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Are You Risk-Ready?

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Presentation delivered to the National Association of ACOs NAACOS. Using Government Benchmarks to Identify, Quantify and Reduce Low and No-Value Care to Succeed in Risk

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Are You Risk-Ready?

  1. 1. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Are you Risk-Ready? Using Government Benchmarks to Identify, Quantify and Reduce Low and No-Value Care to Succeed in Risk
  2. 2. 2 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. CMS: 50% of FFS will be gone by 2018 CMS Means Business! These are just the first pieces to move and transforming payment across the system! Current payment models aren’t changing provider behavior. Providers need help. Effects of Health Care Payment Models on Physician Practice in the United States, May 2015. CMS and The End of FFS Goals for Value
  3. 3. 3 Paid more to perform more & higher intensity services Investment in capital for higher intensity services to attract profitable service lines Sicker population may be more profitable Paid the same regardless of service volume & intensity Investment in efficient and valuable providers & services Healthier population is more profitable FFS Status Quo BPCI Voluntary Value Mandatory System incentivized to keep people healthy and out of the operating room and physician office CJR Mandatory PCMH Voluntary MSSP Voluntary Next- Gen Voluntary This is only the beginning. CMS is getting more aggressive in pushing providers towards risk with the goal of value/capitation FFS Reimbursement Experimentation/Bridge the Gap Value-Based System incentivized to do stuff – Visits, procedures, scripts System incentivized meet quality outcomes and reduce cost incrementally The Future CMS and The End of FFS Goals for Value
  4. 4. 4 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. PercentofRevenue Time Identify & Quantity Value Population Health as Social Investment Profit through bonuses or savings against a flawed benchmark Population Health Proficiency as Profit Driver Profit through pop health management and low value care reduction Short Term: Capture Savings from Program Design Flaws Success driven by market drivers & network performance Long Term: Success from Efficient Networks Value driven by overall population health outcomes and system efficiency Make the leap Are You Risk-Ready? Making the Leap
  5. 5. 5 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. We’ve Been Asking the Wrong Questions How can we capture value by keeping a population healthy? The best clinical performers may be generating the most no-value care because of FFS incentives Are You Risk-Ready? Ask the Right Questions
  6. 6. 6 Are You Risk-Ready? The High Stakes of Low-Value Care The economic driver for pay for value programs is the ability of a government program or marketplace arrangement to not only achieve Triple Aim goals but to also mitigate Low-Value services, which account for thirty cent of every dollar spent on the delivery of care. Over $9B in Orange County, CA $850 Billion Unnecessary Spend in 2014 (Institute of Medicine) Institute of Medicine (IOM) report, “Best Care at Lower Cost,” (Sept. 2012) estimates that the United States lost $750 billion in 2012. (Adjusted in 2013 at $800BB, 2014 at $850BB.) This is about 3% of GDP or roughly the DOD budget for the Iraq War over an 8 year span. No-Value Care (30%) Necessary Utilization (70%) “It’s generally agreed that about 30 percent of what we spend on health care is unnecessary. If we eliminate the unneeded care, there are more than enough resources in our system to cover everybody.” -Dr. Elliott Fisher, Dartmouth Institute for Health Policy “Bigger than higher prices, administrative expenses, and fraud, however, was the amount spent on unnecessary health-care services.” In just a single year, up to 42% of patients receive “No Value” Care. - Dr. Atul Gawande, Department of Health Policy and Management at the Harvard School of Public Health & Department of Surgery at Harvard Medical School
  7. 7. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. CMS is Paying On It 2016 World Economic Forum Annual Meeting in Switzerland On track to sunset 50% of FFS They Mean Business!
  8. 8. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Media Is Reporting on It “Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.”Dr. Atul Gawande, Professor, Department of Health Policy and Management at the Harvard School of Public Health & the Department of Surgery at Harvard Medical School.
  9. 9. As value-based payments increase, physicians will finally be rewarded for quality, rather than quantity of care. With financial incentives, doctors who practice efficient medicine will get even better, while doctors who have made a living on fee-for-service will have to change their practice patterns, or be left behind. Our Risk-Readiness® metrics will make your material unique in educating the general public on the changes that are coming to their health care. 9 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. CMS is committed to value-based care. Physicians and Payers know it. Now let’s tell consumers. Population Health in a Value Based World The High Stakes of Low-Value Care
  10. 10. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Patients Demand It "It's no secret that patients often undergo unnecessary procedures that can be dangerous and costly." Through our collaboration with RowdMap, we are providing patients with meaningful information about these no- or low-value treatments, allowing them to make better, more informed decisions about their doctors, hospitals and medical care.”
  11. 11. 11 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed No Value Care The economic driver behind both the policy push and market drive towards value based programs, as well as the criteria for success in value based programs is the ability of a government program to reduce Low-Value Services. Research Evaluating CMS & Private Plan Programs: “Do they reduce Low Value care?” CMS Critique of Fee for Service: “FFS has too much Low Value care.” Popular Press Reporting and Provider Rankings: “Consumers are/should avoid Low value care.” “…care management programs should incorporate a system for evaluating low- or no-value care (i.e., higher intensity treatments that do not yield better outcomes).”
  12. 12. 12 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Leading the way… US CTO on RowdMap: “Visionary Genius” ABOUT ROWDMAP CMS Knows We Help You …in the shift from fee-for service to pay-for-value. CMS: 50% of FFS will be gone by 2018 Current payment models aren’t changing provider behavior. Providers need help. Effects of Health Care Payment Models on Physician Practice in the United States, May 2015.
  13. 13. 13 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. RowdMap is a Risk Management Tool to match and support the evolution of the payment system towards paying for long-term value (better health outcomes for fewer $ over time) RowdMap identifies the fundamental building blocks that enable the consistent delivery of high value care ABOUT ROWDMAP What We Do
  14. 14. 14 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. ABOUT ROWDMAP What We Do RowdMap’s Risk-Readiness® benchmarks help health plans, physician groups, and hospital systems identify, quantify, and reduce delivery of no-value care—a central tenet of successful pay-for-value programs. RowdMap has no-value care and population health benchmarks for… every physician every hospital every zip code …in the United States. “It’s generally agreed that about 30 percent of what we spend on health care is unnecessary. If we eliminate the unneeded care, there are more than enough resources in our system to cover everybody.” -Dr. Elliott Fisher, Dartmouth Institute for Health Policy No-Value Care (30%) Necessary Utilization (70%) Did you know that more than $850 billion in no-value care is delivered annually in the U.S?
  15. 15. 15 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Health plans and providers in 46 states and the District of Columbia use RowdMap’s benchmarks to reduce the delivery of no-value care. RowdMap’s benchmarks help manage the $850 billion the nation spends on care that leads to no better outcomes. The clients RowdMap serves collectively cover the lives of more than 91 million Americans. RowdMap was founded in 2011 and has grown to more than 30 employees with offices in Louisville, KY and Portland, ME. ABOUT ROWDMAP RowdMap by the Numbers
  16. 16. 16 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Unexplained Variation Often Low-Value Care is the result of perverse incentives from Fee for Service payment models but identifiable as unexplained variation within practice patterns. The estimated 30% of medical expense that goes to no-value care. Unnecessary spending drives billing in a fee-for-serve economic model, but success in pay-for-value comes from managing and mitigating these pockets of variation. Variation: Unwarranted or Unexplained? Every physician has a unique fingerprint Economic Drill Down: Example Utilization Review and Actuarial Unit Cost Analysis against Care Intensity Curve across Total Basket of Care Variation across geographies and within practices across physicians. “Physician-Level Practice Variation: Who You See Is What You Get” Brian Powers, Sachin Jain, David Cutler, and Ziad Obermeyer Health Affairs, September 23, 2015 Definitions, research and geocoding by Hospital Referral Regional available via the Dartmouth Atlas for Unwarranted Variation: www.dartmouthatlas.org NB: Unwarranted variation refers to practice patterns, which hold up across populations but pricing variation may also be unwarranted and marked fluctuates across insurance product and lines and geography. “The Price Ain’t Right.” Cooper, Craig, Gaynor and Van Reenen, 2015.
  17. 17. 17 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Providers in a Market Groups Individual Physicians What is driving a provider’s Risk-Readiness®? Is it procedures, prescriptions, referrals or visits? How big is a provider’s panel? How ready is a provider to succeed in risk compared to peers? By specialty? Within a region? Finger print with practice patterns that mitigate no-value care = Green Dot Finger print with practice patterns that create no-value care = Red Dot Benchmarks for Risk-Readiness® No Value Care Meets No IT Needed Identifying Success in Pay for Value
  18. 18. 18 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed New Government Data Referral Files (Patient flows between PCPS, specialists, hospitals and post acute centers) Dartmouth Atlas of Health Care & Choosing Wisely (Decades of research and data on unwarranted variation by condition and geography to keep things apples-to-apples for comparisons) CMS FFS Data Sets, CDC Data Sets (MEDPAR, Part B, Part D, BRFSS) (Individual providers, groups, hospitals and post acute centers) Provider Pattern Intensity Profiles and Risk Readiness® for every provider, hospital, post acute center in the US. All preloaded with no IT. Affordable Care Act data to determine Risk-Readiness® of Providers / Networks Trick Is Tying It together
  19. 19. 19 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Backend Technology
  20. 20. Your long term approach to Population Health must emphasize high value networks above all else. 20 You can’t reach true population health by chasing inconsistent and imperfect experimental programs Pop Health is only profitable when you are able to identify, quantify and eliminate low value services. A network built on efficient providers is the key to success in moving towards true population health. Are you Ready for Risk? Share benchmarks with physicians Incorporate benchmarks into compensation/gain share Include Efficiency criteria in hiring or network inclusion decisions Are Your Partners Risk Ready? Make a short list of key partners Manage referrals into these key partners Include key partners in additional gain share opportunities What are my best Opportunities for Risk? Assess your Network’s ability to succeed in arrangements/programs Strategically plan for an efficient network and take on more risk Learn to negotiate with payers from a position of strength Risk-ReadinessⓇ benchmarks answer three questions: No Value Care Meets No IT Needed Efficiency Networks Drive Value
  21. 21. 21 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Are you Ready for Risk? Manage Internal Variation  Provider Contracting Strategy  Provider Compensation Strategy  Process Variation & Improvement  Service Line Benchmarking  Provider Reporting  Provider Recruitment & CIN Build  Value Chain & Leakage Reporting  Medical Economics Reporting Are Your Partners Risk Ready? Pick the Best Partners for Risk Arrangements  Primary Care Referral Source Analysis  Acute Care Partner Reporting  Post Acute Partner Reporting  Consulting/Specialty Partner Analysis  Competing Groups/Orgs Analysis What are my best Opportunities for Risk? Match Providers to Risk • Risk-Matching to Payers: Government & Private Payers • Payer Negotiation Reporting • Medical Economics Modeling No Value Care Meets No IT Needed Identifying Success in Pay for Value
  22. 22. 22 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. How do groups and individual providers within the groups compare to their peers and competition? Share information about a provider’s risk-readiness against peers and competition to compare how well they are able to succeed in value base and risk arrangements. Provider Reporting Philadelphia, PA No Value Care Meets No IT Needed Identifying Success in Pay for Value
  23. 23. 23 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Identifying Success in Pay for Value PCPs Regional Benchmarks Pima Co, AZ Am I incentivizing providers in a way that will be successful in risk arrangements? Incentivize individual physicians based on their overall risk-readiness benchmark and their individual drivers (procedures, prescriptions and referrals) to succeed in value based and risk arrangements. Provider Compensation Strategy
  24. 24. 24 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Identifying Success in Pay for Value Provider Recruitment & CIN Build How do you design and implement CIN that succeed in value based arrangements? Select providers that are risk-ready and complement each other’s practice patterns to create a CIN that succeeds in value based and risk arrangements. Saint Louis, MO
  25. 25. 25 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Identifying Success in Pay for Value Value Chain & Leakage Reporting Primary Care Docs Specialist Post Acute Facility Thickness of lines indicates the number of referrals. Note: Some markets are oversupplied. This market is controlled by one provider. Less efficient More efficient How does your population flow through the care continuum and when and where do they fall out? Identify natural patient flows and determine if your network is breaking them or reinforcing high value pathways then incentivize providers to optimize referrals. Target this PCP / DX Radiologist to refer more patients to the higher performing specialist
  26. 26. 26 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Identifying Success in Pay for Value Value Chain & Leakage Reporting How does your population flow through the care continuum and when and where do they fall out? Identify natural patient flows and determine if your network is breaking them and causing leakage address through contracting, education and incentives. University of Miami is underperforming and referrals are internal. This is a concentrated, low value pathway. Holy Cross has high performing specialists, but its PCPs are referring to a variety of specialists. This is a fragmented, but high value pathway. Group Receiving Referrals Group Sending Referrals
  27. 27. 27 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Identifying Success in Pay for Value Medical Economics Reporting How much no value care are you paying for and how much you can save by line of business and down to individual providers? Determine the specific economic impact that you create for whoever owns the risk you manage. Decreased Cost Average Increased Cost LessEfficient 1 2 3 4 5 MoreEfficient $ PMPY per Specialty & Efficiency Score CARDIAC SURGERY GASTROENTER OLOGY ORTHOPEDIC SURGERY DIAGNOSTIC RADIOLOGY PATHOLOGY $609 $228 $334 $65 $79 $770 $253 $365 $71 $88 $973 $271 $419 $72 $91 $1,191 $303 $467 $121 $106 $1,299 $387 $624 $245 $212 Cardiac Surgery Gastroent erology Ortho Surgeon Diagnostic Radiology Pathology Impact on Spend Risk-Readiness® Benchmark Florida
  28. 28. 28 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Identifying Success in Pay for Value Medical Economics Reporting How much no value care are you paying for and how much you can save by line of business and down to individual providers? Identify how much no-value care you are mitigating and the specific cost savings it generates for whoever owns the risk. $ PMPY per Specialty by County In & Out Network In Network Out of Network Scenario: Removing the lowest performing physicians Drill down into Pima County (Phoenix) The highest $PMPY in Phoenix is with in network GI docs at $643 In this scenario, they would have the greatest drop in $PMPY at $119. ($634 - $119 = $524) Arizona $ PMPY per Specialty & Efficiency Score
  29. 29. 29 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Identifying Success in Pay for Value Primary Care Referral Source Analysis Referrals to Orthopedists Group Sending Referrals Group Receiving Referrals Group Receiving Referrals Group Receiving Referrals Group Receiving ReferralsGroup Receiving Referrals Individual Physicians Receiving Referrals Number of Referrals Performance of Physicians Receiving Referrals Which PCPs are sending patients to a given specialist and how well do those PCPs perform? Make sure your PCPs are sending to high performing specialists who are Risk-Ready to succeed in value based and risk arrangements.
  30. 30. 30 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Identifying Success in Pay for Value Acute Care Partner Reporting Which Hospitals are Risk Ready and what are the drivers of success? Identify the hospitals that are risk-ready and the drivers behind their practice patterns to succeed in pay for value and risk arrangements. California
  31. 31. 31 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Identifying Success in Pay for Value Acute Care Partner Reporting Cost by DRG Norton Medical Surgical Medical Surgical Baptist Which Hospitals are Risk Ready and what are the drivers of success? Determine which hospitals are the most efficient and have incentive to work with your specialty in value based arrangements.
  32. 32. 32 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Identifying Success in Pay for Value Post Acute Care Partner Reporting Westchester County, NY Which Post Acute Facilities are Risk Ready and what are the drivers of success? Identify the post acute centers that are risk-ready and the drivers behind their practice patterns to succeed in pay for value and risk arrangements Home Health Top Providers Orange = Preferred
  33. 33. 33 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Regional Benchmarks Consulting/Specialty Partner Analysis Which Partners are Risk Ready and what are the drivers of success? Identify the consulting and specialty partners that are risk-ready and the drivers behind their practice patterns to succeed in pay for value and risk arrangements Harris County, TX No Value Care Meets No IT Needed Identifying Success in Pay for Value
  34. 34. 34 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Risk-Matching to Payers: Government & Private Payers Largest Counties in TX Regional Benchmarks Risk Scores Health Rank Network Opportunity Profit Opportunity MA Profit Opportunity Exchange Medicare Eligibles / MA Enrolled Exchange Subsidy Eligibles / Exchange Enrolled Medicaid Beneficiary Eligibles / Beneficiaries Which value based programs or risk arrangements will be successful in my population? Identify my population’s socio-demographics, health behaviors and prevalence that lead to success in specific value based programs and private payer risk arrangements No Value Care Meets No IT Needed Identifying Success in Pay for Value
  35. 35. 35 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Payer Negotiation Reporting How do I use government benchmark data to negotiate to my strengths and a payer’s weaknesses? Identify performance against national and regional benchmarks. Highlight where you perform well, addresses and have an explanation and/or plan for areas that need work. No Value Care Meets No IT Needed Identifying Success in Pay for Value
  36. 36. 36 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Population Health & Supply Impact on Risk-Readiness® Risk-Matching to Payers: Government & Private Payers Which value based programs or risk arrangements will be successful in my population? You practice in geographies with specific population health profiles and a specific supply of care, so these are the pressures you will face No Value Care Meets No IT Needed Identifying Success in Pay for Value
  37. 37. 37 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. RowdMap provides data and analysis on Population Health factors that drive success in value-based programs: Behaviors – Broader Definitions of Health with Behaviors Utilization – Utilization and Costs of Procedures and Drugs Prevalence – Major Diseases and Conditions Supply – Number of Primary Care Physicians and Specialists Socio-demographics – Income, Environment, etc. Match your strategies to your population to succeed in value-based programs No Value Care Meets No IT Needed Identifying Success in Pay for Value
  38. 38. 38 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. What is the financial impact of no value care that you create for payers that you are not getting credit for? Identify performance against national and regional benchmarks. Highlight where you perform well, addresses and have an explanation and/or plan for areas that need work. Each dot is a physician. Groups are created from specialty, network status, Efficiency score, and geography Dr. Spock NPI: 15000000123 $PMPY: $874 Savings for removing 5’s form in Network Medical Economics Modeling No Value Care Meets No IT Needed Identifying Success in Pay for Value
  39. 39. 39 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Find the right value based program based on your provider patterns around no-value care. Identify the most efficient providers; this may not show up in utilization review or unit cost analysis. Then negotiate like a pro. Now, take on risk to capture the value you create through pop health No Value Care Meets No IT Needed Capture the Value You Create
  40. 40. 40 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. No Value Care Meets No IT Needed Capture the Value You Create CMS: 50% of FFS will be gone by 2018 What if you knew which providers would drive your success? What if you knew which providers would sink you? WHAT WOULD YOU DO IF YOU KNEW who will win and who will lose in value based arrangements

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