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Citi's Population Health Management Virtual Conference
Citi's Population Health Management Virtual Conference
Citi's Population Health Management Virtual Conference
Citi's Population Health Management Virtual Conference
Citi's Population Health Management Virtual Conference
Citi's Population Health Management Virtual Conference
Citi's Population Health Management Virtual Conference
Citi's Population Health Management Virtual Conference
Citi's Population Health Management Virtual Conference
Citi's Population Health Management Virtual Conference
Citi's Population Health Management Virtual Conference
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Citi's Population Health Management Virtual Conference

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Tangible Challenges for Risk-Bearing Providers

Tangible Challenges for Risk-Bearing Providers

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  • 1. Citi’s Population Health Management Virtual Conference June 2013
  • 2. Tangible Challenges for Risk-Bearing Providers • 360 degree view of risk profile Performance Management System Performance Medical Cost Management • Monitor and manage contracted risk over time • Optimize network and drive patients to efficient care • In-network/out-of-network visibility • Gaps in provider network / referral leakage • Trends and risk-adjusted benchmarking Quality Care Management • Quality metrics and goals (ACO33, PQRS, HEDIS) • Data from multiple sources for complete view • Patient-level detail to ID specific gaps to work on Care Management • Population-level view of conditions driving cost/risk • Integrated whole patient data • Act on patient-level opportunities and drive engagement Population Health © 2013 Verisk Health, Inc. All Rights Reserved 2
  • 3. Data Data-driven Performance Medical Claims Charts Insight Actions Data Aggregation Flexible, membercentric, scalable warehousing Other (paper & electronic) Rx Claims (e.g., HRA, labs, bio) Eligibility (from multiple payers) Intelligence Risk profiling Benchmarks Gaps in care Quality scores Provider profiling Disease registry Cohort tracking Predictive models Tools Drill downs Reporting Patient index Nurse dashboards User-defined fields Query-builder Medical Cost Management Total Patient Experience Visibility Ensure the Right Care, Time & Place Budgeting & Risk Contract Management Quality of Care & Reporting Understanding Population Risk © 2013 Verisk Health, Inc. All Rights Reserved 3
  • 4. Provider Intelligence Analyze Cost of Care and Outliers • Total per member per month costs • Spotting those driving costs • Procedures, medications, and other details Identify and Manage Gaps in Care • Patient level (gaps in care, disease registries) • Provider level (referrals/leakage, PCP level analysis) Understand Future Risk • DxCG risk models used by payers • Predictive modeling • Use across various at-risk populations • Support shift to value-based purchasing © 2013 Verisk Health, Inc. All Rights Reserved 4
  • 5. Risk-Adjusted Variation in System Performance Care Gap Score © 2013 Verisk Health, Inc. All Rights Reserved PMPM Cost/ Cost Member Efficiency 5
  • 6. Understanding Drivers of Performance Variation The Provider’s Illness burden is 11% higher than average The Provider’s care gap index is higher than peers Total cost of care for all providers treating the panel is 55% higher than the risk expected cost Admission rate is 10% higher than expected ER encounters are 2.76 times higher than expected © 2013 Verisk Health, Inc. All Rights Reserved 6
  • 7. Peer Performance Metrics to Monitor to Care Guideline and Provide Actionable Feedback Assess each provider’s care gap profile, compare to peers, and identify individuals to target for care © 2013 Verisk Health, Inc. All Rights Reserved 7
  • 8. Pinpoint Individuals for Care Improvement 8 © 2013 Verisk Health, Inc. All Rights Reserved 8
  • 9. Guide Patient Engagement © 2013 Verisk Health, Inc. All Rights Reserved 9
  • 10. Cohort Analysis to Monitor Trends & Measure Outcomes Diabetes Cohort: Comparing outcomes between Diabetics with Gaps and a cohort who complied with guidelines • PMPM costs are lower for diabetics who are compliant with guidelines. Key utilization measures like hospitalization rates are also lower in the better managed cohort. • Leverage data driven analytics to assess the cost of non compliance and the impact of care intervention • Create care strategies and track their impact © 2013 Verisk Health, Inc. All Rights Reserved 10
  • 11. Q&A Thank You! © 2013 Verisk Health, Inc. All Rights Reserved 11

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