Optum One Life Sciences...Optum One Life Sciences . April 15, 2015 . Confidential proprietary of...
Transcript of Optum One Life Sciences...Optum One Life Sciences . April 15, 2015 . Confidential proprietary of...
Optum One Life Sciences April 15, 2015
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
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
Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.
Optum One Overview
Confidential proprietary of Optum. Do not distribute or reproduce without express permission from Optum.
Total Solution: An Intelligent Health Analytics Platform
3rd Party connect
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
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+
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
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
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
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
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
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
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