patient engagement: motivation as the tipping point

Patient Engagement: Motivation as the Tipping PointUnderstanding how patient motivation changes the care management approach

May 8, 2014

Speakers

Kim JayhanSenior Director, Solutions Architect & Consulting,LexisNexis

Population Health Management 2

Today’s Topic

Patient Engagement: Motivation as the Tipping PointUnderstanding how patient motivation changes the care management approachUnderstanding how patient motivation changes the care management approach

The ACA and other health reform initiatives have driven the need to use analytics to enhance the care management experience. As workflows change and new approaches are explored, patient motivation becomes the “tipping point” of success in surfacing true opportunities for reduced and avoidable costs. This session will explore how to combine analytics, using patient motivation as a cornerstone, and incorporating greater insights into the clinical workflows, resulting in successful engagements.insights into the clinical workflows, resulting in successful engagements.


tip∙ping pointnounthe point at which a series of small changes orthe point at which a series of small changes or incidents becomes significant enough to cause a larger, more important change.

“That is the paradox of the epidemic: that in order to create one contagious movement, you often have to create many small movements first.”

“The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.”

“If you want to bring a fundamental change in people's belief and behavior...you need to create a community around them, where those new beliefs can be practiced and expressed and nurtured.”


Source: Malcolm Gladwell, The Tipping Point: How Little Things Can Make a Big Difference

AgendaWhat We Will Discuss Today

The h ll

• Common Problems – Chronic Diseases• Avoidable Costs – Sources• Impact from Non‐Adherence/Non‐ComplianceChallenge • Impact from Non‐Adherence/Non‐Compliance

• Improved Analytics to Stratify & Manage Patients

The Opportunity

• Improved Analytics to Stratify & Manage Patients• Intervene with Patients to Avoid Increased Risk & Cost• Clinical Integration, Data Sharing & Technology to Engage Patients

• Reductions in Cost/Resources• Increased Compliance

The Impact

• Increased Compliance• Avoidance of Disease/Worsening Conditions• Healthier Populations


The Challenge

Population Health Management

Challenges: Common Problems Contributing to High Costs/Risks

• An estimated 26.7% of Adults in the U.S. were reported to be obese in 2009.o Annual healthcare cost of obesity in U.S. (2008) was $147 billion/yearo Approximately 300,000 deaths per year directly related to obesity

• More than 1/3 of Adults have 2 or more major risk factors for heart disease.o Leading cause of morbidity, mortality and health care spending/utilization

• Diabetes is 7th leading cause of death in U.S.o $116 billion in total U.S. healthcare system costs in 2007o Nearly 24 million Americans have diabeteso Approximately 5.7 million have diabetes, but don’t know it.o Approximately 5.7 million have diabetes, but don t know it.o Approximately 186,300 individuals younger than 20 have either Type 1 or Type 2 diabetes.

• Tobacco use is the largest cause of preventable morbidity and mortality in the U.S.o 430 000 deaths each yearo 430,000 deaths each yearo 1 in 5 Adults and 1 in 5 HS Students Smoke, in spite of declined useo For every person that dies from smoking related disease, 20 more people have

at least one serious disease related to its use.

7

Source: Vital Signs: State‐Specific Obesity Prevalence Among Adults ‐‐‐ United States, 2009

Source: Avoidable Costs in U.S. Healthcare: The $200 Billion Opportunity from Using Medicines More Responsibly. Report by the IMS Institute for Healthcare Informatics.


The World of Healthcare is ChangingBeyond Chronic Conditions, Challenges Loom Large

• B b B A l ti C Mi i hifti• Baby Boomers ‐ As population ages, Case Mix is shifting away from more profitable to less profitable care

• Legislation now provides for significant expansion in• Legislation now provides for significant expansion in Medicaid coverage, including Dual Eligibles

• Triple Aim and Health Reform are driving focus onTriple Aim and Health Reform are driving focus onOutcomes, Patient Satisfaction and Reduced Costs

8Population Health Management

What is Avoidable?

68% of avoidable

costs

9

Source: IMS Institute for Healthcare Analytics, Avoidable costs in healthcare study, June 2013


What is the Impact of Avoidable Costs Due to Medication Non‐Adherence?

68.6% Centered on

Two

72.3% Hospital RelatedTwo

Conditions Costs

10



What is the Impact of Delayed Compliance to Measures?

98.3% Centered onDiabetes

86.5% Centered onHospital &Diabetes Hospital &OutpatientRelated Costs



Why Expert Care Management is Critical:Sample Complications Without Interventions

Condition Complication as a Result of Non Adherence

Hypercholesterolemia Acute Myocardial Infarction (AMI)Hypercholesterolemia Acute Myocardial Infarction (AMI)

Diabetes Stroke, Renal Disease, Cardiac

H t i A t M di l I f tiHypertension Acute Myocardial Infarction

C ti H t F il (CHF) All li ti lti i dditi lCongestive Heart Failure (CHF) All complications resulting in additional inpatient, outpatient, emergency room and pharmacy utilization, calculated as incremental difference between non‐incremental difference between non‐adherent and adherent CHF patients

12

Source: IMS Institute for Healthcare Analytics, Avoidable costs in healthcare study, June 2013and LexisNexis


The Opportunity


Population Health Management through Risk Stratification

• Stratifying patients along a management & intervention Care Spectrum

• Identifying the most actionable patients• Identifying the most actionable patients

• Empowering your patient care through risk predictions

Well MembersWell Members

Low Risk MembersLow Risk Members

MediumRisk Members

MediumRisk Members

High Risk Multiple Disease States

High Risk Multiple Disease States

Catastrophic CareCatastrophic Care

PreventionPreventionPrevention and Disease Management

Prevention and Disease Management

Disease Management

Disease Management

Episodic Case Mgmt

Episodic Case Mgmt

InpatientLTC

InpatientLTCManagementManagement gg gg


Evolving Trends – Impact on Patient Engagement

Out with the OLD……………

In with the NEW

Patient/Consumer Care & Engagement• Quality vs. Cost Focus Shift• Patient Rating of Physicians & Experience

In with the NEW……………

• Patient Rating of Physicians & Experience• More Outreach, More Proactive Care• Access to care team through email, secured messaging and patient portals• Wellness Programs Sponsored by Health Plans and Employers (including Benefit Redesigns)

Focus on Diet & Exercise vs MedicationsFocus on Diet & Exercise vs. MedicationsHealth CoachingApps for self managementWeb Based Education

• Patient/Member Incentives for Compliance, Improvements and Pro‐active Preventive Care



Predicted Risks & Costs

Patient Compliance to Evidence Based Protocols

Patient Motivation


“That is the paradox of the epidemic: that in order to create one contagious movement, you often have to create many small movements first.”

Surface Opportunities

Patients at RiskWho Can You Engage & Impact?

Improved Compliance?Reduced Admissions/Readmissions?Reduced Costs?R d d M t lit ?Reduced Mortality?Downward Shifts in Risk?Is Patient Engaged?

Evaluate OpportunitiesEvaluate Performance of Programs or Initiatives

Can you engage the patient?PredictionsNon Compliance

MedicationClinical Measures

Underlying RisksDesign Care

Management Programs/ Interventions

Operate Programs or Initiatives

Motivation

Access to CareEducation

Identify ProvidersCollaborationTransparencyData Sharing Outreach

How to engage the patient?

Data SharingMonitor Patient Engagement


“If you want to bring a fundamental change in people's belief and behavior ... you need to create a community around them, where those new beliefs can be practiced and expressed and nurtured.”

UTILIZATION‐DRIVEN STRATIFICATION ANALYTICS‐DRIVEN STRATIFICATIONLooking at future riskEpisode‐Driven

Looking at past riskCondition‐Driven

Diabetes3402

All Three

Diabetes2999

Hypertension2163

vs.

DiabetesDiabetesHypertension

2163

34021265

34022163

Hyperlipidemia1902

$$$$$

Highly Motivated

326

Risk Driver Heart Disease410

Risk DriverKidney Disease312

Analytics Driven Stratification ResultsTriMorbid Population (1265)(Diabetic, Hypertensive, Hyperlipidemia)

• Highly Motivated (326)Ri k D i H t Di (410)$$$$$ • Risk Driver – Heart Disease (410)

• Risk Driver – Kidney Disease (312)


Analytics as the Change Agent

Create specific program tracks that focus on WHERE the opportunity actually is for improvements & cost savings ( ‘tri‐morbid’ diabetics population in this example)( tri morbid diabetics population in this example).

Use Motivation Index & Gaps in Care Impact Prediction to StratifyUse Motivation Index & Gaps in Care Impact Prediction to Stratify for Low Touch Program(s).

Engage Care Management.Employ Clinical Integration & Data Sharing for Hospital Partners,Physicians & Ancillary Providers.

Measure Impact to Outcomes & Costs/ Avoidable Costs.

Physicians & Ancillary Providers.


Impact of Starting with Highly Motivated Patients

Stratification first on Highly Motivated, then on Predicted Cost Changes

Risk Category # Highly Avg Total Avg Forecasted % ChangeMotivated Members

Cost Cost

Risk Category 5 (High) 290 $40,956 $39,338 ‐4.1%

Risk Category 4 632 $8 719 $13 022 33 0%Risk Category 4 632 $8,719 $13,022 33.0%

Risk Category 3 589 $3,389 $7,478 54.7%

Risk Category 2 312 $1,787 $4,796 62.7%*Risk Category 1 (Low) 137 $1,296 $2,512 48.4%

ALL HIGHLY MOTIVATED 1,960 $10,265 $13,206 22.3%

Approximately $1.1m opportunity at level 2*20Population Health Management

The Future

Predicted Risks & Costs

Patient Compliance to Evidence Based Protocols p

Patient Motivation

Public Data & Its Influence to Patient Risk


The Impact



Factors Contributing to Higher Adherence

• Lower costs for generics for major chronic conditions

• Education & Awareness – Impact of Non Adherence

• Technology/Analytics EnablingTargets for Non Compliance

• Changes in Reimbursement Models• Changes in Reimbursement ModelsRewards for Compliance & Quality


Improvements in First Year Program

FIRST YEAR OF

CARE MANAGEMENT

Created a Provider and Health Plan Partnership to:

• Improve care processes

Developed “Disease Bundles” to Measure

Progress

Example: Preventive care

Identified Cases Using Predictive Analytics and Post‐discharge

PROGRAM • Improve care processes and outcomes for the individuals and the population

• Improve the quality and

Example: Preventive care bundle that includes diseases such as cancer, lipid, diabetes and chlamydia screening and

gInformation

Uses risk ranking and mover identificationAnalytics using

compliance and

DECREASED TOTAL

MEDICAL COST

IMPROVED OVERALL

COMPLIANCE

efficiency of care immunization

DECREASED ADMISSIONS

motivation focused on improving compliance, and resulted in exceeding goals, while MEDICAL COSTCOMPLIANCE

75 %decreasing inpatient resources and impacting overall costs.

Diabetes bundle

Coronary diseasebundle

Preventivecare

bundle

30 %20 % 7 %

*Results are measured across the entire

ReadmissionsAdmissions

15 % 25 %

bundle bundlepopulation of patients


Case Study: Identify the populations where you can have the greatest impact

Focused Disease Management and Outreach Program

High Risk for Emergency Room

Services

Children and Adults with Asthma

Disabled Adults with Chronic or Complex Disease ServicesCo p e sease

Issues

2.3M population

260,000 Enrolled in Program


Using Motivation to Drive Improvements

FOR PARTICIPANTS

WITH ASTHMA:

FOR PARTICIPANTS WITH DIABETES:

• 36% improvement in retinal eye

FOR PARTICIPANTS WITH CORONARY ARTERY

DISEASE:

• 26% improvement in

FOR PARTICIPANTS WITH HEART FAILURE AND/OR COPD:

• 41% improvement in spirometry testing in COPD

• 33% reduction in inpatient utilization for asthma

in retinal eye examinations

• 11% improvement in testing for kidney damage11% i t

26% improvement in reported rate of vaccination for pneumococcal infections (pneumonia)9% i t i

g• 21% improvement in reported rate of vaccination for pneumococcal infections (pneumonia)

• 15% improvement in rate of betaasthma• 20% improvement of use of written

• 11% improvement in statin (cholesterol lowering Rx)

• 10% improvement in aspirin use

• 9% improvement in statin (cholesterol lowering Rx)

• 8% improvement in cholesterol testing

• 15% improvement in rate of beta blocker medication use

Net savingsNet savingsaction plans for persons with asthma

• 9% improvement in cholesterol testing

$169 Milli

$262 Million4th Year Savings

Net savings Net savings ofof$569 $569

MillionMillion

$34 Million1st Year Savings

$104 Million2nd Year Savings

$169 Million3rd Year Savings


Conclusion


“There is a simple way to package information that, under the right circumstances, can make it irresistible. All you have to do is find it.”

tip∙ping pointnounthe point at which a series of small changes or incidents becomes significant enough to cause a larger, more important change.

State of the Art

Innovative Strategies

Vast Comprehensive

Better OutcomesArt

TechnologyStrategiesComprehensive

Data

+ + =• Reduce wasteful spending• Optimize operational

efficiencies• Improve patient health


Q&A

Source: Malcolm Gladwell, The Tipping Point: How Little Things Can Make a Big Difference


Contact

Kim JayhanSenior Director, Solutions Architect & ConsultingLexisNexis Risk SolutionsLexisNexis Risk [email protected] Group: LexisNexis Health Care SolutionsTwitter: @LexisHealthCareTwitter: @LexisHealthCare

This presentation in part or in whole cannot be copied, altered, or reproduced in any way without written consent from LexisNexis Risk Solutions.


patient engagement: motivation as the tipping point

Healthcare

o approximately5

o approximately186

o leadingcauseofmorbidity

billionyear o approximately300

centeredon diabetes

patient motivation

challenges b b b

cardiac h t