Population Health Management-- Can help employers take control of rising healthcare costs? By promoting health, preventing disease, and providing a shorter path to care for employees and their families. Philip Kurtz, CEO CareATC
Population Health Management: “Is the ability to accurately assess the health risk of a population, develop and apply initiatives that engage the population to reduce the health risk of that population. ”
Population Health Management as it applies to employers With PCMH as the driver, workflows create a highly sophisticated and patient-centric approach to advanced care delivery, lifestyle management and nutrition. Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Population Health Management Data Driven Healthcare Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Step 1 – Assess Health Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Data Sources for Assessing Risk • Identifies diagnosis and procedures over time; integration of various specialty Clinic and/or health data exchanges enhances improved health care coordination, diagnosis and treatment while reducing cost Encounters • Identifies historical and present prescriptions; identifies potential conflicts RX between medications and can account for various symptoms; improves health outcomes and cost • Identifies risk with over 60 blood panels, blood pressure, weight, height, circumference, and family medical history; identifies risk catches risk when Personal Health Assessment patient hasn't utilized the health care system; improves diagnostics and treatment. • Identifies diagnosis and treatments used by other professionals where clinical encounters are not available; improves diagnosis and treatment Claim Data • Identifies compliance and obstacles to behavior changes and improves Outreach outcomes of treatment protocols when lifestyle changes are required for nutrition and physical activity. & Coaching Data • Identifies the activity, nutrition and heart rate, blood pressure, glucose, weight, Wellness Data calorie burn and overall disposition of patient on a daily/weekly basis to provide physician a better perspective of complimenting treatment protocols and lifestyle modifications. Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Individual Assessment Identifies Group Risk Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Identify the highest risk Clinical Perspective Financial Perspective High Risk 10%-15% High Cost 80%
Risk Factor Summary – Benchmark Comparison 70% 60% 50% 40% 30% 20% 10% 0% Obesity Prediabetic Diabetic Pre Hypertension Hypertension • • CDC Benchmark Group Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Step 2 – Stratify Risk Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Risk Stratification Risk Analysis Action Patient has life threatening health issue as determined by Requires immediate attention. Could result in ED visit or Panic Value Personal Health Assessment hospitalization Patient life is not immediately threatened but patient is Requires prompt attention by a healthcare provider. Potential for ED Critical Risk likely to have a major incident in the coming 12 months visit or hospitalization Patient is on a path of developing or progressing a chronic disease but has the opportunity to stop or reverse Requires treatment by a healthcare provider to control disease risks High Risk the progression Patient has an indication of some risk factors that need to Requires guidance by a healthcare provider to control modifiable risk be monitored over a period of time to assure patient is factors Moderate Risk not progressing to the next level Normal Risk Patient has little or no risk factors Patient is encouraged to continue a healthy lifestyle 38% 30% 20% 11% 1% Panic Value Critical Risk High Risk Moderate Risk Normal Risk Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Biometric Scores Impact on Costs - Diabetes 998 • PHA Participants • Normal A1c 537 • Non-Diabetic • A1c Between 5.7 – 6.4 369 • Pre-Diabetics • A1c Greater than 6.4 92 • Diabetic Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Cost of Treating Diabetes • A1c Between 5.7 – 6.4 369 • Pre-Diabetics According to Center for Disease Control – up to 30% of these will become diabetics According to American Diabetes Association - Annual Cost of Treating a Diabetic = $13,700 According to National Kidney Foundation – up to 30% of Diabetics Will Develop End-Stage Renal Disease Annual cost of treating ESRD = $85,000 per year (369 X 30%)X $13,700 = $1,516,590 annual cost for treating diabetics + (111 X 30%)X $85,000 = $2,830,500 annual cost for treating ESRD ___________________________________________________________ $4,347,090 Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
The Cost of Doing Nothing Risk Score 2.5 $35,000,000 $30,000,000 2 $25,000,000 1.5 $20,000,000 $15,000,000 1 $10,000,000 0.5 $5,000,000 0 $0 Projected Cost Projected Risk Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Step 3 – Patient Engagement Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Initiatives to engage population • Create rewards and incentives to motivate members of the population within Incentives the plan design. Incentives could include: Gift cards, bonuses, reductions in premiums, additional vacation time, reduction in out of pocket cost, reduction in co-insurance or co-pays. • Educate members of the population on their risk factors and the long-term Education impact of not doing anything, the types of treatments and programs available through your employer and the cost of these programs • Treatment within the clinic, including pharmacy, specialty referrals, and medical Clinical procedures such as surgery and physical therapy. • Develop a plan for altering current lifestyles that increase an individuals risk Lifestyle to one that will reduce the risk and getting the members buy-in. The lifestyle changes should encompass nutrition, activity, and stress management. • Need to have an efficient way to track members risk, medical records, health Tools education, physical activity, nutritional habits, biometric data such as: blood pressure, blood sugar and weight. Care team and social media communication. • Risk assess the population to assure that the initiatives are having the desired Re-assess effect on the members of the population and on the population as a whole. Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Tools Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Mobile App Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Outreach/Lifestyle Coaching Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Step 4 – Manage Performance Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Managing Healthcare Expenditures Other Plan design and incentive programs 4% Disease Management Pharmacy 15% Care Coordination Lifestyle Coaching Hospitals Removing Barriers to Care 50% Physicians Centers of excellence 31% Pharmacy Costs 2014 Healthcare Spending by Type from Centers for Medicare and Medicaid Services Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Care Planning Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Wellness- 2015 HealthyHabits Participants Eligibilble Participants 34% Did Not Participate 66% Participated Participants Didn't participate Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
Wellness- 2015 HealthyHabits Participants Eligibilble Participants 44% Did not meet Goal 66% Met personal Goal Met Goal Didn't meet Goal Confidential information prepared for exclusive use by CareATC, Inc. Unauthorized duplication or dissemination is prohibited.
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