The Case for a Comprehensive Cross-Payer Health Database Providers Perspective

1. The Case for a Comprehensive Cross-Payer Health DatabaseProviders Perspective

2. Shared data – Providers Perspective • Population Health Management • Risk Stratification • Outcomes Measurement • Alternative Payment Models • Accountable Care & Global Risk • Bundled Payment & Episodic Risk Persichetti & Associates, LLC

3. Population Health Management • Goals of population health management (PHM)1: • Keep patient population as healthy as possible • Minimize the need for expensive interventions: • Ambulatory sensitive ED visits • Hospitalizations • Imaging, tests, and procedures • Objectives of PMH: • Lower costs • Focus on high-risk patients • Addresses the preventive and chronic care needs of every patient • Modify the factors that make people sick or exacerbate their illnesses 1Source: Institute for Health Technology Transformation Persichetti & Associates, LLC

4. Population Health Management • The PHM approach consists of a defined process (Control Cycle) with specific ongoing support. The PHM Control Cycle includes 6 steps: • Define population • Identify care gaps • Stratify risks • Engage patients • Manage care • Measure outcomes • The PHM Control Cycle is supported by 4 initiatives: • Data integration • Analysis • Reporting • Communications Persichetti & Associates, LLC

5. Population Health Management Source: Institute for Health Technology Transformation Persichetti & Associates, LLC

6. Risk Stratification • Current screening guidelines and treatment protocols cast a very wide net • Case management and disease management programs require significant human capital • One size fits all diagnostics is very expensive • Should everyone get an annual screening or only those with significant family history of disease • Increases likelihood of unnecessary follow-up testing • Many programs require patient engagement as a prerequisite for success • Models can predict patients more likely to achieve desired outcomes, or eliminate patients for which program will not benefit Persichetti & Associates, LLC

7. Outcomes Measurement • Current quality measurement tied directly to interactions with health system • Percentage of eligible patients with screenings • Readmission rates • Programs designed to achieve specific outcomes often measure anything but the specific outcome • Diabetes management program • Measures number of patients taking metformin and number of lab tests • Will not measure average HbA1c/LDL/BP • Difficult to measure something that did not happen Persichetti & Associates, LLC

8. Alternative Payment ModelsProvider Contracting Today • Fee-for-service • Do more = get paid more • Market clout drives outcome of rate negotiations • Negotiations based on unit cost comparisons • Insurer to Insurer • Provider to Provider • Discounts are king • Little or no transparency or accountability • Cost effectiveness • Quality Persichetti & Associates, LLC

9. Accountable Care and Global Risk • Managing global risk requires the following: • Data management and information exchange between parties • Utilization management • Continuous process improvement • Network management • Clinical alignment • Is it realistic to expect retrospective patient assignment to work? • Management of risk or assumption of risk? Persichetti & Associates, LLC

10. Bundled Payment and Episodic Risk • Single payment vs payment for each service • Can be acute events or chronic conditions • Covers defined set of services for defined period of time • Requires great deal of integration between acute care facilities, physicians and ancillary providers • BPCI data 4,000 admissions resulted in patients receiving care at 100+ SNFs • Opportunity to improve quality through alignment with common clinical goals • Need to determine which providers and services to be bundled • Payment levels • Distribution of payments • Risk adjustment Persichetti & Associates, LLC