additional 1.5 workflow points under review with NCQA

eClinicalWorks PCMH Solutions

• Certified CAHPS Survey Tool vendor

• No Dependency on Patient Portal

• Get distinction for having done surveys on your patients

• Integrated Care Planning

• Customizable Health Risk Assessments

• Generate Patient Specific Action Plans

Market Trends

Source: Leavitt Partners Center for Accountable Care Intelligence

2011 2012 2013 2014 2015 2016 2017 2018 2019 20200.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

2.6 5.614.6 19.2

23.5 3540 50

6072

Projected no. of covered lives in millions

Projected Actual

Achieving the Triple Aim

Improve Health of a Population

Improve Experience of Care

Reduce per Capita Cost

National Conference 2016Join us October 21-24, 2016 at the

Orlando World Center Marriott.

Registration opens in January.