july 2015 accountable care webinar
Post on 17-Aug-2015
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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
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
New York Bureau Chief Modern Healthcare
Accountable care and big data—meeting the challenge
NOW SPEAKING
WEBINARAccountable care and big data—meeting the challenge
Please use the questions box on your webinar dashboard to submit questions to our moderator
Katie WhiteAssistant professor of
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
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
Please use the questions box on your webinar dashboard to submit questions to our moderator
WEBINARAccountable care and big data—meeting the challenge
Kim KauffmanVice president of value-based care
Summit Medical Group Knoxville, Tenn.
Accountable care and big data— meeting the challenge
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”®
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
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
Jason DingerCEO
MissionPoint Health Partners Nashville
Accountable care and big data—meeting the challenge
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
>200% above benchmark
>100% 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
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
Jason DingerCEO
MissionPoint Health Partners
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:
Accountable care and big data—meeting the challenge
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
Jason DingerCEO
MissionPoint Health Partners
Nashville
WEBINAR THANK YOU FOR ATTENDING
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