Embed Size (px)
Citation preview
Christopher Vojta, MD, MBADirector, Deloitte Consulting, LLPChicago, IL
Randall Williams, MD Chief Executive Officer, Pharos Innovations, LLCNorthfield, IL
Sandeep Wadhwa, MD, MBA Medical Director, Colorado Department for Health Care Policy and Financing Denver, CO
David Gorstein, MD James L. Dooley & Associates, Inc Mt. Pleasant, SC
Innovations in Innovations in Population HealthPopulation Health
Still questions about the cost effectiveness of current DM Models
One recent article:
“Cost-effectiveness of Telephonic Disease Management in Heart Failure” (Am J Manag Care. 2008;14:106-115)
Conclusions: The intervention was effective but costly to implement and did not reduce utilization.
Why is this so hard?
Introduction
Being bad is more fun than being good
What are some potential drivers of incremental ROI in DM?
What are some of the ways to align incentives for physicians to be active, enthusiastic partners in chronic care management?
What are the keys to incenting healthy consumer behavior?
Introduction
Innovations in Population Health:Innovations in Population Health:Implications for Consumers, Implications for Consumers, Health Plans and ProvidersHealth Plans and Providers
Chris Vojta, Director, Deloitte Healthcare Consulting, LLP
Traditional health services
Self-directed care
Information seeking
Alternative and non-conventional health services
Financing
Health care consumerism
Deloitte’s 2008 Survey of Health Care Consumers
Factor Content & Compliant
Sick & Savvy
Online & Onboard
Shop & Save
Out & About
Casual & Cautious
Segment size 29% 24% 8% 2% 9% 28%
System use Medium Highest High Medium Medium Lowest
Preferences regarding care Traditional Traditional
Traditional, but open to non- conventional settings
Traditional, but open to alternative and non- conventional settings
Alternative approaches and non- conventional settings
Disengaged, but currently leans toward traditional
Dependence on providers
Accepts what doctor recommends
Takes charge of own care
Leans toward relying on self
Leans toward allowing doctor to make decisions
Makes own decisions/ independent
Leans toward relying on self
Compliance with treatment Most compliant Compliant Compliant Less compliant Least
compliant Less compliant
Satisfaction with providers and plans
Most satisfied Satisfied Satisfied Less satisfied Least satisfied Less satisfied
Other important distinctions
Less likely to seek information; less likely to use value- added services; least interested in shopping for and customizing insurance
Seeks information; sensitive to quality; uses some value- added services; wants to shop for and customize insurance
Seeks information; uses online tools the most; sensitive to quality; maximizes use of value-added services
Makes changes to insurance; price-sensitive; uses value- added services; most likely to travel for care
Seeks information; sensitive to quality; uses some value- added services; wants to shop for and customize insurance
Price-sensitive; unprepared financially for future needs; less likely to seek information; less likely to use value- added services
Consumer Segments have varying attitudes and preferences
Integrated Health Management Vision: One Seamless Organization Focused on the Members; Value and Transparency Throughout...
Inbound Claims/Benefits Calls become a major lever
Predictive Modeling / Gaps in Care
Health Risk Assessment
Utilization Management
Provider Referrals
Nurse Call-in Lines
Pharmacy
Lab results
Referrals from providers & vendors
Information Sources
Health Coaches:Wellness Programs
Lifestyle Management
Coaching
Network Direction
Clinical Specialists:Chronic Disease Management
Care Management
Specialty Networks
End-of-Life
Hospice
PersonalizedHealth Record
Benefit Design & Financial
Management Integration
Web-based EducationAnd tools
Robust Reporting: Operational, Clinical, Financial
Enhanced Member Services
Integrated Common Platform:
Real-time Member Profiles &
Opportunities ID
Next Generation Health Plan Medical Management Strategy
Employers
Individuals
Provider
Physicians are viewed as the trusted source for clinical information
Primary Care PhysicianIncentives: VisitsInvestments: NAIncremental Costs: NAPanel Size: 1,500 activeNet Revenues: $350,000-$600,000
Future StatePrimary Care Physician/Health CoachesIncentives: Increased adherenceInvestments: EMR ($100,000)Incremental Costs: $115,000 per PCP/$78,000 per CoachPanel Size: 1,500 activeNet Revenues: $500,000-$1,000,000
Requires $150 per patient per month reduction to break evenHospitals risk 10% of admissions and 20% of ED visits
Data sharing capability is key
Medical Home Models
Current State
Future Directions in DM: Role of Future Directions in DM: Role of Technology; Role of the PatientTechnology; Role of the Patient--
Provider ConnectionProvider Connection
Randy Williams, M.D.Pharos Innovations
Technology Leveraged DM
• RPM Defined• Specific
operational leverage points
• Model nuances and unanswered questions
• Improvement in ROI
• Results
Provider-Patient Engagement• New models of
provider engagement– P4P Demonstrations– Medical Home
evolving models– Hospitals as Hubs
• New approaches to patient engagement– Population
segmentation approaches
– Non-clinical engagers– Role of physician
endorsement
Engagement, Enrollment & Retention
Our behavioral staffing expertise allows clinicians to be clinicians and not spend valuable time wrestling with patient enrollment and program adoption
Behaviorally trained personnelEducate & enroll patientsEnsure active, on-going program participation
Solving the challenges of patient adoption and adherence
Have successfully enrolled and retained 50 – 75% of target population
“Pharos goes beyond the technology to achieve a higher level of results”
©2004/2008 Pharos Innovations, LLC. All Rights Reserved.
Patient phones with daily clinical & behavioral
status report
Patient phones with daily clinical & behavioral
status report
Nurse Care Manager accesses variance
dashboard
Nurse Care Manager accesses variance
dashboard
Care Manager telephonic patient
assessment
Care Manager telephonic patient
assessment
Reviews adherence to treatment plan
Reviews adherence to treatment plan
Reinforcement of treatment plan,
alteration as needed
Reinforcement of treatment plan,
alteration as needed
Computer collects daily touch-tone patient responses
Algorithms trigger “exception reports”
Patients who have not called in receive automated outbound reminders
Clinical change or self- care compliance
challenge
Clinical change or self- care compliance
challenge
©2004/2008 Pharos Innovations, LLC. All Rights Reserved.
Reduction in Utilization vs. Matched Cohort
Dramatic Improvements in Key Utilization Indicators
Source: Iowa Chronic Care Consortium University of Iowa Analysis; January 2008
Net Savings: $13,600 per enrollee per year
30-Day Readmission Rate Following Hospitalization
Colorado Medicaid PerspectiveColorado Medicaid Perspective
Sandeep Wadhwa, MD, MBAMedicaid Director
Medical Services Premiums Caseload FY 07-08
Other5% Elderly and
Disabled24%
Low-Income Adults15%
Low-Income Children
56%
Medical Services Premiums Expenditure FY 07-08
Other3%
Elderly and Disabled
66%
Low-Income Adults12%
Low-Income Children
19%
Medical Services Premiums Expenditure (in Millions) FY 07-08
Service Management$31.77
1% Insurance$90.26
4%
Acute Care$1,276.41
59%
Community-Based Long Term Care
$235.49 11%
Long Term Care$538.88
25%
Medical Home• Provide a Medical Home for over
270,000 children enrolled in Medicaid and CHP+ within three years
• Develop reimbursement methodology for Medical Home providers
Medical Homes• Created a pilot program
involving 11,000 children that provides continuous, comprehensive and accessible medical and non-medical care
Disease Management ProgramsImplemented disease management programs to serve approximately 6,000 clients•Heart disease•Lung disease•Weight management•High-risk pregnancy•Diabetes
Care Management• Piloting new integrated care
management model for Medicaid disabled individuals with multiple, chronic conditions with a fully capitated PMPM
CORHIO• Participate in funding Colorado
Regional Health Information Organization (CORHIO)
Value in Health Care• Lead the Center for Improving Value
in Health Care
Thank You!
David Gorstein MDJames L. Dooley & Associates, Inc.266 W. Coleman Blvd., Suite 102Mt. Pleasant, SC 29464877-434-6837 x19843-856-0547 [email protected]
http://www.theheadhunter.com/contents/mrinetwor kjobs.php
