Presentation on industry perspectives on the future of population health management. This is a talk I gave at the eClinicalWorks National Users Conference in Nashville, TN (2015). With a lot of buzz surrounding pop health programs, I wanted to provide a roadmap on making the switch and succeeding.

2. INDUSTRY PERSPECTIVES ON FUTURE
TRENDS IN POPULATION HEALTH
ROHAN D’SOUZA SHALEEN DUTTA

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6. * Copyright of eClinicalWorks
Not for public distribution

7. "Health outcomes of a group of individuals,
including the distribution of outcomes within the
group."
-Kindig and Stoddart, 2003
-IOM Roundtable on Population Health
What is Population Health?

8. Fee for Service vs. Value Based Care
RVU RVUCPT

9. Fee for Service vs. Value Based Care

10. Fee for Service vs. Value Based Care

11. Define Measure Analyze Improve Control
Define what VBB
program your
organization will
participate in and its
stakeholders
Number of patients
eligible, current
infrastructure and
barriers to success
Quality Measures, and
Shared Savings
thresholds.
Enroll ‘Moving Risk’
and high risk patients
in Care Management
Programs
Use Predictive Models,
Transitions of care alerts, and
patient engagement to build a
model of sustainability
Five Step Approach to Nailing the Switch

12. Define
Measure
AnalyzeImprove
Control
Five Step Approach to Nailing the Switch

13. CMS MSSP
Shared Savings
Medicare Advantage
PCMH
HEDIS
Bundled Payment
DSRIP
CCM
What Road to take?

14. Understand Your Population

15. Tagging Patients

16. eClincialWorks
PopulationHealthSolutions
* Copyright of eClincalWorks
Not for public distribution
Cohort Management
Building Cohorts

17. • Build a solid IT infrastructure
• Integrate care delivery across facilities
• Measure outcomes and cost for every patient
• Move towards bundled payments for care coordination
• Expand excellent services across geography
• Organize into integrated practice units
The Shift to Value Based Care
*Oct, 2013 Harvard Business Review – Michael Porter and Thomas Lee. ‘The Strategy that will fix healthcare

18. • Build a solid IT infrastructure: CCMR
• Integrate care delivery across facilities: ACO
• Measure outcomes and cost for every patient: HEDIS/CQM
• Move towards bundled payments for care coordination: CCM
• Expand excellent services across geography: TELEMED
• Organize into integrated practice units: PCMH
The Shift to Value Based Care
*Oct, 2013 Harvard Business Review – Michael Porter and Thomas Lee. ‘The Strategy that will fix healthcare

19. eClinicalWorks CCMR

20. An ACO is a network of doctors and hospitals that shares
financial and medical responsibility for providing coordinated
care to patients in hopes of limiting unnecessary spending. At
the heart of each patient's care is a primary care physician.
What is an ACO?

21. + +
What is an ACO

22. Beneficiaries or patients
Quality Measure:
HEDIS
CMS STAR
Improve performance based on Per Member Per
Year Cost threshold
What is an ACO

23. MSSP Landscape

24. eClincialWorks
PopulationHealthSolutions
* Copyright of eClincalWorks
Not for public distribution
1 out of 3
Medicare Patients

25. eClinicalWorks MSSP Landscape
ACOs: Over 8M lives covered

26. eClinicalWorks MSSP Landscape
ACO’s with
NO
Shared
Savings

27. ACO’s with
Shared
Savings

28. All 2014
ACO’s

30. Ǻěțňǻ İ ňč. șǻįđ Fřįđǻỳ țħǻț įț ħǻđ ǻģřěěđ țǿ bųỳ Ħųmǻňǻ İ ňč. fǿř $34.1 bįŀŀįǿň įň čǻșħ
ǻňđ șțǿčķ, fǿŀŀǿẅįňģ ẅěěķș ǿf fřěňżįěđ měřģěř țǻŀķș ǻmǿňģ țħě ŀǻřģěșț ħěǻŀțħ įňșųřěřș.
Ųňđěř țħě đěǻŀ, Ǻěțňǻ ẅǿųŀđ pǻỳ ǻbǿųț $230 ǻ șħǻřě fǿř Ħųmǻňǻ, ǻ přěmįųm ǿf 23%
fřǿm Țħųřșđǻỳ’ș čŀǿșě ǻňđ 29% fřǿm țħě čǿmpǻňỳ’ș șħǻřě přįčě běfǿřě Țħě Ẅǻŀŀ Șțřěěț
Jǿųřňǻŀ įň ŀǻțě M ǻỳ fįřșț řěpǿřțěđ Ħųmǻňǻ ẅǻș ěxpŀǿřįňģ ǻ șǻŀě. İ ňčŀųđįňģ đěbț, țħě
čǿmpǻňįěș șǻįđ, țħě đěǻŀ įș vǻŀųěđ țħě đěǻŀ ǻț $37 bįŀŀįǿň.
Ǻ țǻķěǿvěř ǻppřǿǻčħ fǿř Ħųmǻňǻ ěǻřŀįěř țħįș ỳěǻř țħřųșț țħě bįģģěșț ħěǻŀțħ-įňșųřǻňčě
čǿmpǻňįěș įňțǿ ǻ fįvě-ẅǻỳ měřģěř fřěňżỳ. Čįģňǻ Čǿřp. ǻňđ Ǻěțňǻ ẅěřě vỳįňģ țǿ bųỳ
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http://www.wsj.com/articles/aetna­nears­deal­to­buy­humana­1435883861
M ǺŘĶĚȚȘ ĐĚǺĿȘ ĐĚǺĿȘ & ĐĚǺĿ M ǺĶĚŘȘ
Đěǻŀ įș pǻřț ǿf ǻ čǿňșǿŀįđǻțįǿň pųșħ ǻmǿňģ įňșųřěřș, ŀįfțș Ǻěțňǻ’ș M ěđįčǻřě bųșįňěșș
| |
Aetna’s deal for Humana is likely to face scrutiny from antitrust regulators and will put pressure on the company’s chief
executive, Mark Bertolini, to demonstrate that the huge bet will pay off. PHOTO: JESSICA HILL/ASSOCIATED PRESS
Ųpđǻțěđ Jųŀỳ 3, 2015 11:34 ǻ.m. ĚȚ
Bỳ ĿİŻ ĦǾFFM ǺŇ, ĐǺŇǺ M ǺȚȚİǾĿİ ǻňđ ǺŇŇǺ Ẅ İĿĐĚ M ǺȚĦĚẄ Ș
Ǻňțħěm İ ňč. ǻģřěěđ țǿ bųỳ Čįģňǻ Čǿřp. fǿř $48 bįŀŀįǿň, čǻppįňģ mǿňțħș ǿf měřģěř
fřěňżỳ ǻmǿňģ țǿp Ų.Ș. ħěǻŀțħ įňșųřěřș țħǻț įș șěț țǿ řěșħǻpě țħě įňđųșțřỳ.
Țħě đěǻŀ, čǿmbįňįňģ țħě șěčǿňđ- ǻňđ fįfțħ-ŀǻřģěșț ħěǻŀțħ įňșųřěřș bỳ řěvěňųě, ẅǿųŀđ
čřěǻțě ǻ čǿmpǻňỳ ẅįțħ ǻ ħųģě fǿǿțpřįňț įň čǿmměřčįǻŀ įňșųřǻňčě, țħě țỳpě ǿf čǿvěřǻģě
přǿvįđěđ țǿ ěmpŀǿỳěřș ǻňđ čǿňșųměřș.
Țħě měřģěđ čǿmpǻňỳ įș přǿjěčțěđ țǿ ħǻvě ǻřǿųňđ $115 bįŀŀįǿň įň ǻňňųǻŀ řěvěňųě ǻňđ
čǿvěř ǻbǿųț 53.2 mįŀŀįǿň pěǿpŀě. Țħě įmpěňđįňģ đěǻŀ ǻňđ įțș přįčě ẅěřě fįřșț řěpǿřțěđ bỳ
Țħě Ẅǻŀŀ Șțřěěț Jǿųřňǻŀ ěǻřŀįěř țħįș ẅěěķ.
Țħě țįě-ųp ǿf Ǻňțħěm ǻňđ Čįģňǻ fǿŀŀǿẅș bỳ ǻbǿųț țħřěě ẅěěķș Ǻěțňǻ İ ňč. ’ș ǻģřěěměňț țǿ
bųỳ Ħųmǻňǻ İ ňč. fǿř $34 bįŀŀįǿň ǻňđ fųřțħěř ǻččěŀěřǻțěș țħě řǻpįđ-fįřě řěčǿňfįģųřǻțįǿň
ǿf țħě Ų.Ș. ħěǻŀțħ-įňșųřǻňčě įňđųșțřỳ’ș țǿp řǻňķș, ẅħįčħ įf țħě đěǻŀș čŀǿșě ẅǿųŀđ čǿŀŀǻpșě
fřǿm fįvě mǻjǿř čǿmpǻňįěș țǿ ǻ bįģ țħřěě.
Țħě bįģģěșț čǿmpǻňįěș ǻřě șěěķįňģ mǿřě čǿșț ěffįčįěňčỳ ǻňđ șčǻŀě ǻș țħě ħěǻŀțħ-čǻřě
ŀǻňđșčǻpě čħǻňģěș běčǻųșě ǿf țħě Ǻffǿřđǻbŀě Čǻřě Ǻčț ǻňđ ǿțħěř fǻčțǿřș. Ǿf țħě čųřřěňț
mǻjǿř ħěǻŀțħ įňșųřěřș, ǿňŀỳ ŲňįțěđĦěǻŀțħ Ģřǿųp İ ňč., țħě ŀǻřģěșț bỳ řěvěňųě, ħǻș șǿ fǻř
șǻț ǿųț țħě měřģěř ẅǻvě.
Ųňđěř țħě đěǻŀ’ș țěřmș, İ ňđįǻňǻpǿŀįș-bǻșěđ Ǻňțħěm ǻģřěěđ țǿ pǻỳ $103.40 įň čǻșħ ǻňđ
0.5152 Ǻňțħěm șħǻřě fǿř ěǻčħ Čįģňǻ șħǻřě. Bǻșěđ ǿň Ǻňțħěm’ș čŀǿșįňģ přįčě ǿň M ǻỳ 28—
țħě đǻỳ běfǿřě țħě Jǿųřňǻŀ řěpǿřțěđ țħǻț Ħųmǻňǻ ẅǻș fǿř șǻŀě, șįģňǻŀįňģ țǿ įňvěșțǿřș ǻ
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http://www.wsj.com/articles/anthem­agrees­to­buy­cigna­for­48­billion­1437732331
BŲȘİŇĚȘȘ
Đěǻŀ, ẅħįčħ ňěěđș řěģųŀǻțǿřỳ ǻppřǿvǻŀ, ẅǿųŀđ ħěŀp řěșħǻpě ħěǻŀțħ įňșųřǻňčě įňđųșțřỳ
Ųpđǻțěđ Jųŀỳ 24, 2015 6:55 p.m. ĚȚ
Bỳ ǺŇŇǺ Ẅ İĿĐĚ M ǺȚĦĚẄ Ș ǻňđ ĿİŻ ĦǾFFM ǺŇ

31. No Conditions Coded
Some conditions coded
and with Poor Specificity
All Conditions coded
appropriately
76 years Female 0.468 0.468 0.468
Medicaid Eligible 0.177 0.177 0.177
DM w/vascular 0.181 0.608
Vascular disease 0.324 0.645
CHF 0.395
Disease interaction 0.204
Total RAF 0.645 1.15 2.497
Base Rate $800 $800 $800
PMPM Payment $516 $920 $1,997.6
Annual Payment $6,192 $11,040 $23,971.2
Medicare HCC Coding

32. Measure Outcomes and Cost

33. Context- CCM
70% Deaths 67% Chronic Patients
93% of Spending98% Hospital Readmissions
Financial & Human Cost of Chronic Conditions

35. Key Benefits
• Automation of workflow
• Consent Management
• Faster recruitment of patients
• Easy to use and Integrated Care Planning
• Time Tracking
• Automatic Claim Generation
eClinicalWorks
Population Health Solutions
© eClinicalWorks - Not for public distribution

36. • “The Patient Centered Medical Home is a health care setting that
facilitates partnerships between individual patients, and their
personal physicians, and when appropriate, the patient’s family.”
(www.ncqa.org)
• Key Objectives of a Medical Home:
 Personal physician / holistic care for patients
 Coordinated and planned care for chronic & preventive conditions
 Patient and family involvement
 Eliminate redundancies, measure and improve practice performance
Patient Centered Medical Home

37. eClinicalWorks PCMH Solutions
• NCQA® pre-validated Vendor for Auto Credits
• Get Up to 82 Points towards your recognition by using eCW
– 32.12 Auto Credit Points
– 48.375 additional guaranteed workflow points
– Additional 1.5 workflow points under review with NCQA

38. eClinicalWorks PCMH Solutions
• Certified CAHPS Survey Tool vendor
• No Dependency on Patient Portal
• Get distinction for having done surveys on your patients
• Integrated Care Planning
• Customizable Health Risk Assessments
• Generate Patient Specific Action Plans

39. Market Trends
Source: Leavitt Partners Center for Accountable
Care Intelligence
2.6 5.6
14.6 19.2
23.5
35
40
50
60
72
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Projected no. of covered lives in millions
Projected Actual

40. Achieving the Triple Aim
Improve Health of a Population
Improve Experience of Care
Reduce per Capita Cost

41. National Conference 2016
Join us October 21-24, 2016 at the
Orlando World Center Marriott.
Registration opens in January.