Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
The Five Pillars of
Population Health Management
Dr. Christopher Mathews
Senior Vice President and Chief Medical Officer
ZeOmega
©2013 ZeOmega, Inc. – All Rights Reserved.
First Jiva “go-live”
ZeOmega – a forerunner in
Population Health Management
Integrates data and analytics to drive intelligence, and embeds in the workflow
Jiva reengineered to be first flexible platform to configure & automate workflows
ZeOmega contracts with several payers, covering millions of lives.
ZeOmegaraises Series A funding
IDC MarketScape identifies ZeOmega as a “major player” in Care Management
Contracts with GHC, a national leader in both Patient-Centered Medical Homes and ACOs
Transformation into performance management driving population healthcare
Supporting Delivery System Excellence
Health system begins managing 40,000 lives using Jiva.
2011 2012
$21.5 million growth equity financing
201420132002-2006 2007-20102001
Company founded, Initiates development of Jiva care management platform
©2013 ZeOmega, Inc. – All Rights Reserved.
How We Got Here …
Healthcare’s Perfect Storm
World Health Organization:
Healthcare = 18% of GDP and rising;
Consumer out-of-pocket costs = 21%
Affordable Care Act:
Adding millions of previously
uninsured into system
76 million Americans eligible for
Medicare in next 15 years
Almost half of us have chronic
conditions requiring at least
one form of medication
Regulatory changes:
MU, HIPAA, MLR,
ICD-10, ACA
Sociopolitical forces driving
health insurance exchanges
and healthcare retail markets
Increased use of cloud
computing, mobile
devices with personal &
clinical data
Use of genomic medicine
trending upward
© 2014 ZeOmega, Inc. – All Rights Reserved.
Rapid technological innovation is making solutions available that were not possible before
How the Perfect Storm Is Impacting
Healthcare Organizations
requiring them to shift from
traditional care management to
PHM
while controlling costs and
improving care
Stakeholders must re-think
roles
© 2014 ZeOmega, Inc. – All Rights Reserved.
Triple Aim
What Is Population Health Management?
Population Health
Experience of Care
Per Capita Cost
Improve the overall health of
the population being served by
increasing the quality of care
Improving the overall
experience for individuals
Lowering the per capita cost
of care through improvement
Effective Population Health
Management should be based
in the Triple Aim Strategy
© 2014 ZeOmega, Inc. – All Rights Reserved.
What Is Population Health Management?
Across Multiple Care Settings
From home to hospital to hospice, and
all settings in between
Across the Care Continuum
From birth to end-of-life
Across Multiple Domains of Health
Medical, behavioral, and psychosocial
determinants of health
Improving the overall health and well-being of an individual…
…and doing it consistently for every
individual in the population we serve.
© 2014 ZeOmega, Inc. – All Rights Reserved.
RulesEngine
Care Teams
Post Acute Providers
Analysts
Patient / Caregivers
Physicians
Payers
AdministratorsPharmacists
What Is Needed For a Successful PHM Program?
• Long Term Acute Care
• Inpatient Rehab Facilities
• Skilled Nursing Facilities
• Home Health
• Hospice
• Health plans
• Agencies
• Reinsurers
• Employers
• Ambulatory Care
• Acute Care
• Financial Analysts
• Clinical Analysts
• Supervisors
• Compliance Personnel
• CFO
• Care Manager
• Utilization Manager
• Nurses & Clinicians
• Social Workers
© 2014 ZeOmega, Inc. – All Rights Reserved.
The Five Pillars of
Population Health Management
Data Integration & Aggregation
Actionable Intelligence
Holistic, Patient
Centered Care Management
Consumer Engagement
Program Design and Governance
Population Health Management
© 2014 ZeOmega, Inc. – All Rights Reserved.
• Compliance, Cost, Quality,
• Clarity on measurement of the short and long
term goals
• Assessment of current capabilities and strengths
• Current Weaknesses and gaps in capabilities
required to achieve long term goals
• Ensures incentives of all stakeholders are
aligned
• Achieves short term goals quickly, and builds on
these to tackle long term goals
• Metrics to measure achievement of goals
• Periodic (preferably real time) monitoring
P1: Program Design & Governance
Leadership
commitment and
change management
strategies.
Technological
capabilities can
determine how
successful your PHM
program will be.
PHM Goals
Current Capabilities
The Plan
Performance Measurement &
Monitoring
© 2014 ZeOmega, Inc. – All Rights Reserved.
Legacy
Current
Next Generation
P2: Data Integration & AggregationInteroperability is the “new wine in the old bottle”…
Str
uctu
red
Un
str
uctu
red
Real time, self
authenticating
data exchange
Point
to
Point
Batch
Key Considerations:
• Master Patient
Index
• Master Provider
Index
• Elimination of
duplicates
• Tracking the
authenticity &
quality of data
sources
• Natural Language
Processing
• Data Normalization
& Tagging
Non-Clinical ClinicalDemographic, Claims,
Billing, RCM
Imaging, Lab, Diagnostics,
Pharmacy, EMR, Biometrics
© 2014 ZeOmega, Inc. – All Rights Reserved.
P3: Actionable Intelligence
Platform driven real-time adjustment
of risk, propensity to change,
Optimization of resources based on
out come and behavioral change
prediction - NEXT BEST THING
TO DO
Predictive Analytics
Low
Act
ion
abili
ty&
Eff
ect
ive
ne
ss
H
igh
Embedded analytics in workflow
Risk Identification and stratification
Dashboards (STAR, ACO
Measures, Patient registries)
Data Mining & BI
Ad-hoc reporting
BI Tools, Limited to power users,
Static dashboards to support
business users
Real-time Big Data Analytics
drives personalized pop health
Claims,
ICD9/CPT
+ Lab, Drug,
Diagnostic
+ HRA,
Demographics,
Personal Preferences
+ Behavioral, Provider
quality, biometrics,
EMR structured data,
Unstructured data
+ Consumer data,
Environmental data
Example: Compliance Reports,
Standard Outcomes reports
Basic Reporting
Low Accuracy & Effectiveness of Analytics High
© 2014 ZeOmega, Inc. – All Rights Reserved.
P4: Holistic, patient-centered care
management
Evidence-based medicine, that is
completely personalized to the
individual
Meeting the patient, their advocate,
and the care team where they are
with the right technologies
Actionable intelligence that
accounts for not only medical needs
but also behavioral, psychological,
social, financial, emotional,
environmental, spiritual, and cultural
factors in driving actions – the
NEXT BEST THING TO DO
RulesEngine
Care Teams
Post Acute Providers
Analysts
Caregivers
Physicians
Payers
AdministratorsPharmacists
© 2014 ZeOmega, Inc. – All Rights Reserved.
P5: Consumer Engagement
Educate
Engage
Empower
It is all about getting to Patient Commitment and Empowerment
• Deliver the right information at
the right time in the right
communication channel to the
right stakeholder
• Educational Mailers, Coaching
Campaigns• Analytics that clearly
assess need for
change, propensity
to change, factors
that drive change,
factors that induce
change fatigue
• Medication alerts,
• Decision Support Tools
• Cost Price Transparency
• Quantification of Quality
• Convenience
The Five Pillars of
Population Health Management
Dr. Christopher Mathews
Senior Vice President and Chief Medical Officer
ZeOmega