2. Predictive Care Management for CHS Single Practitioner

3. Predictive Care Management for CHS Single Practitioner
S

4. Predictive Care Management for CHS Single Practitioner
S
O

5. Predictive Care Management for CHS Single Practitioner
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O
A

6. Predictive Care Management for CHS Single Practitioner
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O
A
P

7. Predictive Care Management for CHS Single Practitioner

8. Predictive Care Management for CHS Single Practitioner

9. Predictive Care Management for CHS Single Practitioner

10. Predictive Care Management for CHS Single Practitioner

11. Predictive Care Management for CHS Single Practitioner

12. Predictive Care Management for CHS Single Practitioner

13. Predictive Care Management for CHS Single Practitioner

14. Predictive Care Management for CHS Single Practitioner

15. Predictive Care Management for CHS Single Practitioner

16. Predictive Care Management for CHS Single Practitioner

17. Predictive Care Management for Single Practitioner

18. Predictive Care Management for CHS Single Practitioner

19. Predictive Care Management for CHS Single Practitioner

20. Predictive Care Management for Single Practitioner

21. Transitioning CHS Care Management to Population Stratification
Purpose of MEDai Risk Navigator Clinical for Community Health Solutions
 Identify savings from TOTAL COST UNDER FORECASTED COST by Dx Categories
 Identify HIGH RISK members in SCS population
 Use RNC reports to demonstrate measured savings after CM engagement
 Develop new programs from SCS population strata
 Determine a process to move away from diagnosis trigger codes for CM
 Establish a reliable ROI from the RNC data that could not have been attained prior

22. Transitioning CHS Care Management to Population Stratification
 Identify HIGH RISK members in SCS population

23. Transitioning CHS Care Management to Population Stratification
 Identify HIGH RISK members in SCS population

24. Transitioning CHS Care Management to Population Stratification
 Identify HIGH RISK members in SCS population

25. Transitioning CHS Care Management to Population Stratification
Provide predictive analytics to identify future costs for each member
 Identify members with TOTAL COST 10% GREATER than FORECASTED COST
 Run a report for all members with greater than $50,000 TOTAL COST
 Establish threshold dollar amount for PHARMACY FORECAST COST for
example GREATER than $10,000
 Determine the gap between TOTAL COST and FORECASTED COST for each
SCS Shared Savings Age group

26. Transitioning CHS Care Management to Population Stratification
 Determine gap between TOTAL COST + FORECASTED COST for each SCS Shared Savings Age group

27. Transitioning CHS Care Management to Population Stratification
Identify members in our SCS population that pose high risk for care
 Run monthly reports for all member FORECASTED RISK INDEX > 50
 Determine a threshold limit FORECASTED RISK INDEX for CM eligibility, for
example any member greater than INDEX = 5 eligible for CM process
 Identify our Psychiatric Disorders Group Aggregate HIGH RISK INDEX since
this Group is SCS greatest Diagnostic Category
Segregate and indentify LOW RISK population strata and do not engage CM
at level below 1.0 unless FORECASTED COST > $30,000

28. Transitioning CHS Care Management to Population Stratification
 Segregate and indentify LOW RISK population strata; do not engage CM at level below 1.0

29. Transitioning CHS Care Management to Population Stratification
 Segregate and indentify LOW RISK population strata; do not engage CM at level below 1.0
80.6%

30. Transitioning CHS Care Management to Population Stratification
Ability to run Comparative Analysis on several CHS clients
 Within SCS service line, determine Risk Index for each Group
 Monitor TOTAL COST in relationship to FORECASTED COST for each client
 Compare effects of CM engagement within each SCS Group
 Determine HIGH RISK Diagnostic Categories within each SCS Groups
 Identify members who are predicted to have HIGH TOTAL COST that can
engage CM right now

31. Transitioning CHS Care Management to Population Stratification

32. * End of Presentation *
Beginning of Predictive Care Management
August 2, 2010
Dr. Curtis J. Tinsley
Community Health Solution of America
Office of Chief Medical Officer
Office of Clinical Data Governance
“Transition Community Health Solutions to Predictive Care Management
with MEDai Risk Navigator Clinical Suite”