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Population Health Management

ITENTIVE WEBINAR SERIES

IntroductionOur healthcare system has its challenges. These include:

A fragmented system based on a sickness model

A high prevalence of chronic conditions

An aging population with an increasing number of chronic conditions

Transitioning payer markets

The need to understand new technologies designed to make treating chronic diseases easier

Non-compliant patients when trying to implement health management programs

A Few Statistics

• 133 million Americans have chronic conditions One third of young adults aged 18-34 have at least one

chronic condition

One third of adults aged 45 to 65 have at least one chronic condition

90% of the elderly have at least one chronic condition

Chronic ConditionsThe treatment of ongoing chronic conditions accounts for the largest percentage of healthcare costs in the American health system today. These include:

Diabetes,

Congestive heart failure

Coronary artery disease

Asthma

Depression

To name a few…..

Cost of Chronic Conditions

• By 2020, 157 million people are expected to have a chronic condition• 81 million will have multiple chronic conditions

• More than 75% of all health care costs are due to chronic conditions• Four of the five most expensive health conditions

are chronic conditions (heart disease, cancer, mental disorders, and pulmonary conditions)

• By 2023, the top 7 chronic conditions will cause the US $4.2 trillion in treatment costs and lost economic output

Ambulatory Market

A Transitioning Market• Shifting away from Volume-based towards value-

based reimbursement models Fee-for-outcome services in rules based precision care

are transitioning away from in office services towards minute-clinic like entities i.e. Walmart, CVS, etc.

Greater number of NP based practices

• Value based models focus on quality over quantity Most well known value-based program: Meaningful

Use

• Payers and Insurance Companies are looking to embody value-based reimbursement programs Greater alignment of incentives for the consumer,

customer, and provider

Jeffery, Bendix. "Top 10 Challenges Facing Physicians in 2014." Modern Medicine Network. 25 Dec. 2013. Web.

Changing Trends

Volume-based reimbursement models already exist in the private market, and it is expected more private insurance companies will implement these types of programs

• In California, 200 physician organizations participating in a statewide Pay for Performance Program received over $450 million in incentives through 2012 from the following private payer participants:

Aetna

Anthem Blue Cross

Blue Shield of California

Cigna Healthcare of California

Health Net

United Healthcare

Western Healthcare Advantage

Christensen, Clayton M., and Jerome H. Grossman. The Innovator's Prescription: A Disruptive Solution for Health Care. New York: McGraw-Hill, 2009. Print.Value-Based Pay for Performance: Rewarding Affordability Alongside Quality (Health Affairs Blog ValueBased Pay for Performance Rewarding Affordability Alongside Quality Comments)

Healthcare Networks

Healthcare networks will be structured to profit from keeping chronically ill patients well

• Bundled payments for services

• Episodes of care

• Meaningful Use, PQRS, CQMs, etc.

• Shared Savings Programs

• Patient Centered Medical Home

• Payer owned IPAs

• Per-month membership programs

The New Role of the ProviderProviders will take on the management and oversight of patient behavior intensive diseases with compensation based on outcomes through population health management creating a new challenge…

Regardless of whether the patients are compliant or non-compliant, chronically ill or well, the health outcomes will be the basis for reimbursements

Changes in Approach

Shifting Market• We must recognize that the patient population is shifting

Aging population

Increase in Obesity Rates

Stagnant Smoking Rates

Increase in chronic conditions

Increase in multiple chronic conditions

• These trends directly result in greater challenges to manage a patient population in a value-based, pay for performance world

The Patient Factor• We must recognize that patients

are often non-compliant. According to the New England Journal of Medicine, people with chronic conditions only receive 56% of the recommended care they should receive

There is a lack of adherence to the processes involved in care

• Only 52.5% of patients obtain their suggested screenings

• Only 58.5% of patients receive the recommended follow-up care

In order to overcome the patient factor….we must change our approach.

Transition from Reactive to Proactive Increase patient engagement for preventative care Work to prevent patients from falling through the

cracks Increase quality reporting for value based measures Improve return visits, compliance, patient outcomes Create target outreach for patients identified as

needing additional care to have positive health outcomes

What exactly is Population Health Management?

• Active approach to proactively manage medical conditions of patient populations with the primary goals to: Reduce the cost of care while improving outcomes

Increase adherence to programs and care plans at a mass level

Reduce health care inequalities and disparities

• This approach requires data, interoperability, and analytics to address specific problems and to mitigate risk at a mass level

EHR and Population Health Management

• Electronic Health Records improves the ability of physicians to more effectively analyze their patient population Mass collection of data

Easily collaborate with multiple healthcare organizations

Focus on quality improvement metrics• Reminders for immunizations and preventative

diagnostic studies

• Ability to configure clinical protocols

Efficiently reaches out to patients with health disparities through automated processes

"How Can Electronic Health Records Improve Public and Population Health Outcomes?" HealthIT.gov. 15 Jan. 2013. Web.

Population Health Management Benefits

Patient Benefits

• Reduce the frequency of Emergency Room visits and hospitalizations

• Lower the cost per service

• Improve patient experience, especially with improved access to care

• Promote patient engagement

• Empower patients through participation of care plans

• Provides the ability to monitor patient compliance electronically such as diabetic patients with high A1C levels, hypertensive patients through blood pressure checks, reminders for preventative screenings, reminders for flu shots, etc.

Physician Benefits

• Maximize financial return in value based care

• Increases reimbursements for preventative screenings

• Shared saving opportunities

• Increases patient satisfaction

NextGen Care

NextGen Care• Provides the opportunity to proactively engage with patient

population to increase outreach, improve outcomes, and grow ROI

Quickly identify at-risk patient population and take actions efficiently

• Expands upon the original features of NextGen Population Health

Encompasses data and information from NextGen applications

• EHR, Practice Management, Patient Portal, Dashboard, Population Health, and Share

• Partnered with Milliman, a healthcare actuarial firm with expertise in patient risk to develop NextGen Care in order to easily identifies patients with high, medium, or low risk

NextGen Care• Major Concepts

Risk Stratification for Care Management and Outreach

• Shares data with NextGen applications to stratify patient data based low, medium, or high risk

Organized to take action effectively and efficiently with an automated outreach feature that can be customized based on patient conditions and stratified demographics

• Fully utilize the Population Health Management tool

Integrated Care Management

• Track patients and identify gaps in care, such as missing immunizations, lack in follow-up care, labs that are due, etc.

• Access to patients’ charts, patient dashboard, add recall plans, send messages to the portal, create tasks, refer patients, generate documents to quickly take action

Advanced Integration with NextGen Ambulatory Suite

• Quickly identifies preferred contact method

Risk Stratification and Quick Action

NextGen Population Health• Integrated into NextGen Care

• Six major functions: Care Management, Risk Stratification, Patient Engagement, Referral Management, Data Sharing, and Analytics

Targets patients for follow-up

Risk Stratification• Identify at-risk patients

• Example: Hypertensive patients over 65 years old who have not had a blood pressure check in 6 months and do not have an appointment in the next 2 months

Track outreach and measure performance of program to identify treatment opportunities• Run reports such as Expected Revenue by Appointment Type,

Patient Response Time Details, ROI Projections by Chronic Condition

In conclusion…

• There will be challenges in implementing the quality metrics that value based reimbursement programs create

• New tools could allow for quickly identifying at-risk patients that would reduce reimbursement rates and have negative health outcomes

• Automated processes allow providers to quickly and efficiently take care of the most challenging patients Flu shot visits, diabetes management, hypertension

management, preventative screenings, cancer screenings, and more

• Tracking outreach methods could result in the most effective way to identify missed treatment opportunities

Questions

Lindsay Tarolli• Implementation Consultant

• ltarolli@Itentive.com

• (224)220-5557

Cynthia Kincade• Vice President – Client Solutions

• ckincade@Itentive.com

• (224)220-5575

Thank you