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Population Health Management: Opportunities and Challenges

Population Health Management: Opportunities and Challenges. David E. Blair, MD President, MHPP-GR and Affinia Health Network January 13, 2017. Population Health Management. Involves Specific Actions To: Improve the Experience of Care Improve the Health of the Population

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Population Health Management: Opportunities and Challenges

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  1. Population Health Management:Opportunities and Challenges David E. Blair, MD President, MHPP-GR and Affinia Health Network January 13, 2017

  2. Population Health Management Involves Specific Actions To: • Improve the Experience of Care • Improve the Health of the Population • Reduce per Capita Cost (Triple Aim)

  3. Population Health Management • Strategy • Provider • Customer | Patient

  4. Trinity Health: People Centered 2020

  5. Our 22-State Diversified Network 3 National Health Ministries*** 93 4 Hospitals* in 20 Regional Health Ministries** Mission Health Ministries 23,900 Affiliated Physicians 14 59 47 Home Care & Hospice Locations Serving 116 Counties PACE CenterLocations Continuing Care Facilities 5,300 Employed Physicians *Owned, managed or in JOAs or JVs. **Operations are organized into Regional Health Ministries ("RHMs"), each an operating division which maintains a governing body with managerial oversight subject to authorities. ***Includes multiple locations for Trinity Home Health Services, Trinity Senior Living Communities and PACE facilities.

  6. Adverse Events • Readmission Rate • Total Cost of Care • Number of Lives in Value Based • Hypertension; % Controlled Contracts • Operating Margin • % of total operating revenue • H-CAHPS – Overall Rate Hospital • CG-CAHPS – Would Recommend Office • Turnover

  7. Source: CMS

  8. Source: CMS

  9. Source: CMS

  10. Trinity Health Next Generation ACO utilizes Evidence-based Criteria to Stratify and Identify Population for Care Management Review 1. Sort population by Medical Spend 2. Stratify Top Spenders using Evidence-based Criteria: • 2 or more Inpatient Admits within 12 months OR • 2 or more Readmissions within 12 months OR • 2 or more ED visits within 12 months OR • 2 or more Diagnoses of Chronic Conditions (Heart Failure, Hypertension, Diabetes, CAD, COPD, Asthma or Behavioral Health) Top 1% $121,570 Average Spend Top 5% $53,666 Average Spend Top 10% $27,914 Average Spend Top 30% $9,862 Average Spend 3. Identify Beneficiaries who require further clinical review 4. Care Management begin “Detective Work” 5. Review with Accountable Clinical Team • Reference: Proactively Identifying the High Cost Population: Insights from the Health Care Transformation Task Force

  11. Care Management Strategic Plan

  12. Population Health Management Summary Better for: • Patients • Providers • Society

  13. Population Health Management Questions?

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