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Population Health and the NCM Care Transformation Collaborative of R.I.

Population Health and the NCM Care Transformation Collaborative of R.I. Nancy Mamo , Managing Director, Population Health Analytics, BCBSRI May 5, 2015. Population Health – What Is It. Google Definitions: An approach to health that aims to improve the health of an entire population

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Population Health and the NCM Care Transformation Collaborative of R.I.

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  1. Population Health and the NCMCare Transformation Collaborative of R.I. Nancy Mamo, Managing Director, Population Health Analytics, BCBSRI May 5, 2015

  2. Population Health – What Is It Google Definitions: • An approach to health that aims to improve the health of an entire population • Stratifies and segments critical population groups for outreach and intervention to promote compliance with evidence-based medicine, improved care coordination and lower utilization. • The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort

  3. Why Is Population Health Management So Important • Recently has gained attention from mainstream organizations because: • Healthcare reimbursement is changing • Emphasis clearly is shifting from volume to value • Organizations that focus on providing patient-centered, quality healthcare across a population will come out ahead. • Need to deliver the right care at the right time in the right setting to impact cost and utilization

  4. Goal of Population Health Management • Will become a required core competency for provider organizations in a post-fee-for-service payment environment • The need to manage health care costs • Reduce the frequency of health care crisis and costly ED visits and hospitalizations • Improve the overall patient experience by improving access to care • Promote patient engagement and empower patients to better self-manage their health and participate in the decision making process.

  5. How Data Has Changed Healthcare • Proper collection and use of data is key • Integration of data sources on a more real time basis • Healthcare traditionally has been reactive instead of proactive • Predictive modeling allows for us to predict the use/cost of a member based on past experience

  6. Data Automation and Integration Makes Population Health Feasible, Scalable, Sustainable Define Population Measure Outcomes • Automated and Ongoing • Data integration • Analysis • Reporting • Communications Identify Care Gaps Stratify Risks Manage Care Engage Patients

  7. What We Have Found • 14 % of our population has the following conditions: • Diabetes, CHF, CAD, COPD, Asthma • These members drive about 39% of our overall costs • Behavioral Health plus any of these conditions raises the risk exponentially • CHF – not the highest prevalence • Highest overall PMPM • Highest inpatient per thousand • Highest ER per thousand • Changed our criteria to include those members with CHF in our CCM lists

  8. NCMs Will Help Drive Success • Your focus on the high-risk patients who generate the majority of health utilization and costs will help to drive down utilization and cost • Through your work, you will make a difference

  9. Questions

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