Enabling ACO Growth - Tableau Conference 2018 · Development Performance Production Data Warehouse...

Enabling ACO Growth and Medical Cost Savings at Cigna®

# T C 1 8

#CignaDataAnalytics

Paul Van Dorpe

Analytics Business Lead

Cigna

Jo Ann Bidwell

Informatics Lead

Cigna

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna

Agenda

Cigna Strategy for Healthcare Affordability

Our Approach to Accountable Care Organizations

Using Tableau Reporting to Drive Healthcare Affordability

Q&A


Cigna Overview

Cigna is a global health service company dedicated to helping people improve their health, well-being and sense of security.

• $41.B in revenues

• 1M+ relationships with health care providers, clinics and facilities

• Active in 30+ countries and jurisdictions

• 95M global customer relationships

• 45K+ employees worldwide

https://www.cigna.com/about-us/company-profile/cigna-fact-sheet


https://www.cigna.com/about-us/company-profile/cigna-fact-sheet

Cigna and Connected Care - Our Strategy

Cigna and connected care optimized relationships that connect care between customers and providers to drive better

health, affordability, and experience.

OUR STRATEGY MEASURABLE OBJECTIVES

BETTER HEALTH

BETTER AFFORDABILITY

BETTER EXPERIENCE

OUR GOALS

Customer

Provider

CONNECTED

CARE

Competitive

risk-adjusted PMPM

(Per Member Per Month)

Medical trend

cost reduction

Provider

experience

and collaboration

Engaged consumer

health improvement

50/90

value-based

payment goal


Value Based Care Programs Accountable Care Organizations


Integration: What Makes Us Different


Easy

navigation

Integration

with

value-based

providers

Deep

analytics

and

insights

that fuel

our

solutions

Our focus

on the

individual

Effective

clinical

managementDriving

innovation

Cigna Accountable Care Powered by Analytics

Population Health and Tools Patient Actionable Data, Facilitating Clinician Collaboration,

Rewards for Outcomes focuses on:

Customers

CignaProviders

Daily

• Hospitalized patients

• High-risk patients

Monthly

• Predictive risk scores

• Gaps in care

• Case management activity

Quarterly

• Market comparison

(successes and opportunities)

• Joint Operating Committee meetings

Providers use our

tools to help

improve competitive

edge in the market

Optimized

relationships drive

better health,

affordability

and experience Cigna shares

claims-based

analysis to identify

actionable

opportunities


Map is illustrative.

*Cigna internal analysis of existing arrangements as of July 2018. Subject to change.

Cigna Collaborative Care Active Arrangements

Accountable Care Program

Specialist Program

Hospital Program

195+ specialist programs

in six disciplines*

140+ hospital programs

with 470+ facilities*

220+ Accountable Care

programs in 32 states

serving over 2.5M customers*

IA


Using Analytics to Drive Healthcare Affordability


High Level Architecture


Development

Performance

Production

Data

Warehouse

Source

SystemsWeb Server

Tableau Server

Web Server

Tableau Server

Authorization

Authentication

AuthorizationInternal User

Firewall

Internal

Cigna Champion Award

External User

Portal

Portal

Tracking Performance and Adoption

Server Metadata

for Insights

Opportunities

for training

found based on

usage


Performance Tuned to Unique Demand Patterns

Server metadata for

insights

Now we can

correlate medical

cost successes to

report usage


Solution Overview and Capabilities

Utilizing feedback from Collaborative Accountable Care (CAC) groups and Cigna teams

• All performance reports are now in a visual analytics solution

• Accessible via a new self-serve delivery platform: The Cigna Collaborative Care (CCC) reporting portal

• The CCC Reporting Portal is a secure web portal with internal insights features allowing Cigna Information

Management & Analytics to track usages

Overall Enhancements

Secure

web portal

Easier

drill down

capabilities

More efficient

filtering on

key elements

Direct access

for CAC groups

Timely content

& functionality

enhancements


41% use Cigna’s quarterly performance

reports more often now that they are delivered in visual format.

More detailed, practical reporting showing specifics on how to reduce costs.

ACO in NC

ACO in NC


Cigna Collaborative Care Solutions with Visual Analytics


Before Visual Analytics


Better Design Yields Quicker Insights

Healthcare Quality

Opportunities

Patient health

quality opportunities

identified

Highly specific

actions at physician

and patient level

Quality metric

performance

qualifies groups for

increased incentive

payments


Drug Prescription Efficiency Opportunities

Improves affordability

through efficient

prescribing patterns

Highly specific

physician and drug

analysis to drive action

Generic drugs are

typically <10% of the

cost of brand drugs*

*Based on internal Cigna analysis for YTD 2018 excluding specialty drugs


Opioid Drug Utilization Opportunities

Excessive opioid

utilization beyond

CDC guidelines

analyzed

Highlights

patients with

multiple opioid

prescribers

Opioid

prescriptions

have decreased

25% Q417 vs.

FY15*

*https://www.cigna.com/newsroom/news-releases/2018/cignas-partnership-with-physicians-successfully-reduces-opioid-use-by-25-percent-one-year-ahead-of-goal


Provider Report Card

Individual

Providers profiled

Selectable

measurement

(total medical

cost, CT or MRI

Scans, ER, etc.)

Providers

compared to

peers, overall

practice, and

Market



Provider Report Card continued

Out of Network

spend detailed

Specific quality

measure

improvements

Provides

actionable info for

specific doctors

to improve

performance



Provider Report Card Trends

Trend over time

for key measures

for specific

doctors compared

to overall practice

and market

Key lever to

improve

affordability



Episodes of Care Highlights – Specialty Group

Savings

opportunities by

type of action for

specific

orthopedic

episodes

Intuitive

navigational paths

based on greatest

opportunity

Cigna has 250

specialty provider

groups with value

based contracts


*Based on internal Cigna analysis for 2016 - 2017

Episodes of Care: Place of Service Utilization

Surgery location

greatly affects

cost

Specific

physician and

hospital patterns

show steerage

opportunities for

shared savings

Outpatient knee

replacements

average 50% of

the cost done

inpatient facility*



Episodes of Care Potentially Avoidable Complications (PAC)

Analysis of

surgery

complications

expose areas to

improve clinical

workflow

Complication

rates are shown

relative to peers

Potentially

avoidable

complications

are 5-8% of

total episode

costs*



Key Benefits and Next Steps


Key Benefits - Controlling Cost of Care

1. Cigna 10/1/16 analysis showing 1/3 of large physician groups nationally active at least one year see an average 3% total medical cost savings over two years.

2. Cigna 10/1/16 analysis of medical BOB customers in top 40 US markets, defined by market size, within 15-mile Zip code radius (Zip code to Zip code distance) of large physician group primary care physicians. Subject to change.

3. Cigna internal analysis of Cigna Collaborative Care, Large Physician Group annual results for 2014 and 2015. ROI Methodology = (Total Savings-Total CCR Costs)/Total CCR Costs. Reflects performance since inception of groups, with experience of one or more years.

4. Calculated from trend of aligned member claims plus care coordination reimbursements paid vs. trend of Cigna's comparable claims within the local market on a risk adjusted PPPM (per patient per month) basis. Cigna Collaborative Care Large Physician Groups with effective

dates through 2015.

88%have access to aCollaborative Care physician in the top 40 markets.2

Top performers saved

in total medical cost among groups

active one year or more.1

$120 saved annually per patient1

PROVIDERS

2:1 ROI3

$145Mtotal medical cost

= savings to date.4

CUSTOMERS CLIENTS

3%


Lessons Learned

• Visual analytics can have dramatic impact on healthcare affordability

• Show the art of the possible to build support

• Use your network for quick expertise


Next Steps and Future Direction

• Expand ACO footprint and other value based programs

• Additional specialty groups/episodes

• Facilities

• Expand the healthcare reporting content to target additional Affordability

• Clinical data exchange for maximum usefulness


Q & A


Thank you!

#TC18

#CignaDataAnalytics

Paul Van Dorpe

Analytics Business Lead

Cigna

Jo Ann Bidwell

Informatics Lead

Cigna



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