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Implementing a Population Health Model (Hon Pak)

  1. Implementing a Population Health Model Health IT Perspective
  2. 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. 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. 4. All Rights Reserved.11 November 2016© 3M 3M Confidential. The Concentration of Health Care Spending 0% 0 10% 10 20 15.4 95 990.0 0.1 0.4 1.3 2.9 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 SpendingCumulativePercentofTotalSpending 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. 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 Maryland Quality-Based Reimbursement Program STATE OVERVIEW
  6. 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. 7. All Rights Reserved.11 November 2016© 3M 3M Confidential. Experience matters in today’s healthcare world 45MILLION LIVES 63 HEALTH PLANS & PAYERS INSURANCE CARD 0000-5555-000-22 with whom 3M has relationships or from whom 3M accepts data* 300 THOUSAND PHYSICIANS reported by the AHA Guide for the states from which 3M manages or receives payer data 2 covered through 3M’s payer data assets* 5,000+ healthcare provider customers* 15-20% $44 million in gross savings COLORADO reduction in hospital readmissions (relative to a comparison population prior to program implmentation.) $6 million net 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 and cost of potentially preventable complications (PPC)* *Data on file Thank You