Wednesday, September 30, 2015

#NATE/HIE Conference – Charles Kennedy #PopHealth at Healthagen/@Aetna

I am at the NATE/HIE Conference in the Population Health session.

Charles Kennedy of Healthagen gave a very insightful presentation on:

Population Health Management

60% of Providers say value-based care is part of their Strategic Plan.

We are in the very early stages of ACO evolution.

Provider risk-taking: 70% are only taking upside risks. Yet 23% see themselves as leaders in taking risk.

Leading providers (23%) have common factors:
– Plan and Provider assets, at least 1 arrangement with full risk and over 70,000 covered lives.

  • Providers are beginning to develop full-risk capabilities beginning with their employee populations. (Dog fooding)

Public Policy is driving change in the ACO world.

Infrastructure and vendors were not in place to meet the legislative objective – to give every american an electronic medical record.

Fee for Service is moving to fee for service with incentives for efficiency and quality (MIPS)
Risk Managed Care is moving to include quality objectives. (APMs)

These two approaches both meet at Population Health.

MIPS program has real teeth to impact reimbursement based on quality outcomes. By 2022 there could be a Plus or minus 9% impact to reimbursement.

As a zero sum payment model the competitive nature of Physicians can really drive change.

50% of Medicare reimbursement will be in Category 2 or better by 2018.
90% of all Fee For Service payments will be linked to service.

Value-based care requires management of disease and the progression of disease.

Population Health Management is a critical evolving capability.

“Everything begins with Data”

Claims data is price and not cost.

Value-based care needs a real-time navigation system. Timely indicators that enable changes to care in real-time at the time care is delivered.

Lowest Value Care in Fee For Service = ~$800B/Year

  • Prevention Failures: $56B
  • Fraud: $80B
  • Unnecessary Services: $216B
  • Inflated Prices: $112B
  • Inefficient Care Delivery: $136B
  • Administration Costs: $200B

Address with:
– Transparency
– Health IT
– Administrative Platforms
– Care Management and Clinical Re-engineering

Aetna/Humana merger is about reducing administrative costs.

ACO Care Systems – Building a Virtual Care System. A contract between Payer, Physician Network and Hospital System.

All parties need a single view of the patient.

Keys to success:
– Population Health Management
– Care Coordination
– Patient Engagement
– Data Exchange and Analytics

Pop Health Management:
– Wellness
– Prevention
– Care Management
– Reduce Waste / Improve Efficiency
– Clinical Teams

Analytics needs to be at least as good as the doctors assessment. It needs to be contextual.

Today systems focus on:

  • Transitions of Care
  • Ambulatory Care Management
  • Utilization Management

Improved performance will translate to lower cost for consumers or higher payments for medical professionals.

Aetna owns Medicity. Looking to link with ActiveHealth (another acquisition). Looking to develop Analytics Algorithms.

Insurance Exchanges are helping to direct consumers to better solutions.

Look at Delivery Systems intent. Is Value or Market Dominance the driver?

How is the Patient engaged?
You need a fundamental understanding of the patient.

Chronic disease drives cost so patient engagement is a critical component.

Medical knowledge needs to be distilled to a point that it is actionable by the patient and their caregiving team.

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MaMrk Scrimshire

IT and Health Data Ninja

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Stay up-to-date: Twitter @ekivemark


I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. This involves creating a Data API. Watch out for more about BlueButton on FHIR.

The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.

Medyear: Less Hassle, Better Care.

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