Partnering for Population Health: Strategies to Promote Collaboration Among the Patient, Provider and Employer

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Partnering for Population Health: Strategies to Promote Collaboration Between the Patient, Provider and Employer

Christina ArenzRegional Vice President

Strategic Solutions, Value-Based Care

Conifer Health Solutions


Christina ArenzRegional Vice PresidentStrategic Solutions, Value-Based Care

Christina Arenz currently serves as Regional Vice President of Strategic Solutions for Conifer Health Solutions Value-Based Care business line. In this role, she is responsible for leading a team of transformation experts who are tasked with developing forward-thinking solutions that give Conifer Health clients a strategic

Ms. Arenz came to Conifer Health Solutions in 2012, following the company’s acquisition of InforMed, LLC, where she had served as an Account Manager since 2010. During her career, she has had key roles in operations, finance, project management and process improvement. Christina has also served as a Human Resources leader who was responsible for all aspects of people management for a community-based, acute care hospital.

advantage as the industry shifts from volume to value-based care. She works with a variety of clients including employers, healthcare systems, medical management organizations, PHOs, ACOs and TPAs.

Who We AreConifer Health Solutions combines deep-rooted healthcare operational and financial management experience with innovative, high-touch services and technologies that simplify the healthcare experience.

Our Purpose

Unity. Integrity. Service. Respect.

Provide the Foundation for Better Health

Our Values


Our Footprint FACTS

National Scale with Local Presence Service clients in 40+ states 20 Service Centers 700+ clients 12,000+ employees

Breadth & Scale $25+ billion net revenue

processed annually 19+ million patient touch-

points annually 4+ million managed lives $17+ billion medically

managed spend 1+ million clinical admission

reviews 60,000 patient satisfaction

surveys annually

Conifer Health – Service Centers

Revenue Cycle Management Client Locations

Patient Communications Client Locations

Value-Based Care Client Locations

Key

Conifer Health Corporate Office & Revenue Cycle Management Operations

Patient Communications & Engagement Office

Value-Based Care Office


Stakeholders in Healthcare Historically working in isolation

• Cost of care• Quality of care• Access to care

Consumers

• Financial challenges• Government mandates• Patient quality/safety• Accountable care

Providers

• Cost containment• Wellness improvement• Population health management

Health Plans

• Financial risk management• Health information exchanges• Regulatory mandates

Employers


Commons Challenges

People are ill Chronic and often complicated cases

Costs for care are high

Consumers are unsure how to access to healthcare

system; or lack appropriate access


Partnering for Population HealthStakeholders Now Share Common Goals

Lowering cost of care delivery

Improving quality of care

Achieving best outcomes


Every Stakeholder Plays a Role

Providers, payors, plan sponsors and individual members all play a part in connecting the disparate elements of the healthcare industry to increase profitability, create efficiencies, improve patient outcomes and enable individuals to better manage their personal health.


Transforming how care is delivered

And engaging the care team and individuals to improve the health of populations

Align with providers to achieve clinical performance

Deliver patient-centered care across the continuum and population

Assume risk appropriately and successfully managefinancial performance

Partnering to Break Down WallsCoordinating to build cooperative relationships


Holding the Alliance TogetherData

EMRs

HRAs

Medical Claims

Rx Claims

Lab Results

Health Histories

Nurses

Care Coordinators

Eligibility

Physician Offices

Imaging Links

Other

Global HealthcareData Center andReporting

Health management Financial management and

reporting Patient and physician

portals

Health Information Exchange

Nurses/Care Coordinators

Administrators/Managers

Physician Offices

Individual Patients

Others

Includes users at self-insured employers, providers, care managers, health plans

Data Sources Data Processing and Analytics Different Views/Interfaces

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Risk Stratification Population’s Conditions Predictive Modeling Provider/Plan

Performance

Holding the Alliance TogetherPopulation Health Management


Holding the Alliance TogetherContent and Patient Education, Community-based resources


Four Steps to Reach Commons Goals

Get the disparate data in one place

Identify the trends/issues throughout an entire

population

Identify the individuals driving risk/cost and connect

them with a nurse/care coordinator

Decrease in financials will naturally follow


Getting the Data in One PlaceA Longitudinal Record

In this example: Five most frequent diagnoses being

treated 12-month history of medications,

emergency room use and hospital stays

Names of top five physicians seeing the patient most frequently

Adherence with standards of practice for the management of any chronic illness

Compliance with preventative screenings and chronic care issues


Getting the Data in One PlaceClinician Desktop


Getting the Data in One Place Care Management Platform


Getting the Data in One PlacePersonal Health Record (PHR)


Identify the Population and the Individuals

Participant stratification levelsPercent of population

Benchmark Client population

57% 53%

22%25%

12% 13%

7% 9%

No risk Low Moderate High Priority

Features present in high risk populationPercent of high-risk participants

Poor or ineffective uti-lization patterns

Condition related to instability

High Predicted cost

Lab results out of range

High restrospective costs

Non-compliance with EBM guidelines

Total unique

89.20%

78.30%

76.40%

24.20%

23.10%

12.30%

100.00%


How Stakeholders Come TogetherSelf-Insured Employers

Employers – Self Insured

Taking on risk for covered members

Building partnerships with local plan administrators & networks

Creating win-win for all stakeholders using data

Members

HealthNetworks

ASC

HospitalTPAs

CareManagers

PhysicianOffices

Employer


How Stakeholders Come TogetherEmployers Partner with Health Systems

Employers & Providers

Go direct for health & wellness programs

Direct contracts for care of members

Members

Employer Health Systems


How Stakeholders Come TogetherProvider-Owned Health Plans

Provider-Owned Health Plan

Goes direct to members/consumers

Enlists the help of Local plan administrators to define network

Health System

Provider-Owned Health Plan

Members/Consumers

Local Plan Administrators


Fool-proofing the PlanWhere we’ve seen failure

Lack of Investment in infrastructure

Accomplishing synergy requires investments in the right partnerships, technology and

human resources

Unrealistic expectations

Partnering is a long-term commitment

Improvements in the health status of population and financial risk will not happen

overnight

Expect 12 to 36 month timeframe for impact and results

Starting too broadly

The best sample set of a community is within your own four walls

Leverage your own employees to develop a winning approach to population health

management

Apply strategies internally to minimize risk and define measureable improvements


There are several inputs into choosing the right care management model

What delivery model is in place in the market?Primary care medical home | ACO | Employed physicians | No structure

What payment model will the population be covered under?P4P or penalties | Upside risk | Employee ACO | Upside/Downside | Full risk

What population will the market be caring for? Does the population have specific characteristics?Population age | Chronic conditions | Behavior patterns

What care management capabilities exists in the market?None | Transitions of care nurses | Full care management

What are the operational strengths and weaknesses of the market?ED Through-put | Engaged physicians | Social services