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Population Health - People Get Ready
The document discusses the urgent need for innovative approaches to population health management, emphasizing the importance of data acquisition and ownership in improving health outcomes. It highlights the integration of care management strategies and the effectiveness of telemedicine, behavioral health, and chronic disease management in reducing costs and improving care. The text asserts that population health is fundamentally a care delivery model that benefits from a market-driven innovation approach and emphasizes the need for proactive action in health systems.
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Population Health - People Get Ready
- 1. © 2021 HealthCatalyst © 2021 Health Catalyst Population Health: People Get Ready Will Caldwell, MD, MBA Senior Vice President, Population Health, Health Catalyst Senior Health Advisor, PIH - Haiti
- 4. Do You KnowRobin?
- 5. Readmissions Telemedicine Chronic disease management Clinicalpathway development Artificial intelligence and machine learning Closing care gaps EMR point of care integration Role of preventative care Importance of internal and external reporting TCOC reduction strategies Building a data driven culture around pop health management
- 6. Your Next 40Minutes… • Rethink the meaning of population health • Excite you about your role making a difference • Answer “Why now?” • Define “smart” data acquisition and ownership • Rotate the care management paradigm 90 degrees • Suggest a large, unrealized opportunity to manage quality and cost more effectively – what are we not talking about?
- 8. The identification andmanagement of the drivers of clinical and financial risk impacting a patient’s health, agnostic to payer model
- 9. Population health isa care delivery model, NOT a payment model…
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- 12. Why Now –What is Different?
- 13. Opportunity “Never before inhistory has innovation offered promise of so much to so many in so short a time” ― Bill Gates Market Driven Innovation “The complexity of medicine outruns the ability of the expert mind” ― David Eddy MD Moral Obligation “We are now faced with the fact that tomorrow is today. We are confronted with the fierce urgency of now.” ― Martin Luther King Jr.
- 14. Opportunity “Never before inhistory has innovation offered promise of so much to so many in so short a time” ― Bill Gates
- 15. Consequences of skippingsteps in developing health systems?
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- 17. Per Capita GDP •US $56,116 • Haiti $818 • Sierra Leone $6530
- 18. “All things outpatient” BillFrist MD, 2005 Market Driven Innovation $100B Invested in Healthcare from PE Sources in 2018 A Shifting Target for Investment… “Behavioral health management, pharmacy economics, and virtual care services are what self insured employers are looking for today” Brad Wilson, 2021 “Telemedicine is here to stay” Brent James MD, 2021
- 19. “The complexity of medicineoutruns the ability of the expert mind” ― David Eddy MD Private equity provides capital to fund innovation not supported by traditional players in the healthcare ecosystem “A private equity firm that invests in a care delivery organization reimbursed under value-based payment should be expected to encourage investments and operational changes that support better health outcomes and lower costs, even if acting purely out of financial self-interest”. JAMA Online (8/11/2021)
- 20. What Can WeLearn From Financial Services? Shifting Financial Risk Drives Access to Data and Services Reducing information asymmetry supports innovation (democratize data) Who owns my healthcare data? SECURE Act, 21st Century Cures Act Transfer of financial risk creates market demand for access to data Market Driven Innovation #2
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- 23. Determinants of Health Thisdiagram is a model of all factors correlated with health outcomes for an individual 7% Physical Environment 11% Medical Care 36% Individual Behavior 24% Social Circumstances 22% Genetics and Biology
- 24. Why data matters In alllow income countries around the world today, how many girls finish primary school? 20%, 40%, 60% In the last 20 years, the proportion of the world population living in extreme poverty has? Doubled, remained the same, cut in half What is the average life expectancy of the world today? 50y, 60y, 70y How many of the world’s 1 year old children today have been vaccinated against some diseases? 20%, 50%, 80% How many people in the world today have access to electricity? 20%, 50%, 80% 24
- 26. Smart Data Approach Startat the End of the Process Create a process or pathway to address it Identify data sources informing process Use analytics to create information from the data useful in guiding decisions Identify a clinical or business need Ingest and normalize only needed data
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- 31. 5 Horizontals toConsider in Care Management Nutrition and Weight Management Behavioral Health 2.0 Preventative and Palliative Care Exercise and Physical Therapy Financial Health
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- 34. What do Ithink is the largest untapped clinical and financial opportunity in population health?
- 35. Florida Medicare Population TCOCattributable to chronic disease higher in Medicare patients with a BH diagnosis? BMC 2020 • 21% of patients with mood disorder admitted from ER/12% without mood disorder admitted • 2.6% of patients with mood disorder admitted to ICU/1.6% without mood disorder admitted to ICU • 1.5x more likely to be readmitted within 30 days if patients have an undiagnosed or poorly controlled mood disorder 23,000 attributed lives 7130 patients with depression (31% of Medicare pop in FL) A Financial Argument # with depression ∆TCOC Avoidable Spend (27%) Total Savings DM (36%) 2566.8 15,468 4176.36 $ 3,725,313.12 CHF/Heart condition (75%) 5347.5 13,044 3521.88 $ 6,543,653.04 COPD (30%) 2139 10,800 2916 $ 2,166,588.00 $ 12,435,554.16 Shared Savings (75%) $ 9,326,665.62 Rev. equiv. (5% margin) $ 186,533,312.40 CMS website data 2014, Milliman
- 37. Your Last 40Minutes… • Population Health is not a payer model • A new dawn for population health supported and funded by new capital sources • Shift in financial and clinical risk • More data is not always better –Must pivot from a vertical, disease specific care management approach to horizontally integrated programs across a population. • Be smart! • “BH redefined” is largest opportunity – the missing piece in population health management
- 38. Jaime Jaramillo “PapaJaime”
- 41. Do You KnowAny Robins?
- 42. “We are nowfaced with the fact that tomorrow is today. We are confronted with the fierce urgency of now. In this unfolding conundrum of life and history, there ‘is’ such a thing as being too late. This is no time for apathy or complacency. This is a time for vigorous and positive action.” ― Martin Luther King Jr.
- 43. Will Caldwell, MD,MBA will.caldwell@healthcatalyst.com 704-996-9376
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