July 2015 accountable care webinar

WEBINAR WELCOME!

Katie WhiteAssistant professor of

health policy and management University of Minnesota School of Public Health, Minneapolis

Kim KauffmanVice president of value-based care

Summit Medical Group Knoxville, Tenn.

Melanie Evans Moderator

New York Bureau Chief Modern Healthcare

During today’s discussion, feel free to submit questions at any time by using the questions box.

A follow-up e-mail will be sent to all attendees with links to the presentation materials online.

Jason DingerCEO

MissionPoint Health Partners

Nashville

Panelists:

Accountable care and big data—meeting the challenge

WEBINAR HOUSEKEEPING

NOW SPEAKING

Please use the questions box on your webinar dashboard to submit questions to our moderator

WEBINARAccountable care and big data—meeting the challenge

Melanie EvansModerator



NOW SPEAKING




health policy and managementUniversity of Minnesota School

of Public Health, Minneapolis

Accountable care and big data— meeting the challengeAccountable care and big data— meeting the challenge

Findings from Two Studies: Case Study

Comparative Analysis of First Year Experiences of Select Medicare ACOs:

Pioneer and MSSP Funded by The Medicare Payment Advisory Commission (MedPAC)

Katie White, EdD, MBA, Dave Knutson, M.S., Jean Abraham, PhD, Peter Huckfeldt, PhD, Jessica Zeglin, MPH, Lindsay Grude, MPH, Matthew Timmel, MHA, Hannah Johnson, MHA, Jesse Eikenberry

University of Minnesota School of Public Health Division of Health Policy & Management

Findings and interpretations are those of the authors.

Endorsement by MedPAC is not intended nor inferred

Background

• Health sector underinvested in information technology

• 80s and 90s decades of catching-up

•HITECH Act 2009 – incentives for meaningful use:

•2008 9% of hospitals had “basic or comprehensive EHR” whereas in 2013 60% of U.S. hospitals

•ACA and Accountable Care Organizations

• Venture capital investment $200M in 2007 to $2.4B in 2014

About the Studies

• 6 Pioneers and 6 MSSP ACOs studied – maximize contrasts(geography, organization type, market position, 1st yearresults)

• Case study comparative design

• Site visits, series of team and one-on-one interviews,document review, survey (MSSP)

• 3 geographic areas each:

• Pioneer: Northeast, Southwest, upper Midwest

• MSSP: South Central, Southeast, Midwest

Pioneer ACOs

• For organizations with experience offering coordinated, patient-centered care, and operating in ACO-like arrangements

• Established ability to manage financial risk contracts

• Minimum of 15,000 Medicare beneficiaries with rural exceptions

• 5 year timeframe –Years 1-3: FFS-based

–Years 4, 5: transition to population-based payments

32 organizations nationally in first year, 19 remaining

www.cms.gov. (May 2014)

Findings: ACOs & HIT

• Organization structure & history mattered

• Focus on structure for value analytics/ population health

• Pioneers - health information technology infrastructure in place

• MSSP - Steep learning curve for developing data infrastructure & analytics resources (especially for IPAs)

• External vendors to complement internal IT capabilities

• Predictive analytics/ risk stratification

• Health Information Exchange (HIE)/ data warehouse

Findings: ACOs & HIT

• Physician portals/ dashboards

• Multiple EMRs (one IPA in MSSP created own HIE)

• Sharing data across partners

• Tracking care transitions/ alerts

• Tracking quality metrics was difficult

• Goals: to translate data from claims & EMRs into informationto effectively manage care & monitor performance

NOW SPEAKING





Accountable care and big data— meeting the challenge

In Pursuit of Actionable Data:

Summit Medical Group

Formed 1995

220 physicians

150 PCPs

50 hospitalists

20 pulmonologists

140 advance practitioners

54 practice locations

12 counties in southeast TN

275,000 primary care pts

1.1 M pt encounters

Lab, imaging, urgent care

Formed 2015

Business partner of SMG

Practice management

Pop health management

care coordination health education provider engagement data analytics

risk adjustment

quality reporting

Strategies for “better care, lower cost”®

Strategy vs. Culture

Aligned incentives

Transparency

Dashboards

In HouseDISEASE REGISTRIES• Pts with CHF and / or COPD

treated by Summit PCP inBOTH time periods

* 25% of pts engaged by CCas of Q1 2013, expense ↓ 6.7%

* Pts not yet engaged by CC as of Q1 2013,expense ↑15% ($7M)

• Admission D/C Transfer feeds

• Physician referrals in EMR

Outsourced – paid claims analytics

Second Lens: Providers

Within Specialty, Analysis of Services

Within Specialty, Analysis of High Volume TIDs

Kimberly Kauffman

[email protected]

NOW SPEAKING



Jason DingerCEO

MissionPoint Health Partners Nashville


The IT Behind Accountable Care

Setting the Stage – MissionPoint

2

States

Served

7

Providers

7,200+

Members

250kHealth

Spend

Managed

$XXB$1.5BOnsite &

Multi-

Employer

Clinics

5

Data Drives Decisions

3

Connected by Datarobust analytics help target

interventions and drive results

• Population Analysis

• Comprehensive Analysis of Population

via 3 – 5 years of claims data

• Risk Scores Assigned, Allows for

Proactive Outreach

• Benchmarking set for industry,

geography and risk distribution

• Care Management Tool Enables

Comprehensive View of Member

• Health Partners access to hospital and

provider EHRs, past claims data

• Enables communication between

Health Partners and Providers

4

Population 360 Analysis Drives Health Partner Outreach

Using Data to Understand A Population

Population 360

Analysis

Plan Paid by Individual Spend Stratifications

Company A

Percent Costliest

Individuals

Contributing to X

Percent of Spend

1% 32%

5% 62%

10% 75%

20% 87%

50% 98%

100% 100.00%

3 – 5 Years Health Claims

5

Patient Data Maximized to Guide Effective Interactions

Managing Patient Risk

Prioritize Highest Risk Members:Immediately deploy Health Partners to

patients during “trigger events” – the

importance of real time interfaces

should not be underestimated

Target Members Showing Warning Signs:Track future risk scores and population trends

for proactive Health Partner engagement –

clinical data still rules stratification and informs

predictive models

Create Opportunities Across Members:Leverage highly effective, low cost

screenings and preventative care for

optimal health outcomes across members

Healthy

Members

At-Risk

Members

High-CostMembers

Rising-Risk

Members

Data Determines Outreach

6

ED Utilization

Hospital

Admissions

Medical

PMPM Drug PMPM

Severe Heart

Failure

Musculoskeletal

Active Cancer

Asthma

>300% above benchmark



0.1-100% above benchmark

0.1-10% below benchmark

>10% below benchmark

>25% below benchmark

Utilization/Expenditure OverviewCompared to Benchmark Values

Data reveals that low asthma

drug utilization is driving higher

than typical ER usage in Asthma

patients

Data Drives Interventions

Patient Information Supports Effective Engagement

• ED activity analysis quantifies utilization and savings opportunities by patient, by day of week and versus benchmarks

• Frequent users can be identified and grouped for care management intervention

Patient Profile highlights

cost drivers, chronic

conditions and

compliance with Evidence

Based Measures

Ambulatory Care Team is

able to build an overall

strategy based on risk

scores and historical

behavior

8

Tomorrow Today

Machine Learning and Predictive Modeling

The Internet of Things

The Rise of Mobile

Data Convergence: Persons, Places, and Things

TODAY’S PANELISTS

During today’s discussion, feel free to submit questions at any time by using the questions box







Jason DingerCEO


Nashville

WEBINARAccountable care and big data—meeting the challengeAccountable care and big data— meeting the challenge

Expect a follow-up email within two weeks with links to presentation materials and information about how to offer feedback.

For more information about upcoming webinars, please visit ModernHealthcare.com/webinars

Thanks also to our panelists:








Jason DingerCEO


Nashville

WEBINAR THANK YOU FOR ATTENDING

July 2015 accountable care webinar

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