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Implementing a Population Health Model Health IT Perspective
2 . All Rights Reserved. 11 November 2016 © 3M 3M Confidential.
Disclosure
Hon S. Pak, MD Chief Medical Officer
3M Health Information Systems “We are Data Scientists of Language of Health, and we organize healthcare data and provide tools
to support our clients journey toward value based care“
PEHRC, Executive Committee AAD Coding and Reimbursement Committee
Editorial Board Telemedicine and e-Health Journal Past President, American Telemedicine Association
President of Lavonne Morse Foundation Former CIO and CMIO, Army Medical Department
3 . All Rights Reserved. 11 November 2016 © 3M 3M Confidential.
Population Health Models and Value Based Payment Models
APMS
ACO/ PCMH
Bundled Payments
P4P Value Based Care
Example: Supporting a health system’s ability to manage risk-based contracts and bundled payment models.
Foundation: Data Aggregation and Classification
Value Based Care
Population Health Strategy Pillars
4 . All Rights Reserved. 11 November 2016 © 3M 3M Confidential.
2
The Concentration of Health Care Spending
program spending and the top 5 percent are responsible for 38 percent of spending.1
With numbers like these, it is clear that per-person spending among the highest users is substantial and represents a natural starting point when thinking about how to curb health care spending. For instance, the average expenditure for each of the approximately 3 million people comprising the top 1 percent of spenders was more than $90,000 in 2009 (Figure 2). The top 5 percent of spenders were responsible for
$623 billion in expenditures or nearly $41,000 per patient. In contrast, mean annual spending for the bottom half of distribution was just $236 per person, totaling only $36 billion for the entire group of more than 150 million people.
While the highly skewed distribution of spending has been observed for many years, spending has actually become slightly less concentrated over time as high spending has spread to a broader swath of the population. For example, whereas 56 percent of
0%
0
10%
10 2015.4
95 990.0 0.1 0.4 1.32.9
5.6
10.4
18.8
34.8
50.5
78.2
100.0
30 40 50 60 70 80 90 100
20%
30%
40%
50%
60%
70%
80%
90%
100%
Total Personal Health Care Spending= $1.259 Trillion
Top 1% of spenders account for >20% of spending ($275 billion)
Top 5% of spenders account for almost half of spending ($623 billion)
$36 Billion $1,223 Billion
Percent of Civilian Non-Institutionalized Population Ordered by Health Care SpendingCu
mul
ativ
e Pe
rcen
t of T
otal
Spe
ndin
g
FIGURE 1. CUMULATIVE DISTRIBUTION OF PERSONAL HEALTH CARE SPENDING, 2009
NIHCM Foundation analysis of data from the 2009 Medical Expenditure Panel Survey.
Foundation to Pop Health • Aggregation of the data (claims, clinical,
and other)- Master Data Management • Categorization/ Risk stratification of
population (Examples: DRG, APR, CRGs, etc)
Population Health Tools • Bundle Payments: Patient Focused
Episode Groupers • Shared Saving/ Risk Sharing/ Capitation
• Opportunities for cost reduction (prevent readmissions, ER visits, complications)
• Opportunities to identify gaps in care • Pay for Performance
• Provider/ system performance in comparison to national standards of care
• Predictive models
5 . All Rights Reserved. 11 November 2016 © 3M 3M Confidential.
Health Information Systems
19 . All Rights Reserved. 28 October 2015 © 3M 3M Confidential.
Maryland Quality-Based Reimbursement Program 2009–2011 RESULTS & NATIONAL OPPORTUNITY
Extrapolated from 2-year Maryland’s
6% inpatient cost savings to Medicare’s
Fee-for-Service national program
Hospital Pay-For-Performance Programs in Maryland Produced Strong Results, Including Reduced Hospital-Acquired Conditions - Sule Calikoglu, Robert Murray, Dianne Feeny, Health Affairs, 31, no. 12 (2012): 2649-2658
Health Information Systems
17 . All Rights Reserved. 28 October 2015 © 3M 3M Confidential.
Maryland Quality-Based Reimbursement Program STATE OVERVIEW
6 . All Rights Reserved. 11 November 2016 © 3M 3M Confidential.
Opportunity/Challenge for Population Health
Additional Source of Data • Patient-reported outcomes
data • Social determinants of
health data • Activity-based costing data
that will allow accurate management of financial margins in per-capita reimbursement contracts.
7 . All Rights Reserved. 11 November 2016 © 3M 3M Confidential.
Experience matters
in today’s healthcare world
45MILLION
LIVES
63HEALTH PLANS & PAYERS
INSURANCE CARD
0000-5555-000-22
with whom 3M has relationships or from whom 3M accepts data*
300THOUSAND
PHYSICIANSreported by the AHA
Guide for the states fromwhich 3M manages orreceives payer data 2
covered through 3M’s payer data assets*
5,000+
healthcare provider customers*
15-20%
$44 millionin gross savings
COLORADO
reduction in hospital readmissions(relative to a comparison population prior to program implmentation.)
$6 millionnet reduction in total cost of
care for program enrollees
From the Accountable Care Collaborative Annual Report,Colorado Department of Health Care Policy and Financing (November 2013)
$105 million
3M helped the state of Maryland save
over a two-year span by reducing the incidence andcost of potentially preventable complications (PPC)*
*Data on file
Thank You