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PRESENTED BY:
Decreasing Medical CostsAre your members listening to you?
September 22, 2016
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
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.
Welcome
• 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
Today’s Agenda
3
Introduction – Aaron CrowellMTM, Inc.
Executive Vice President, Managed Care
3
Increasing Healthcare Access, Promoting Independence & Connecting Resources
The Impact of Access
4
Access to preventative care
Provider contracting and compliance
Care plan Post-acute care
Areas of Support
Removing Transportation Barriers
• Physical & cognitive needs
• Language & ethnic specific services
• Attendants & caregivers
Access to Preventative Care
5
Facility and Case Manager Support
• Coordinate recurring trips
• Convenient discharge & facility transports
• Communicate on membership & utilization trends
Care Plan Support
6
Readmissions and ER Diversion Strategies
• Member & caregiver outreach
• Educate on preventative care & transportation options
• Coordinate scheduling & confirmation of visits
Post-Acute Care Support
7
Introduction – Gary JacobsCareCentrix
Executive Vice President Strategic Relationships
8
Post acute care is a significant portion of the total cost of an episode of care
10
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
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
17.2 14.88.7 10.6
Medicare65+
Medicaid18-64
PrivatelyInsured18-64
Uninsured18-64
Total All-Cause 30 day readmission rates by payer,
2011
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
Improving PAC value requires managing the full continuum of PAC services on an at-risk basis
11
Four critical elements of a value enhancing PAC Model
Integrated, Home-Centric
PAC Management
Shared Risk and Guaranteed
Savings
Network Optimization
Advanced Technology and
Analytics
• 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 homebased care solutions
• High performing network by diseasestate and geography
• Provider performance tracked for quality and cost performance and provider selection optimized for eachpatient
• Aligned incentives based on risksharing models (bundled payments,full or partial capitation, shared savings)
• Performance guarantees based onmutually agreed upon targets forcost and quality improvements
• State-of-the-art technology andanalytics based on machine learning
• Analytics support risk identification,transitions management, providerselection
31
Immediate savings
Over 3 years for a commercial plan
80%+ Therapy adherence
12
Advanced technology and analytics enable network optimization and reduce readmissions and costs
Hospital 1
Hospital 2
Hospital 3
Home Health
DRG 238
Colors of lines indicates readmission rates of HHA vs national
benchmark.
Thickness shows how many patients were sent to given home
health.
Intelligent analytics forecast the probability of a readmission and guide appropriate care transitions
32
Immediate savings
Over 3 years for a commercial plan
80%+ Therapy adherence
13
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
Referral “Quality Scores” identify the best provider for the patient’s specific condition
33
Introduction – Dan MasciopintoNextHealth Technologies
Senior Vice President of Product and Services
10
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
From Insights to Medical Savings–An Analytics Maturity Model
4.0 Systematically orchestrating sustained medical savings
3.0 Behavior Change
Consumer Engagement
CampaignManagement
Call center
2.0: Segment & View Prescriptive Analytics Behavioral economics Direct mail
Predictive Analytics Causal modeling Message framing Email
1.0: Traditional Descriptive Analytics Risk identification Machine learning Personalized nudges Text
Data ManagementRetrospective view
Correlates Resource optimization Persistence Web
ETL Population profiles Clusters RCTs
Data lake Impactability score
Big data appliance
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
A Medical Cost Reduction System -Prescriptive Analytics and Consumer Engagement
WHO?
WHAT?
HOW WELL?
IDENTIFY IMPACTABLETARGETS
PERSONALIZE ENGAGEMENT
MEASURE AND OPTIMIZE OUTCOMES
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
A Turn Key Open Source and Secure SaaS Platform
Today’s Takeaways – Dan MasciopintoNextHealth 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
Introduction – Allison J. YoungLouisiana Community Plan – UnitedHealthcare
President and CEO
12
This Louisiana Health Overview
Overall Health Rank 50th out of 50 states
• Behaviors• High levels of obesity• High prevalence of smoking• High levels of physical inactivity• Rank 49th in Chlamydia
• Social and Economic Factors• Rank 50th for children in poverty • Rank 30th in per capita income• Medicaid is the largest health plan/payer in the state
America’s Health Rankings 2016—United Healthcare Foundation 20
Why Now?!
14
• Medicaid Expansion• Expansion of Managed Care• Integration of Benefits• Delivery System Reforms • Recognition of Broader Influences of Health• Data, Data, Data
Strategy For Health – Knitting it Together
22
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
Right Care, Right Time, Right Place , Right Incentives
Appendix
PRESENTED BY:
Decreasing Per Episode Costs:Post-Acute Care & Mobility Management
September 22, 2016
Aaron CrowellExecutive Vice President, MTM, Inc.
Impact of Access:Mobility Management
The Importance of Mobility Management
19
Preventative care On-demand service
Non-emergency ambulance
Care plan support
Areas of Impact
Impact: Preventative Care
• Utilization
• Level of need
• Urgent & same-day trips
• Quality & compliance
The Transportation Effect
20
Impact: On-Demand Service
• Urgency for high-risk & chronic members
• Impact of on-time performance on outcomes
• Real-time provider scheduling & tracking
Same Day is the New Normal
21
Impact: On-Demand Service
29
Opportunities
• Immediate access
• Real-time tracking
• Reduced complaints
• Reduced costs
“The Uber Effect”
Challenges
• Compliance
• Credentials
• Mode limitations
• Geographic limitations
Impact: Non-Emergency Ambulance
23
Solutions
Establish detailed protocols
Prior authorization model
Post authorization model
Needs
Control utilization to the most appropriate mode
Claims adjudication & cost controls
Impact: Care Plan Support
24
Facility & Case Manager
support
Special needs & high risk requests
Outreach, educate & coordinate
Support: Facilities & Case Managers
• Coordinate recurring trips
• Convenient discharge & facility transports
• Communicate on membership & utilization trends
Convenience in Coordination
25
Support: Special Needs Requests
• Physical & cognitive needs
• Language & ethnic specific services
• Attendants & caregivers
Protecting Members
26
Support: Outreach, Educate & Coordinate
• Member & caregiver outreach
• Educate on preventative care & transportation options
• Coordinate scheduling & confirmation of visits
Targeted Post-Acute Care Initiatives
27
Questions
EVP, Managed Care
MTM, Inc.
(314) 323-7007
Aaron Crowell
28
PRESENTED BY:
Decreasing Per Episode Costs:Post-Acute Care: Reducing Per Episode Costs
September 22, 2016
Gary JacobsExecutive Vice President, CareCentrix
Post acute care is a significant portion of the total cost of an episode of care
37
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
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
17.2 14.88.7 10.6
Medicare65+
Medicaid18-64
PrivatelyInsured18-64
Uninsured18-64
Total All-Cause 30 day readmission rates by payer,
2011
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
Improving PAC value requires managing the full continuum of PAC services on an at-risk basis
38
Four critical elements of a value enhancing PAC Model
Integrated, Home-Centric
PAC Management
Shared Risk and Guaranteed
Savings
Network Optimization
Advanced Technology and
Analytics
• 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 homebased care solutions
• High performing network by diseasestate and geography
• Provider performance tracked for quality and cost performance and provider selection optimized for eachpatient
• Aligned incentives based on risksharing models (bundled payments,full or partial capitation, shared savings)
• Performance guarantees based onmutually agreed upon targets forcost and quality improvements
• State-of-the-art technology andanalytics based on machine learning
• Analytics support risk identification,transitions management, providerselection
31
Immediate savings
Over 3 years for a commercial plan
80%+ Therapy adherence
39
Advanced technology and analytics enable network optimization and reduce readmissions and costs
Hospital 1
Hospital 2
Hospital 3
Home Health
DRG 238
Colors of lines indicates readmission rates of HHA vs national
benchmark.
Thickness shows how many patients were sent to given home
health.
Intelligent analytics forecast the probability of a readmission and guide appropriate care transitions
32
Immediate savings
Over 3 years for a commercial plan
80%+ Therapy adherence
40
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
Referral “Quality Scores” identify the best provider for the patient’s specific condition
33
Commercial Medicaid Medicare Total
8.6%
11.2% 11.2%10.6%
6.4%
10.2%9.6%
9.0%
Baseline Readmit Rate Program Year 1 Readmit Rate
30 Day Readmission Results on Care Management
Eligible Patients
Results: 30 day readmissions were reduced by 9% in the first year for a Medicaid population
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 bythe PAC model of care, e.g.
• Readmissions• Medication management• Risk of falling
34
Contact Information
Executive Vice President, Strategic Relationships
CareCentrix
(945) 328-1124
Gary Jacobs
35
PRESENTED BY:
Decreasing Medical Costs:Nudging Members to More Optimal Care Settings
September 22, 2016
Dan MasciopintoSVP of Product and Services
NextHealth Technologies
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
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
From Insights to Behavior Change – An Analytics Maturity Model
4.0 Systematically orchestrating sustained medical savings
3.0 Behavior Change
Consumer Engagement
Campaign Management Call center
2.0: Segment & View Prescriptive Analytics Behavioral economics Direct mail
Predictive Analytics Causal modeling Message framing Email
1.0: Traditional Descriptive Analytics Risk identification Machine learning Personalized nudges Text
Data ManagementRetrospective view
Correlates Resource optimization Persistence Web
ETL Population profiles Clusters RCTs
Data lake Impactability score
Big data appliance
38
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
The Challenge: Moving Consumers to Optimal Care Sites
39
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
Sustained Medical Cost Reduction - a Prescriptive Analytics and Consumer Engagement Platform
WHO?
WHAT?
HOW WELL?
IDENTIFY IMPACTABLETARGETS
PERSONALIZE ENGAGEMENT
MEASURE AND OPTIMIZE OUTCOMES
40
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
A Turn Key Open Source and Secure SaaS Platform
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
WHO - More Precise Targeting:Where would you focus for ER visit reduction?
Joe Harris• 55 year-old male
• 2 recent ER visits
• 8 years on plan
• Chronic diabetic
• Poor compliance
• Overweight
• Has PCP
Victoria Chavez• 25 year-old female
• No ER visits
• 3 months on plan
• 1 and 3 year-old children w/multiple ER visits
• No PCP
41
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
WHAT - Personalized Messaging Utilizing Behavioral Economic Frames
42
30-40% Immediate savings
$171M Over 3 years for a commercial plan
80%+ Therapy adherence
HOW WELL - Prove and Measure Outcomes w/”RCTs”
The “Before and After” Method
Target Population
ER Visits/1000
“The campaign reduced ER
visits...But how do we know it was
the campaign that caused the
change and not something else?”
Vs.
Year 0
Execute Outreach Campaign
Measure
-200 visits
Year 1
Measure
RCTs and Statistical Significance
Target Population
ER Visits/1000
“There is only a 4% chance of
measuring this lift or more if the true lift
is really zero. ”
Year 0
Randomly assign:• 50% = Control• 50% = Campaign
- 74 visitsp=0.04
Year 1
Measure Measure pValue to ensure
result is ‘significant’
…And then optimize by focusing resources on what is working (and turning off what isn’t) 43
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
Contact Information
Senior Vice President, Product & Services
NextHealth Technologies
Dan Masciopinto
45
