Partnering for Population Health: Strategies to Promote Collaboration Among the Patient, Provider and Employer

1. Partnering for Population Health: Strategies to Promote Collaboration Between the Patient, Provider and Employer Christina Arenz Regional Vice President Strategic Solutions, Value-Based Care Conifer Health Solutions 1 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.

2. Christina Arenz Regional Vice President Strategic Solutions, Value-Based Care Christina Arenz currently serves as Regional Vice President of Strategic Solutions for Conifer Health Solutions Value-Based Care business line. In this role, she is responsible for leading a team of transformation experts who are tasked with developing forward-thinking advantage as the industry shifts from volume to value-based care. She works with a variety of clients including employers, healthcare systems, medical management organizations, PHOs, ACOs and TPAs. 2 ©2014 Conifer Health Solutions, LLC. All Rights Reserved. solutions that give Conifer Health clients a strategic Ms. Arenz came to Conifer Health Solutions in 2012, following the company’s acquisition of InforMed, LLC, where she had served as an Account Manager since 2010. During her career, she has had key roles in operations, finance, project management and process improvement. Christina has also served as a Human Resources leader who was responsible for all aspects of people management for a community-based, acute care hospital.

3. Who We Are Conifer Health Solutions combines deep-rooted healthcare operational and financial management experience with innovative, high-touch services and technologies that simplify the healthcare experience. Our Purpose Provide the Foundation for Better Health Our Values Unity. Integrity. Service. Respect.

4. Our Footprint FACTS Conifer Health Corporate Office & Revenue Cycle Management Operations Key 4 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.  National Scale with Local Presence  Service clients in 40+ states  20 Service Centers  700+ clients  12,000+ employees  Breadth & Scale  $25+ billion net revenue processed annually  19+ million patient touch-points annually  4+ million managed lives  $17+ billion medically managed spend  1+ million clinical admission reviews  60,000 patient satisfaction surveys annually Conifer Health – Service Centers Revenue Cycle Management Client Locations Patient Communications Client Locations Value-Based Care Client Locations Patient Communications & Engagement Office Value-Based Care Office

5. Stakeholders in Healthcare Historically working in isolation 5 ©2014 Conifer Health Solutions, LLC. All Rights Reserved. • Cost of care • Quality of care • Access to care Consumers • Financial challenges • Government mandates • Patient quality/safety • Accountable care Providers • Cost containment • Wellness improvement • Population health management Health Plans • Financial risk management • Health information exchanges • Regulatory mandates Employers

6. Commons Challenges  People are ill  Chronic and often complicated cases  Costs for care are high  Consumers are unsure how to access to healthcare system; or lack appropriate access 6 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.

7. Partnering for Population Health Stakeholders Now Share Common Goals  Lowering cost of care delivery  Improving quality of care  Achieving best outcomes 7 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.

8. Every Stakeholder Plays a Role Providers, payors, plan sponsors and individual members all play a part in connecting the disparate elements of the healthcare industry to increase profitability, create efficiencies, improve patient outcomes and enable individuals to better manage their personal health. 8 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.

9. Transforming how care is delivered And engaging the care team and individuals to improve the health 9 ©2014 Conifer Health Solutions, LLC. All Rights Reserved. of populations Align with providers to achieve clinical performance Deliver patient-centered care across the continuum and population Assume risk appropriatel y and successfully manage financial performance Partnering to Break Down Walls Coordinating to build cooperative relationships

10. Holding the Alliance Together Data Data Sources Data Processing and Analytics Different Views/Interfaces  EMRs  HRAs  Medical Claims  Rx Claims  Lab Results  Health Histories  Nurses  Care Coordinators  Eligibility  Physician Offices  Imaging Links  Other 10 ©2014 Conifer Health Solutions, LLC. All Rights Reserved. Global Healthcare Data Center and Reporting  Health management  Financial management and reporting  Patient and physician portals Health Information Exchange  Nurses/Care Coordinators  Administrators/Managers  Physician Offices  Individual Patients  Others Includes users at self-insured employers, providers, care managers, health plans

11. Holding the Alliance Together Population Health Management  Risk Stratification  Population’s Conditions  Predictive Modeling  Provider/Plan Performance 11 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.

13. Four Steps to Reach Commons Goals  Get the disparate data in one place  Identify the trends/issues throughout an entire population  Identify the individuals driving risk/cost and connect them with a nurse/care coordinator  Decrease in financials will naturally follow 13 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.

14. Getting the Data in One Place A Longitudinal Record In this example:  Five most frequent diagnoses being treated  12-month history of medications, emergency room use and hospital stays  Names of top five physicians seeing the patient most frequently  Adherence with standards of practice for the management of any chronic illness  Compliance with preventative screenings and chronic care issues 14 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.

18. Identify the Population and the Individuals Participant stratification levels Percent of population No risk Low Moderate 7% 9% 12% 13% 22% 57% 53% 18 ©2014 Conifer Health Solutions, LLC. All Rights Reserved. 25% Benchmark Client population Features present in high risk population Percent of high-risk participants 89.20 % 78.30 % 76.40 % 24.20 % 23.10 % 12.30 % 100% Poor or ineffective utilization patterns Condition related to instability High Predicted cost Lab results out of range High restrospective… Non-compliance with EBM… Total unique

19. How Stakeholders Come Together Self-Insured Employers 19 ©2014 Conifer Health Solutions, LLC. All Rights Reserved. Employers – Self Insured  Taking on risk for covered members  Building partnerships with local plan administrators & networks  Creating win-win for all stakeholders using data Members ASC Health Networks Hospital TPAs Care Managers Physician Offices Employer

20. How Stakeholders Come Together Employers Partner with Health Systems Employer Health Systems 20 ©2014 Conifer Health Solutions, LLC. All Rights Reserved. Employers & Providers  Go direct for health & wellness programs  Direct contracts for care of members Members

21. How Stakeholders Come Together Provider-Owned Health Plans Provider-Owned Health Plan  Goes direct to members/consumers  Enlists the help of Local plan administrators to define network 21 ©2014 Conifer Health Solutions, LLC. All Rights Reserved. Health System Provider-Owned Health Plan Local Plan Administrators Members/Consumers

22. Fool-proofing the Plan Where we’ve seen failure  Lack of Investment in infrastructure  Accomplishing synergy requires investments in the right partnerships, technology and human resources  Unrealistic expectations  Partnering is a long-term commitment  Improvements in the health status of population and financial risk will not happen overnight  Expect 12 to 36 month timeframe for impact and results  Starting too broadly  The best sample set of a community is within your own four walls  Leverage your own employees to develop a winning approach to population health management  Apply strategies internally to minimize risk and define measureable improvements 22 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.

23. There are several inputs into choosing the right care management model What delivery model is in place in the market? Primary care medical home | ACO | Employed physicians | No structure What care management capabilities exists in the market? None | Transitions of care nurses | Full care management What population will the market be caring for? Does the population have specific characteristics? Population age | Chronic conditions | Behavior patterns What payment model will the population be covered under? P4P or penalties | Upside risk | Employee ACO | Upside/Downside | Full risk What are the operational strengths and weaknesses of the market? ED Through-put | Engaged physicians | Social services 23 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.

Partnering for Population Health: Strategies to Promote Collaboration Among the Patient, Provider and Employer

Du liest eine Vorschau.

Hier ansehen

Partnering for Population Health: Strategies to Promote Collaboration Among the Patient, Provider and Employer

Weitere Verwandte Inhalte

Diashows für Sie (20)

Ähnlich wie Partnering for Population Health: Strategies to Promote Collaboration Among the Patient, Provider and Employer (20)

Aktuellste (20)