Citi's Population Health Management Virtual Conference

Citi’s Population Health ManagementVirtual Conference

June 2013

© 2013 Verisk Health, Inc. All Rights Reserved

Tangible Challenges for Risk-Bearing Providers

Quality Care Management• Quality metrics and goals (ACO33, PQRS, HEDIS)• Data from multiple sources for complete view• Patient-level detail to ID specific gaps to work on

Care Management

• Population-level view of conditions driving cost/risk• Integrated whole patient data• Act on patient-level opportunities and drive

engagement

Performance Management• 360 degree view of risk profile• Monitor and manage contracted risk over time• Optimize network and drive patients to efficient care

Medical Cost Management• In-network/out-of-network visibility• Gaps in provider network / referral leakage• Trends and risk-adjusted benchmarking

Population Health

SystemPerformance

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Data-driven PerformanceData

Insight

Medical Claims(from multiple payers)

Rx Claims Eligibility

Actions

Ensure the Right Care, Time & Place

Understanding Population Risk

Total Patient Experience VisibilityMedical Cost Management

Budgeting & Risk Contract Management

Quality of Care & Reporting

Other(e.g., HRA, labs, bio)

Charts(paper & electronic)

Data AggregationFlexible, member-centric,

scalable warehousing

IntelligenceRisk profilingBenchmarksGaps in care

Quality scoresProvider profiling

Disease registryCohort tracking

Predictive models

Nurse dashboardsUser-defined fields

Query-builder

Drill downsReporting

Patient index

Tools

3


Provider Intelligence

Analyze Cost of Care and Outliers• Total per member per month costs

• Spotting those driving costs

• Procedures, medications, and other details

Identify and Manage Gaps in Care• Patient level (gaps in care, disease registries)

• Provider level (referrals/leakage, PCP level analysis)

Understand Future Risk• DxCG risk models used by payers

• Predictive modeling

• Use across various at-risk populations

• Support shift to value-based purchasing

4


Care Gap Score

PMPM Cost/ Member

CostEfficiency

Risk-Adjusted Variation in System Performance

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Understanding Drivers of Performance Variation

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The Provider’s Illness burden is 11% higher than average

Total cost of care for all providers treating the panel is 55% higher than the risk expected cost

Admission rate is 10% higher than expected

ER encounters are 2.76 times higher than expected

The Provider’s care gap index is higher than peers


Peer Performance Metrics to Monitor to Care Guideline and Provide Actionable Feedback

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Assess each provider’s care gap profile, compare to peers, and identify individuals to target for care


Pinpoint Individuals for Care Improvement

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Guide Patient Engagement

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Cohort Analysis to Monitor Trends & Measure Outcomes

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• PMPM costs are lower for diabetics who are compliant with guidelines. Key utilization measures like hospitalization rates are also lower in the better managed cohort.

• Leverage data driven analytics to assess the cost of non compliance and the impact of care intervention

• Create care strategies and track their impact

Diabetes Cohort: Comparing outcomes between Diabetics with Gaps and a cohort who complied with guidelines


Q&A Thank You!

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Citi's Population Health Management Virtual Conference

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