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.
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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.
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