using analytics for successful plan and provider collaboration · 2019-10-29 · using analytics...

©Blue Health Intelligence, an Independent Licensee of the Blue Cross and Blue Shield Association. All rights reserved. Proprietary and Confidential. Blue Health Intelligence (BHI) is a trade name of Health Intelligence Company, LLC

Using Analytics for Successful Plan and Provider CollaborationOctober 16, 2019

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Our Speakers Today

Barb FernandezGuideWell Health

Melissa SingerGuideWell Health

Kimberly GaskaBHI

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Presentation Agenda

• What is Truli Health?– What is the Operating Model?– Foundational Strategic Goals– What is Truli Doing Differently?

• Data and Analytics Principles– How Does Data Governance Support Truli for Health’s Goals?– Utilizing a Common Data Platform– What Larger Analytic Strategy is at Play?

• Truli for Health and BHI’s Partnership – Leveraging National Data– Providing Targeted Audience Specific Analytics– Solution Timing

Who Is Truli for Health and What Market Issues Are They Addressing?

Provider Analytics For All | October 2019 | 5

MISSION and VISIONHelp people and communities achieve better health

Launching July 2020

Truli Overview


A highly curated network

Use high performing provider partners

Leverage Centers of Excellence

Truli for Health’s Four Strategic Pillars

Bi-directional data sharing through moderndata platform and analytics

Personalized member support

Real-time notifications to help membersmaximize their benefits and stay on course

A more integrated Plan/Provider operating model

Engaged and financially aligned delivery model

Optimize network configuration secured via a curated set of high-performing providers

Significant financial alignment betweenthe plan and providers to replicate the economics of plan ownership

Personalized benefits to support chronic care management and consumerism

Reduce cost shares on benefits that improvecare pathway compliance

Incent healthy behavior by awarding Care Credits

Co-develop provider-friendly, physician-led CareManagement Programs

Truli Overview


For product salability to local employer groups, GWHP will be an open access HMO. However, levers can be pulled to support PCPs in managing populations in a self-referral environment.

A Care Model That Supports Product Design

Member onboarding process will introduce the PCP as the member’s clinical guide to consult before seeking urgentor specialist care

Care and Disease Management supplement PCP’s course of treatment to provide additional support for members with chronic conditions (e.g., diabetes, hypertension)

Product design includes chronic condition management programs for members with certain disease states (e.g., diabetes, hypertension)

Lighter prospective medical necessity review requirementsfor high performing providers simplifies UM process

To provide services beyond Evaluation and Management, specialists must notify PCPs within preferred turnaround times before appointment in order for the specialist to receive payment forthe service1,2

GWHPProduct

Care Coordination

Levers

GWHP Care Model

Truli Overview


The GWHP product promotes access to high value care — care that provides the best health results for patients at the right price, in the right setting, for the right reason enabled through just-in-time data analytics. VBID promotes patients’ use of high-value care options by reducing cost sharing for treatments providing increased clinical value.

Truli’s Approach to Value Based Insurance Design (VBID)VBID

Program Goals

Guide Consumers via Product DesignPromote High-Value Care Delivery

• Reward providers for delivering health care based on clinical evidence

• Informed by clinical research that assesses the comparative clinical benefit of different treatment options and the cost of delivery

• Product designs encourage members to build relationships with their provider

• Allow consumers to get care that fits their conditions

• Provide resources that clearly explain value-based benefits structure to members


Truli Wants to Work Differently with its Provider Partners

• Easy access/use of information

• Low effort to extract actionable insight

• Reports that contain the latest and greatest information available

• More frequent, on-going reporting to evaluate changing performance results

• Reports with consistent results acrossdata sources

Providers’ Fears Providers’ Needs

We Don’t Trust Your Data We’re Not Engaged

Truli Overview

Lack of CommonValue-Based Care Insights

Leveraging Data and Analytics Differently?


Engaged Data Owners and Stewards

Policies, Procedures and Repeatable

Processes

Data Governanceand Quality Tools

Critical Success Path

Data Governance Practiced Daily

Governance at a Glance: Enabling a Truli Data Driven Health Plan

Data Governance DefinedData Governance is the orchestration of business-led decision making based on trusted data assets through a system of decision rights and accountabilities for information-related processes, executed according to agreed-upon models which describe who can take what actions with what information, and when, under what circumstances, using what methods. Data Governance enables controlled access to data at the speed of business.


Implementation of Data Governance and Qualitywithin the Analytic Strategy

Identify Data Owners/ Stewards

Truli for Health Data

Mart

BusinessGlossary

SystemHealth

Dashboards

Data Quality Scorecards

KDE’s

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AgilityFaster development and

deployment cycle to meet business needs

StabilityPhysical and logical layer

independence insulates end users from the underlying

physical data changes

VersatilityPull data from heterogenous data

platforms (RDBMS, no SQL, text files, applications, etc.) using API and other data transmission methods

BusinessFriendliness

Empower business to access data without relying on IT

BHI’s Common Data Platform (CDP): Best-in-Class Data Governance

Value Creations LeversSingle Source of Truth• All applications and methodologies share a single

common data model• Receive data one time for a customer and leverage

that data across all products

Operational Efficiency Goals• Streamline implementation processes for subsequent

product deployments• Supports and administers all internally and externally

developed methodologies• Enhances data with national data and other

supplemental data elements through virtualizationand API’s

Analytic Data Mart

• Ability to access data directly and apply BHI developed or customer developed methodologies and analytics

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Available Data SourcesMembership

Enrollment

Account Structure

Medical Claims

Pharmacy Claims

Dental Claims

Vision Claims

Hearing Claims

Capitation

Premium

Health Assessments

Care Management

Wellness (HRA, Lifestyle Coaching, etc.)

EHR/EMR Referral/Admission/DischargeBiometric Data

Lab Results

Engagement Status and Preferences

Call Center

Provider Reference, DesignatedProviders, ACO/System/Group

Relationships

Provider Network

Member Attribution

Socio-Economic, Behavioral, Lifestyle Factors

Program Participation

External Non-BCBS Experience

Demographicand

FinancialAdditional

Clinical


GuideWell Health Plans Analytics Strategy Overview

Customer Demands GuideWell’s Response

Improving outcomes, lowering costs, and increasing overall access to care

Transitioning away from fee-for-service and use fee-for-value models

Collaborative Requirements

Provide access to a single source of accurate, actionable, and timely information to:• Assess financial performance• Understand quality performance• Identify opportunities for improvement

Trended Spend by Category of

Service

Population Health and

Clinical Performance

QualityPerformance

Employer and

Group Analytics

Value Based Program

Performance

Provider Performance, Efficiency and

Profiling

ProductStrategy

Leading Indicators

and Predictive

Scores

Sales andDistribution

Revenue Program

Management

Success Blue Print

Provided data will be uniform and consistent data across all delivery channels (direct and indirect)

Promote the democratization of data by enablingself service analytic capabilities

Adhere to the “three click presentation rule”

Truli Overview

The Truli-BHI Partnership

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What Analytics for Everyone Looks and Feels Like

• More time can be devoted to analysis insteadof manipulating data

• Business knowledge is more important foranalysis than technical skill (SAS, SQL, R, etc.)

• Less time is spent on arts and crafts results assembly since custom and standardized reports are generated automatically

• Stories are more easily told and explained in an easy a variety of formats – including Mobily accessible tool

• Everyone has uniform access to summary dashboards an drill down capabilities to examine root causes

Assuring Democratized Information and Self-Service Insights

Time

Past

Current

Data Manipulation

Data Analysis

Knowledge

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National Benchmarks

Provider Analytics

Delivering Self-Service Insights via the WhyzenAnalytics Platform

Employer/Group Analytics

Analytics Data Platform that delivers:• A single source of uniform and consistent data across all delivery channels

• Broad and comprehensive capabilities and content

• Powerful associative data model

| One Platform Three Modules

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BHIs Provider Analytics

Delivering consistent data, transparent methodologies, and easy-to use analytic tools needed to support successful provider engagement and collaboration

Evaluate Manage Enable

Identify High Performing Providers

Monitor Clinical and Financial Results

Enable Collaborationand Care Coordination

• Identify Cost, Quality and Efficiency outliers

• Build high performing networks

• Spot opportunities to steer care to High Value Providers

• Evaluate potential partners for risk-based arrangements

• Measure Cost/Use/Price and Quality

• Identify opportunities to reduce cost and improve outcomes

• Track contract specific performance metrics

• Calculate financial settlements from contract parameters

• Deliver timely, actionable information on attributed/ designated populations

• Identify and communicate careand coding gaps

• Alter providers to patients with potentially high impact events

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Leveraging the Power of Our National Data WarehouseBlue Data Depth and Breadth

10+ YEARSof historic data

Data refreshedMONTHLY

Data conformedUNIFORMLY

19+ BILLIONhealthcare claims

95%OF ALL U.S.PHYSICIANS1 of 2

American lives

96%OF ALL U.S.HOSPITALS

75%PROVIDER EXPERIENCE

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Facility PCP Specialists

Cost and Efficiency Indexes • Case/mix and severity adjusted. Efficiency index uses Standardized pricing methodology.

• At the ACO/Contract, facility, PCP, and specialist level

• At the episode level

Quality Measurement• Combined Quality Index blends results of Readmission and Complication Indexes

• Unplanned 30-day Readmission Index

• Complication Index for major complications and infections

Care/Cost Efficiency Opportunities• Predicted potentially avoidable hospitalizations, admissions, and readmissions

• Retrospective opportunities for care/cost efficiency (e.g., complications, avoidable admissions, readmissions, ER…)

• Sites of services, leakage, members with outlier utilization, etc.

BenchmarkingLocal, national, custom benchmarks to measure relative performance of acute care hospitals, ambulatory surgery centers, ACOs,individual and various groupings of providers

Provider Performance Evaluation

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BHI’s Foundational Provider Capabilities

Population Cost and Utilization

Efficiency Opportunity

Quality Performance

CareCoordination

ContractPerformance

Member Roster Cost and Utilization ꟷ Drill to 3 Levels

InappropriateER Use

Contract Specific Quality Measures

Care and CodingGaps

Key Contract Metrics Dashboard

PopulationOverview

Medical and Pharmacy

Potentially Avoidable Events

Quality Benchmark Comparison

High Cost Claimants Financial Performance Estimates

Attribution Trend

Leakage Advanced Imaging Quality Trend CM ProgramEngagement

FinancialSettlement Report

Site of Service CM Alerts

Low Value Care MedicationNon-adherence orContraindication

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Guidewell and BHI’s Provider Analytics Timeline

Release 1 – Jan 2020 Release 2 – April 2020 Release 3 – July 2020

EvaluateManage Enable

Thank you

using analytics for successful plan and provider collaboration · 2019-10-29 · using analytics...

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