Using Predictive Analytics For Care Management And Coordination
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This presentation was given by Dennis O'Donnell for the Chicago Technology For Value-Based Healthcare Meetup (https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/)
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Using Predictive Analytics For Care Management And Coordination
- 1. Using Predictive Analytics for Care Management and Coordination Chicago Technology for VBHC January 30, 2017
- 2. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 2 Agenda Evolution of Bundles Care Management Predictive Analytics Q&A Essential Capabilities
- 3. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 3 CMS Goals: Triple Aim Source: CMS CJR Introduction Slides More coordinated, higher quality careBetter Care Smarter Spending Hold hospitals accountable for total episode spending Heathier People & Communities Result of “Better Care” and “Smarter Spending”
- 4. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 4 A Commitment to Value and Quality HSS = The Department of Health and Human Services; APM = Alternative Payment Model; FFS = fee-for-service. Source: CMS, 2015. Historical Performance 20% 68% 60% 32% 20% 2011 2014 HHS Goals 30% 50% 55% 40% 15% 10% 2016 2018 … efficient, coordinated and high quality care Traditional Medicare FFS Other FFS linked to quality APMs (Bundled Payment) 80% 85% 90%
- 5. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 5 Bundled Payment: An Evolving Model 5 ACE “Expand and Scale” 2018 2020 Permanent Payment Model Voluntary Voluntary Mandatory 2013 BPCI 2009 ACE 2016 CJR Mandatory EPM SHFFT 2017 ???
- 6. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 6 Bundles Are Gaining Momentum…why? September 25, 2016 June 28, 2016 “Bundled payments will finally unleash the competition that patients want.”
- 7. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 7 CMS Costs Are Declining 9.6% 3.5% -0.6% -0.6% -1.6% -1.6% -2.8% -0.04 -0.02 0 0.02 0.04 0.06 0.08 0.1 0.12 2009 2010 2011 2012 2013 2014 2015 CMS National Trend Factors, MS-DRG 470, 2009-2015
- 8. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 8 Outcomes Are Improving % 32 INCREASED PATIENTS GOING HOME FEWER READMISSIONS 56 % LOWER EPISODE COSTS $ 15 % Reference: PinpointCare BPCI customer data
- 9. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 9 Creating Competition within Census-Based Regions
- 10. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 10 Determining CJR Target Prices: Years 1 and 2 $27,400 $23,820 Average Historical Payment (2012-2014) Target Price Weighting 2/3 1/3 $25,000 3% CMS Discount $24,250 Target Price Hospital: Region: *Trended forward to current year Trend Factor* 1.0 1.0 ($750)
- 11. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 11 Risk & Opportunity: Stop Gain and Stop Loss Limits 5% 5% 10% 20% 20% -5% -10% -20% -20% -25% -20% -15% -10% -5% 0% 5% 10% 15% 20% 25% Y1 Y2 Y3 Y4 Y5 Capped Upside Capped Downside
- 12. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 12 Hospital Type % Change (Y1 to Y5) High Payment -16% Moderate Payment -9% Low Payment -4% The Race to the Bottom $20,000 $21,000 $22,000 $23,000 $24,000 $25,000 $26,000 $27,000 $28,000 $29,000 $30,000 Historical Payment Ave (2012-2014) 2016 2017 2018 2019 2020 Declining Target Price within Region 3% Discount 33% Region Rebasing 2014-16 67% Region 100% Region Rebasing 2016-18
- 13. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 13 Aligning Stakeholders Integrating Data Redesigning Care Optimizing Resources Focusing on Essential Capabilities
- 14. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 14 The Traditional Payment and Data Model Hospital Doctor SNF HHAOPT
- 15. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 15 Bundled Payment: A Single Payment for an Episode of Care Hospital Doctor SNF HHAOPT
- 16. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 16 Data Challenges Persist 9 months old!
- 17. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 17 PinpointCare Empowers Customers to Break Traditional Models PinpointCare Model Traditioanl Call Center Model 1:250 Call Center 1:750
- 18. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 18 Reducing Variability in Episode Cost Dramatically Reduces the Risk Episode Cost EpisodeCount With PinpointCare Model and Technology Off-PlanOn-PlanOn-Plan
- 19. © 2016 popHeatlh Strategies, LLC | Confidential and Proprietary. Do not distribute or copy. 19 Predictive Analytics: Data, Analytics, and Integration • Proactive identification of high-risk patients • Real-time ‘pulse’ of program performance • Ongoing feedback loop • Single-source application Decision Data Extracts Real-time Data In-Flight Historical Historical Future
- 20. Q&A Dennis O’Donnell, MHA, PT dodonnell@pophealthstrategies.com dodonnell@pinpointcare.com (224) 548-4812