Operationalizing Population Health

Speaker Name

Title Organization

Operationalizing

Population Health

Population-linked Service Systems

PATRICK GAUTHIER

What is Population Health?

• Systematic effort to improve health outcomes in sub-populations that share multiple clinical and social attributes, a given geography, and health insurance coverage

• Reflects the interdependence of biology, behaviors, social, cultural, economic, and environmental factors that impact wellbeing

• Compels healthcare and social service providers and the insurer to envision and develop organized and integrated delivery systems capable of achieving the Triple Aim

Market research designed to identify scope and nature of populations’ health consists of the following:

1. Estimating prevalence and incidence of specific conditions in specific populations

2. Measuring historic utilization and trends

3. Assessing full spectrum of provider accessibility and availability

4. Assessing connections and linkages between service providers and systems

Product development of population-specific solutions into a viable business consists of the following:

1. Recommending and

developing solutions to “fill the gaps” and create more cohesive connections

2. Costing and pricing solutions 3. Building a capable and

properly resourced entity to govern and manage the operations

Demand Supply

Operationalizing Population

Health Management

1

Collaborating with Partners and Payers to Initially Define Attributes of Target Population(s)

2

Identify Immediate Gaps in Care and Services and Develop Improvement Plan to Include Additional

Partners/Providers

3

Predictive Modeling: Stratify Risks Based on Epidemiological Analysis of

Prevalence and Historic Utilization

4

Engage Patients in Treatment Planning, Treatment, and Self-Management

5

Manage Care and Benefits. Coordinate Care within Integrated Delivery System. Continue to Refine Risk Stratification.

6

Measure Outcomes and Monitor Performance of System in Relation to Quality and Reimbursement Model

• Data Integration • Information Exchange

• Communication & Collaboration • Care Coordination to Include

Team-based Intervention • Apply Evidence & Standards • Partner with Service Providers • Patient & Family Education • Analysis & Reporting

Population Health Tools

and Approaches

Population Health Tools

and Approaches

Why Data Warehousing and Informatics?

1. Fragmented information systems

2. Redundant business processes

3. Lack of standards

=

Lack of visibility and reliable business and clinical

intelligence

Health Information Exchange

Referrals and plans of care

Surveillance

Transactional business processes Clinical decision support Collaborative view Shared data

Outcomes and quality improvement Predictive modeling and

risk management Financial risk management Clinical benchmarking Coordinated care

Chronic condition management Innovation

Connected Healthcare Supporting

Population Health

Community Population Health Management Business Intelligence Point-of-Care

Information is Power

Outcomes Data Claims Data Diagnostic Data Risk Stratification Utilization Data Prevalence Data Socio-Economic Data Product Development and Risk Profile

Core Processes and Value-based Reimbursement

Implementing Intelligence

Aggregate

Data

Validate and

Normalize

Data

Draw

Insights

from Data

Mobilize

Data

• Business process • Operations • Financial • Outcomes • Quality • Reports • Predictive modeling • Stratification • Performance management • Disease/cluster-specific • Assessing risks • Contracting • Partnerships • Productivity • CQI

Analytics and Reporting System Transition

PEOPLE Analytics System Transition PROCESS TECHNOLOGY Skills

Training and Education

Tools

New Job Categories

Centralization

Process Consolidation

Data Management

Analytics Life Cycle Management

Service Request Management

Support and Maintenance

Data Analysis

Report Deprecation

Data Migration

Tool Migration

Master Data Management

HHS National Quality Strategy 2015

Payer Value Equation

• Public policymakers are intent on measuring the value of healthcare services and rewarding clinicians and healthcare entities that

improve that value.

• Private payers are also shifting rapidly to pay-for-performance

models, as illustrated by the work of Catalyst for Payment Reform to develop scorecards, databases, and other value-driven tools on

Driving Revenue with Performance

Measures

• Outcomes

• Intermediate outcomes

• Patient experience

• Access AND Availability

• Process improvements and efficiencies

Revenue Drivers

• Quality bonuses

• Shared savings

Provider Challenge: Managing Complexity

• The difficulty that providers face in transitioning from volume to value should not be underestimated

• Managing risk-based contracts with multiple health plans and MCOs increases the difficulty

– Different measures

– Different contracts and fee schedules/reimbursement

• The cost of managing this additional complexity may reinforce the trend towards consolidation and integrated delivery systems

Measures Measures Measures

• Revenue cycle

• Contract performance

• Quality

• Access and availability

• Population risk stratification

• Patient experience/satisfaction

• Outcomes—medical/clinical (symptom and functionality)

• Outcomes—Quality of Life (QoL) indicators

• Utilization

• Productivity

• Cost, P&L

Population Health Measures

• Quality of Life (QoL) indicators

• Provider network adequacy

• Timeliness • Required signatures/ releases • Multi-disciplinary treatment plan/team • Adherence to EBPs • Transitions in care – Appropriate – Timely – Seamless

– Diversion effect (savings)

• Access to medical detox, H&P, psychiatric evaluation, and MAT

Quality of Life (QoL)

•

Health-related quality of

life

•

Recovery maintenance

•

Housing

•

Employment

•

Family reunification

•

Legal issues (probation,

parole, DUI, child

placement, etc.)

•

Medical/primary care

•

Risky behaviors

Access

• Engagement—access to clinician/screening/ assessment (same day)

• Emergent access (24 hours)

• Urgent access (72 hours)

• Routine access (7 days)

• Cancellations

• Retention—adherence to treatment

• Average length of stay/episode

Clinical Outcomes

• Assessment scores

– PHQ-9

– BASIS 32

– SF-12 and 36

– CAGE, AUDIT, BDI and any other measures of diagnosis, acuity/severity, functioning, symptoms, etc.

• Intermittent scores

• Post-discharge scores at 30, 60, 90, 180, 365 days

Other National Standard Measures

• National Quality Forum (NQF)

– 20 quality measures focused on behavioral health

• Health Related Quality of Life

– CDC Measures

• Atlas of Integrated Behavioral Health Care (IBHC) Quality Measures

(AHRQ)

– In support of integrated care

• Experience of Care and Health Outcomes (ECHO)

– Merges Mental Health Statistics Improvement Program (MHSIP) Consumer Survey and Consumer Assessment of Behavioral Health Services (CABHS) instrument

Other National Standard Measures

• Inpatient Psychiatric Facility Quality Reporting (IPFQR)

– Applies to the Inpatient Psychiatric Facilities (IPF) Medicare Prospective Payment System (PPS)

• Hospital-Based Inpatient Psychiatric Services (HBIPS)

• Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey

– Children’s health care quality measures: Child Questionnaire and Children with Chronic Conditions (CCC) Supplemental Items

• Healthcare Effectiveness Data and Information Set (HEDIS)

– Set of standardized performance measures designed to ensure that

purchasers and consumers can reliably compare the performance of health plans

Institute of Medicine (IOM)

Core Metrics for Health and Health

Care Progress

•

IOM uses a four-domain framework—healthy people, care

quality, lower cost, and engaged people—to propose a

streamlined set of 15 standardized measures with

recommendations for their application at every level and across

sectors

PROMIS Measures

• Patient Reported Outcomes Measurement Information System

(PROMIS) Global Health Measure —assesses global physical, mental, and social HRQoL through questions on self-rated health, physical HRQoL, mental HRQoL, fatigue, pain, emotional distress, social activities, and roles

• PROMIS development led by National Institutes of Health (NIH) in conjunction with Patient-Centered Outcomes Research Institute (PCORI)

Recommendations

QA Director IT Director Clinical Director

Performance Management Plan Finance Director National Standards Measures/Tools Infrastructure Training Qualifications Budget/Timeline Analyst Researcher Data Entry Trainer Database Admin.

QA Director IT Director Clinical Director Performance Management Plan Finance Director National Standards Measures/Tools Infrastructure Training Qualifications Budget/Timeline Analyst Researcher Data Entry Trainer Database Admin.

PERFORMANCE PLANNING TEAM

Data Warehouse Solutions (interface, analysis, reporting) and Business Intelligence

Recommendations

– Assign team to understanding population health in your market

• Payers and providers

• Integrated and organized delivery systems

• Target populations

• Goals and objectives

• Measures

– Conduct strategic performance planning

– Review contracts for requirements and opportunities

– Prepare to invest in a data warehouse, analytical and reporting tools

– Prepare to invest in a highly configurable Business Intelligence dashboard solution

Recommendations

• Conduct a gap analysis

• Identify solutions and alternatives

• Identify resource requirements including sufficient expertise to implement measures/tools and train staff

• Develop a timeline with reasonable and rational expectations

• Develop a budget

• Assign an implementation team to the implementation plan

Thank You

To receive more information, please contact:

PATRICK GAUTHIER

Director, AHP HealthcareSolutions

3415 S. Sepulveda Boulevard, Suite 1100 Los Angeles, CA 90034

Phone: 508.395.8429