The 5 Pillars: A Structured Approach to Program Design in Turbulent Times

As leaders during this very uncertain period in healthcare, we must remain focused and flexible. During this presentation, we will explore a structured approach to assessing population health management programs and how you can use that approach to position your organization for rapid response to the myriad changes occurring within the industry. We will focus on program structure, technology, engagement and analytics decision points in our discussion.

Transcript

1. Elizabeth Barnett, BSN, JD The 5 Pillars: A Structured Approach to Program Design in Turbulent Times
2. World Health Organization: Healthcare = 18% of GDP and rising; Consumer out-of-pocket costs = 21% Affordable Care Act: Adding millions of previously uninsured into system through Medicaid expansion(~ 6 million) and Exchanges 76 Millions of Americans eligible for Medicare in next 15 years Almost half of us have chronic conditions requiring at least one form of medication Regulatory changes: MACRA, HIPAA, MLR, ICD-10, ACA Sociopolitical forces driving health insurance exchanges and healthcare retail markets Increased use of cloud computing, mobile devices and telemedicine with personal & clinical data Use of genomic medicine trending upward . 2 How We Got Here…Healthcare’s Perfect Storm
3. Rapid technological innovation is making solutions available that were not possible before How the Perfect Storm Is Impacting Healthcare Organizations driving a shift to PHM and value-based care while controlling costs and improving care Stakeholders must re-think roles 5/1/2017 3
4. Population Health Management 4
5. Patient-Centered Holistic Care Model 5 40% 33% 25% 65+, men 65+, women 50-64 % up to date with all age-specific recommended preventive services 62% 70% 47% Screened On Medication Hypertension in control % of hypertension patients Decades of DM by payers, chronic illnesses are still not well managed Healthcare Dive, Aug. 11, 2016 Case Study: Behavioral Health Associates (BHA) integrated into UCLA Health (ACO) 4% 13% 2012 2015 21% Diagnosed with a behavioral health disease % primary care patients treated by (BHA) 13% reduction in ED visits for BHA patients Social/economical Clinical Care Physical environment Personal behaviors Focusing on clinical care may not be sufficient Robert Wood Johnson Foundation, Health Affairs, 2014 CDC: A Framework for Patient-Centered Health Risk Assessments, 2011 The Relative Contribution of Multiple Determinants to Health Outcomes Copyright 2016 ZeOmega. All
6. 6 Design programs and platforms that address the nuances of Engage stakeholders who Aggregate and integrate Better understand patient risks with Deliver patient-centered care leveraging • Medically complex populations • Regulatory requirements and quality measures • Multiple payment models • Today’s as well as future healthcare environment • Network performance management • Are involved in the entire care continuum, including patients, physicians, care teams, payers, etc. • Need tailored programs for patient activation/ engagement • Have diverse preferences in communications • Data from disparate sources across the entire care continuum, and • Meet the needs of data convergence: clinical, financial, etc., to • Provide a true 360- degree patient-centric, longitudinal view for care teams • Accurate risk analytics based on comprehensive patient data • Identification of risk drivers • Assessments unique to the patient and focusing on clinical as well as social determinants • Care plans unique to the patient and focusing on clinical as well as social determinants of health • EBM and best practices • Sharing and coordination among multi-disciplinary care teams The Population Health Management Challenge
7. A Foundational Approach to Addressing the Issues . 7 The 5 Pillars of Population Health Management Program Design and Governance Data Integration and Aggregation Actionable Intelligence Holistic, Patient Centered Care Management Stakeholder Engagement Population Health Management
8. • Compliance, Cost, Quality, • Clarity on measurement of the short and long term goals • Assessment of current capabilities and strengths • Current weaknesses and gaps in capabilities required to achieve long term goals • Ensures incentives of all stakeholders are aligned • Achieves short term goals quickly, and builds on these to tackle long term goals • Metrics to measure achievement of goals • Periodic (preferably real time) monitoring P1: Program Design & Governance Leadership commitment and change management strategies. Technological capabilities can determine how successful your PHM program will be. PHM Goals Current Capabilities The Plan Performance Measurement & Monitoring . 8
9. Legacy Current Next Generation P2: Data Integration & Aggregation Structured Unstructured Real time, self authenticating data exchange Point to Point Batch Key Considerations: • Master Patient Index • Master Provider Index • Elimination of duplicates • Tracking the authenticity & quality of data sources • Natural Language Processing • Data Normalization & Tagging Non-Clinical Clinical Demographic, Claims, Billing, HCC Scores, Scheduling Imaging, Lab, Diagnostics, Pharmacy, EMR, Biometrics . 9
10. P3: Actionable Intelligence Platform driven real-time adjustment of risk, propensity to change Optimization of resources based on outcome and behavioral change prediction – BEST THING TO DO NEXT Predictive Analytics Low Actionability & Effectiveness High Embedded analytics in workflow, risk Identification and stratification, dashboards (Star, ACO measures, patient registries) Data Mining & BI Ad-hoc Reporting BI Tools, limited to power users, static dashboards to support business users Real-time Big Data Analytics drives personalized pop health Claims, ICD9/CPT + Lab, drug, diagnostic data + HRA, demographics, personal preferences + Behavioral, provider quality/ cost, biometrics, EMR structured data Unstructured data + Consumer data, environmental data Compliance reports, standard outcomes reports Basic Reporting Time Legacy Current Next Generation . 10
11. P4: Holistic, patient-centered care management  Evidence-based medicine that is completely personalized to the individual  Meeting the patient, their advocate, and the care team where they are with the right technologies  Actionable intelligence that accounts for not only medical needs but also behavioral, psychological, social, financial, emotional, environmental, spiritual, and cultural factors in driving actions – the BEST THING TO DO NEXT . Rules Engine Care Management Teams Facility and Ancillary Providers Analysts Caregivers Payers Administrators Pharmacists Physicians
12. P5: Stakeholder Engagement Educate Engage Empower It is all about getting Patient & Physician Commitment and Empowerment • Deliver the right information at the right time in the right communication channel to the right stakeholder • Analytics that clearly assess need for change, propensity to change, factors that drive change, timing for change, and factors that induce change fatigue • Decision Support Tools • Cost/ Price Transparency • Quantification of Quality • Convenience .
13. The Five Pillars of Population Health Management . 13 Population Health Management Program Design and Governance Data Integration and Aggregation Actionable Intelligence Holistic, Patient Centered Care Management Stakeholder Engagement  Performance management dashboards  Data mining and reporting  Manage multiple lines of business  Patient consent management  Health information exchange  Enterprise master person index  Enterprise date warehouse  Integration engine  Analytics  Patient registries  Actionable assessments  Rules-based expert system  Evidence-based medicine by age groups  Multi-disciplinary care team support  Personalized care plans  Referral management  Portal & mobility solutions  Direct secure messaging  Patient activation  Multi-channel communications
14. Discussion 14
15. Managing Care in the Online Environment 15