9/28/2018

Hitchhiker’s Guide to Population Health

Ray HerschmanVP Accountable Care Strategy and Business DevelopmentCerner Corporation

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 1

Health Care Market Transformation - 2 Major Vectors of Change1

Insurance Coverage Transformation

Regulatory Reform/Private Sector Restructuring

Care Delivery&Reimbursement Transformation

Before 2014

• Federal/state regulations

• Interpretation and preparation

• Private exchange investments

• Rationalizing DB health coverage/self vs fully insured

Innovation, Proto-types and Proof of Concept

• Patient Centered Medical Homes

• Bundled Payment/(warranty)

• Accountable Care Organizations

• EMR, HIE and Analytics

• P4P, Shared savings, Shared risk

New Normal

2020 and 2025

• Localized choice

• Level playing field & competition

• Regulatory refinement

• Broad range of collaborative care models

• Cost, quality and patient experience transparency

• Competition based on cost and quality

• Clinical data interoperability

• Radical improvement in quality & value

New Normal

Implementation & Adaptation

2014 - 2020

• Public exchanges open

• Private exchange adoption

• Movement from B2B to B2C

• Benefit and network redesign

• Re-emergence of PSP models

• Consumer activation and agitation

Volume to Value

• Provider-driven health management

• Carve-in / re-aggregation of total costs

• Provider accountability/control

• Adaptation/maturity of care models

• Emergence of new enablers/intermediaries – data, analytics, services, devices

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 2

Macro Context: Provider Consolidation

Delivery systems and providers continue to consolidate

• Access to capital

• Collective contracting power

• Improved access to information technology• Economic viability and survival for community hospitals• Acquisition of primary care foundational for population health

and referral volume capture

With more scale, health systems are better positioned to succeed with value-based contracts

• Scale creates leverage against dominant incumbent payors

• Duopoly dynamics in many markets triggers advanced strategies for capturing market share, particularly with top 1 and 2 health systems

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 3

Macro Context: Shift of Network Definition

Provider Networks Have Evolved• Promise of better value as a result of integration

• Alignment of incentives among in-network providers – value based payments

• Affiliations are still relevant, even with

consolidation

Prevalence of Narrow Networks• 47% of Medicare Advantage networks are narrow or small

(< 49% of hospitals in network)

• 51% of MA beneficiaries are in a small or narrow network

(≈8.7MM lives)

• Tradeoff between cost and access from both members and plan sponsors

J a c o b s o n , G r e t c h e n , A r ie l T r i l l in g , A n t h o n y D a m ic o , a n d M a r s h a G o ld . “ M e d ic a r e A d v a n t a g e H o s p it a l N e t w o r k s : H o w

M u c h D o T h e y V a r y ? ” M e n lo P a r k , C A : T h e H e n r y J . K a is e r F a m ily F o u n d a t io n , J u n e 2 0 , 2 0 1 6 .

h t t p : / /k f f .o r g /m e d ic a r e /r e p o r t /m e d ic a r e - a d v a n t a g e - h o s p it a l - n e t w o r k s - h o w - m u c h - d o - t h e y - v a r y / .

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 4

Provider Network Performance Management

Scale (S)

Co

ntr

ol (

C)

C a 1/S: Control - the ability to manage performance, is inversely proportional to the scale, heterogeneity & complexity of the provider network being managed

Micro-Networks: • Episodes/Bundled

Payment• Medical

Home/Neighborhood

high

low

DeliverySystem

Accountable Care Organization

Clinically Integrated Network Narrow/

Exclusive/High Performance

NetworkHealth

Maintenance Organization

Preferred Provider

Organization

low high

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 5

Credible Provider Performance Measures

Source: Mercer Analytics Milstein/Herschman 2005

OpportunitiesüIncrease high performer volume through-put

üDrive up lower performers

üTrim poor performers

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 6

Provider Risk Continuum & Capabilities

Capability FFS Value-based FFS

Episode/ Bundled

Payments

SharedSavings

Shared Risk/ Global

Capitation

Provider-sponsored

Plan/ Full Risk

D ata O perations

N etw ork A ssessm ent &M anagem ent

R eferral M anagem ent

Provider Perform ance M anagem ent

Provider C ontracting

R isk A djustm ent

C are M anagem ent

A ctuarial M odeling

H ealth P lan O perations

Performance Risk

Insurance Risk

% H

ealth

care

dol

lar a

t ris

k

SophisticationR equired

N one

Basic

Interm ediate

Advanced

Providers contend with a sliding scale of required capabilities based off Fee-For-Service / Fee-For-Value Mix

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 7BRNDEXP 2.1 0714 © 2014 Cerner Corporation. All rightsreserved.This document contains Cerner confidential and/or proprietary information belonging to Cerner Corporation and/or its related affiliates which may not be reproduced or transmitted in any form or by any means without the express written consent of Cerner

3

MU Stage 1 Starts

VBP &Readmissions

MU Stage 2 Starts

ICD-10Transition

MU Stage 3Starts

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

HITECH P.P.A.C.AMU Stage 1

Rules Finalized MU Stage 2Rules FinalizedACO Rules

Released

Population Health Adoption Curve

(Estimated)

EMR Adoption Curves(Estimated)

EMR Next Wave Drivers Replacing OutdatedTechnology CostControl

Health SystemConsolidationChoosing Supplier WithVision

Mostly Replacement

Two suppliers share most of business

Greenfield and upgrades of

existing EMR

Multiplesuppliers

benefit

Greenfield

New Competitive Landscape Incumbent Advantage

EMR Waves Transition to Population Health

MACRABegins

Shift toFee-For-Value

© C erner C orporation. A ll rights reserved. This docum ent contains C erner confidentia l and/or proprietary inform ation belonging to C erner C orporation and/or its re lated affilia tes w hich m ay not be reproduced or transm itted in any form or by any m eans w ithout the express w ritten consent of C erner.

8

The acute EMR market is saturated

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 9

From Point Solutions to Population Health Platforms

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 10

Population Health Management Capabilities Maturity Framework

Prior Authorization

Medical Management Payer Utilization Management Medication Management Wellness and Incentives

Care Programs

Referral Management

Wellness Program Management

Care Coordination and Transition

Concurrent Review

Encounters Management

Medication Therapy Management

Incentives Program Management

Appeals & Grievances

Care Planning

Virtual Care Virtual CarePatient Monitoring Telehealth

Clinical Content Clinical ContentScreenings and Assessments Evidence-Based Guidelines Clinical Decision Support Tools Patient Education

Data, Reporting and Analytics BI and Analytics

Engagement Virtual Care

Risk Stratification Clinical Analytics Financial Analytics Operational Reporting Quality Management and Reporting Ecosystem Integration

W orkforce M anagem ent D ig ital O utreach D ashboardsW orkflow M anagem ent

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 11

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 12

Parallel Technology Growth Paths – EHRs and CRM

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 13

Healthcare + CRM is a Greenfield Market

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 14

Profile Driven Health Care

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 15

Master Consumer Profile

Individual Demographics/Attributes

• Name• Identifiers (eMPI, coverage ID, other)

• Gender• Age• Marital status

• Guardian/delegates• Family/Affiliations

• Employer/sponsor• Address• Contact info

• Communication preference(s)• Occupation(s)

Social Determinants

• Personal Characteristics: Ethnicity, Language, military

service• Family and Home• Money and Resources

• Education status• Family status/support

• Child care• Food/Transportation/utilities• Stressors/emotional safety

Clinical Longitudinal Record

• Disease (real & suspected)• Episodes/treatments

• Risk scores & predictors• Rx• Preventive services

• Health status• Protocol adherence

Entitlements

• Carrier/Sponsor• Insurance coverage type,

programs and services• Network(s) • Rx Formulary

• Carve outs

Other factors

• Patient Experience Surveys• Care preferences

• Wellbeing• Interests

Attributed Care Team

• Primary Care Provider• Specialists

• Ancillary• Family/Friends• Social services

• Care Manager(s)

Health Behaviors

• Psychographic/Attitudes• Activation (PAM)

• Readiness to Change• Knowledge/Skills – self

management

• Adherence/compliance

Interaction History (Emerging)

• Modalities• Frequency

• Content/Nature/Type

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 16

Profile Driven Health Care

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 17

Master Physician Profile

Core Profile Attributes

Individual physician identifiers and descriptors:• Name• Identifiers (NPI, TIN, etc.)• Gender• Age, practice duration• Specialty & Taxonomies• Training & Education• Board Certifications• Geographic Location(s)• Contact Information• Language(s)• Modalities of practice (F2F, Video,

email etc.)

Payer Networks

Par status with payer defined networks:• Payer specific network

designations (PPO, HMO, EPO, HPN)

• Line of business (MA, Commercial, Medicaid)

• Product specific designations

Clinical Quality

Structure, process, and outcomes measures correlated to clinical quality:• CMS MIPS Quality Payment Program• Physician Compare• HEDIS & MA Stars• MSSP ACO• Malpractice history, sanctions

Affiliations

Formal legal entity relationship and affiliations:• Practice(s)• Group(s)• Health System(s)• Region(s)• CIN(s)• ACO(s)• Facilities

Misc.

Measurement of other performance attributes:• Patient Experience (CAHPS)• Patient Interaction and engagement

profile• EHR usage/adoption• Participation and leadership

Patient Attribution

Direct and derived relationships:• Panel size• Panel density• Panel profiles (age, risk, geo,

payer mix)

Cost Efficiency & Resource Utilization

Outcomes measures of associated resource utilization:• Referral patterns• Diagnostic and Rx resource use rates• Peer-based: Risk-adjusted episodic

cost efficiency by specialty

Perfo

rman

ce

Interaction History (Emerging)

• Modalities• Frequency• Content/Nature/Type

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 18

Intelligent Data and Content Powering Precision Engagement

Engagem ent

Closed loop

B R N D E X P 3 .0 © C e r n e r C o r p o r a t io n . A l l r ig h ts r e s e r v e d .

T h is d o c u m e n t c o n ta in s C e r n e r c o n f id e n t ia l a n d /o r p r o p r ie ta r y in fo r m a t io n b e lo n g in g to C e r n e r C o r p o r a t io n a n d /o r i ts r e la te d a f f i l ia te s w h ic h m a y n o t b e r e p r o d u c e d o r t r a n s m it te d in a n y fo r m o r b y a n y m e a n s w i th o u t th e e x p r e s s w r i t te n c o n s e n t o f C e r n e r . 19

Next Wave of Innovation: Content

Clinical Knowledge Bases

Analytic Content

Journey Content

© C erner C orporation. A ll rights reserved. This docum ent contains C erner confidentia l and/or proprietary inform ation belonging to C erner C orporation and/or its re lated affilia tes w hich m ay not be reproduced or transm itted in any form or by any m eans w ithout the express w ritten consent of C erner.

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In Person Phone

Inbound and Outbound

Fax

Snail M ail

Em ail

Patient Portal

IVR

Text M essage

Live C hat

Biometric Device

Monitoring

C om m unitySocial M edia

EM R

K iosk

Em ployee Portal

H ealth P lan Portal

Provider Portal

V ideo stream

Video -live

M obile A pp

B ot/VA

Provider Recruiting

& Academic Affairs

Provider Credentialing

Sales & Direct

Contracting

Digital Experience

Volunteer & Community

Services

FoundationEndowments

Marketing/ PR

Provider Sponsored

Plan

ACO & Network

Performance Management

Patient Access/

Scheduling

Practice Management

IT –InfrastructureUser Support

R evenue C ycle Patient

Financial Services

PayerContracting

HumanCapital

Population Health

Home Health,

Infusion, DME

Surveillance & Public Health

Patient Experience

Telehealth, Remote, 2nd

Opinion

Primary Care/

Community Practice

Specialty Clinical Service

lines

Skilled Nursing &

Rehab

Clinical Trials/

Research

Quality & Safety

Management

Pharmacy

21 Common Modes of Interaction: omni-

channel

Enterprise Stakeholder CategoriesØ MarketingØ Service/OperationsØ Clinical/DeliveryØ Provider Sponsored PlanØ Provider Network

Enterprise Perspective CRMVision

New Governance Models

Orchestration of Engagement Strategies

Integration of Touchpoints

© C erner C orporation. A ll rights reserved. This docum ent contains C erner confidentia l and/or proprietary inform ation belonging to C erner C orporation and/or its re lated affilia tes w hich m ay not be reproduced or transm itted in any form or by any m eans w ithout the express w ritten consent of C erner.

21