Technology and Value-Based Care: How to Make the Best Market & Business Positioning Decisions. October 24, 2018

Transcription

1 Technology and Value-Based Care: How to Make the Best Market & Business Positioning Decisions October 24, 2018

2 Presenters Laurie Nelson Group Product Manager - Analytics, Relias Laurie leads the Relias team in charge of implementing a clinically-designed suite of metrics used to stratify risk and identify care gaps in a population of patients. She brings 22 years of Information Technology experience to Relias, along with over 10 years in Product Management, specializing in Business Intelligence. Kevin McDonnell Senior Director, Population Health & Healthcare Analytics, Relias Kevin is responsible for business development for the Population Health and Analytics solutions offered by Relias. He is passionate about evidence-based, whole-person health and the use of data to improve outcomes and reduce cost. He enjoys building strong networks of behavioral health providers and payers who are championing integrated care and leading the way with value-based contracting. Mike Garrett Chief Executive Officer, Horizons Mental Health Center Mike has worked at Horizons Mental Health Center since 1981 and has been the CEO since He holds a graduate degree in Clinical Psychology and practiced exclusively as a clinician for several years before taking on administrative responsibilities at Horizons. From , Mike served as President of the ACMHCK. 2

3 Laurie Nelson 3

4 Session Takeaways Identify the trends changing healthcare Understand how technology is impacting Behavioral Health organizations Learn about how technology needs change when shifting payment models Understand the role of Performance Management and Population Health Management Systems in value-based arrangements Take a look at how Relias partnering with organizations Learn how Horizons Mental Health Center has used technology over the years 4

5 7 Trends Changing the Future of Healthcare in America 1. Reimbursement systems shift: Pay-for-Performance or Value Fee-for-Service 2. Incentives and requirements to provide Integrated Care 3. Changing population demographics 4. Increased demand because of more universal insurance coverage 5. Demand for more effective prevention services to contain costs 6. Technology and data 7. Healthcare workforce shortage 5

6 Types of Analytics Descriptive Displaying gathered information to understand a situation Diagnostic Figuring out why something happened Predictive Prescriptive Predictive Using past information to predict future outcomes Prescriptive Providing insights about possible actions Descriptive Diagnostic

7 Examples of Analytics in Everyday Life 7

8 Science and Technology in Behavioral Health Advances in treatments and diagnostics Data exchange and interoperability More informed and technology-savvy consumers Technology solutions Big data impact Telehealth Wearables Predictive technology Artificial intelligence Machine learning Mobile apps Internet of things You have to get out of your Comfort Zone. 8

9 Shifting Payment Models 9

10 Definition of Terms Term Analytics Performance Management Definition A class of software and services used to apply algorithms to data sets to extract patterns, often resulting in the form of metrics and advanced visualizations. Analytics products come in many different varieties to solve many different types of problems. The organizational framework that consists of a combination setting measurable goals within an organization, establish a cadence of accountability to facilitate the change process, and establish and delver a set of incentives to reward performance. Population Health Medicaid Waiver Risk Refers to a series of activities targeted at managing the total cost of care and/or the patient outcomes, of a defined population of members (e.g. members of a plan). This contrasts the traditional FFS (fee for service) healthcare model, by which payment is solely based on procedures, and there is no accountability for the total cost, nor the state of health of the patient. An alternative way that Medicaid programs can request flexibility to provide services to people who would otherwise situated in a long-term care setting in the community instead. The opportunity to make more (or some times less) money based on delivering care to specific standards or achieving certain outcomes. A key value component of value-based care Fully Insured/Capitated Being responsible for the total cost of care for patients, bearing the risk for the cost of health care for a population 10

11 The Spectrum of Value-Based Reimbursement High Integration & Accountability Low Integration & Accountability Accountability for the cost and quality of the services passed on to the provider. Payers assume an administrative-only role. Provider responsible for the totality of a member s needs. Fee-for-Service Incentive Payments Pay for Performance Bundled Payments Shared Savings Shared Risk Partial Capitation Full Capitation Payers financial risk and accountability for delivering the care are minimized. Low Financial Risk High Financial Risk 11

12 Technology on the Spectrum of Value-Based Reimbursement Fee-for-Service Incentive Payments Pay for Performance Bundled Payments Shared Savings Shared Risk Partial Capitation Full Capitation Performance Management Healthcare Enterprise Analytics Financial Quality and Business Intelligence Population Health Management Care Coordination Benchmarking 12

13 Performance Management 13

14 The Analytics Knowing-Doing Continuum 14

15 3 Performance Gaps Are Key to Value-Based Care Success Moving from a FFS System to a High Performing System 100% 95% Average System Incremental Improvement Opportunities Top Peforming System 90% 85% 80% 75% Identification gaps Training gaps Process gaps 70% 65% 60% 15

16 Population Health Management 16

17 Population Health Management Pre Analytics Evaluate Population Identify Care Gaps Stratify Risks Manage Care Measure Outcomes Lack of information Lack of focus Higher costs Reduced patient outcomes Evidence based algorithms Standards based algorithms What are the gaps? What issues are most important to the organization? Which lead to poor patient outcomes? Which are costliest activities? Which are impactable? Tiered Intervention for Patient or Provider Across the population Reduced cost? Improved Patient health outcomes? 17

18 Case Study #1: Missouri Outcomes HEALTH IMPROVEMENTS (Feb 2012 Jan 2014) Cholesterol 37% Blood Pressure 42% REDUCTIONS IN HOSPITALIZATIONS IN THE FIRST YEAR 9.1% COST SAVINGS (after 1 year) Missouri Health Homes have saved an estimated $31+ million! Blood Sugar 46% 18

19 Kevin McDonnell Are you ready to use Data to manage your Population? 19

20 Problems with the Status Quo BH Provider EMR platforms have only data from inside their own walls The data within is not ready for analysis - A lot of unstructured data To create reports or track performance is burdensome or impossible It s impossible to track total costs of care There isn t a way to learn of risks that are actionable across a population. 20

21 How Relias Is Helping Providers Get Better Reduce Clinical Variation Moving to Population Heath, VBP Activities Tracking and Trending of Key Performance Measures Identify Highcost, High-risk populations and people Seeing the Whole Patient View of Care Staff Efficiency 21

22 Reduce Clinical Variation Problematic Prescribing 21% decrease in triggering opioid post intervention in randomized control trial over 6-month period 17% decrease of opioid use 60+ days in the absence of a diagnosis supporting chronic use in adults 14% decrease of opioid use 60+ days in the absence of a diagnosis supporting chronic use in elderly adults 11% (p= 0.07) decrease of multiple prescribers of opioids without a malignant cancer diagnosis 22

23 Reduce Clinical Variation 23

24 Identify Highcost, High-risk populations and people 24

25 Risk Stratification: High-Cost, High-Need 25

26 Moving to Population, VBP Activities What is Population Health Management? Population Health Management is the aggregation of patient data across multiple health information technology resources, the analysis of that data into a single, actionable patient record, and the actions through which care providers can improve both clinical and financial outcomes. 26

27 Seeing the Whole-Patient View of Care 27

28 Tracking and Trending of Key Performance Measures 28

29 Staff Efficiency 29

30 Staff Efficiency: EMR Interoperability QI Alerts Diagnoses Health Alert Outliers Pharmacy Alerts Medical Events 30

31 Mike Garrett, M.S., CEO, Horizons Mental Health Center Executive Decision Making on Technology 31

32 Background: Horizons Mental Health Center Primarily grant funded in early years Moved to FFS in 1980s Tracking productivity became important 2007 was the beginning of Managed Care Wholly owned subsidiary of the Association of CMHCs 2008/2009 financial crisis Medicaid was a method many states used to balance their budgets 2010 was the signing of the ACA 2013 all of Medicaid came under Managed Care in KS KS selected 3 MCOs to manage Medicaid in KS 32

33 As Healthcare Accountability Increased, So Did the Need for Technology Overarching strategies for technology purchases Operational efficiencies For the consumer and the provider Financial accuracy and efficiencies Automation of RCM Production of accurate financial documents Clinical utilization Ease of use by provider Documentation to meet regulatory and payer standards Track services provided and Outcomes to care 33

34 History of Technology at Horizons Transcribing dictation and paper records and charts 1983 Lotus and in 1987 Excel 1996 Tele-video for remote sites Computers were needed 1997 Behavioral Care Management System (BCMS) 2006 Began putting computers on every desk 2007 ClaimTrak (EMR) 34

35 History of Technology at Horizons 2008 data uploading into MTM SPQM 2008 Direct service costs and overhead 2011 Costs and Net Revenue by Provider Type 2011 Uploading Outcome data into SPQM 2015 Costs and Net Revenue by CPT/HCPCS code; update every two years 2015 Health Homes began in KS First attempt by our ACMHCK for a uniform electronic record Focus on population health and services provided outside of the CMHC 35

36 History of Technology at Horizons 2015 Health Homes Began working with CMT for population health management Biggest challenge was getting data uploads from the State 2016 Clearing House Previously uploading claims directly into the MCOs portals 2017 Behavioral Health Apps Enhancement to clinical services Self regulation and symptom management for the consumer 2017/2018 KS development of an IPA Negotiate contracts as a system of care Technology needed to demonstrate system management of Costs and Outcomes 2019 KS set to begin OneCare Kansas (i.e. health home) 36

37 Summary Very little change in technology needed The use of technology increases Technology utilization increases threefold 2019 onward Need to anticipate the development and utilization of technology to grow even more rapidly As healthcare continues to be held accountable for costs and outcomes, our efforts to increase efficiencies and to demonstrate value will increase our reliance on technology. 37

38 Q&A 38

39 Readiness Checklist Access to Aggregate Data Clinical Digital Data Claims Data Access or Capability to Build a Patient Registry Tool Spreadsheet Technology Based Vendor Solution Knowledge of Important Risks Relative to Performance Measures Clinical Financial Staff or External Resource with Statistical/Applied Math/Informatics Expertise In House Statistical Analyst Clinician/Physician as Data Scientist Capable External Vendor External Validity Tools that Allow you to Validate your Stratification/Predictive Model Outside of Your Own Data 39

40 THANK YOU