Applying Strategy and Measuring Impact of Key Population Health Activities DATE HFMA Tri-State Institute September 12, 2019
Session Objectives Learn how to bring a strategic orientation to one of the most operationally leveraged capabilities in population health - care management ▪ Recognize the importance of aligning a highly operational clinical capability to an organization's broader value-based strategy ▪ Understand an approach to measuring the impact of clinical interventions and effectively disseminating the resulting, nuanced insights DATE 2
Agenda Front Health – background Anticipating key financial roadblocks in VBC transitions A thoughtful approach to care management Measuring the impact of clinical interventions DATE 3
Who we are Greg Long, MD ▪ We were born from the Midwest CMO Health Collaborative (MHC) , a greg.long@fronthealth.com consortium of six health systems throughout Ohio 1 , dedicated to delivering exceptional clinical ▪ Greg has deep population health and outcomes and increased physician leadership expertise and satisfaction at lower costs partners with clients to help them achieve success in their value-based care ▪ We incubated our solutions at transformation MHC and demonstrated their ▪ Greg is a board-certified Family Medicine value within our member systems’ physician with more than 25 years of at-risk populations clinical and executive experience, including 10 years as CMO of ThedaCare, a ▪ Front Health, a team of analysts, progressive, integrated health system in strategists, designers, and Wisconsin clinicians, now offers these ▪ Prior to that, he helped lead ThedaCare’s solutions to payers and primary care division through care model DATE providers committed to redesign resulting in the best clinical transforming healthcare quality performance in the state of Wisconsin 1: Cleveland Clinic, OhioHealth (Columbus), ProMedica (Toledo), Premier (Dayton), TriHealth (Cincinnati), and Aultman (Canton) 4
Our focus has been on high value capabilities that best enable success in value-based care Performance improvement Chronic Condition Breakdown Allowed PMPM 1 , 2017 $71 $449 $13 $19 $17 $13 Rapid and in-depth $20 $26 $21 $30 $32 $81 $107 Chronic 64% 4% 3% 5% 2% 3% 4% 4% 1% 0% 1% Healthy Active Cancer Diabetes w/o CAD Neurological Disorders Chronic musculoskeletal/ OA/ Osteoperosis Mental Health/ Substance Abuse Asthma Severe heart failure/ transplant/ heart disease Renal Failure Severer Rheumatic Disease All other (12) Total conditions Hypertension performance diagnostic and How we work with organizations % of total PMPM % diff. from MHC, 2017 11% 13% 11% 6% Service General 1% 3% 0% -12% -12% improvement program against lines & waste/ -15% -20% episodes misuse ▪ Building a stronger individual populations (e.g., Service-line Breakdown Allowed $ PMPM, 2017 $125 $449 Waste/misuse by system % waste of total PMPM , 2017 $20 $19 $21 $ Allowed Waste PMPM $29 $21 EHP) and/or high impact $34 6.2% $35 5.3% performance improvement $37 5.1% $39 4.0% $69 2.7% $3.89 ORTHO GI CARDIO ENDO NEURO GYN PSYCH PULM DERM ENT All other Total (12) % of total PMPM CCF System 1 System 2 System 3 System 4 % diff. from MHC, 2017 28% capabilities “muscle” 13% 8% 2% 3% 2% 0% -1% -1% -16% ▪ Maximizing contract performance Contract CONTRACT / POP 3 CONTRACT / POP 2 Metrics/standards ▪ Creating consistent and data management ▪ Quality measure 2 CONTRACT / POP 1 Metrics/standards ▪ Quality measure 9 ▪ Quality measure 1 Metrics/standards ▪ Quality measure 10 driven care management ▪ Quality measure 4 ▪ Quality measure 1 ▪ Quality measure... ▪ Quality measure 7 CONTRACT 3 ▪ Quality measure 2 ▪ Quality measure 20 ▪ Quality measure... CONTRACT 2 ▪ Quality measure 3 Achieving ▪ Risk adj. standard 1 ▪ Quality measure 25 ▪ Quality measure... CONTRACT 1 ▪ Measuring the impact of ▪ Risk adj. standard 1 ▪ Quality measure 20 operational ▪ Risk adj. standard 1 clinical programs simplicity while managing inherent Pt w/gaps Primary focus of today’s discussion contractual Pt w/gaps, in care mgmt. complexity DATE Data visualization that surfaces meaningful insights is a part of our DNA 5
Agenda Front Health – background Anticipating key financial roadblocks in VBC transitions A thoughtful approach to care management Measuring the impact of clinical interventions DATE 6
Proactively managing the value-based care (VBC) transition will increase confidence in achieving a return 1 on the transformational investment Key Elements Description Realized value 1 ▪ Segment populations Invest in proven VBC delivery models in a Design and ▪ Customize care for each segment fiscally responsible way ▪ deploy VBC care PCP-led team models, e.g., PCMH 2 , model(s) CM 3 , BH 4 , PharmD ▪ Virtual care options ▪ Strive for net neutral care team costs, Create leader and operational visibility to 2 e.g., increase panel size for team the system profitability impact of the VBC Predict systemic ▪ Account for all VBC payments transformation; informed adjustments as P + L ▪ Estimate FFS losses with improved care necessary fluctuations ▪ Focus on new patient growth ▪ Use data to influence decisions ▪ 3 Use best practice care models Ensure clinical team resources are highly ▪ productive and effective in achieving Maximize Standardize when possible desired VBC outcomes operational care ▪ Create transparency of performance by standards team member ▪ Study and adjust until desired results 4 ▪ Objectively assess the effectiveness of Analyze outcomes for each VBC each VBC clinical intervention; informed intervention DATE Understand ▪ adjustments as necessary Apply statistical methods to ensure impact validity ▪ Study and adjust until desired results 1: Cost, Quality and Experience, i.e., the Triple Aim; 2: PCMH = Patient-Centered Medical Home; 3: CM = Care Management; 4: BH = Behavioral Health 7
Agenda Front Health – background Anticipating key financial roadblocks in VBC transitions A thoughtful approach to care management Measuring the impact of clinical interventions DATE 8
CARE MANAGEMENT A best in class care management function delivers on a range of key elements End to end approach to Care Management Key characteristics Key outcomes ▪ ▪ Organizational buy-in and support of care management with a Program design clearly defined strategy for where and how (e.g., programs) you ▪ Strategy: populations & Prioritization of want to apply CM programs populations ▪ A roadmap where/when resources will be applied (populations) A singular, well-coordinated team that is connected to the primary Model to align staffing by Org construct & care givers with resources aligned to reflect population prioritization population staffing Sophisticated stratification that leverages key data sets and evolves Customized risk over time to incorporate increasing access to add’l data (e.g., social stratification and patient Risk stratification determinants)—for care mgmt, end of life discussions, general risk prioritization ▪ ▪ Interventions Successful enrollment A compelling message to patients that drives enrollment ▪ approach ▪ Engage/enroll An end to end patient engagement and management model that ▪ ▪ Targeted interventions empowers patient to understand and effectively manage their Assess based on disease state health ▪ Develop plan ▪ ▪ A model that balances ongoing patient involvement with the need Maximizing impact ▪ Manage through defined & flexible to maximize the impact across many patients ▪ Graduate graduation criteria ▪ ▪ Defined measures of success Operational dashboard ▪ DATE Clear visibility into daily operational metrics ▪ Performance reporting: Systematic impact ▪ operational + impact Systematic view of impact and insight into what drives impact for tracking further program refinement This comprehensive approach is easily adapted to improve any system’s or payer’s care management operation 9
STRATEGY The first step in a care management strategy is defining where—and to what extent—you are supporting a given population ILLUSTRATIVE Population (in order of Total lives High risk Rising risk priority) (est.) support support Employee Health Plan 6,000 Highest priority Payer 1 MA 5,300 What are the right programs for a Payer 2 CML 5,300 specific population to maximize impact? MSSP 31,400 Further, where do Medicaid 5,000 you set the “dials” on each of those Anthem (CML + MA) 18,000 programs? Aetna (MA) 2,500 MMO (MA) 13,000 DATE ~85,000 10
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