return on engagement: the fundamental metric of population health management

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© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright

Health Catalyst WebinarMarch 23, 2016

Return On Engagement: The Fundamental Metric of Population Health Management

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Introductions• Dale Sanders, Executive Vice

President, Product Development

• Russ Staheli, Vice President, Product Line Manager, Population Health

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Our observations on Population Health

Details of Care & Patient Relationship Management strategy and application

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How we approach everything

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Founded 2008Employees 450+HQ Salt Lake City, UT

Patients Hospitals

65M+ 200+Clinics

2000+

Integrated Delivery Systems

Accountable Care Organizations

Community Hospitals

Children’s Hospitals

Academic Medical Centers

Health Catalyst Clients

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Population Health Management is to chronic disease what Public Health Management has been to infectious disease

 ”…the science and art of preventing disease, prolonging life and promoting health through organized efforts and informed choices of society, organizations, public and private, communities and individuals."

”…the health outcomes of a group of individuals, including the distribution of such outcomes within the group."

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Someday, we’ll drop the adjectiveIt won’t be a new “thing”… it will just be

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Return On Engagement

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Robert Wood Johnson & University of WisconsinPublic Health Institute

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Our current state of existence in US

healthcare

Norman, G (2003) New Strategies in Disease and Utilization Management. Society of Actuaries: San Francisco Spring. Meeting, June 24-22, 2002. Proceedings in: Record 28(2), 2003.

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Challenges to the Change

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Two Basic Types of Professional Services Contracts

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Any wonder why physicians are burned out?

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What the leaders are doing

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Courageous, visionary CEOIn 2010, she took the negotiations and data to the payers

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Cost of Care @ Point of Care

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Multiple payer contracts, one comp modelComplex allocation models have been a failure

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Her proposal for fixed-fee contracts

Inpatient procedures• Knee replacement• Hip replacement• Hip and knee replacement

revisions• Hip and knee arthroscopy

Outpatient procedures• Cataract removal• Perinatal care• Hysterectomy• Maternity

Chronic conditions• Asthma• Diabetes• End stage renal

Acute conditions• Upper respiratory

infection

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For better and worse, software has overtaken the impact of heroic leadership as the greatest agent of change in human behavior.

We have to build software that deliberately borrows lessons from the software that has changed human behavior.

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Care ManagementGetting patients involved in the numerator and denominator of ROE

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Agenda• Definition & Key Driver

• Care Management Strategy

• Product Demos

• Open Discussion

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Population Health

Care Mgmt.

Disease Mgmt.

Sometimes referred to as Care Coordination

Broader than traditional Case or Disease Management.

More narrow than full Population HealthSource: Frost & Sullivan 2015

• Under “Fee-For-Service” only the health plan was incented to optimize care across settings

• “At-Risk” value based reimbursement aligns the incentive with care providers

Care Managementour definition of care management

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1%

5%

Patients that account for

20%of your costs

Patients that account for

50%of your costs

-2012 study by NIHCM Foundation

Care Managementkey driver of care management

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Poll Questions• Which of the following depicts your perception of the “financial

value” care management will provide over the next 3-5 years?• 300 respondents

a) It will have a high financial ROI – 54%b) It will have a neutral financial ROI – 31%c) It will have a negative financial ROI, needs reformation – 15%

• Which of the following depicts your perception of the “clinical quality” care management will provide over the next 3-5 years?

• 181 respondentsa) It will have a major positive impact – 59%b) It will have a slightly positive impact – 36%c) It will have a neutral/negative impact, needs reformation – 5%

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Agenda• Definition & Key Driver

• Care Management Strategy

• Product Demos

• Open Discussion

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Care Management Strategy• Review Existing Frameworks and Market Need

• Define Health Catalyst’s Framework

• Demonstrate Product Flow

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Care Management Strategyreview existing frameworks and market need

1st Half 2015 - Leveraged;- Internal;

- Visioning from internal Catalyst leadership- Partners Health System iCMP initiative

- External;- 10+ 3rd party companies in this space assessed in build vs buy- 10+ requests for proposals (RFPs)- 3+ current client requests- Competitive analysis report- Market capitalization report- SI Patient Engagement Model

- Many other discussions and meetings…

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Care Management Strategyreview existing frameworks and market need

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Data Integration (EDW)

Patient Stratification &

Intake

Care Coordination

Patient Engagement

Performance Measurement

Care Management Strategydefine health catalyst’s framework

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Care Management Strategydemonstrate product flow

AB

A

BA

AB

A

BA

A

A

A

AA

AB

A Care Program A

Care Program B

Claims Clinical

EDW

Population Under at Risk

Contract

Configurable Catalyst Patient Complexity Score

& Stratification

Configurable cut point and initial;

program, PCP, and team attribution

Pre-enrollment patient list refinement (add/remove)

Final attribution to Care Program

Fina

l attr

ibut

ion

to C

are

Team

and

PC

P

Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance Measurement

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Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance MeasurementCare Management Strategy

demonstrate product flow

Agreement on:- Patient Centered Goals- Tasks to drive to Goals

Initial tasks are prioritized, scheduled, and dispersed

On an ongoing basis;- Goals are modified- Tasks are modified- Tasks are re-assigned- Alerts are created and sent based on

task- Extended care team members are

added (or removed) as needed- Secure SMS communication between

all playersTypes of tasks for patients include;- Education materials to be reviewed- PROM surveys to be completed- Daily activity and measurements to be

enteredTypes of tasks for care team include;- Active medications review- Follow up appointment creation- Identify local resource/support for

patient

Patient “discharged” from care program

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Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance MeasurementCare Management Strategy

demonstrate product flow

How are our patients doing?

How are we performing to our plan?

Is it working? Are we getting “Return on Engagement”

What do we do more of… what do we change?

Outcome

Process

Balance

Insights

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Poll Question

• Those of you who are a part of a health system, which of the following best describes your current state in care management?

• 141 respondentsa) We do not have a program and don’t plan on adding one – 9%b) We do not have a program and are evaluating starting – 25%c) We have a program, that isn’t working well – 19%d) We have a program that is successful but can get better – 47%

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Agenda• Care Management Strategy

• Product Demos

• Open Discussion

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- Patient Stratification

- Patient Intake

- Care Coordination

- Care Companion

- Care Team Insights

Care Management Products

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Care Management ProductsPatient Stratification

Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance Measurement

AB

A

BA

AB

A

BA

A

A

A

AA

AB

A Care Program A

Care Program B

Claims Clinical

EDW

Population Under at Risk

Contract

Configurable Catalyst Patient Complexity Score

& Stratification

Pre-enrollment patient list refinement (add/remove)

Final attribution to Care Program

Fina

l attr

ibut

ion

to C

are

Team

and

PC

P

Configurable cut point and initial;

program, PCP, and team attribution

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Care Management ProductsPatient Stratification

Demo

Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance Measurement

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Care Program A

Care Program B

Claims Clinical

EDW

Population Under at Risk

Contract

Configurable Catalyst Patient Complexity Score

& Stratification

Fina

l attr

ibut

ion

to C

are

Team

and

PC

P

Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance Measurement

Configurable cut point and initial;

program, PCP, and team attribution

AB

A

BA

AB

A

BA

A

A

A

AA

AB

A

Final attribution to Care Program

Pre-enrollment patient list refinement (add/remove)

Care Management ProductsPatient Intake

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Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance MeasurementCare Management Products

Patient Intake

Demo

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Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance MeasurementCare Management Strategy

Care Coordination

Agreement on:- Patient Centered Goals- Tasks to drive to Goals

Initial tasks are prioritized, scheduled, and dispersed

On an ongoing basis;- Goals are modified- Tasks are modified- Tasks are re-assigned- Alerts are created and sent based on

task- Extended care team members are

added (or removed) as needed- Secure SMS communication between

all playersTypes of tasks for patients include;- Education materials to be reviewed- PROM surveys to be completed- Daily activity and measurements to be

enteredTypes of tasks for care team include;- Active medications review- Follow up appointment creation- Identify local resource/support for

patient

Patient “discharged” from care program

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Care Management ProductsCare Coordination

Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance Measurement

Demo

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Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance MeasurementCare Management Strategy

Care Companion

Agreement on:- Patient Centered Goals- Tasks to drive to Goals

Initial tasks are prioritized, scheduled, and dispersed

On an ongoing basis;- Goals are modified- Tasks are modified- Tasks are re-assigned- Alerts are created and sent based on

task- Extended care team members are

added (or removed) as needed- Secure SMS communication between

all playersTypes of tasks for patients include;- Education materials to be reviewed- PROM surveys to be completed- Daily activity and measurements to be

enteredTypes of tasks for care team include;- Active medications review- Follow up appointment creation- Identify local resource/support for

patient

Patient “discharged” from care program

© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 46

Care Management ProductsCare Companion

Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance Measurement

Demo

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Care Management ProductsCare Team Insights

Data Integration

Patient Stratification

& Intake

Care Coordination

Patient Engagement

Performance Measurement

Demo

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Agenda• Care Management Strategy

• Product Demos

• Open Discussion