Decreasing Medical. Costs. Are your members listening to you? PRESENTED BY: September 22, 2016

Transcription

1 Decreasing Medical Costs Are your members listening to you? PRESENTED BY: Aaron Crowell, Executive Vice President, MTM, Inc. Gary Jacobs, Executive Vice President, CareCentrix Dan Masciopinto, SVP of Product, NextHealth Technologies Allison Young, President and CEO, UnitedHealthcare Louisiana Community Health Plan Moderator: Melissa O Connor, VP Marketing, NextHealth Technologies September 22, 2016

2 Medicaid Health Plans of America mhpa2016 Conflict of Interest Disclosure: Faculty/Planning Committee/Reviewers/Staff Participating speakers in Decreasing Per Episode Costs: The 30% Solution have no conflict of interest to disclose relative to the content of the presentation.

3 Welcome Today s Agenda Panel overview and introductions Panelists will present real-world examples of how they are using analytics, behavioral economics, clinical programs, and consumer engagement to reduce medical costs Panel Q & A Audience questions 3

4 Introduction Aaron Crowell MTM, Inc. Executive Vice President, Managed Care Increasing Healthcare Access, Promoting Independence & Connecting Resources 3

5 The Impact of Access Access to preventative care Provider contracting and compliance Areas of Support Care plan Post-acute care 4

6 Removing Transportation Barriers Access to Preventative Care Physical & cognitive needs Language & ethnic specific services Attendants & caregivers 5

7 Facility and Case Manager Support Care Plan Support Coordinate recurring trips Convenient discharge & facility transports Communicate on membership & utilization trends 6

8 Readmissions and ER Diversion Strategies Post-Acute Care Support Member & caregiver outreach Educate on preventative care & transportation options Coordinate scheduling & confirmation of visits 7

9 Introduction Gary Jacobs CareCentrix Executive Vice President Strategic Relationships 8

10 Post acute care is a significant portion of the total cost of an episode of care Managing the PAC continuum can produce up to 25% savings on a 90 day episode; reducing readmissions is an essential component of the savings MA Example: 40% of the cost of a 90 day bundle is for post acute services 17.2 Total All-Cause 30 day readmission rates by payer, Medicare 65+ Medicaid Privately Insured Uninsured The Opportunity: Up to 27% reduction through appropriate care transitions management; Up to 35% reduction in hospital readmissions; An average of 10 15% savings through administrative and unit cost reduction 10

11 Improving PAC value requires managing the full continuum of PAC services on an at-risk basis 30-40% Immediate savings Four critical elements of a value enhancing PAC Model Reduce the impact of PAC silos Clinical care coordination across the full episode of care up to 90 days Care transitions management with appropriate maximization of home $171M Integrated, Shared Risk and Home-Centric Over Guaranteed 3 years for a commercial plan PAC Savings Performance guarantees based on based care solutions Management Aligned incentives based on risk sharing models (bundled payments, full or partial capitation, shared savings) mutually agreed upon targets for cost and quality improvements 80%+ Advanced Network Optimization Therapy Technology and adherence Analytics High performing network by disease state and geography Provider performance tracked for quality and cost performance and provider selection optimized for each patient State-of-the-art technology and analytics based on machine learning Analytics support risk identification, transitions management, provider selection 11 31

12 Advanced technology and analytics enable network optimization and reduce readmissions and costs Intelligent analytics forecast the probability Immediate of a readmission savings and guide appropriate care transitions DRG 238 Home Health Over 3 years for a commercial plan Hospital 1 80%+ Hospital 2 Hospital 3 Therapy adherence Colors of lines indicates readmission rates of HHA vs national benchmark. Thickness shows how many health. patients were sent to given home 12 32

13 Referral Quality Scores identify the best provider for the patient s specific condition Immediate savings By understanding what services an agency does well, and what they don t, you can lower total costs and improve outcomes, while still ensuring patient access Over 3 years for a commercial plan 80%+ Therapy adherence 13 33

14 Introduction Dan Masciopinto NextHealth Technologies Senior Vice President of Product and Services 10

15 From Insights to Medical Savings An Analytics Maturity Model 30-40% 4.0 Systematically orchestrating sustained medical savings Immediate savings 3.0 Behavior Change Campaign Management $171M 2.0: Segment & View Over Prescriptive 3 years Analytics Behavioral for a economics commercial Direct mail plan 80%+ Therapy adherence Consumer Engagement Call center Predictive Analytics Causal modeling Message framing 1.0: Traditional Descriptive Analytics Risk identification Machine learning Personalized nudges Text Data Management Retrospective view ETL Population profiles Clusters RCTs Data lake Big data appliance Correlates Resource optimization Persistence Web Impactability score

16 A Medical Cost Reduction System - Prescriptive Analytics and Consumer Engagement 30-40% Immediate savings WHO? IDENTIFY IMPACTABLE TARGETS $171M Over 3 years WHAT? for a commercial plan PERSONALIZE ENGAGEMENT 80%+ Therapy adherence HOW WELL? MEASURE AND OPTIMIZE OUTCOMES

17 A Turn Key Open Source and Secure SaaS Platform 30-40% Immediate savings $171M Over 3 years for a commercial plan 80%+ Therapy adherence

18 Today s Takeaways Dan Masciopinto NextHealth Technologies Reducing medical costs isn t easy Marry consumer engagement with analytics insights alone aren t enough 1. Better targeting improves capacity and lift 2. Personalize your interventions 3. Ability to prove and measure what is working or not working allows quick pivots 4. Need a system that allows for rapid adjustments and scale 11

19 Introduction Allison J. Young Louisiana Community Plan UnitedHealthcare President and CEO 12

20 This Louisiana Health Overview Overall Health Rank 50 th out of 50 states Behaviors High levels of obesity High prevalence of smoking High levels of physical inactivity Rank 49 th in Chlamydia Social and Economic Factors Rank 50 th for children in poverty Rank 30 th in per capita income Medicaid is the largest health plan/payer in the state America s Health Rankings 2016 United Healthcare Foundation 20

21 Why Now?! Medicaid Expansion Expansion of Managed Care Integration of Benefits Delivery System Reforms Recognition of Broader Influences of Health Data, Data, Data 14

22 Strategy For Health Knitting it Together Right Care, Right Time, Right Place, Right Incentives 1. Supporting State Transformation Goals via Value Based Programs 2. Strengthening our relationship with and supporting individual PCPs 3. Improving Access to Care 4. Enhancing Delivery System Innovation 22

23 Appendix

24 Decreasing Per Episode Costs: Post-Acute Care & Mobility Management PRESENTED BY: Aaron Crowell Executive Vice President, MTM, Inc. September 22, 2016

25 Impact of Access: Mobility Management

26 The Importance of Mobility Management Preventative care On-demand service Areas of Impact Non-emergency ambulance Care plan support 19

27 Impact: Preventative Care The Transportation Effect Utilization Level of need Urgent & same-day trips Quality & compliance 20

28 Impact: On-Demand Service Same Day is the New Normal Urgency for high-risk & chronic members Impact of on-time performance on outcomes Real-time provider scheduling & tracking 21

29 Impact: On-Demand Service The Uber Effect Opportunities Immediate access Real-time tracking Reduced complaints Reduced costs Challenges Compliance Credentials Mode limitations Geographic limitations 29

30 Impact: Non-Emergency Ambulance Needs Control utilization to the most appropriate mode Claims adjudication & cost controls Establish detailed protocols Solutions Prior authorization model Post authorization model 23

31 Impact: Care Plan Support Facility & Case Manager support Special needs & high risk requests Outreach, educate & coordinate 24

32 Support: Facilities & Case Managers Convenience in Coordination Coordinate recurring trips Convenient discharge & facility transports Communicate on membership & utilization trends 25

33 Support: Special Needs Requests Protecting Members Physical & cognitive needs Language & ethnic specific services Attendants & caregivers 26

34 Support: Outreach, Educate & Coordinate Targeted Post-Acute Care Initiatives Member & caregiver outreach Educate on preventative care & transportation options Coordinate scheduling & confirmation of visits 27

35 Questions Aaron Crowell EVP, Managed Care MTM, Inc. (314)

36 Decreasing Per Episode Costs: Post-Acute Care: Reducing Per Episode Costs PRESENTED BY: Gary Jacobs Executive Vice President, CareCentrix September 22, 2016

37 Post acute care is a significant portion of the total cost of an episode of care Managing the PAC continuum can produce up to 25% savings on a 90 day episode; reducing readmissions is an essential component of the savings MA Example: 40% of the cost of a 90 day bundle is for post acute services 17.2 Total All-Cause 30 day readmission rates by payer, Medicare 65+ Medicaid Privately Insured Uninsured The Opportunity: Up to 27% reduction through appropriate care transitions management; Up to 35% reduction in hospital readmissions; An average of 10 15% savings through administrative and unit cost reduction 37

38 Improving PAC value requires managing the full continuum of PAC services on an at-risk basis 30-40% Immediate savings Four critical elements of a value enhancing PAC Model Reduce the impact of PAC silos Clinical care coordination across the full episode of care up to 90 days Care transitions management with appropriate maximization of home $171M Integrated, Shared Risk and Home-Centric Over Guaranteed 3 years for a commercial plan PAC Savings Performance guarantees based on based care solutions Management Aligned incentives based on risk sharing models (bundled payments, full or partial capitation, shared savings) mutually agreed upon targets for cost and quality improvements 80%+ Advanced Network Optimization Therapy Technology and adherence Analytics High performing network by disease state and geography Provider performance tracked for quality and cost performance and provider selection optimized for each patient State-of-the-art technology and analytics based on machine learning Analytics support risk identification, transitions management, provider selection 38 31

39 Advanced technology and analytics enable network optimization and reduce readmissions and costs Intelligent analytics forecast the probability Immediate of a readmission savings and guide appropriate care transitions DRG 238 Home Health Over 3 years for a commercial plan Hospital 1 80%+ Hospital 2 Hospital 3 Therapy adherence Colors of lines indicates readmission rates of HHA vs national benchmark. Thickness shows how many health. patients were sent to given home 39 32

40 Referral Quality Scores identify the best provider for the patient s specific condition Immediate savings By understanding what services an agency does well, and what they don t, you can lower total costs and improve outcomes, while still ensuring patient access Over 3 years for a commercial plan 80%+ Therapy adherence 40 33

41 Results: 30 day readmissions were reduced by 9% in the first year for a Medicaid population 30 Day Readmission Results on Care Management Eligible Patients 8.6% 6.4% 11.2% 11.2% 10.2% 9.6% 10.6% Commercial Medicaid Medicare Total Baseline Readmit Rate 9.0% Program Year 1 Readmit Rate 3 Year 90 Day Commercial Results: 38% reduction in readmissions $50 M savings 95% satisfaction Value Added: Key quality reporting metrics can be positively impacted by the PAC model of care, e.g. Readmissions Medication management Risk of falling 34

42 Contact Information Gary Jacobs Executive Vice President, Strategic Relationships CareCentrix (945)

43 Decreasing Medical Costs: Nudging Members to More Optimal Care Settings PRESENTED BY: Dan Masciopinto SVP of Product and Services NextHealth Technologies September 22, 2016

44 Key Takeaways Reducing medical costs isn t easy Marry consumer engagement with analytics insights alone aren t enough 1. Better targeting improves capacity and lift 2. Personalize your interventions 3. Ability to prove and measure what is working or not working allows quick pivots 4. Need a system that allows for rapid adjustments and scale 37

45 From Insights to Behavior Change An Analytics Maturity Model 30-40% 4.0 Systematically orchestrating sustained medical savings Immediate savings 3.0 Behavior Change Consumer Engagement Campaign Management Call center $171M 2.0: Segment & View Over Prescriptive 3 Analytics years Behavioral for economics a commercial Direct mail plan Predictive Analytics Causal modeling Message framing 1.0: Traditional Descriptive Analytics Risk identification Machine learning Personalized nudges Text Data Management 80%+ Retrospective view Therapy adherence ETL Population profiles Clusters RCTs Data lake Big data appliance Correlates Resource optimization Persistence Web Impactability score 38

46 The Challenge: Moving Consumers to Optimal Care Sites 30-40% Immediate savings $171M Over 3 years for a commercial plan 80%+ Therapy adherence 39

47 Sustained Medical Cost Reduction - a Prescriptive Analytics and Consumer Engagement Platform 30-40% Immediate savings WHO? IDENTIFY IMPACTABLE TARGETS $171M WHAT? Over 3 years for a commercial plan PERSONALIZE ENGAGEMENT HOW WELL? 80%+ Therapy adherence MEASURE AND OPTIMIZE OUTCOMES 40

48 A Turn Key Open Source and Secure SaaS Platform 30-40% Immediate savings $171M Over 3 years for a commercial plan 80%+ Therapy adherence

49 WHO - More Precise Targeting: Where would you focus for ER visit reduction? 30-40% Immediate savings Joe Harris 55 year-old male 2 recent ER visits 8 years on plan $171M Over 3 months years on plan for a commercial plan Chronic diabetic Poor compliance Overweight Has PCP Victoria Chavez 25 year-old female No ER visits 1 and 3 year-old children w/multiple ER visits No PCP 80%+ Therapy adherence 41

50 WHAT - Personalized Messaging Utilizing Behavioral Economic Frames 30-40% Immediate savings $171M Over 3 years for a commercial plan 80%+ Therapy adherence 42

51 HOW WELL - Prove and Measure Outcomes w/ RCTs 30-40% The Before and After Method Immediate savings RCTs and Statistical Significance Measure Target Population ER Visits/1000 Measure Measure Target Population ER Visits/1000 Measure pvalue to ensure result is significant $171M -200 visits Over 3 years for a commercial plan Execute Outreach - 74 visits Campaign Year 0 Year 1 The campaign reduced ER visits...but how do we know it was the campaign that caused the change and not something else? Randomly assign: 50% = Control 50% = Campaign Year 0 80%+ Vs. Therapy adherence Year 1 p=0.04 There is only a 4% chance of measuring this lift or more if the true lift is really zero. And then optimize by focusing resources on what is working (and turning off what isn t) 43

52 Key Takeaways Reducing medical costs isn t easy Marry consumer engagement with analytics insights alone aren t enough 1. Better targeting improves capacity and lift 2. Personalize your interventions 3. Ability to prove and measure what is working or not working allows quick pivots 4. Need a system that allows for rapid adjustments and scale 44

53 Contact Information Dan Masciopinto Senior Vice President, Product & Services NextHealth Technologies 45