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The ACA and other health reform initiatives have driven the need to use analytics to enhance the care management experience. As workflows change and new approaches are explored, patient motivation becomes the “tipping point” of success in surfacing true opportunities for reduced and avoidable costs. This session will explore how to combine analytics, using patient motivation as a cornerstone, and incorporating greater insights into the clinical workflows, resulting in successful engagements.
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Patient Engagement: Motivation as the Tipping PointUnderstanding how patient motivation changes the care management approach
May 8, 2014
Speakers
Kim JayhanSenior Director, Solutions Architect & Consulting,LexisNexis
Population Health Management 2
Today’s Topic
Patient Engagement: Motivation as the Tipping PointUnderstanding how patient motivation changes the care management approachUnderstanding how patient motivation changes the care management approach
The ACA and other health reform initiatives have driven the need to use analytics to enhance the care management experience. As workflows change and new approaches are explored, patient motivation becomes the “tipping point” of success in surfacing true opportunities for reduced and avoidable costs. This session will explore how to combine analytics, using patient motivation as a cornerstone, and incorporating greater insights into the clinical workflows, resulting in successful engagements.insights into the clinical workflows, resulting in successful engagements.
Population Health Management 3
tip∙ping pointnounthe point at which a series of small changes orthe point at which a series of small changes or incidents becomes significant enough to cause a larger, more important change.
“That is the paradox of the epidemic: that in order to create one contagious movement, you often have to create many small movements first.”
“The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.”
“If you want to bring a fundamental change in people's belief and behavior...you need to create a community around them, where those new beliefs can be practiced and expressed and nurtured.”
Population Health Management 4
Source: Malcolm Gladwell, The Tipping Point: How Little Things Can Make a Big Difference
AgendaWhat We Will Discuss Today
The h ll
• Common Problems – Chronic Diseases• Avoidable Costs – Sources• Impact from Non‐Adherence/Non‐ComplianceChallenge • Impact from Non‐Adherence/Non‐Compliance
• Improved Analytics to Stratify & Manage Patients
The Opportunity
• Improved Analytics to Stratify & Manage Patients• Intervene with Patients to Avoid Increased Risk & Cost• Clinical Integration, Data Sharing & Technology to Engage Patients
• Reductions in Cost/Resources• Increased Compliance
The Impact
• Increased Compliance• Avoidance of Disease/Worsening Conditions• Healthier Populations
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The Challenge
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Challenges: Common Problems Contributing to High Costs/Risks
• An estimated 26.7% of Adults in the U.S. were reported to be obese in 2009.o Annual healthcare cost of obesity in U.S. (2008) was $147 billion/yearo Approximately 300,000 deaths per year directly related to obesity
• More than 1/3 of Adults have 2 or more major risk factors for heart disease.o Leading cause of morbidity, mortality and health care spending/utilization
• Diabetes is 7th leading cause of death in U.S.o $116 billion in total U.S. healthcare system costs in 2007o Nearly 24 million Americans have diabeteso Approximately 5.7 million have diabetes, but don’t know it.o Approximately 5.7 million have diabetes, but don t know it.o Approximately 186,300 individuals younger than 20 have either Type 1 or Type 2 diabetes.
• Tobacco use is the largest cause of preventable morbidity and mortality in the U.S.o 430 000 deaths each yearo 430,000 deaths each yearo 1 in 5 Adults and 1 in 5 HS Students Smoke, in spite of declined useo For every person that dies from smoking related disease, 20 more people have
at least one serious disease related to its use.
7
Source: Vital Signs: State‐Specific Obesity Prevalence Among Adults ‐‐‐ United States, 2009
Source: Avoidable Costs in U.S. Healthcare: The $200 Billion Opportunity from Using Medicines More Responsibly. Report by the IMS Institute for Healthcare Informatics.
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The World of Healthcare is ChangingBeyond Chronic Conditions, Challenges Loom Large
• B b B A l ti C Mi i hifti• Baby Boomers ‐ As population ages, Case Mix is shifting away from more profitable to less profitable care
• Legislation now provides for significant expansion in• Legislation now provides for significant expansion in Medicaid coverage, including Dual Eligibles
• Triple Aim and Health Reform are driving focus onTriple Aim and Health Reform are driving focus onOutcomes, Patient Satisfaction and Reduced Costs
8Population Health Management
What is Avoidable?
68% of avoidable
costs
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Source: IMS Institute for Healthcare Analytics, Avoidable costs in healthcare study, June 2013
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What is the Impact of Avoidable Costs Due to Medication Non‐Adherence?
68.6% Centered on
Two
72.3% Hospital RelatedTwo
Conditions Costs
10
Source: IMS Institute for Healthcare Analytics, Avoidable costs in healthcare study, June 2013
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What is the Impact of Delayed Compliance to Measures?
98.3% Centered onDiabetes
86.5% Centered onHospital &Diabetes Hospital &OutpatientRelated Costs
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Source: IMS Institute for Healthcare Analytics, Avoidable costs in healthcare study, June 2013
Why Expert Care Management is Critical:Sample Complications Without Interventions
Condition Complication as a Result of Non Adherence
Hypercholesterolemia Acute Myocardial Infarction (AMI)Hypercholesterolemia Acute Myocardial Infarction (AMI)
Diabetes Stroke, Renal Disease, Cardiac
H t i A t M di l I f tiHypertension Acute Myocardial Infarction
C ti H t F il (CHF) All li ti lti i dditi lCongestive Heart Failure (CHF) All complications resulting in additional inpatient, outpatient, emergency room and pharmacy utilization, calculated as incremental difference between non‐incremental difference between non‐adherent and adherent CHF patients
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Source: IMS Institute for Healthcare Analytics, Avoidable costs in healthcare study, June 2013and LexisNexis
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The Opportunity
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Population Health Management through Risk Stratification
• Stratifying patients along a management & intervention Care Spectrum
• Identifying the most actionable patients• Identifying the most actionable patients
• Empowering your patient care through risk predictions
Well MembersWell Members
Low Risk MembersLow Risk Members
MediumRisk Members
MediumRisk Members
High Risk Multiple Disease States
High Risk Multiple Disease States
Catastrophic CareCatastrophic Care
PreventionPreventionPrevention and Disease Management
Prevention and Disease Management
Disease Management
Disease Management
Episodic Case Mgmt
Episodic Case Mgmt
InpatientLTC
InpatientLTCManagementManagement gg gg
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Evolving Trends – Impact on Patient Engagement
Out with the OLD……………
In with the NEW
Patient/Consumer Care & Engagement• Quality vs. Cost Focus Shift• Patient Rating of Physicians & Experience
In with the NEW……………
• Patient Rating of Physicians & Experience• More Outreach, More Proactive Care• Access to care team through email, secured messaging and patient portals• Wellness Programs Sponsored by Health Plans and Employers (including Benefit Redesigns)
Focus on Diet & Exercise vs MedicationsFocus on Diet & Exercise vs. MedicationsHealth CoachingApps for self managementWeb Based Education
• Patient/Member Incentives for Compliance, Improvements and Pro‐active Preventive Care
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“The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.”
Predicted Risks & Costs
Patient Compliance to Evidence Based Protocols
Patient Motivation
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“That is the paradox of the epidemic: that in order to create one contagious movement, you often have to create many small movements first.”
Surface Opportunities
Patients at RiskWho Can You Engage & Impact?
Improved Compliance?Reduced Admissions/Readmissions?Reduced Costs?R d d M t lit ?Reduced Mortality?Downward Shifts in Risk?Is Patient Engaged?
Evaluate OpportunitiesEvaluate Performance of Programs or Initiatives
Can you engage the patient?PredictionsNon Compliance
MedicationClinical Measures
Underlying RisksDesign Care
Management Programs/ Interventions
Operate Programs or Initiatives
Motivation
Access to CareEducation
Identify ProvidersCollaborationTransparencyData Sharing Outreach
How to engage the patient?
Data SharingMonitor Patient Engagement
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“If you want to bring a fundamental change in people's belief and behavior ... you need to create a community around them, where those new beliefs can be practiced and expressed and nurtured.”
UTILIZATION‐DRIVEN STRATIFICATION ANALYTICS‐DRIVEN STRATIFICATIONLooking at future riskEpisode‐Driven
Looking at past riskCondition‐Driven
Diabetes3402
All Three
Diabetes2999
Hypertension2163
vs.
DiabetesDiabetesHypertension
2163
34021265
34022163
Hyperlipidemia1902
$$$$$
Highly Motivated
326
Risk Driver Heart Disease410
Risk DriverKidney Disease312
Analytics Driven Stratification ResultsTriMorbid Population (1265)(Diabetic, Hypertensive, Hyperlipidemia)
• Highly Motivated (326)Ri k D i H t Di (410)$$$$$ • Risk Driver – Heart Disease (410)
• Risk Driver – Kidney Disease (312)
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Analytics as the Change Agent
Create specific program tracks that focus on WHERE the opportunity actually is for improvements & cost savings ( ‘tri‐morbid’ diabetics population in this example)( tri morbid diabetics population in this example).
Use Motivation Index & Gaps in Care Impact Prediction to StratifyUse Motivation Index & Gaps in Care Impact Prediction to Stratify for Low Touch Program(s).
Engage Care Management.Employ Clinical Integration & Data Sharing for Hospital Partners,Physicians & Ancillary Providers.
Measure Impact to Outcomes & Costs/ Avoidable Costs.
Physicians & Ancillary Providers.
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Impact of Starting with Highly Motivated Patients
Stratification first on Highly Motivated, then on Predicted Cost Changes
Risk Category # Highly Avg Total Avg Forecasted % ChangeMotivated Members
Cost Cost
Risk Category 5 (High) 290 $40,956 $39,338 ‐4.1%
Risk Category 4 632 $8 719 $13 022 33 0%Risk Category 4 632 $8,719 $13,022 33.0%
Risk Category 3 589 $3,389 $7,478 54.7%
Risk Category 2 312 $1,787 $4,796 62.7%*Risk Category 1 (Low) 137 $1,296 $2,512 48.4%
ALL HIGHLY MOTIVATED 1,960 $10,265 $13,206 22.3%
Approximately $1.1m opportunity at level 2*20Population Health Management
The Future
Predicted Risks & Costs
Patient Compliance to Evidence Based Protocols p
Patient Motivation
Public Data & Its Influence to Patient Risk
21Population Health Management
The Impact
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“The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.”
Factors Contributing to Higher Adherence
• Lower costs for generics for major chronic conditions
• Education & Awareness – Impact of Non Adherence
• Technology/Analytics EnablingTargets for Non Compliance
• Changes in Reimbursement Models• Changes in Reimbursement ModelsRewards for Compliance & Quality
23Population Health Management
Improvements in First Year Program
FIRST YEAR OF
CARE MANAGEMENT
Created a Provider and Health Plan Partnership to:
• Improve care processes
Developed “Disease Bundles” to Measure
Progress
Example: Preventive care
Identified Cases Using Predictive Analytics and Post‐discharge
PROGRAM • Improve care processes and outcomes for the individuals and the population
• Improve the quality and
Example: Preventive care bundle that includes diseases such as cancer, lipid, diabetes and chlamydia screening and
gInformation
Uses risk ranking and mover identificationAnalytics using
compliance and
DECREASED TOTAL
MEDICAL COST
IMPROVED OVERALL
COMPLIANCE
efficiency of care immunization
DECREASED ADMISSIONS
motivation focused on improving compliance, and resulted in exceeding goals, while MEDICAL COSTCOMPLIANCE
75 %decreasing inpatient resources and impacting overall costs.
Diabetes bundle
Coronary diseasebundle
Preventivecare
bundle
30 %20 % 7 %
*Results are measured across the entire
ReadmissionsAdmissions
15 % 25 %
bundle bundlepopulation of patients
24Population Health Management
Case Study: Identify the populations where you can have the greatest impact
Focused Disease Management and Outreach Program
High Risk for Emergency Room
Services
Children and Adults with Asthma
Disabled Adults with Chronic or Complex Disease ServicesCo p e sease
Issues
2.3M population
260,000 Enrolled in Program
25Population Health Management
Using Motivation to Drive Improvements
FOR PARTICIPANTS
WITH ASTHMA:
FOR PARTICIPANTS WITH DIABETES:
• 36% improvement in retinal eye
FOR PARTICIPANTS WITH CORONARY ARTERY
DISEASE:
• 26% improvement in
FOR PARTICIPANTS WITH HEART FAILURE AND/OR COPD:
• 41% improvement in spirometry testing in COPD
• 33% reduction in inpatient utilization for asthma
in retinal eye examinations
• 11% improvement in testing for kidney damage11% i t
26% improvement in reported rate of vaccination for pneumococcal infections (pneumonia)9% i t i
g• 21% improvement in reported rate of vaccination for pneumococcal infections (pneumonia)
• 15% improvement in rate of betaasthma• 20% improvement of use of written
• 11% improvement in statin (cholesterol lowering Rx)
• 10% improvement in aspirin use
• 9% improvement in statin (cholesterol lowering Rx)
• 8% improvement in cholesterol testing
• 15% improvement in rate of beta blocker medication use
Net savingsNet savingsaction plans for persons with asthma
• 9% improvement in cholesterol testing
$169 Milli
$262 Million4th Year Savings
Net savings Net savings ofof$569 $569
MillionMillion
$34 Million1st Year Savings
$104 Million2nd Year Savings
$169 Million3rd Year Savings
26Population Health Management
Conclusion
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“There is a simple way to package information that, under the right circumstances, can make it irresistible. All you have to do is find it.”
tip∙ping pointnounthe point at which a series of small changes or incidents becomes significant enough to cause a larger, more important change.
State of the Art
Innovative Strategies
Vast Comprehensive
Better OutcomesArt
TechnologyStrategiesComprehensive
Data
+ + =• Reduce wasteful spending• Optimize operational
efficiencies• Improve patient health
28Population Health Management
Q&A
Source: Malcolm Gladwell, The Tipping Point: How Little Things Can Make a Big Difference
29Population Health Management
Contact
Kim JayhanSenior Director, Solutions Architect & ConsultingLexisNexis Risk SolutionsLexisNexis Risk [email protected] Group: LexisNexis Health Care SolutionsTwitter: @LexisHealthCareTwitter: @LexisHealthCare
This presentation in part or in whole cannot be copied, altered, or reproduced in any way without written consent from LexisNexis Risk Solutions.
30Population Health Management