transition chs to predictive care management with medai rnc final
TRANSCRIPT
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
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Predictive Care Management for CHS Single Practitioner
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Predictive Care Management for CHS Single Practitioner
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Predictive Care Management for CHS Single Practitioner
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O
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Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for CHS Single Practitioner
Predictive Care Management for Single Practitioner
Transitioning CHS Care Management to Population Stratification
Purpose of MEDai Risk Navigator Clinical for Community Health Solutions
Identify savings from TOTAL COST UNDER FORECASTED COST by Dx Categories
Identify HIGH RISK members in SCS population
Use RNC reports to demonstrate measured savings after CM engagement
Develop new programs from SCS population strata
Determine a process to move away from diagnosis trigger codes for CM
Establish a reliable ROI from the RNC data that could not have been attained prior
Transitioning CHS Care Management to Population Stratification
Identify HIGH RISK members in SCS population
Transitioning CHS Care Management to Population Stratification
Identify HIGH RISK members in SCS population
Transitioning CHS Care Management to Population Stratification
Identify HIGH RISK members in SCS population
Transitioning CHS Care Management to Population Stratification
Provide predictive analytics to identify future costs for each member
Identify members with TOTAL COST 10% GREATER than FORECASTED COST
Run a report for all members with greater than $50,000 TOTAL COST
Establish threshold dollar amount for PHARMACY FORECAST COST for example GREATER than $10,000
Determine the gap between TOTAL COST and FORECASTED COST for each SCS Shared Savings Age group
Transitioning CHS Care Management to Population Stratification
Determine gap between TOTAL COST + FORECASTED COST for each SCS Shared Savings Age group
Transitioning CHS Care Management to Population Stratification
Identify members in our SCS population that pose high risk for care
Run monthly reports for all member FORECASTED RISK INDEX > 50
Determine a threshold limit FORECASTED RISK INDEX for CM eligibility, for example any member greater than INDEX = 5 eligible for CM process
Identify our Psychiatric Disorders Group Aggregate HIGH RISK INDEX since this Group is SCS greatest Diagnostic Category
Segregate and indentify LOW RISK population strata and do not engage CM at level below 1.0 unless FORECASTED COST > $30,000
Transitioning CHS Care Management to Population Stratification
Segregate and indentify LOW RISK population strata; do not engage CM at level below 1.0
Transitioning CHS Care Management to Population Stratification
Segregate and indentify LOW RISK population strata; do not engage CM at level below 1.0
80.6%
Transitioning CHS Care Management to Population Stratification
Ability to run Comparative Analysis on several CHS clients
Within SCS service line, determine Risk Index for each Group
Monitor TOTAL COST in relationship to FORECASTED COST for each client
Compare effects of CM engagement within each SCS Group
Determine HIGH RISK Diagnostic Categories within each SCS Groups
Identify members who are predicted to have HIGH TOTAL COST that can engage CM right now
Transitioning CHS Care Management to Population Stratification
* End of Presentation *
Beginning of Predictive Care Management
August 2, 2010
Dr. Curtis J. TinsleyCommunity Health Solution of America
Office of Chief Medical OfficerOffice of Clinical Data Governance
“Transition Community Health Solutions to Predictive Care Management with MEDai Risk Navigator Clinical Suite”