The Five Pillars of Population Health Management...conditions requiring at least one form of...

The Five Pillars of

Population Health Management

Dr. Christopher Mathews

Senior Vice President and Chief Medical Officer

ZeOmega

©2013 ZeOmega, Inc. – All Rights Reserved.

First Jiva “go-live”

ZeOmega – a forerunner in


Integrates data and analytics to drive intelligence, and embeds in the workflow

Jiva reengineered to be first flexible platform to configure & automate workflows

ZeOmega contracts with several payers, covering millions of lives.

ZeOmegaraises Series A funding

IDC MarketScape identifies ZeOmega as a “major player” in Care Management

Contracts with GHC, a national leader in both Patient-Centered Medical Homes and ACOs

Transformation into performance management driving population healthcare

Supporting Delivery System Excellence

Health system begins managing 40,000 lives using Jiva.

2011 2012

$21.5 million growth equity financing

201420132002-2006 2007-20102001

Company founded, Initiates development of Jiva care management platform

©2013 ZeOmega, Inc. – All Rights Reserved.

How We Got Here …

Healthcare’s Perfect Storm

World Health Organization:

Healthcare = 18% of GDP and rising;

Consumer out-of-pocket costs = 21%

Affordable Care Act:

Adding millions of previously

uninsured into system

76 million Americans eligible for

Medicare in next 15 years

Almost half of us have chronic

conditions requiring at least

one form of medication

Regulatory changes:

MU, HIPAA, MLR,

ICD-10, ACA

Sociopolitical forces driving

health insurance exchanges

and healthcare retail markets

Increased use of cloud

computing, mobile

devices with personal &

clinical data

Use of genomic medicine

trending upward

© 2014 ZeOmega, Inc. – All Rights Reserved.

Rapid technological innovation is making solutions available that were not possible before

How the Perfect Storm Is Impacting

Healthcare Organizations

requiring them to shift from

traditional care management to

PHM

while controlling costs and

improving care

Stakeholders must re-think

roles


Triple Aim

What Is Population Health Management?

Population Health

Experience of Care

Per Capita Cost

Improve the overall health of

the population being served by

increasing the quality of care

Improving the overall

experience for individuals

Lowering the per capita cost

of care through improvement

Effective Population Health

Management should be based

in the Triple Aim Strategy


What Is Population Health Management?

Across Multiple Care Settings

From home to hospital to hospice, and

all settings in between

Across the Care Continuum

From birth to end-of-life

Across Multiple Domains of Health

Medical, behavioral, and psychosocial

determinants of health

Improving the overall health and well-being of an individual…

…and doing it consistently for every

individual in the population we serve.


RulesEngine

Care Teams

Post Acute Providers

Analysts

Patient / Caregivers

Physicians

Payers

AdministratorsPharmacists

What Is Needed For a Successful PHM Program?

• Long Term Acute Care

• Inpatient Rehab Facilities

• Skilled Nursing Facilities

• Home Health

• Hospice

• Health plans

• Agencies

• Reinsurers

• Employers

• Ambulatory Care

• Acute Care

• Financial Analysts

• Clinical Analysts

• Supervisors

• Compliance Personnel

• CFO

• Care Manager

• Utilization Manager

• Nurses & Clinicians

• Social Workers


The Five Pillars of


Data Integration & Aggregation

Actionable Intelligence

Holistic, Patient

Centered Care Management

Consumer Engagement

Program Design and Governance



• Compliance, Cost, Quality,

• Clarity on measurement of the short and long

term goals

• Assessment of current capabilities and strengths

• Current Weaknesses and gaps in capabilities

required to achieve long term goals

• Ensures incentives of all stakeholders are

aligned

• Achieves short term goals quickly, and builds on

these to tackle long term goals

• Metrics to measure achievement of goals

• Periodic (preferably real time) monitoring

P1: Program Design & Governance

Leadership

commitment and

change management

strategies.

Technological

capabilities can

determine how

successful your PHM

program will be.

PHM Goals

Current Capabilities

The Plan

Performance Measurement &

Monitoring


Legacy

Current

Next Generation

P2: Data Integration & AggregationInteroperability is the “new wine in the old bottle”…

Str

uctu

red

Un

str

uctu

red

Real time, self

authenticating

data exchange

Point

to

Point

Batch

Key Considerations:

• Master Patient

Index

• Master Provider

Index

• Elimination of

duplicates

• Tracking the

authenticity &

quality of data

sources

• Natural Language

Processing

• Data Normalization

& Tagging

Non-Clinical ClinicalDemographic, Claims,

Billing, RCM

Imaging, Lab, Diagnostics,

Pharmacy, EMR, Biometrics


P3: Actionable Intelligence

Platform driven real-time adjustment

of risk, propensity to change,

Optimization of resources based on

out come and behavioral change

prediction - NEXT BEST THING

TO DO

Predictive Analytics

Low

Act

ion

abili

ty&

Eff

ect

ive

ne

ss

H

igh

Embedded analytics in workflow

Risk Identification and stratification

Dashboards (STAR, ACO

Measures, Patient registries)

Data Mining & BI

Ad-hoc reporting

BI Tools, Limited to power users,

Static dashboards to support

business users

Real-time Big Data Analytics

drives personalized pop health

Claims,

ICD9/CPT

+ Lab, Drug,

Diagnostic

+ HRA,

Demographics,

Personal Preferences

+ Behavioral, Provider

quality, biometrics,

EMR structured data,

Unstructured data

+ Consumer data,

Environmental data

Example: Compliance Reports,

Standard Outcomes reports

Basic Reporting

Low Accuracy & Effectiveness of Analytics High


P4: Holistic, patient-centered care

management

Evidence-based medicine, that is

completely personalized to the

individual

Meeting the patient, their advocate,

and the care team where they are

with the right technologies

Actionable intelligence that

accounts for not only medical needs

but also behavioral, psychological,

social, financial, emotional,

environmental, spiritual, and cultural

factors in driving actions – the

NEXT BEST THING TO DO

RulesEngine

Care Teams

Post Acute Providers

Analysts

Caregivers

Physicians

Payers

AdministratorsPharmacists


P5: Consumer Engagement

Educate

Engage

Empower

It is all about getting to Patient Commitment and Empowerment

• Deliver the right information at

the right time in the right

communication channel to the

right stakeholder

• Educational Mailers, Coaching

Campaigns• Analytics that clearly

assess need for

change, propensity

to change, factors

that drive change,

factors that induce

change fatigue

• Medication alerts,

• Decision Support Tools

• Cost Price Transparency

• Quantification of Quality

• Convenience

The Five Pillars of


Dr. Christopher Mathews

Senior Vice President and Chief Medical Officer

ZeOmega

The Five Pillars of Population Health Management...conditions requiring at least one form of...

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