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Using Predictive Analytics For Care Management And Coordination
The document discusses the use of predictive analytics in care management and coordination, focusing on the evolution and implementation of bundled payments within the healthcare system. It outlines the goals of the CMS to improve care quality and efficiency while reducing costs, highlighting positive trends in patient outcomes and spending. Additionally, it emphasizes the importance of integrating data, optimizing resources, and aligning stakeholders to enhance healthcare delivery.
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Using Predictive Analytics For Care Management And Coordination
- 1. Using Predictive Analyticsfor Care Management and Coordination Chicago Technology for VBHC January 30, 2017
- 2. © 2016 popHeatlhStrategies, LLC | Confidential and Proprietary. Do not distribute or copy. 2 Agenda Evolution of Bundles Care Management Predictive Analytics Q&A Essential Capabilities
- 3. © 2016 popHeatlhStrategies, 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 popHeatlhStrategies, 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 popHeatlhStrategies, 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 popHeatlhStrategies, 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 popHeatlhStrategies, 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 popHeatlhStrategies, 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 popHeatlhStrategies, LLC | Confidential and Proprietary. Do not distribute or copy. 9 Creating Competition within Census-Based Regions
- 10. © 2016 popHeatlhStrategies, 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 popHeatlhStrategies, 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 popHeatlhStrategies, 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 popHeatlhStrategies, LLC | Confidential and Proprietary. Do not distribute or copy. 13 Aligning Stakeholders Integrating Data Redesigning Care Optimizing Resources Focusing on Essential Capabilities
- 14. © 2016 popHeatlhStrategies, LLC | Confidential and Proprietary. Do not distribute or copy. 14 The Traditional Payment and Data Model Hospital Doctor SNF HHAOPT
- 15. © 2016 popHeatlhStrategies, 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 popHeatlhStrategies, LLC | Confidential and Proprietary. Do not distribute or copy. 16 Data Challenges Persist 9 months old!
- 17. © 2016 popHeatlhStrategies, 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 popHeatlhStrategies, 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 popHeatlhStrategies, 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