partnering for population health: strategies to promote collaboration among the patient, provider...
DESCRIPTION
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.TRANSCRIPT
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Partnering for Population Health: Strategies to Promote Collaboration Between the Patient, Provider and Employer
Christina ArenzRegional Vice President
Strategic Solutions, Value-Based Care
Conifer Health Solutions
2 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.
Christina ArenzRegional Vice PresidentStrategic Solutions, Value-Based Care
Christina Arenz currently serves as Regional Vice President of Strategic Solutions for Conifer Health Solutions Value-Based Care business line. In this role, she is responsible for leading a team of transformation experts who are tasked with developing forward-thinking solutions that give Conifer Health clients a strategic
Ms. Arenz came to Conifer Health Solutions in 2012, following the company’s acquisition of InforMed, LLC, where she had served as an Account Manager since 2010. During her career, she has had key roles in operations, finance, project management and process improvement. Christina has also served as a Human Resources leader who was responsible for all aspects of people management for a community-based, acute care hospital.
advantage as the industry shifts from volume to value-based care. She works with a variety of clients including employers, healthcare systems, medical management organizations, PHOs, ACOs and TPAs.
Who We AreConifer Health Solutions combines deep-rooted healthcare operational and financial management experience with innovative, high-touch services and technologies that simplify the healthcare experience.
Our Purpose
Unity. Integrity. Service. Respect.
Provide the Foundation for Better Health
Our Values
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Our Footprint FACTS
National Scale with Local Presence Service clients in 40+ states 20 Service Centers 700+ clients 12,000+ employees
Breadth & Scale $25+ billion net revenue
processed annually 19+ million patient touch-
points annually 4+ million managed lives $17+ billion medically
managed spend 1+ million clinical admission
reviews 60,000 patient satisfaction
surveys annually
Conifer Health – Service Centers
Revenue Cycle Management Client Locations
Patient Communications Client Locations
Value-Based Care Client Locations
Key
Conifer Health Corporate Office & Revenue Cycle Management Operations
Patient Communications & Engagement Office
Value-Based Care Office
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Stakeholders in Healthcare Historically working in isolation
• Cost of care• Quality of care• Access to care
Consumers
• Financial challenges• Government mandates• Patient quality/safety• Accountable care
Providers
• Cost containment• Wellness improvement• Population health management
Health Plans
• Financial risk management• Health information exchanges• Regulatory mandates
Employers
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Commons Challenges
People are ill Chronic and often complicated cases
Costs for care are high
Consumers are unsure how to access to healthcare
system; or lack appropriate access
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Partnering for Population HealthStakeholders Now Share Common Goals
Lowering cost of care delivery
Improving quality of care
Achieving best outcomes
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Every Stakeholder Plays a Role
Providers, payors, plan sponsors and individual members all play a part in connecting the disparate elements of the healthcare industry to increase profitability, create efficiencies, improve patient outcomes and enable individuals to better manage their personal health.
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Transforming how care is delivered
And engaging the care team and individuals to improve the health of populations
Align with providers to achieve clinical performance
Deliver patient-centered care across the continuum and population
Assume risk appropriately and successfully managefinancial performance
Partnering to Break Down WallsCoordinating to build cooperative relationships
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Holding the Alliance TogetherData
EMRs
HRAs
Medical Claims
Rx Claims
Lab Results
Health Histories
Nurses
Care Coordinators
Eligibility
Physician Offices
Imaging Links
Other
Global HealthcareData Center andReporting
Health management Financial management and
reporting Patient and physician
portals
Health Information Exchange
Nurses/Care Coordinators
Administrators/Managers
Physician Offices
Individual Patients
Others
Includes users at self-insured employers, providers, care managers, health plans
Data Sources Data Processing and Analytics Different Views/Interfaces
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Risk Stratification Population’s Conditions Predictive Modeling Provider/Plan
Performance
Holding the Alliance TogetherPopulation Health Management
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Holding the Alliance TogetherContent and Patient Education, Community-based resources
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Four Steps to Reach Commons Goals
Get the disparate data in one place
Identify the trends/issues throughout an entire
population
Identify the individuals driving risk/cost and connect
them with a nurse/care coordinator
Decrease in financials will naturally follow
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Getting the Data in One PlaceA Longitudinal Record
In this example: Five most frequent diagnoses being
treated 12-month history of medications,
emergency room use and hospital stays
Names of top five physicians seeing the patient most frequently
Adherence with standards of practice for the management of any chronic illness
Compliance with preventative screenings and chronic care issues
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Getting the Data in One PlaceClinician Desktop
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Getting the Data in One Place Care Management Platform
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Getting the Data in One PlacePersonal Health Record (PHR)
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Identify the Population and the Individuals
Participant stratification levelsPercent of population
Benchmark Client population
57% 53%
22%25%
12% 13%
7% 9%
No risk Low Moderate High Priority
Features present in high risk populationPercent of high-risk participants
Poor or ineffective uti-lization patterns
Condition related to instability
High Predicted cost
Lab results out of range
High restrospective costs
Non-compliance with EBM guidelines
Total unique
89.20%
78.30%
76.40%
24.20%
23.10%
12.30%
100.00%
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How Stakeholders Come TogetherSelf-Insured Employers
Employers – Self Insured
Taking on risk for covered members
Building partnerships with local plan administrators & networks
Creating win-win for all stakeholders using data
Members
HealthNetworks
ASC
HospitalTPAs
CareManagers
PhysicianOffices
Employer
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How Stakeholders Come TogetherEmployers Partner with Health Systems
Employers & Providers
Go direct for health & wellness programs
Direct contracts for care of members
Members
Employer Health Systems
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How Stakeholders Come TogetherProvider-Owned Health Plans
Provider-Owned Health Plan
Goes direct to members/consumers
Enlists the help of Local plan administrators to define network
Health System
Provider-Owned Health Plan
Members/Consumers
Local Plan Administrators
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Fool-proofing the PlanWhere we’ve seen failure
Lack of Investment in infrastructure
Accomplishing synergy requires investments in the right partnerships, technology and
human resources
Unrealistic expectations
Partnering is a long-term commitment
Improvements in the health status of population and financial risk will not happen
overnight
Expect 12 to 36 month timeframe for impact and results
Starting too broadly
The best sample set of a community is within your own four walls
Leverage your own employees to develop a winning approach to population health
management
Apply strategies internally to minimize risk and define measureable improvements
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There are several inputs into choosing the right care management model
What delivery model is in place in the market?Primary care medical home | ACO | Employed physicians | No structure
What payment model will the population be covered under?P4P or penalties | Upside risk | Employee ACO | Upside/Downside | Full risk
What population will the market be caring for? Does the population have specific characteristics?Population age | Chronic conditions | Behavior patterns
What care management capabilities exists in the market?None | Transitions of care nurses | Full care management
What are the operational strengths and weaknesses of the market?ED Through-put | Engaged physicians | Social services