1) The document discusses using patient motivation as the tipping point for successful patient engagement and care management. Analytics can be used to stratify patients based on motivation and risk levels.
2) Intervening with high-risk, high-cost patients and those who are highly motivated can lead to improved compliance, reduced costs from avoidable hospitalizations and complications, and healthier populations.
3) Combining risk stratification, clinical integration, and data sharing allows care managers to engage the right patients and bring about fundamental changes in behaviors that spread through communities.
3. Today’s Topic
Patient Engagement: Motivation as the Tipping Point
Understanding 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
4. tip∙ping point
noun
the 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.”
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Source: Malcolm Gladwell, The Tipping Point: How Little Things Can Make a Big Difference
5. 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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7. 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/year
o 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 2007
o Nearly 24 million Americans have diabetes
o 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 year
o 1 in 5 Adults and 1 in 5 HS Students Smoke, in spite of declined use
o 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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8. 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 on
Outcomes, Patient Satisfaction and Reduced Costs
8Population Health Management
12. 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
12
Source: IMS Institute for Healthcare Analytics, Avoidable costs in healthcare study, June 2013
and LexisNexis
Population Health Management
14. 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
Members
Well
Members
Low Risk
Members
Low Risk
Members
Medium
Risk
Members
Medium
Risk
Members
High Risk
Multiple
Disease
States
High Risk
Multiple
Disease
States
Catastrophic
Care
Catastrophic
Care
PreventionPrevention
Prevention
and Disease
Management
Prevention
and Disease
Management
Disease
Management
Disease
Management
Episodic Case
Mgmt
Episodic Case
Mgmt
Inpatient
LTC
Inpatient
LTCManagementManagement gg gg
14Population Health Management
15. 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. Medications
Health Coaching
Apps for self management
Web Based Education
• Patient/Member Incentives for Compliance, Improvements and Pro‐active Preventive Care
15Population Health Management
24. 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
g
Information
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
disease
bundle
Preventive
care
bundle
30 %
20 % 7 %
*Results are measured
across the entire
ReadmissionsAdmissions
15 %
25 %
bundle bundle
population of patients
24Population Health Management
26. 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
damage
11% 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 Million
4th Year Savings
Net savings Net savings
ofof$569 $569
MillionMillion
$34 Million
1st Year Savings
$104 Million
2nd Year Savings
$169 Million
3rd Year Savings
26Population Health Management