rowdmap at the cape
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All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
At the Cape
2All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
No-Value Care (30%)
Necessary Utilization(70%)
Care That Doesn’t Produce Better Outcomes
$850 Billion Unnecessary Spend in 2014(Institute of Medicine)
No-Value Care:
.30 / Each $ Is Wasted
Low Value Care Drives Billing in Fee for Service
“#1 Weakness of FFS Payment System Is
Excess Use of Low Value Services”
Dr. Patrick Conway, Chief Medical Officer, CMS
All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
No-Value Care:
CMS Is Paying on It
2016 World Economic ForumAnnual Meeting in Switzerland
On track to sunset 50% of FFS
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without the prior written consent of the Company, is prohibited.
No-Value Care:
Market Advocates for It
In a series of white papers, HCTTF, following research,
recommends that payers, providers and CMS use low-
value care as evaluation criteria for success in pay for
value models and incentivize providers based on it to
create sustainable economic models for transition to value-based care.
All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
“Millions of people are receiving drugs that aren’t
helping them, operations that aren’t going to make
them better, and scans and tests that do nothing
beneficial for them, and often cause harm.”
Dr. Atul Gawande, Professor, Department of Health Policy and Management at the Harvard School of Public Health & the Department of Surgery at Harvard Medical School.
No-Value Care:
Media Is Reporting on It
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without the prior written consent of the Company, is prohibited.
"It's no secret that patients often undergo unnecessary procedures that can be dangerous and costly." Through our collaboration with RowdMap, we are providing patients with meaningful information about these no- or low-value treatments, allowing them to make better, more informed decisions about their doctors, hospitals and medical care.”
No-Value Care:
Consumers Demand It
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without the prior written consent of the Company, is prohibited.
RowdMap has no-value care and population health benchmarks for…
every physician
every hospital
every zip code
…in the United States. What if you knew which providers would
drive your success?
No-Value Care:
RowdMap Has It
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Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
You can have great outcomes…On a surgery you don’t need
You can have great patient experience...On a surgery you don’t need
You can have realtively low costs...On a surgery you don’t need
How Much Outcome Does Your Dollar Buy?
Guys, it’s $/Outcome.Think Moneyball
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How Much Outcome Does Your Dollar Buy?
RowdMap’s Risk-Readiness® benchmarks help health plans, physician groups, and hospital
systems identify, quantify, and reduce delivery of no-value care — a central tenet of successful
pay-for-value programs.
10All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
Leading the way…
US CTO on RowdMap: “Visionary
Genius”
ABOUT ROWDMAPReception & Press
…in the shift from fee-for service to pay-for-value.
And featured in… RowdMap Partner
11All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
Health plans and providers in 48 states and the District of Columbiause RowdMap’s benchmarks to reduce the delivery of no-value care.
RowdMap’s benchmarks help manage the $850 billion the nation spends on care that leads to no better outcomes.
The clients RowdMap serves collectively cover the lives of more than 100 million Americans.
RowdMap was founded in 2011 and has offices in Louisville, KY and Portland, ME.
ABOUT ROWDMAPRowdMap by the Numbers
Payers in Marketplace/Exchange, MA, Medicaid, Commercial and Government Programs
Providers including PCP & Specialty Groups, CINs & Systems, ACOs, Bundles & other CMMI Program Participants.
12All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
Where It’s WorkedNetwork and Medical Economics• Built a high-performing specialist network that significantly reduced no-value care delivered
• Performed a network comparison against a plan’s competitors to determine which groups were essential to contract with when entering a new market
• Tripled a plan’s original goal of contracting with targeted providers by using RowdMap benchmarks as a basis for conversation (and in some cases, out of exclusivity arrangements)
Value-Based Innovation• Crafted value-based contracting strategies for leading specialist groups looking to move to
even more aggressive risk arrangements with payer partners
• Developed a five-year government programs expansion strategy that identified high-performing physician groups to put on a pathway to risk
Product Portfolio and Benefit Design• Launched high-end concierge plan that broke member price sensitivity and generated
significant profit, doubling original membership goal
• Reformulated a multi-state health plan’s exchange portfolio by considering network efficiency and population behaviors to increase profit today and succeed over time
Strategy, Growth, and Expansion• Created a plan’s expansion strategy for Medicare Advantage using RowdMap’s population
health, physician performance, and market-level benchmarks
• Moved a plan’s membership in high-performing physician groups from 2% to 30% in 12 months through new messaging and marketing tactics
Where we’ve done it…
ABOUT ROWDMAPMarket Adoption
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CMS: 50% of FFS will be gone by 2018
What if you knew which providers would
drive your success?
What if you knew which providers would sink you? WHAT WOULD YOU DO IF YOU KNEW
who will win and who will lose in value based arrangements
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Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
Appendix
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At the core of Risk-Readiness® is
Unwarranted Variation:
RowdMap applies the Dartmouth Atlas forUnwarranted Variation methodologies to data on Medicare Parts B & D. This research has been repeatedly validated over the last 30 years and we now have a national data set to apply the methodologies at a large scale.
The estimated 30% of medical expense that goes to no-value care.
This unnecessary spending drives billing in a fee-for-serve economic model, but success in pay-for-value comes from managing and mitigating these pockets of variation. Every provider has a unique practice
pattern that informs Risk-Readiness®
WHAT WE DORisk-Readiness® – Practice Patterns
16All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
WHAT WE DORisk-Readiness® – Practice Patterns
Providers in a Market
Groups
Individual Physicians
What is driving a provider’s Risk-Readiness®? Is it procedures, prescriptions, referrals or visits?
How big is a provider’s panel?
How ready is a provider to succeed in risk
compared to peers? By specialty?
Within a region?
Finger print with practice patterns that mitigate no-value care = Green Dot
Finger print with practice patterns that create no-value care = Red Dot
Benchmarks for Risk-Readiness®
17All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
RowdMap provides data and analysis on Population Health factors that drive success in value-based programs:
WHAT WE DORisk-Readiness® – Population Health
Behaviors – Broader Definitions of Health with Behaviors
Utilization – Utilization and Costs of Procedures and Drugs
Prevalence – Major Diseases and Conditions
Supply – Number of Primary Care Physicians and Specialists
Socio-demographics – Income, Environment, etc.
Match your strategies to
your population to succeed in value-based
programs
18All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
Great profile for aggressive risk
Tread carefully for some risk
Match Provider Practice Patternswith Value Based Programsbased on Population Health Behaviors
WHAT WE DORisk-Readiness® – Risk Arrangements
19All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
WHAT WE DOWhat Payers Get – Menu of Analytic Use Cases
Get started by choosing some options below:
Network DevelopmentCreate a Risk-Ready Network• Network Explorer
• Network Builder
• Network Optimizer
• Network Calculator
Product Design & RiskDesign Profitable Products• Competitive Benefit Design Analysis
• Network Based Benefit Design
• Population Health Based Product Analysis
Sales & MarketingGrow into Profitable Membership• Network Based Growth Analysis
• Provider Growth Analysis
• Measuring Growth Analysis
20All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
WHAT WE DOWhat Providers Get – Menu of Analytic Use Cases
Are you Ready for Risk?Manage Internal Variation Provider Contracting Strategy Provider Compensation Strategy Process Variation & Improvement Service Line Benchmarking Provider Reporting Provider Recruitment & CIN Build Value Chain & Leakage Reporting Medical Economics Reporting
Are Your Partners Risk Ready?Pick the Best Partners for Risk Arrangements Primary Care Referral Source Analysis Acute Care Partner Reporting Post Acute Partner Reporting Consulting/Specialty Partner Analysis Competing Groups/Orgs Analysis
What are my best Opportunities for Risk?Match Providers to Risk• Risk-Matching to Payers: Government & Private Payers • Payer Negotiation Reporting • Medical Economics Modeling
Get started by choosing some options below:
21All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
WHAT WE DOAchieving Financial Sustainability
Grow into Markets / ProvidersProfitable Today & Tomorrow
22All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
Government benchmark data serves as the common languagenecessary to build relationships with providers to improve the member experience and profitability
The benchmarks are available today with no IT involvement
The data already have a level of analysis on top, so you can see if a provider is over/under benchmarks
It’s from CMS; it’s a standard; it’s already used to day to drive reimbursement
WHAT WE DOPower of Government Data
Government Benchmarks
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Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
Government Benchmarks vs. Claims
Over / Under CodingCounty & Zip Code
Under Coding Over Coding
Under-codingJacksonville
Overs-coding Miami
Government data outperforms claims i.e. - you don’t need claims history for cost projections or to identify over/under-coding
WHAT WE DOPower of Government Data
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