Decreasing Medical Costs - medicaidconference.com€¦ · Supporting State Transformation Goals via...

PRESENTED BY:

Decreasing Medical CostsAre your members listening to you?

September 22, 2016

Aaron Crowell, Executive Vice President, MTM, Inc.

Gary Jacobs, Executive Vice President, CareCentrix

Dan Masciopinto, SVP of Product, NextHealth Technologies

Allison Young, President and CEO, UnitedHealthcare Louisiana Community Health Plan

Moderator:

Melissa O’Connor, VP Marketing,

NextHealth Technologies

Medicaid Health Plans of America mhpa2016

Conflict of Interest Disclosure: Faculty/Planning Committee/Reviewers/Staff

Participating speakers in “Decreasing Per Episode Costs: The 30% Solution” have no conflict of interest to disclose relative to the content of the presentation.

Welcome

• Panel overview and introductions• Panelists will present real-world examples of how they are using analytics,

behavioral economics, clinical programs, and consumer engagement to reduce medical costs

• Panel Q & A

• Audience questions

Today’s Agenda

3

Introduction – Aaron CrowellMTM, Inc.

Executive Vice President, Managed Care

3

Increasing Healthcare Access, Promoting Independence & Connecting Resources

The Impact of Access

4

Access to preventative care

Provider contracting and compliance

Care plan Post-acute care

Areas of Support

Removing Transportation Barriers

• Physical & cognitive needs

• Language & ethnic specific services

• Attendants & caregivers

Access to Preventative Care

5

Facility and Case Manager Support

• Coordinate recurring trips

• Convenient discharge & facility transports

• Communicate on membership & utilization trends

Care Plan Support

6

Readmissions and ER Diversion Strategies

• Member & caregiver outreach

• Educate on preventative care & transportation options

• Coordinate scheduling & confirmation of visits

Post-Acute Care Support

7

Introduction – Gary JacobsCareCentrix

Executive Vice President Strategic Relationships

8

Post acute care is a significant portion of the total cost of an episode of care

10

Managing the PAC continuum can produce up to 25% savings on a 90 day episode; reducing readmissions is an essential component of the savings

MA Example: 40% of the cost of a 90 day bundle is for post acute services

The Opportunity: Up to 27% reduction through appropriate care transitions management; Up to 35% reduction in hospital readmissions; An average of 10 – 15% savings through administrative and unit cost reduction

17.2 14.88.7 10.6

Medicare65+

Medicaid18-64

PrivatelyInsured18-64

Uninsured18-64

Total All-Cause 30 day readmission rates by payer,

2011

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

Improving PAC value requires managing the full continuum of PAC services on an at-risk basis

11

Four critical elements of a value enhancing PAC Model

Integrated, Home-Centric

PAC Management

Shared Risk and Guaranteed

Savings

Network Optimization

Advanced Technology and

Analytics

• Reduce the impact of PAC silos• Clinical care coordination across

the full episode of care up to 90 days• Care transitions management with

appropriate maximization of homebased care solutions

• High performing network by diseasestate and geography

• Provider performance tracked for quality and cost performance and provider selection optimized for eachpatient

• Aligned incentives based on risksharing models (bundled payments,full or partial capitation, shared savings)

• Performance guarantees based onmutually agreed upon targets forcost and quality improvements

• State-of-the-art technology andanalytics based on machine learning

• Analytics support risk identification,transitions management, providerselection

31

Immediate savings

Over 3 years for a commercial plan

80%+ Therapy adherence

12

Advanced technology and analytics enable network optimization and reduce readmissions and costs

Hospital 1

Hospital 2

Hospital 3

Home Health

DRG 238

Colors of lines indicates readmission rates of HHA vs national

benchmark.

Thickness shows how many patients were sent to given home

health.

Intelligent analytics forecast the probability of a readmission and guide appropriate care transitions

32

Immediate savings

Over 3 years for a commercial plan

80%+ Therapy adherence

13

By understanding what services an agency

does well, and what they don’t, you can

lower total costs and improve outcomes,

while still ensuring patient access

Referral “Quality Scores” identify the best provider for the patient’s specific condition

33

Introduction – Dan MasciopintoNextHealth Technologies

Senior Vice President of Product and Services

10

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

From Insights to Medical Savings–An Analytics Maturity Model

4.0 Systematically orchestrating sustained medical savings

3.0 Behavior Change

Consumer Engagement

CampaignManagement

Call center

2.0: Segment & View Prescriptive Analytics Behavioral economics Direct mail

Predictive Analytics Causal modeling Message framing Email

1.0: Traditional Descriptive Analytics Risk identification Machine learning Personalized nudges Text

Data ManagementRetrospective view

Correlates Resource optimization Persistence Web

ETL Population profiles Clusters RCTs

Data lake Impactability score

Big data appliance

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

A Medical Cost Reduction System -Prescriptive Analytics and Consumer Engagement

WHO?

WHAT?

HOW WELL?

IDENTIFY IMPACTABLETARGETS

PERSONALIZE ENGAGEMENT

MEASURE AND OPTIMIZE OUTCOMES

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

A Turn Key Open Source and Secure SaaS Platform

Today’s Takeaways – Dan MasciopintoNextHealth Technologies

Reducing medical costs isn’t easy

Marry consumer engagement with analytics – insights alone aren’t enough

1. Better targeting improves capacity and lift

2. Personalize your interventions

3. Ability to prove and measure what is working or not working allows quick pivots

4. Need a system that allows for rapid adjustments and scale

11

Introduction – Allison J. YoungLouisiana Community Plan – UnitedHealthcare

President and CEO

12

This Louisiana Health Overview

Overall Health Rank 50th out of 50 states

• Behaviors• High levels of obesity• High prevalence of smoking• High levels of physical inactivity• Rank 49th in Chlamydia

• Social and Economic Factors• Rank 50th for children in poverty • Rank 30th in per capita income• Medicaid is the largest health plan/payer in the state

America’s Health Rankings 2016—United Healthcare Foundation 20

Why Now?!

14

• Medicaid Expansion• Expansion of Managed Care• Integration of Benefits• Delivery System Reforms • Recognition of Broader Influences of Health• Data, Data, Data

Strategy For Health – Knitting it Together

22

1. Supporting State Transformation Goals via Value Based Programs

2. Strengthening our relationship with and supporting individual PCPs

3. Improving Access to Care

4. Enhancing Delivery System Innovation

Right Care, Right Time, Right Place , Right Incentives

Appendix

PRESENTED BY:

Decreasing Per Episode Costs:Post-Acute Care & Mobility Management

September 22, 2016

Aaron CrowellExecutive Vice President, MTM, Inc.

Impact of Access:Mobility Management

The Importance of Mobility Management

19

Preventative care On-demand service

Non-emergency ambulance

Care plan support

Areas of Impact

Impact: Preventative Care

• Utilization

• Level of need

• Urgent & same-day trips

• Quality & compliance

The Transportation Effect

20

Impact: On-Demand Service

• Urgency for high-risk & chronic members

• Impact of on-time performance on outcomes

• Real-time provider scheduling & tracking

Same Day is the New Normal

21

Impact: On-Demand Service

29

Opportunities

• Immediate access

• Real-time tracking

• Reduced complaints

• Reduced costs

“The Uber Effect”

Challenges

• Compliance

• Credentials

• Mode limitations

• Geographic limitations

Impact: Non-Emergency Ambulance

23

Solutions

Establish detailed protocols

Prior authorization model

Post authorization model

Needs

Control utilization to the most appropriate mode

Claims adjudication & cost controls

Impact: Care Plan Support

24

Facility & Case Manager

support

Special needs & high risk requests

Outreach, educate & coordinate

Support: Facilities & Case Managers

• Coordinate recurring trips

• Convenient discharge & facility transports

• Communicate on membership & utilization trends

Convenience in Coordination

25

Support: Special Needs Requests

• Physical & cognitive needs

• Language & ethnic specific services

• Attendants & caregivers

Protecting Members

26

Support: Outreach, Educate & Coordinate

• Member & caregiver outreach

• Educate on preventative care & transportation options

• Coordinate scheduling & confirmation of visits

Targeted Post-Acute Care Initiatives

27

Questions

EVP, Managed Care

MTM, Inc.

(314) 323-7007

acrowell@mtm-inc.net

Aaron Crowell

28

PRESENTED BY:

Decreasing Per Episode Costs:Post-Acute Care: Reducing Per Episode Costs

September 22, 2016

Gary JacobsExecutive Vice President, CareCentrix

Post acute care is a significant portion of the total cost of an episode of care

37

Managing the PAC continuum can produce up to 25% savings on a 90 day episode; reducing readmissions is an essential component of the savings

MA Example: 40% of the cost of a 90 day bundle is for post acute services

The Opportunity: Up to 27% reduction through appropriate care transitions management; Up to 35% reduction in hospital readmissions; An average of 10 – 15% savings through administrative and unit cost reduction

17.2 14.88.7 10.6

Medicare65+

Medicaid18-64

PrivatelyInsured18-64

Uninsured18-64

Total All-Cause 30 day readmission rates by payer,

2011

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

Improving PAC value requires managing the full continuum of PAC services on an at-risk basis

38

Four critical elements of a value enhancing PAC Model

Integrated, Home-Centric

PAC Management

Shared Risk and Guaranteed

Savings

Network Optimization

Advanced Technology and

Analytics

• Reduce the impact of PAC silos• Clinical care coordination across

the full episode of care up to 90 days• Care transitions management with

appropriate maximization of homebased care solutions

• High performing network by diseasestate and geography

• Provider performance tracked for quality and cost performance and provider selection optimized for eachpatient

• Aligned incentives based on risksharing models (bundled payments,full or partial capitation, shared savings)

• Performance guarantees based onmutually agreed upon targets forcost and quality improvements

• State-of-the-art technology andanalytics based on machine learning

• Analytics support risk identification,transitions management, providerselection

31

Immediate savings

Over 3 years for a commercial plan

80%+ Therapy adherence

39

Advanced technology and analytics enable network optimization and reduce readmissions and costs

Hospital 1

Hospital 2

Hospital 3

Home Health

DRG 238

Colors of lines indicates readmission rates of HHA vs national

benchmark.

Thickness shows how many patients were sent to given home

health.

Intelligent analytics forecast the probability of a readmission and guide appropriate care transitions

32

Immediate savings

Over 3 years for a commercial plan

80%+ Therapy adherence

40

By understanding what services an agency

does well, and what they don’t, you can

lower total costs and improve outcomes,

while still ensuring patient access

Referral “Quality Scores” identify the best provider for the patient’s specific condition

33

Commercial Medicaid Medicare Total

8.6%

11.2% 11.2%10.6%

6.4%

10.2%9.6%

9.0%

Baseline Readmit Rate Program Year 1 Readmit Rate

30 Day Readmission Results on Care Management

Eligible Patients

Results: 30 day readmissions were reduced by 9% in the first year for a Medicaid population

3 Year 90 Day Commercial Results:

• 38% reduction in readmissions• $50 M savings• 95% satisfaction

Value Added: • Key quality reporting metrics

can be positively impacted bythe PAC model of care, e.g.

• Readmissions• Medication management• Risk of falling

34

Contact Information

Executive Vice President, Strategic Relationships

CareCentrix

(945) 328-1124

Gary Jacobs

35

PRESENTED BY:

Decreasing Medical Costs:Nudging Members to More Optimal Care Settings

September 22, 2016

Dan MasciopintoSVP of Product and Services

NextHealth Technologies

Key Takeaways

Reducing medical costs isn’t easy

Marry consumer engagement with analytics – insights alone aren’t enough

1. Better targeting improves capacity and lift

2. Personalize your interventions

3. Ability to prove and measure what is working or not working allows quick pivots

4. Need a system that allows for rapid adjustments and scale

37

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

From Insights to Behavior Change – An Analytics Maturity Model

4.0 Systematically orchestrating sustained medical savings

3.0 Behavior Change

Consumer Engagement

Campaign Management Call center

2.0: Segment & View Prescriptive Analytics Behavioral economics Direct mail

Predictive Analytics Causal modeling Message framing Email

1.0: Traditional Descriptive Analytics Risk identification Machine learning Personalized nudges Text

Data ManagementRetrospective view

Correlates Resource optimization Persistence Web

ETL Population profiles Clusters RCTs

Data lake Impactability score

Big data appliance

38

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

The Challenge: Moving Consumers to Optimal Care Sites

39

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

Sustained Medical Cost Reduction - a Prescriptive Analytics and Consumer Engagement Platform

WHO?

WHAT?

HOW WELL?

IDENTIFY IMPACTABLETARGETS

PERSONALIZE ENGAGEMENT

MEASURE AND OPTIMIZE OUTCOMES

40

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

A Turn Key Open Source and Secure SaaS Platform

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

WHO - More Precise Targeting:Where would you focus for ER visit reduction?

Joe Harris• 55 year-old male

• 2 recent ER visits

• 8 years on plan

• Chronic diabetic

• Poor compliance

• Overweight

• Has PCP

Victoria Chavez• 25 year-old female

• No ER visits

• 3 months on plan

• 1 and 3 year-old children w/multiple ER visits

• No PCP

41

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

WHAT - Personalized Messaging Utilizing Behavioral Economic Frames

42

30-40% Immediate savings

$171M Over 3 years for a commercial plan

80%+ Therapy adherence

HOW WELL - Prove and Measure Outcomes w/”RCTs”

The “Before and After” Method

Target Population

ER Visits/1000

“The campaign reduced ER

visits...But how do we know it was

the campaign that caused the

change and not something else?”

Vs.

Year 0

Execute Outreach Campaign

Measure

-200 visits

Year 1

Measure

RCTs and Statistical Significance

Target Population

ER Visits/1000

“There is only a 4% chance of

measuring this lift or more if the true lift

is really zero. ”

Year 0

Randomly assign:• 50% = Control• 50% = Campaign

- 74 visitsp=0.04

Year 1

Measure Measure pValue to ensure

result is ‘significant’

…And then optimize by focusing resources on what is working (and turning off what isn’t) 43

Key Takeaways

Reducing medical costs isn’t easy

Marry consumer engagement with analytics – insights alone aren’t enough

1. Better targeting improves capacity and lift

2. Personalize your interventions

3. Ability to prove and measure what is working or not working allows quick pivots

4. Need a system that allows for rapid adjustments and scale

44

Contact Information

Senior Vice President, Product & Services

NextHealth Technologies

dmasciopinto@nexthealthtechnologies.com

Dan Masciopinto

45