July 2015 accountable care webinar
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Accountable care and big data—meeting the challenge. Editorial webinar for July 22, 2015
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July 2015 accountable care webinar
- 1. WEBINAR WELCOME! Katie White Assistant professor of health policy and management University of Minnesota School of Public Health, Minneapolis Kim Kauffman Vice president of value-based care Summit Medical Group Knoxville, Tenn. Melanie Evans Moderator New York Bureau Chief Modern Healthcare During today’s discussion, feel free to submit questions at any time by using the questions box. A follow-up e-mail will be sent to all attendees with links to the presentation materials online. Jason Dinger CEO MissionPoint Health Partners Nashville Panelists: Accountable care and big data—meeting the challenge
- 3. NOW SPEAKING Please use the questions box on your webinar dashboard to submit questions to our moderator WEBINAR Accountable care and big data— meeting the challenge Melanie Evans Moderator New York Bureau Chief Modern Healthcare Accountable care and big data— meeting the challenge
- 4. NOW SPEAKING WEBINAR Accountable care and big data— meeting the challenge Please use the questions box on your webinar dashboard to submit questions to our moderator Katie White Assistant professor of health policy and management University of Minnesota School of Public Health, Minneapolis Accountable care and big data— meeting the challenge Accountable care and big data— meeting the challenge
- 5. Findings from Two Studies: Case Study Comparative Analysis of First Year Experiences of Select Medicare ACOs: Pioneer and MSSP Funded by The Medicare Payment Advisory Commission (MedPAC) Katie White, EdD, MBA, Dave Knutson, M.S., Jean Abraham, PhD, Peter Huckfeldt, PhD, Jessica Zeglin, MPH, Lindsay Grude, MPH, Matthew Timmel, MHA, Hannah Johnson, MHA, Jesse Eikenberry University of Minnesota School of Public Health Division of Health Policy & Management Findings and interpretations are those of the authors. Endorsement by MedPAC is not intended nor inferred
- 6. Background • Health sector underinvested in information technology • 80s and 90s decades of catching-up •HITECH Act 2009 – incentives for meaningful use: •2008 9% of hospitals had “basic or comprehensive EHR” whereas in 2013 60% of U.S. hospitals •ACA and Accountable Care Organizations • Venture capital investment $200M in 2007 to $2.4B in 2014
- 7. About the Studies • 6 Pioneers and 6 MSSP ACOs studied – maximize contrasts (geography, organization type, market position, 1st year results) • Case study comparative design • Site visits, series of team and one-on-one interviews, document review, survey (MSSP) • 3 geographic areas each: • Pioneer: Northeast, Southwest, upper Midwest • MSSP: South Central, Southeast, Midwest
- 8. Pioneer ACOs • For organizations with experience offering coordinated, patient- centered care, and operating in ACO-like arrangements • Established ability to manage financial risk contracts • Minimum of 15,000 Medicare beneficiaries with rural exceptions • 5 year timeframe –Years 1-3: FFS-based –Years 4, 5: transition to population-based payments 32 organizations nationally in first year, 19 remaining
- 10. Findings: ACOs & HIT • Organization structure & history mattered • Focus on structure for value analytics/ population health • Pioneers - health information technology infrastructure in place • MSSP - Steep learning curve for developing data infrastructure & analytics resources (especially for IPAs) • External vendors to complement internal IT capabilities • Predictive analytics/ risk stratification • Health Information Exchange (HIE)/ data warehouse
- 11. Findings: ACOs & HIT • Physician portals/ dashboards • Multiple EMRs (one IPA in MSSP created own HIE) • Sharing data across partners • Tracking care transitions/ alerts • Tracking quality metrics was difficult • Goals: to translate data from claims & EMRs into information to effectively manage care & monitor performance
- 12. NOW SPEAKING Please use the questions box on your webinar dashboard to submit questions to our moderator WEBINAR Accountable care and big data— meeting the challenge Kim Kauffman Vice president of value-based care Summit Medical Group Knoxville, Tenn. Accountable care and big data— meeting the challenge
- 13. In Pursuit of Actionable Data: Summit Medical Group
- 14. Formed 1995 220 physicians 150 PCPs 50 hospitalists 20 pulmonologists 140 advance practitioners 54 practice locations 12 counties in southeast TN 275,000 primary care pts 1.1 M pt encounters Lab, imaging, urgent care Formed 2015 Business partner of SMG Practice management Pop health management care coordination health education provider engagement data analytics risk adjustment quality reporting Strategies for “better care, lower cost”®
- 15. Strategy vs. Culture Aligned incentives Transparency Dashboards
- 16. In House DISEASE REGISTRIES • Pts with CHF and / or COPD treated by Summit PCP in BOTH time periods * 25% of pts engaged by CC as of Q1 2013, expense ↓ 6.7% * Pts not yet engaged by CC as of Q1 2013, expense ↑15% ($7M) • Admission D/C Transfer feeds • Physician referrals in EMR
- 17. Outsourced – paid claims analytics
- 19. Within Specialty, Analysis of Services
- 20. Within Specialty, Analysis of High Volume TIDs
- 22. NOW SPEAKING Please use the questions box on your webinar dashboard to submit questions to our moderator WEBINAR Accountable care and big data— meeting the challenge Jason Dinger CEO MissionPoint Health Partners Nashville Accountable care and big data— meeting the challenge
- 23. The IT Behind Accountable Care
- 24. Setting the Stage – MissionPoint 2 States Served 7 Providers 7,200+ Members 250k Health Spend Managed $XXB$1.5B Onsite & Multi- Employer Clinics 5
- 25. Data Drives Decisions 3 Connected by Data robust analytics help target interventions and drive results • Population Analysis • Comprehensive Analysis of Population via 3 – 5 years of claims data • Risk Scores Assigned, Allows for Proactive Outreach • Benchmarking set for industry, geography and risk distribution • Care Management Tool Enables Comprehensive View of Member • Health Partners access to hospital and provider EHRs, past claims data • Enables communication between Health Partners and Providers
- 26. 4 Population 360 Analysis Drives Health Partner Outreach Using Data to Understand A Population Population 360 Analysis Plan Paid by Individual Spend Stratifications Company A Percent Costliest Individuals Contributing to X Percent of Spend 1% 32% 5% 62% 10% 75% 20% 87% 50% 98% 100% 100.00% 3 – 5 Years Health Claims
- 27. 5 Patient Data Maximized to Guide Effective Interactions Managing Patient Risk Prioritize Highest Risk Members: Immediately deploy Health Partners to patients during “trigger events” – the importance of real time interfaces should not be underestimated Target Members Showing Warning Signs: Track future risk scores and population trends for proactive Health Partner engagement – clinical data still rules stratification and informs predictive models Create Opportunities Across Members: Leverage highly effective, low cost screenings and preventative care for optimal health outcomes across members Healthy Members At-Risk Members High-Cost Members Rising-Risk Members Data Determines Outreach
- 28. 6 ED Utilization Hospital Admissions Medical PMPM Drug PMPM Severe Heart Failure Musculoskeletal Active Cancer Asthma >300% above benchmark >200% above benchmark >100% above benchmark 0.1-100% above benchmark 0.1-10% below benchmark >10% below benchmark >25% below benchmark Utilization/Expenditure Overview Compared to Benchmark Values Data reveals that low asthma drug utilization is driving higher than typical ER usage in Asthma patients Data Drives Interventions
- 29. Patient Information Supports Effective Engagement • ED activity analysis quantifies utilization and savings opportunities by patient, by day of week and versus benchmarks • Frequent users can be identified and grouped for care management intervention Patient Profile highlights cost drivers, chronic conditions and compliance with Evidence Based Measures Ambulatory Care Team is able to build an overall strategy based on risk scores and historical behavior
- 30. 8 Tomorrow Today Machine Learning and Predictive Modeling The Internet of Things The Rise of Mobile Data Convergence: Persons, Places, and Things
- 31. TODAY’S PANELISTS During today’s discussion, feel free to submit questions at any time by using the questions box Katie White Assistant professor of health policy and management University of Minnesota School of Public Health, Minneapolis Kim Kauffman Vice president of value-based care Summit Medical Group Knoxville, Tenn. Melanie Evans Moderator New York Bureau Chief Modern Healthcare Jason Dinger CEO MissionPoint Health Partners Nashville WEBINAR Accountable care and big data— meeting the challenge Accountable care and big data— meeting the challenge
- 32. Expect a follow-up email within two weeks with links to presentation materials and information about how to offer feedback. For more information about upcoming webinars, please visit ModernHealthcare.com/webinars Thanks also to our panelists: Accountable care and big data—meeting the challenge Katie White Assistant professor of health policy and management University of Minnesota School of Public Health, Minneapolis Kim Kauffman Vice president of value-based care Summit Medical Group Knoxville, Tenn. Melanie Evans Moderator New York Bureau Chief Modern Healthcare Jason Dinger CEO MissionPoint Health Partners Nashville WEBINAR THANK YOUFOR ATTENDING