Innovations in Population Health Christopher Vojta MD MBA

Innovations in Population Health Christopher Vojta, MD, MBA Director, Deloitte Consulting, LLP Chicago, IL Randall Williams, MD Chief Executive Officer, Pharos Innovations, LLC Northfield, IL Sandeep Wadhwa, MD, MBA Medical Director, Colorado Department for Health Care Policy and Financing Denver, CO David Gorstein, MD James L. Dooley & Associates, Inc Mt. Pleasant, SC

Introduction Still questions about the cost effectiveness of current DM Models One recent article: “Cost-effectiveness of Telephonic Disease Management in Heart Failure” (Am J Manag Care. 2008; 14: 106 -115) Conclusions: The intervention was effective but costly to implement and did not reduce utilization. Why is this so hard?

Being bad is more fun than being good

Introduction What are some potential drivers of incremental ROI in DM? What are some of the ways to align incentives for physicians to be active, enthusiastic partners in chronic care management? What are the keys to incenting healthy consumer behavior?

Innovations in Population Health: Implications for Consumers, Health Plans and Providers Chris Vojta, Director, Deloitte Healthcare Consulting, LLP

Deloitte’s 2008 Survey of Health Care Consumers Self-directed care Traditional health services Information seeking Health care consumerism Alternative and non -conventional health services Financing

Consumer Segments have varying attitudes and preferences Factor Content & Compliant Sick & Savvy Online & Onboard Shop & Save Out & About Casual & Cautious Segment size 29% 24% 8% 2% 9% 28% System use Medium Highest High Medium Lowest Traditional, but open to alternative and nonconventional settings Alternative approaches and nonconventional settings Disengaged, but currently leans toward traditional Preferences regarding care Traditional, but open to nonconventional settings Dependence on providers Accepts what doctor recommends Takes charge of own care Leans toward relying on self Leans toward allowing doctor to make decisions Makes own decisions/ independent Leans toward relying on self Compliance with treatment Most compliant Compliant Less compliant Least compliant Less compliant Satisfaction with providers and plans Most satisfied Satisfied Less satisfied Least satisfied Less satisfied Other important distinctions Less likely to seek information; less likely to use valueadded services; least interested in shopping for and customizing insurance Seeks information; sensitive to quality; uses some valueadded services; wants to shop for and customize insurance Seeks information; uses online tools the most; sensitive to quality; maximizes use of value-added services Makes changes to insurance; price-sensitive; uses valueadded services; most likely to travel for care Seeks information; sensitive to quality; uses some valueadded services; wants to shop for and customize insurance Price-sensitive; unprepared financially for future needs; less likely to seek information; less likely to use valueadded services

Integrated Health Management Vision: One Seamless Organization Focused on the Members; Value and Transparency Throughout. . . Next Generation Health Plan Medical Management Strategy Enhanced Member Services Information Sources Personalized § Inbound Claims/Benefits Calls become a major lever § Predictive Modeling / Gaps in Care § Health Risk Assessment § Utilization Management § Provider Referrals § Nurse Call-in Lines § Pharmacy § Lab results § Referrals from providers & vendors Integrated Common Platform: Real-time Member Profiles & Opportunities ID Health Coaches: Health Wellness Programs Record Individuals Lifestyle Management Coaching Network Direction Clinical Specialists: Chronic Disease Management Care Management Benefit Design & Financial Management Integration Specialty Networks Web-based End-of-Life Education Hospice Robust Reporting: Operational, Clinical, Financial Employers And tools Provider

Physicians are viewed as the trusted source for clinical information

Medical Home Models Future State Current State § § § Primary Care Physician Incentives: Visits Investments: NA Incremental Costs: NA Panel Size: 1, 500 active Net Revenues: $350, 000 -$600, 000 § § § Primary Care Physician/Health Coaches Incentives: Increased adherence Investments: EMR ($100, 000) Incremental Costs: $115, 000 per PCP/$78, 000 per Coach Panel Size: 1, 500 active Net Revenues: $500, 000 -$1, 000 Requires $150 per patient per month reduction to break even Hospitals risk 10% of admissions and 20% of ED visits Data sharing capability is key

Future Directions in DM: Role of Technology; Role of the Patient. Provider Connection Randy Williams, M. D. Pharos Innovations

Technology Leveraged DM • RPM Defined • Specific operational leverage points • Model nuances and unanswered questions • Improvement in ROI • Results

Provider-Patient Engagement • New models of provider engagement – P 4 P Demonstrations – Medical Home evolving models – Hospitals as Hubs • New approaches to patient engagement – Population segmentation approaches – Non-clinical engagers – Role of physician endorsement

Engagement, Enrollment & Retention Solving the challenges of patient adoption and adherence Our behavioral staffing expertise allows clinicians to be clinicians and not spend valuable time wrestling with patient enrollment and program adoption § Behaviorally trained personnel § Educate & enroll patients § Ensure active, on-going program participation Have successfully enrolled and retained 50 – 75% of target population “Pharos goes beyond the technology to achieve a higher level of results” © 2004/2008 Pharos Innovations, LLC. All Rights Reserved.

Patient phones with daily clinical & behavioral status report Reinforcement of treatment plan, alteration as needed Clinical change or self-care compliance challenge § Computer collects daily touch-tone patient responses § Algorithms trigger “exception reports” § Patients who have not Reviews adherence to treatment plan called in receive automated outbound reminders Care Manager telephonic patient assessment Nurse Care Manager accesses variance dashboard

Dramatic Improvements in Key Utilization Indicators Decreased Admissions Reduction in Utilization vs. Matched Cohort -29% -39% Decreased Readmissions Improved Prescription and Physician services Total Admits -49% Readmits HF -29% Admits HF Readmits -41% -59% -69% -79% © 2004/2008 Pharos Innovations, LLC. All Rights Reserved. -63% Net Savings: $13, 600 per enrollee per year -75% Source: Iowa Chronic Care Consortium University of Iowa Analysis; January 2008

30 -Day Readmission Rate Following Hospitalization

Colorado Medicaid Perspective Sandeep Wadhwa, MD, MBA Medicaid Director

Medical Services Premiums Caseload FY 07 -08

Medical Services Premiums Expenditure FY 07 -08

Medical Services Premiums Expenditure (in Millions) FY 07 -08

Medical Home • Provide a Medical Home for over 270, 000 children enrolled in Medicaid and CHP+ within three years • Develop reimbursement methodology for Medical Home providers

Medical Homes • Created a pilot program involving 11, 000 children that provides continuous, comprehensive and accessible medical and nonmedical care

Disease Management Programs • • • Implemented disease management programs to serve approximately 6, 000 clients Heart disease Lung disease Weight management High-risk pregnancy Diabetes

Care Management • Piloting new integrated care management model for Medicaid disabled individuals with multiple, chronic conditions with a fully capitated PMPM

CORHIO • Participate in funding Colorado Regional Health Information Organization (CORHIO)

Value in Health Care • Lead the Center for Improving Value in Health Care

Thank You! David Gorstein MD James L. Dooley & Associates, Inc. 266 W. Coleman Blvd. , Suite 102 Mt. Pleasant, SC 29464 877 -434 -6837 x 19 843 -856 -0547 fax dgorstein@theheadhunter. com http: //www. theheadhunter. com/contents/mrinetwork jobs. php