Cynthia Kilroy's presentation from the December 2014 PH Alliance Forum.

1. Putting Patients First
Cynthia Kilroy, SVP Consumer Strategic Solutions
PH Alliance, December 11, 2014
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Learning objectives
Identify the fundamentals to manage a population
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Identify population risk stratification models to determine appropriate care models
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Ensure the allocation of resources to deliver optimal outcomes and effective risk management
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Define a consumer-centric approach grounded in an individuals attitude and behavior to health
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WHERE DO WE BEGIN?
Improving health care quality, lowering costs, and improving health status for consumers, employers, payers, government and care providers is the ultimate objective …

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What does it take to manage a total population?
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Clinical Transformation
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Population Health Focus
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•
Evidenced-based medicine
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Integration across the continuum
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Physician participation in governance
Service Distribution
Effectiveness
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•
Innovative care delivery models
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Personalized patient engagement
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Manage health longitudinally
Financial Stability
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Financial and clinical risk management
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Investment/Appropriate use of resources
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Aligned payer contracts
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Board primary care base
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Seamless referrals
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Care at lowest cost setting
IT Sophistication
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Clinical and behavioral analytics
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Digital Health/TeleHealth
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Integration of information

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of providers and healthplans involved in accountable care consider analytics their top investment priority
Source: 2014 Health Catalyst: Analytics Outweighs Accountable Care, Population Health, ICD-10 as an IT Priority

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Actionable knowledge begins with the right data
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Analytics to predict future medical costs of individuals and populations are limited by the characteristics of the types of available data:
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Claims Data
Clinical Data
Socio- Demographic and Care Management Data
– insensitive
– non-specific
– untimely
+ always available
+ sensitive
+ specific
+ timely
– variably available
(may be incomplete or unstructured in EMR, or unavailable from
non-EMR users)
+ sensitive
– non-specific
+ timely
+ generally available

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Understanding the population risk segments identifies value opportunities
Population Segmentation with Illustrative Population and Spend
*Modifiable Risk Factors: Smoking, Obesity, High Blood Pressure, Occupation, High Cholesterol, Stress, Drug or Alcohol Abuse
**Conditions: Cancer, COPD, CHF, Asthma, Diabetes, Depression, CAD, Cirrhosis
***Rare Conditions: CF, AIDS/HIV, MS, ALS, Gaucher’s, Parkinson’s, RA, Lupus, Sickle Cell, Hematologic Disorders, Hemophilia, Dermatomyositis, Polymyositis, Scleroderma
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Health Advocates
Primary Care (PCMH)
Chronic Care Management
Specialty Clinics
Comprehensive Care Clinics
Extensivist
AICU
Segment
Healthy and Early Stage at Risk
Early Stage Chronic
Complex Acute
Severe Behavioral
Chronic High (Interventional)
Rare High Cost Condition
Poly chronic
Catastrophic
Definition
No current diagnosed conditions and low risk factors
Lowest 75% of medical spend with one condition
Top 5% of medical spend without defined disease or condition
Patients with severe behavioral disorder with no other condition
Top 10-25% of medical spend with one or more condition
Patients with complex/ specialty conditions requiring specialized care
Top 10% of medical spend with 2 or more conditions
Top 2% of medical spend with define disease and condition
Avg. Cost Per Member
$232
$164
$2,354
$555
$592
$825
$1,817
$7,347
Approx. % of Population
56.6%
11.6%
0.7%
14.4%
7.7%
1.5%
2.4%
2.3%
Avg. Risk Score
0.62
1.12
1.82
1.47
2.02
2.93
3.74
6.26
Approx. % of Spend
20.4%
3.4%
2.9%
14.2%
9.1%
2.9%
8.6%
33.6%

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Population
Health Care
Delivery Models
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Hospitalists
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Centers of Excellence
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Inpatient Care Management
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Surgical Focus Factory
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Health Coaches
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Specialty Clinics (i.e. Heart Failure)
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Chronic Care Management
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Specialty PCMH (i.e. ESRD, Diabetes)
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Comprehensive Care Clinics
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PCMH
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Extensivists (by segment)
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Ambulatory ICU
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Complex Pediatrics
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Integrated Behavioral/Medical
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Palliative Care
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Integrate Home Health
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SNFist
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Hospital at Home
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Hospice Care
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Urgent Care
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Convenient Care
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Wellness Clinics
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Health Advocates
Different population health care delivery models ensures a holistic approach
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Individual behavior accounts for
of health status
80%
the #1 determinant, ahead of environment, genetics and access.

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Personalized health care evaluates an individuals motivations and behaviors
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What consumers say they do and want
(Attitudes)
What consumers actually do
(Behaviors)
Who consumers are
((Demographic)

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Evaluating an individual’s motivation and attitudes
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3,600 individuals interviewed across multiple and diverse markets
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Questions focused on
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106 Motivational Statements
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10 Behavioral Dimensions
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Resulted in 12 Primary Segments
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Perceived Health Status
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Healthy Lifestyle
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Solution Seeking
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Financial Well Being
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Health System Usage
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Access
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Demand for Innovation
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Need for Guidance Support
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Relationship with Providers
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Insurance / Payer Trust
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Hunger for information

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Seven attitudinal segments go beyond demographic and health identifiers
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Assured Actives
Trusters
Uninvolved
Progressive Preventers
Overwhelmed
Strivers
More Healthy
Less Healthy
Motivated Seekers
Get health care advice at the gym from trainers and friends
Solution seekers that are open to new ideas
and prefer homeopathic options
Like the health system and trust their doctor; do what their doctor recommends
Don’t think about health and aren’t searching for options or advice; resist changing lifestyle
Prioritize health last behind work and family; need convenience
Motivated to take care of themselves and search
for solutions
Knows they should follow doctor’s advice, but confused and don’t know where to begin

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Attitudinal segments defines relationship between confidence and awareness
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Low confidence
High confidence
in navigating their health, benefits and the system
Low awareness
High awareness of own health needs
Overwhelmed 13%/24%
Motivated
14%/25%
Trusters
16%/13%
Assured Actives
15%/9%
Striver
15%/13%
Uninvolved
14%/9%
Progressive Preventor
13%/7%
% of Population/% of Spend

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Next Frontier:
Intersection of Information Drives Population Care Models

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Intersection of attitudinal and population risk segments results in four key patient profiles
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Attitudes
Clinical Risk
Overwhelmed
Striver
Progressive Preventer
Motivated Seekers
Uninvolved
Assured Actives
Trusters
Healthy
Modifiable At Risk
Early Stage Onset
Complex Acute
Complex Chronic
Rate High Cost
Poly Chronic
Catastrophic
Value (Risk)
High
Low
Low
High Attitude
Uninvolved Chronic
High Value / Low Activation
Engaged Chronic
High Value / High Activation
Healthy/At Risk
Low Value / Low Activation
Proactive Wellness Seekers
Low Value / High Activation
Value: the individual burden (i.e. risk) on the system
Activation: Measure of ownership of one’s health by level of interaction with the system
Patient Profiles

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Health Coach
Aligning patient profiles with resource allocation to support population health
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Value (Risk)
High
Low
Activation
Low
High
Health Coach
Care
Manager
Physician
Care
Manager
Physician
Health
Advocate
Physician
Support healthcare questions and navigate the system on an as needed basis
Health
Advocate
Physician
Gain healthcare knowledge, navigate the system and monitor health status to proactively maintain health
Health Coach
Uninvolved Chronic
Engaged Chronic
Healthy
Proactive Wellness Seekers
Health Coach
Support personalized education and guidance to help gain confidence to become engaged
Proactively engage to support a personalized care management plan
Self-Service
Self-Service
Self-Service
Self-Service

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Population Care Delivery Models
Merging patient profiles with population care delivery models
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Patient Profiles
Episodic Care Management Models
Chronic Care Management Models
Post Acute Care Models
Preventive Care Models
Primary Care Models
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Understand the needs by markets: Medicare, MA, Medicaid, Commercial
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Determine where populations and individuals fall within patient segments
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Evaluate most appropriate delivery model investments based on market need and spend
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Not a one size fits all

18. Thank you.
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