Driving Population Outcomes with Data Sciences

Transcript

1. Tracy Korman Driving Population Outcomes with Data Sciences
2. Agenda • Changing Landscape • New Imperatives • Primary Use Cases • Panel Discussion 2
3. Source: CMS Changing Landscape for Payers and Providers 1. Regulatory uncertainties but also clear momentum ⁃ “Nobody knew that healthcare could be so complicated” ⁃ Repeal? Replace? Repair? Reword? Retreat? ⁃ States thrust into lead but with funding constraints ⁃ Momentum: value based payments for providers and risk and quality based payments for payers 3 Today 2018
4. Changing Landscape for Payers and Providers 2. Aging demographics, declining health status, and rising poverty further stressing the ecosystem ⁃ Americans living, working, or on disability longer ⁃ Larger chronic medical and mental disease burdens ⁃ Greater social stressors and behavioral drivers 4 Source: U.S. Administration on Aging using US Census data; HealthDSG analysis Source: Gaudette et alia, “Health and Health Care of Medicare Beneficiaries in 2030, Forum Health Econ Policy. 2015 Dec; 18(2): 75–96. HealthDSG analysis
5. Changing Landscape for Payers and Providers 3. Continued market consolidation of payers and providers ⁃ Build greater scale ⁃ Leverage branding, quality, and technology ⁃ Increase negotiating strength 4. Innovations in delivery, payments, and risk sharing blurring the lines between providers and payers ⁃ Boundaries dissolving between care delivery and care management ⁃ Who owns risk and costs for readmissions, complications, low quality treatment practices... 5
6. Changing Landscape for Payers and Providers Value and risk based payment models driving fundamental change in payer business models 6 Old Model • Market selector • Broad network assembler • Conservative rate card setter • Less competitive pressure New Model • Population care manager • Performance network builder • Intense competition focused on quality outcomes and price
7. Population Health Strategic Imperatives 1. Quantify how population risk factors drive utilization and cost outcomes 2. Stratify and segment for precise and effective interventions 3. Address medical risks, social determinants, and behavioral blockers as far upstream as possible 4. Steer members to providers with best practice patterns and high quality to cost ratios 5. Manage care of members with high modifiable risks and ready to engage 6. Use payments to share risk, reward quality, and promote integrated care 7 Require Data: • Integrated • Trustworthy • Transparent • Enriched That Feeds: • Risk models • Stratification • Segmentation • Chase lists • Engagement • Workflows • Metrics • Value payments
8. Primary Population Health Use Cases 1. Reduce inpatient overutilization by managing admissions, length of stay, and readmissions 2. Steer utilization to highest value / lowest cost providers and settings 3. Increase and improve care management and coordination of high risk members 4. Improve medication compliance while reducing downstream substance abuse risks 8
9. Panel Discussion • Sean Jessup, Director, Medicaid Programs, Eastern Oregon Coordinated Care Organization • Marion McGowan, Chief Clinical Officer, UPMC Health Plan • Tom Warnes, PhD, Chief Operating Officer, Health Integrated 9
10. Panel Questions 1. How are population health and data sciences changing as components of your care management and business strategies? 2. What population health success stories can you share and what are the key drivers of that success? 3. How has data or data perceptions blocked or enabled your population health initiatives? 4. Where is data or innovation stuck in silos in your plan and what steps are you taking to break them down? 5. Do you prioritize initiatives that directly touch members versus those that work through providers? Why? 6. Do you feel nimble enough to keep up with pace of change? How fast do you need to go from opportunity ID to launch? 10
11. Managing Care in the Online Environment