Session #6: Population Health Must Haves Care Coordination

Transcription

1 Session #6: Population Health Must Haves Care Coordination Presenter: Robert Wieland, M.D. Arbor Lakes Saturday, Jan. 7, :15 a.m. 12:15 p.m.

2 Robert A. Wieland, M.D. Robert A. Wieland, M.D. (Bob) currently serves as executive vice president, Network/Integration Division of Allina Health. In this role, he is responsible for all strategic, administrative and operation activities encompassing the business units of the division. Included in the division are overseeing the Allina Integrated Medical Network, strategy and business development, pharmacy, care management, marketing and communications, technology integration strategies, home care, hospice and palliative care services, and a contact center which serves patients in the Twin Cities and surrounding area including western Wisconsin. Previously, Dr. Wieland served as vice president of medical affairs at Abbott Northwestern Hospital, executive vice president for the Allina Clinic Division and as district medical director for the Allina Medical Clinics. He is also co-founder of the Hospitalist Service at Abbott Northwestern. Dr. Wieland earned his bachelor s degree in mechanical engineering at the University of Minnesota, medical degree at the University of Minnesota Medical School, and Internal Medicine training at Abbott Northwestern Hospital.

3 Population Health 2017 MHA Trustee Conference "Governance Through Partnerships" January 7, 2017 Bob Wieland, MD, SVP and Chief Strategy Officer Allina Health 1. Get Started Steep Learning Curve FFS -vs-ffv 2 1

4 Allina Pioneer ACO Quarterly Performance 3 Estimated Estimated NGACO Performance NGACO Performance Optum Analysis (assumes 1.5% annual HCC Improvement) Optum Analysis (assumes 1.5% annual HCC Improvement) 4 2

5 Allina Health 2017 Populations Allina Health Care Management will be actively managing 10 distinct contracts/client relationships in 2017, serving over 200,000 members. Revenue to support Care Management is secured through either a PMPM or a withhold-based payment structure Network Form and/or join a clinically integrated network 6 3

6 Current Membership: >3,000 Physicians (1,300 Allina; 1,700 Independent) >60 Physician Groups 26 Hospitals 13 Allina Health 13 Independent AIM Network Profile Vision: The AIM Network aligns independent physicians and Allina to deliver marketleading quality and efficiency in patient care AIM NETWORK GOALS: Achieve clinical integration that enables AIMN participants to partner with each other to improve quality and reduce cost Build an infrastructure that supports effective care coordination Deliver consistent, evidence-based, best practice health care to the patients and communities we serve Position AIMN to jointly contract with payers for value based payment 7 3. Actionable Data & Analytics EDW 70 data sources, clinical data, claims data and patient experience Health Catalyst registries, risk stratification 8 4

7 4. Clear Definition Prospective Assigned -vs- Attributed Claims data Delegated Care Management Benefit Design 9 5. Focused Interventions Caregiver Culture Centralized Model 10 5

8 6. Single Care Management Program Accountable Leader

9 7. Business Model pmpmfrom health plan Health Plan Collaboration Hybrid Model for Care Management Call Center On boarding New members 14 7

10 9. HCC Program 15 HCC critical success factor in Medicare risk Hierarchical Condition Categories Coding - Medicare program designed to predict cost - Used to adjust targets for population cost - Used for quality / safety reporting - Specific diagnoses have assigned weights (RAF = risk adjustment factor) - Codes must be documented in an encounter each calendar year Has as big an impact on success as the same degree of utilization reduction Target PMPM Actual PMPM Relative RAF Adjusted PMPM Performance Group A $800 $ $831 $31 worse than target Group B $800 $ $771 $29 better than target 16 8

11 HCC Activities All patients must be seen each calendar year - Medicare Annual Wellness Visits - Other encounters Problem list should be optimized - Data mining / chart audit for missed diagnoses - More specific codes should be used (e.g. diabetes with complications) Chronic diagnoses should be recorded and properly documented - EMR reminders, chart prep, encounter review Code submission must not be truncated Assign resources to patients Internal patient panel analysis and compensation Community Partnerships 18 9

12 Determinants of Health Genetics 5% Medical Care 20% Environmental and Social Factors Behavioral Factors 20% Get Started Summary Network 3. Analytic Solution 4. Definition 5. Focused Interventions 6. Single Care Management Program 7. Business Model 8. Health Plan Collaboration 9. HCC Program 10. Community Partnerships 10