Optum One Life Sciences...Optum One Life Sciences . April 15, 2015 . Confidential proprietary of...

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Optum One Life Sciences April 15, 2015

Transcript of Optum One Life Sciences...Optum One Life Sciences . April 15, 2015 . Confidential proprietary of...

Page 1: Optum One Life Sciences...Optum One Life Sciences . April 15, 2015 . Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum. ... Total

Optum One Life Sciences April 15, 2015

Page 2: Optum One Life Sciences...Optum One Life Sciences . April 15, 2015 . Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum. ... Total

Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

Creating a profound and lasting impact on the health system

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•Lower the cost trend

•Drive improved patient outcomes

•Helping consumers navigate the system to make better decisions that result in the right care at the right time

•24/7 online health and wellness tools to drive engagement and ultimately, better health

•Making health care easier, more convenient, and more affordable

•> $100 billion •Unnecessary costs due to improper payments and administrative inefficiencies

•22 hours per day •Time physician needs to see patients and meet recommended guidelines

•> 50% •Portion of unnecessary clinical costs that consumers can influence

•> $80 billion •Unnecessary annual spend due to low health information technology adoption

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

What is Optum One? • A dynamic, software-as-a-service solution providing clinical intelligence analytics for providers to

proactively manage their patient population health across the continuum of care .

The Problem The Solution

Organize, Identify and Stratify patients intelligently

At risk for a heart attack

Only 17% compliant with prescribed diabetes medications

Overdue for a mammogram

Does not have a PCP

Visited ED 5 times but missed

primary care appointments

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

Optum One Overview

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

Total Solution: An Intelligent Health Analytics Platform

3rd Party connect

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

How are Providers Using Optum One?

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• ACO • Track progress against Measures 12-33 • Efficiently deploy resources against

patients not meeting measures • Evaluate resource utilization against clinical

outcomes

• Code Improvement • Identify gaps in coding • Identify uncoded chronic patients based on

clinical factors

• Cohort Analytics • Identify clinical, demographic, and risk

profiles of different disease cohorts • Understand trends in polychronic patient

populations

• Gaps in Care • Identify patients who are not receiving

standard care by site of care and provider • Share lists daily with providers or care

managers so gaps can be discussed in daily huddles and addressed in upcoming appointments

• Financial Risk Management • Track PMPM and Per 1000 utilization • Isolate risk adjusted provider variation • Identify cost outliers and at-risk patients • Support network management

• Care Coordination & High Risk Patient Management • Identify actionable clinical opportunities for care

coordinators • Refer patients to outreach programs • Support Care Coordination workflow and

documentation • Track outcomes of coordinated populations

• Physician Scorecards • Quickly evaluate physician performance in

process and outcomes of care • Publish reports to the physician network to build

a data-driven care framework

• Analysis of Prescribing Patterns • Identify drug prescribing patterns vis-à-vis

clinical outcomes • Track compliance against medication protocols

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

Optum One Geographic Footprint – Current + Projected

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Projected Database Statistics Patient lives 55M+

Active Clinicians 108,000+

Hospitals 500+

Clinics 4,500+

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

•ACO Pt Count

•Non-ACO Pt Count

•Measure

3% 7%

27%

39%

26% 30%

1%

35%

52%

12%

20%

34%

46%

30%

42%

2%

43%

58%

0%

10%

20%

30%

40%

50%

60%

70%

62,227 1,689,873 5,763,086 1,676,100 6,644,714 12,160,769 6,139,243 2,921,668 1,494,717

26,252 746,547 2,322,737 741,580 2,657,739 4,647,391 2,470,122 1,209,659 629,659

(12) MedicationReconciliation

(13) Falls:Screening for Fall

Risk

(14) InfluenzaImmunization

(15) PneumococcalVaccination

(16) Adult WeightScreening and

Follow-up

(17) Tobacco UseAssessment and

CessationIntervention

(18) DepressionScreening

(19) ColorectalCancer Screening

(20)Mammography

Screening

Non ACO ACO

General Screening Measures: ACO %’s are much higher than Non ACO %’s

•Note: Data pulled from 40 Groups in Total, 26 ACO, 14 Non ACO

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

Create Value for Both Provider Systems and Constituents in Areas of Mutual Interest

• Better understand/serve their patients

• New channel to directly influence outcomes

• Better manage high risk patients • Consumer connectivity, loyalty

• Create efficiencies, improve processes

• Deeper insight - more real world data

• Optimal impact on bottom line, costs

• Test solutions in a data-driven ecosystem

•Opportunities to drive value in real world

•Life Sciences

•Better tools to improve performance, outcomes

•Provider

•Approach: Leverage the Optum One infrastructure to integrate data from patient interactions and interventions outside the practice, while improving outcomes.

•Accelerate

•Innovation

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

Goal: Create value for providers in areas of mutual interest

Network Scale Analytic Software

Targeted Care-Enablement Tools

• Engaged provider groups

• 55M+ longitudinal patient records

• Population and

risk analytics platform

• Patient engagement

• Medication adherence

• Remote monitoring

• Patient reported outcomes

Opportunity: Leverage existing infrastructure to advance data-driven, digital health solutions which can inform care decisions, improve outcomes, and be measured in real world practice.

•CONTINUOUSLY MEASURE & TRACK EFFECTIVENESS

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

Framework

Identify and profile patients

for outreach

Engage provider groups

Educate, interact, collect data

Ongoing research and measurement

analytics

Inform practice patterns

Send data back to provider

Opportunities for Continuous Improvement & Network Scale

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

Example Patient Engagement: Diabetes Targeted Interventions to Enable Better Patient Care

Explain Role of Medications, Treatment Options

Encourage Patients to Take an Active Role

Generate Awareness re Hypoglycemia

ENGAGE

Survey Patients to Obtain Signs, Symptoms, Satisfaction

•Interactive: Ask Questions for care manager follow up

Program Evaluation & Measurement for Continuous Improvement

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

Example Remote Monitoring: Diabetes Monitor Glucose Readings to Proactively Manage Patients & Identify Risk

Patient enters blood glucose readings from home ― using any meter device

Data syncs to mobile device, inc lifestyle (nutrition, exercise), vitals (e.g., weight)

Data sent to platform, combined with EHR for analytics, reporting

Clinicians evaluate patient activity to inform/modify treatment

Program Evaluation & Measurement for Continuous Improvement

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Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.

Real world data analytics supports population health

Date-driven Quality Improvement

Insights Action

Population health analytics

Patient interactions / interventions

Performance dashboards Collaboration and dialogue

Digital health innovation

Comparative benchmarks

Risk ID and profiling

Patient engagement

Medication adherence

Pt reported outcomes

Remote monitoring