Trend Overview

Trend Management Overview By: Andrew McClure

Agenda ,[object Object],[object Object],[object Object],[object Object],[object Object],© Andrew McClure September 10, 2009

Background ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Andrew McClure September 10, 2009

Trend Management Components of Trend and Approaches to Mitigation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PMPM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Prof. Inpatient Ancillary Hospital Inpatient Prof. Outpatient Facility Outpatient Pharmacy © Andrew McClure September 10, 2009

Trend Dimensions to Consider ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Andrew McClure September 10, 2009

Claim Cost pmpm Time Savings Generic Drugs reduce unit cost Diabetes DM reduces IP utilization Radiology UM reduces utilization Recontracting effort reduces unit cost Trend Management – Impact Illustration © Andrew McClure September 10, 2009

Trend Management Process ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Andrew McClure September 10, 2009

Trend Management Pipeline ,[object Object],Development Implementation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Andrew McClure September 10, 2009

Measurement Approach ,[object Object],[object Object],[object Object],[object Object],Notes: 1. Frequency: M= Monthly, Q=Quarterly; A=Annually © Andrew McClure September 10, 2009 Type Measure Owner Source Freq 1 Target KPI OPs Dash Perf. Assess. Ops Cases ID’d Smith Registry M 1000 X X X X Calls made Smith Vendor Q 36,000 X X X Clin HbA1c tests Jones HEDIS A 92% X Rx Compliance Jones Rx Data A 88% X Util Decrease Inpt Wilson Claims M/Q 5/1000 X X Increase Rx Rose Claims M/Q 800/1000 X Fin Vendor Expense Lane Cnt Mgt M/Q/A $300,000 X Savings Lane Calculate M/Q $900,000 X X ROI Lane Calculate M/Q/A 3:1 X

Critical Success Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Andrew McClure September 10, 2009

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Editor's Notes