Leveraging Crimson to Support Network Utilization Strategy

Transcription

1 Crimson Population Risk Management Leveraging Crimson to Support Network Utilization Strategy January 25, 2016

2 2 Managing Your Screen To minimize the control panel To minimize the presentation area Minimizes the control panel to the right side of your screen The blue button with the white square will maximize the presentation to fill your screen Re-opens the control panel

3 3 If You Would Like to Ask a Question If you would having any questions during the webinar, please type your question in the question panel by following the steps below: Questions Panel Simply type your question and click Send. This will let the presenter know you have typed a question. The presenter may choose to answer your question through the questions panel or by responding through audio. Enter a Question in the Questions Panel

4 4 Today s Presenters Joe Gaul Associate Director, Crimson Population Risk Management gaulj@advisory.com Kristen Jaros Director, Product Management jarosk@advisory.com (202)

5 5 Agenda for Today s Webinar Background of Provider Development as key component of population health infrastructure and success Introduction to Network Utilization Analytics Demonstration of Network Utilization Analytics functionality and use cases in CPRM application Review of provider roster requirements Question & answer session

6 Crimson Population Health Success Strategies Next-generation areas of focus from Advisory Board National Research specifically tailored to your organization REDESIGN & ENHANCE CARE TRANSFORMATION ENHANCE MARGIN MANAGEMENT OPTIMIZE NETWORK DEVELOPMENT Achieving Savings Through High Quality, Cost Effective Care Maintaining Margin Through Cost Containment & Growth Strategies Examining Efficiency of Care Among Providers Evidence-Based Care Pathways Ambulatory Sensitive Avoidable Admissions Population risk stratification and panel management Chronic Disease Management, Prevention, and Wellness Tracking and monitoring program success overtime Reducing Episodic cost variation Eliminating unnecessary utilization hospitalizations, procedures, utilization Contracting Strategy Best-Practices Demonstrating success in Population Health Management to enter into new contracts (Medicare ACO, Medicare Advantage, Commercial Risk, Direct-to- Employer) Examining Individual primary care provider and practice performance Specialist performance insight cross-continuum episodes of care Develop a highly selective and coordinated Post-Acute care network Network referrals & services to match market demands through keepage analytics Source: Advisory Board National Research and Insights

7 7 Network Development Vital to Population Management Provider Network Partner Network High-performing PCPs, Specialists, & alternate providers In-network referrals & services to match market demand Post-acute care, retail clinics, & pharmacies Community partners (clinical & social) Business Impact Overarching goal in successful population management will include constructing and managing a preferred provider network (PPN) and directing business to the top performers Requires: Close monitoring of provider performance to identify high efficiency providers as well as improvement opportunities Uncovering drivers of out of network utilization and working with providers and partners to address them

8 8 Using Crimson to Improve Keepage Understand drivers of out of network utilization to improve keepage Value to ACO and CI Network Administrators & Analysts Leverage 360 view of utilization to identify key sources of leakage by multiple dimensions - including practice, PCP and service category detail Intervene with PCPs who may be referring to specialists out of network Recommend alternative in network providers Explore strategies to address service gaps Quantify cost of leakage away from employed and affiliated providers Monitor keepage by preferred providers

9 9 Network Utilization Analytics: Behind the Numbers Methodology to determine in/out of network cost from the health system perspective The attending or billing providers on all medical claims are analyzed to determine whether the associated cost (utilization) should be categorized as in or out of network The provider reviewed varies according to the nature of the cost as defined by the HCG Major Service Category or Care Setting: Inpatient: billing provider Outpatient: billing provider Professional: attending provider Ancillary: billing provider The network affiliation of the attending or billing provider, as applicable, is derived based on the provider roster submitted by the member Domestic employed/owned Affiliated otherwise affiliated, but not employed/owned Out of network identified as out of network or present in claims, but not identified Claim cost is determined to be in network if the provider is identified as domestic or affiliated (otherwise, out of network)

10 10 Network Utilization Capabilities Current Features and Future Enhancements Currently Available View by practice (aggregated cost by PCP s practice) Drill-down detail by PCP, billing provider, attending provider, service category, DRG, procedure, patient Cost and utilization by 3 tiers: domestic, affiliated, out of network Provider network affiliation defined at member level In Development Additional views with aggregated total cost by: PCP Service category Billing provider Attending provider DRG Procedure code Pending Discovery Cost and utilization across preferred provider tiers within network More granular analysis of in/out of network by population

11 Demo 11

12 12 Provider Roster Data Request Enhanced data required to support network utilization analytics Attribute Network Affiliation Expected Result by Provider (Physicians and Facilities) Employed/owned = Domestic Affiliated, but not employed/owned = Affiliated Known, but not affiliated = Out of Network Clinic name Practice name (primary) for the provider

13 13 Upcoming Webconferences Technology Training & Terrain Expertise Special Topic Opportunities February Focus of the Month: Margin Enhancement Tuesday, February 2 nd, 11-11:30 ET Join us as we delve into effective margin enhancement strategies from avoiding unnecessary and low-utility utilization to reducing episodic variance and being selective about tele-health and hospice referral practices. We'll also focus on growth strategies, such as adding lives under risk and expanding risk-based contracts. Register Here March Focus of the Month: Care Transformation Tuesday, March 8 th, 11-11:30am ET What are the best-in-class care transformation strategies? In this session we ll explore everything from hardwiring evidence-based medicine practice to improve compliance and address behavioral and socio-economic risk factors, to managing a large patient panel and effectively risk stratifying for identification of the right patients for the right interventions at the right time. Register Here Q1 Care Management Roundtable: The Three Things most Difficult to Get Right in Care Management (and their Trade-Offs) Wednesday, February 10 th, 2-3pm ET In this first roundtable of the year, we ll cover the three things most difficult to get right in care management, along with their trade-offs, which include leadership models, staff models, and committee structures. Join us for an interactive roundtable featuring a combination of the latest work from Research and Insights latest, the cohort s newest case studies, and member networking opportunities. Register Here ACO Benchmarking Update: What's Changed Since 2012? Wednesday, March 2 nd, 11am-12pm ET In a special collaboration between Research & Insights and your delivery team, we ll release a unique cohort-wide analysis revealing the top savings opportunities and focus areas of the past year. Followed by a comparison of these findings with those of 2012, you ll learn your biggest improvements, as well as how these results stack up against your peers. Don t miss this exclusive event! Register Here Visit advisory.com to register, or ask your Crimson Advisor Team for more information. Source: Crimson Market Advantage.