Population Health Success at the North Carolina State Health Plan April 15, 2015 Janet Cowell, Treasurer, State of North Carolina Charles Saunders, M.D., Chief Executive Officer, Healthagen DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
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Population Health Success at the North Carolina State Health Plan
April 15, 2015 Janet Cowell, Treasurer, State of North Carolina
Charles Saunders, M.D., Chief Executive Officer, Healthagen
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflict of Interest Janet Cowell and Charles Saunders, MD have no real or apparent conflicts of interest to report
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Learning Objectives 1. Explain how the North Carolina State Health Plan designed a technology-enabled population health and care management strategy that became a national model for improving health and well-being across its membership.
2. Identify the advantages of a diverse outreach strategy leveraged by the North Carolina State Health Plan including its direct impact on care quality, member engagement and costs
3. Best practices for personalized and meaningful outreach efforts
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Benefits Realized for the Value of Health IT
Satisfaction Engaged members are surveyed to assess their satisfaction with population health programs and nurse coach interaction
Treatment and Clinical
Reduction in overall, lifestyle-related risk factors
Electronic Information and Data
Clinical analytics and data give us the ability to stratify and engage our population through high-touch, highly personalized population health efforts
Prevention and Patient Education
Education through various communication channels is key to meeting our clinical and financial goals
Savings The NCSHP has recorded lower than expected net claims payments and net administrative costs
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Who We Are • We serve teachers and local school
personnel, state employees, retirees, current and former lawmakers, state university and community college faculty and staff and their dependents
• We empower members to make healthier lifestyle choices and to become partners in addressing their health care needs
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NC State Health Plan Demographics Total Membership
• 680,000 Medicare/MA, Active, COBRA and Pre-65 Retiree members • 80% are Active, COBRA and Pre-65 Retiree members
Average age is 46 11% use tobacco* 32% are obese*
Members reside in all 100 counties across the state
Areas of focus for today • NCSHP’s Strategic Plan • Member Health and Population Health IT • Financial Status
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48% 51%
1%
More than half of our members have a chronic illness including 1% with a catastrophic illness
Chronic Illness
Healthy/Acute
Catastrophically Ill
% of Total Population
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Source: Segal Report CRG 2013
12%
76%
12%
Chronically ill members account for 76% of annual costs
Chronic Illness
Healthy/Acute
Catastrophically Ill % of Total Claim Cost
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Source: Segal Report CRG 2013
Guiding principles for our strategic plan Mission Improve the health and health care of North Carolina teachers, state employees, retirees and their dependents in a financially sustainable manner, thereby serving as a model to the people of North Carolina for improving their health and well-being.
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Guiding Principles • Improve Affordability
• Improve Members’ Health
• Ensure Access to Quality Care
• Incent Member Engagement
• Promote Health Literacy
• Provide Member Choice
• Maintain Financial Stability
Priority Description Goal Description
Improve members’ health
PCMH Utilization Increase % of members receiving care from a NCQA recognized PCMH
Quality of Care Increase % of members with targeted high prevalence conditions receiving care according to national clinical standards
Worksite Wellness
Increase number of worksites offering worksite wellness
These goals and future targets will lead to: • Healthier and more engaged members • Better managed chronic disease • Members receiving high quality, coordinated care
Improve members’ health
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Population health programs to meet the population’s diverse needs: • Disease and case management
• Active lifestyle coaching
• 24 hour nurse-line
• Clinical decision support and health opportunity identification
• Patient Centered Medical Home practice support
• Tobacco cessation programs
Improve members’ health
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Complex Chronic
Major Chronic
Minor Chronic
At Risk
Healthy
High Impact Intensive Outpatient Care Management
Moderate Impact Care Coordination
Lower Impact Wellness & Lifestyle Enhancement
Decision Support
Improve members’ health
Catastrophic
Population health shifts from a disease focus to a care focus
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Find the right people with the right data Improve members’ health
Data Aggregation
Clinical Alerts Analytics Care Coordination Patient Engagement
Analysis and Intelligence Provider Workflow
Data Integration
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Analyze data against clinical rules and evidence-based medicine
10,000+ Clinical analytic rules
Based on standards from American Heart Association, National Institute of Health, CDC, BMJ, American Academy of Pediatrics, American Diabetes Association, and more
1,453 Care considerations (CCs)
250+ Unique conditions
100+ Care management assessments
200+ Quality measures*
Evidence-based Medicine Claims evaluation based on EBM rules**
Health opportunity identification
Health opportunity communication to patients and providers
Clinically Validated Rules
*ActiveHealth, NQF, PQRS, Meaningful Use, HEDIS, Medicare Stars and 21 measures endorsed by NQF **Rules are reviewed and endorsed by Harvard
Improve members’ health
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Risk stratification – population level
Healthy At Risk Minor Chronic
Major Chronic
Catastrophic and End of
Life
Preventative care
Isolated lifestyle issues
At risk for diabetes
At risk for CAD
At risk for stroke
At risk for cancer
Pre-hypertension
Overweight
Smoking
Asthma
Hypertension
Obesity
Diabetes
Heart disease
COPD
Cancer
Chronic kidney disease
Late-stage diseases
Long term care
Hospice care
Patients at risk and opportunities to close gaps in care are identified, so resources can be tailored to the unique needs of sub-populations
Increase in # of active members registered on TPA site, usage of provider search and transparency tools, and attendance at educational roadshows
These goals and future targets will lead to: • Increased member engagement • Higher level of trust • More informed members empowered in their decision making
Improve members’ experience
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• Increased awareness of member health status by engaging members in 2014
– Incent members through premium reduction to for complete Health Assessment
– Member portal provides each member with immediate feedback on personalized Health Assessment report with a detailed plan to take action
– Health Assessment completions increased from 10,919 in January 2013 to 233,368 in November 2014
– Generated 40+% increase in identified health opportunities across the population
Incent members to complete Health Assessment to be more aware
Improve members’ experience
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Improve the members’ experience
85% engaged from
those contacted
14% total population
engaged
93% member
satisfaction
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Priority Description Goal Description
Ensure a financially stable state health plan
Net Income/Loss Actual at or above budget for plan year
PMPM Claims Expenditures
At or below budget for plan year
Member Cost-Sharing
% of total claims cost paid by members through copays, deductibles and coinsurance at or below benchmark
These goals and future targets will lead to: • Reduced costs for members and the Plan • Reduced fraud, waste, abuse and overuse • Delivery of appropriate care in the appropriate setting • Payment for quality and value rather than quantity
Ensure financial stability
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Savings from Population Health Improvement
*Validated by independent 3rd party actuarial consultants