Introducing Value-Based Care Analytics

Transcription

1 Introducing Value-Based Care Analytics June 28, 2018 Donna Maddox, RN Director, Product Management GE Healthcare

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3 Introducing Value-Based Care Analytics Executive Summary Key Issues Increasing impact of CMS programs 1. Data availability providing insights for risk based management 2. Dealing with multiple payer contracts, and the rules are different for each one 3. Need to merge claims data with EHR data for effective risk analysis This presentation will help you Enhance care quality by understanding risk contract alignment opportunities with your quality goals Increase provider efficiency by setting patient outcome objectives and enabling effective, efficient measurement awareness Strengthen financial performance with time sensitive insights to metrics tied to positive/negative payment adjustments June 28,

4 Introducing Value-Based Care Analytics Agenda Healthcare Expenditures Community Health Centers / Medicaid Expansion Value-Based Care Analytics Demo Summary and Q&A June 28,

5 Healthcare Expenditures

6 National Health Expenditure Projections National health spending increase at average rate of 5.5 percent per year for and to reach $5.7 trillion by Health spending increase 1.0 percentage point faster than Gross Domestic Product (GDP) per year over the period. Medicaid spending growth - accelerate to 6.9 percent in 2018 from 2.9 percent in 2017, primarily due to faster projected growth in Medicaid s net cost of health insurance. Number of MA enrollees will grow to 30 million beneficiaries by 2025, or nearly 40% of all Medicare patients. Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html June 28,

7 Medicare Enrollment Traditional Medicare Medicare Advantage & Other Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html June 28,

8 Community Health Centers and Medicaid Expansion

9 Demographic Profile of Health Center Patients, ,375 community health centers >9,750 communities 24.3 million patients served 55% located in rural areas 92% had income at or below 200% FPL 60% female 61% non-elderly adults 31% children June 28,

10 Medicaid/CHIP Enrollees Receiving Care at Health Centers, 2015 June 27,

11 Trend in Health Center Patient Volume, by Health Insurance Type June 28,

12 Medicaid Expansion 33 States, DC have expanded Medicaid 50% nationwide were covered by Medicaid Medicaid expansion states 55% compared to 34% non June 27,

13 Health Coverage by State Medicaid Expansion June 27,

14 Driving Change Value-Based Care If we re serious about transforming our health system toward paying for value, Medicare and Medicaid will play a key role. I don t intend to spend the next several years tinkering with how to build the very best joint-replacement bundle we want to look at bold measures that will fundamentally reorient how Medicare and Medicaid pay for care and create a true competitive playing field where value is rewarded handsomely. Alex M. Azar II America s Health Insurance Plans March 8, 2018, Washington, D.C. June 28,

15 Striving for High Performance on Standardized Quality Frameworks like HEDIS Payers collect HEDIS measures to report the number of chronic disease screenings providers administer to patients, as well as to monitor healthcare utilization rates, follow-up appointments for medical and behavioral conditions, and supplemental healthcare evaluations Providers spend 100% of multiple FTEs committed to monitoring compliance, sometimes days retrospective June 28,

16 Value-Based Care Analytics Uncover hidden inefficiencies, leverage the solution s insights and flexibility, identify documentation and suspected risk gaps Easily capture & aggregate data for reporting Measure sets impacting revenue Identify patients with gaps for targeted outreach Understand and impact measure performance Continuously optimize workflows Track patient flow through providers and support staff Balance responsibilities throughout patient visits Monitor workflow efficiency alongside quality More accurately document patient risk Infer un-coded conditions from EHR data Understand enterprise-level performance Automate chart audits targeting HCCs June 28,

17 DEMO

18 Value-Based Care Analytics June 28,

19 Meet Sara Park, RN Practice Manager Southside Clinic Sara is Southside Clinic s practice manager. The clinic is a Community Health Center. The patient panel is 25% uninsured, 40% Medicaid, 10% Medicare and the rest various commercial plans. Sara oversees the clinical processes, design patient services, and implement work policies for the clinic. Making sure our patients receive the very best and ensuring our workflows align with quality requirements. Managing processes to align with quality incentive programs maximize revenue, is critical for our practice s success. June 28,

20 Meet Mark Stanze, RN - Quality Director Southside Clinic Mark monitors physician grant measurement performance to ensure financial, operational and strategic objectives are being satisfied, primary point of contact for answering questions about physician analytics and reporting issues and interpretations. Mark coordinates the clinic s contractual and regulatory reporting efforts. He is very concerned about the meeting the contract targets and the potential financial impact. Monitoring performance against grants is only a part of my very busy day. I worry about missing a critical indicator impacting our revenue. I can't afford the time to dig for the details. June 28,

21 Summary and Q&A

22 GE Healthcare is Committed to Your Success in Value-Based Care Increase Provider Efficiency Population Health Analytics Patient Engagement Care Delivery Financial Management Enhance Care Quality Strengthen Financial Performance June 28,

23 Value-Based Care Analytics Helping you achieve the outcomes that matter most to you Enhanced Care Quality Identify patients with gaps for targeted outreach Understand and impact measure performance Improved Provider Efficiency Track patient flow through providers and support staff Balance responsibilities throughout patient visits Strengthened Financial Performance Understand enterprise-level performance Automate chart audits targeting HCCs Identify network issues June 28,

24 Thank you! Donna Maddox Director, Product Management GE Healthcare June 27,

25 June 27,