Advanced Analytics. The key to unlocking the Triple Aim and Value-Based Purchasing. Ines Vigil MD, MPH, MBA
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1 Advanced Analytics The key to unlocking the Triple Aim and Value-Based Purchasing Ines Vigil MD, MPH, MBA
2 Advanced Analytics: The key to unlocking the Triple Aim and Value-Based Purchasing Current State Desired Future State Triple Aim Value-Based Purchasing/Reimbursement Analytic Capabilities Impact and Timeline to Act
3 Current State Fragmentation Inefficiency Wide Variation in both Quality and Cost Focus on treatment of illness(es) Current reimbursement methods contribute to current state It follows, then, that the current incentives must change as a prerequisite to health care delivery system transformation this responsibility falls to purchasers of health care to implement the strategy of value-based purchasing. Purchasers buying on quality, service, and cost, rather than cost alone, will catalyze the re-engineering of health care toward a system of population health improvement and management, and a value-driven system in which ever-increasing quality of care is achieved at the lowest possible cost. *National Business Coalition on Health s Value-based Purchasing Council
4 Desired Future State Fundamentally transform the current health care delivery system to provide care that is safe, timely, efficient, effective, equitable, and patient-centered Population health improvement and management is the desired outcome Two Frameworks: Triple Aim Value-Based Purchasing/Reimbursement
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6 Value-Based Purchasing/Reimbursement Value-based purchasing is a demand side strategy to measure, report, and reward excellence in health care delivery. Value-based purchasing involves the actions of coalitions, employer purchasers, public sector purchasers, health plans, and individual consumers in making decisions that take into consideration access, price, quality, efficiency, and alignment of incentives.
7 Value-Based Purchasing/Reimbursement Effective health care services and high performing health care providers are rewarded with improved reputations through public reporting, enhanced payments through differential reimbursements, and increased market share through purchaser, payer, and/or consumer selection Two Core Tenets: *National Business Coalition on Health s Value-based Purchasing Council Optimizing the care for the patient population Getting the right dollars in order to care for that population
8 Types of Value-Based Purchasing Patient-Centered Medical Home (PCMH) Enhanced capitation rate to recognize increased care coordination activities and infrastructure Bundled Payment Gainsharing, typically for episodic care Risk-based contracts Accountable Care Organizations (ACOs) Gainsharing Global Capitation Risk-Based Contracts
9 In the News While value-based contracts account for only a small percentage of the current reimbursement arrangements, recent events indicate that payment based on outcomes and cost will dominate in the coming years Medicare s ACO experiment in 2014 showed only a fraction of participants actually earned a bonus, but many more achieving cost cuts while improving quality and the patient experience A bipartisan-commission recommended state governments take the lead on replacing the nation s reliance on fragmented, fee-forservice care with comprehensive, coordinated care using payment models that hold organizations accountable for cost control and quality gains
10 Analytic Capabilities One of our biggest successes has been using predictive analytics to define the high-risk patients and then get our arms around them, Greg Sheff, Executive Vice President of Clinical Services at Seton Healthcare Family in Austin
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17 What is Advanced Analytics? Advanced Analytics is a grouping of analytic techniques used to predict future outcomes, including: Predictive analytics What will happen next if my patient population continues to utilize health care services as they have in the past? Simulation What if we change the way we deliver health care services, how will that impact the health of my patients? Optimization How can we achieve the best care for the best price? (costeffectiveness) How do I optimize my value-based contract and share in costsavings?
18 Future Value
19 What is Advanced Analytics? Advanced Analytics is a grouping of analytic techniques used to predict future outcomes, including: Predictive analytics Using historical data to predict future events and risks: This includes readmission management and preventive care management, tools to identify gaps and variations in care and their effects on outcomes Prescriptive analytics Real-time clinical decision support and real-time population health management, with registries, alerts and reminder cues
20 Analytic Capabilities- Who, What, When, Where, Why, How? Program effectiveness determine cost savings (Why?) Descriptive trending and comparatives (Who?) Population Segmentation categorization of members (What?) Program optimization find the sweet spot for intervention (When?) Morbidity hazard determine impact on health (Where?) Prediction gain precision to head-off waste and disease (How?) Program effectiveness determine cost savings (Why?)
21 What is the Impact? While value-based contracts account for only a small percentage of the current reimbursement arrangements, recent events indicate that payment based on outcomes and cost will dominate in the coming years Medicare s ACO experiment in 2014 showed only a fraction of participants actually earned a bonus, but many more achieving cost cuts while improving quality and the patient experience A bipartisan-commission recommended state governments take the lead on replacing the nation s reliance on fragmented, fee-forservice care with comprehensive, coordinated care using payment models that hold organizations accountable for cost control and quality gains
22 What is the Timeline to Act? CMS made a bold announcement in January 2015: It plans to ramp up its timeline for transitioning Medicare from fee-forservice (FFS) payments to value-based reimbursement 30 percent of payments will be tied to alternative payment ACO or bundled payment arrangements by the end of Payments related to these models will increase to 50 percent by the end of percent of all traditional Medicare payments will be tied to quality or value by 2016 and 90 percent by 2018 through programs such as Hospital Value Based Purchasing and Hospital Readmissions Reduction Aetna, Blue Cross, Health Care Services Corporation, Ascension Health, and Trinity Health, stated that 75 percent of their respective businesses would be operating under value-based payments by 2020
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