Presentation on theme: "NextGen® Population Health"— Presentation transcript:
1 NextGen® Population Health “The Game Changer”May 14, 2014
2 Industry dynamics driving population health management Presented by Elise Freedman, MBA Senior Market Manager, Business Development
3 Population Health is hot! Everyone says they have a population health solution….Really?If it was that easy….And population health is defined differently depending on who is using the termNextGen Population HealthHelps providers to deliver the most appropriate preventative care and intervention based on the patient’s condition, risk and severity of illness …. across the entire patient panel.An automated and targeted patient outreach and engagement solution(“Set it and Forget it!”)Fully integrated with NextGen EHR, PM, Patient Portal and DashboardHelps healthcare providers improve:Patients healthQuality of carePractice productivity/efficiencyFinancial outcomes
5 Core objectives of population health management Deliver better care in lower cost settingsReduce avoidable ER visits and hospitalizationsReduce hospital readmissionsSignificantly improve patient health outcomesFinancial BenefitsMaximize financial return for value-based careReimbursement preventative carePayment for “non‐visit” contactNegotiate better risk sharing terms with payers
6 Dynamics driving need for population health management US healthcare system ― fragmented care, unsustainable costsIncreasing chronic disease and comorbid conditions,obesity, heart disease and diabetesBaby boomers (born between 1946 and 1964) extremely high utilizers especially end of life careApproximately 10,000 Americans turn 65 every day40.3 million people age 65 or older in 2010; by 2050 projected 88.5 million; 8 in 10 seniors suffer from at least one chronic conditionAbout 25 percent of seniors are obese20 percent have diabetes70 percent have heart diseaseProjected physician shortagePatient non-compliance with treatmentTransition to coordinated, collaborative, integrated, value-basedNew diagnostic/treatment available to improve chronic conditionsThe A challenging nationaleconomy, chronic disease, and an aging population combine to placea tremendous strain on the system. As the new diagnostic and treatment options have been introduced at anaccelerated rate.In response to this convergence of economic stress, chronic disease,comorbidity, an aging population, and medical innovation, thepopulation health management (PHM) model is evolving to effectivelymanage patients across the continuum of health and care by deliveringappropriate intervention according to patient risk and disease severity.PHM has grown in prominence and practice, particularly as recentfederal healthcare reform efforts stimulate the public and private sectorsto adopt models of reimbursement and care delivery that rely uponPHM to bend down the cost curve and improve care.Today, the healthcare system is transitioning from an inefficient, volume based,fee-for-service model to a coordinated, integrated, and value basedparadigm for which PHM is ideally suited.
7 How providers get paid is changing Payer trendsStarted with CMS quality incentive programs, now commercial payers on board with performance-based payment models (because Medicare is going broke, had to do something)Patient Centered Medical Home (PCMH) and practices implementing Accountable Care (ACO) programsPaying per member/per month (pm/pm) care management fees and gain sharing revenue for lowering healthcare costsPayers are buying physician groups and launching physician group practices, IPAsCMSAmerican medical association practice management centerChapter 14: Evolving compensation methodologies foremployed physicians in an era of changing clinicalpractice, reimbursement and health reformElias N. Matsakis, Esq., Rod St. Clair, M.D., John L. Bender, M.D.
8 “Your patient your responsibility” But the clincher is: Responsibility for patients’ health is shifting to providersThe onus for managing, improving and reporting the health of patients is shifting to providers, particularly primary care physiciansReporting on these outcomes will impact how and how much they get paidRegardless of whether or not your patients are:CompliantNon-compliantChronically illSick short termMy Patients’ Health“Your patient your responsibility”Along with that the onus for managing the health of all patients, compliant and non-compliant, chronic, sick or well is shifting to the providers across the care continuum….That is what MU , PCMH and Accountable Care is all about!
9 The impact of patient noncompliance Non-compliance accounts for:11% of all hospital admissions40% of nursing home admissions20% prescriptions never filled30% prescriptions never refilledContact with doctors and hospitals is sporadic/infrequentProblems are not addressed until patient is in crisis2020, 25% of the American population will have multiple chronic conditionsWe all are aware Patient non-compliance to follow-up visits and medication adherence impacts the bottom line as well as patient care.Some quick facts: Non-compliance accounts for 11% of all hospital admissions and 40% of nursing home admissions; Up to 20% of all prescriptions written by physicians are never filled; 30% of prescriptions are never refilled. Patient non-compliance is costly to everyone.Patient non-compliance to follow-up visits and medication adherence negatively impacts patient health and health care costs across the health care continuum.Source: Wu, S., & Green, A. Projection of Chronic Illness Prevalence and Cost Inflation. In RAND Corporation.
10 The prevalence of chronic diseases has created a national health care crisis Six "unhealthy truths" about chronic disease in the United States:1 Chronic diseases are the No. 1 cause of death and disability in the U.S.2 Treating patients with chronic diseases accounts for 75 percent of the nation's health care spending (75% of $2.8 trillion!)3 Two-thirds of the increase in health care spending is due to increased prevalence of treated chronic disease4 The doubling of obesity between 1987 and today accounts for 20 to 30 percent of the rise in health care spending5 The vast majority of cases of chronic disease could be better prevented or managed6 Many Americans are unaware of the extent chronic diseases could be better prevented or managed
11 Many chronic diseases can be prevented with lifestyle and behavioral changes Modifiable behaviors that cause illness, suffering, and early death related to chronic diseaseslack of physical activitypoor nutritiontobacco useexcessive alcohol consumptionPage last reviewed: August 13, 2012Page last updated: August 13, 2012Content source: National Center for Chronic Disease Prevention and Health Promotion
12 Blame is not a factor possible reasons for patient non-compliance Language barriers (including regional semantics)Example: (Diabetes vs Sugar)Socio-economic conditionsUnwillingness to follow treatmentLack of understanding treatment instructionsInsufficient provider follow-upWhat else is going on with my patients?Patient's personal life and circumstances could be contributing to their poor health and non-compliance
13 What percent of your patient population looks like this? Very Healthy
14 What percent of your patient population looks like this? Mostly Healthy
15 What percent of your patient population looks like this? Not so goodWhere does this guy go when he goes into cardiac arrest?When do you think he last saw a doctor for a check-up?
16 Then, there’s everyone else… When’s the last time you had a preventative screening on time?How many doctor’s appointments did you cancel this year because you were too busy?Do you always take your medications as prescribed?Do you stop taking medication when you start feeling better?Do you eat properly?Exercise regularly?Get enough sleep?Even relatively healthy people need to follow directions. Population health management applies to all patients.
17 Population Health as it relates to NextGen Care Coordination
18 You can’t measure what you don’t track P4P programs (PCMH/ACO) earn incentive payments for programs such PQRS, Bridge to Excellence (BTE) and MUPractices must track and monitor the health status of their entire patient populationProviders are responsible for documenting and reporting outreach effortsBottom line:You can’t get paid on what you don’t report
19 NextGen Population Health generates reports that track and analyze performance Physicians and practice administrators can produce analytical reports on CQM performance as well as detailed patient reports identifying treatment opportunities within the patient populationOutreach communication reports that can be scheduled for deliveryGraphical reports to measure performance of outreach program
20 NextGen Health Quality Measures (HQM) collects EHR data organized by patient encounter Produces summary and detail outcomes results per program rulesPerforms automated calculation, tracking and reportingExtracts new clinical dataProvides useable reports to provide insight and performance metrics at a practice, provider and patient levelEnables clients to receive incentive for performanceAutomatically submits CQM reports for MU ComplianceHQM is NextGen for reporting CQM’s and Objectives for Primarily for Meaningful Use but used for other reportingData Warehouse collects and stores non-PHI clinical data to produce summary and detail reports using specific program rulesAutomated calculations are performed in an aggregate format which can be used forattestation/reporting depending on yearHQM reporting eliminates the need for Claims reporting and G-CodesBenchmarking against other NG clients
21 Integrated NextGen solutions in a single platform bringing it all together CCO Phase1 integrates and optimizes NextGen products in our Ambulatory EHR and EPMPatient Registry (new!)Population HealthPatient PortalNextGen ShareDashboardKBM
22 Tools for comprehensive provider-driven population health management CCO Phase 2 provides a complete, vendor-agnostic solution leveraging Mirth products by providing:Comprehensive care management and collaborative chronic disease managementCentral Data Repository and Data exchangePopulation health activationAdvanced “cohort” analytics and risk modelingNeed graphic from creative
23 Advanced data analytics identify treatment opportunities and report those outcomes Ultimately, providers will need to predict which patients are likely to get sick to minimize future costsData driven workflows manage care plans, track events, and schedule appointments and reminders.Patient engagement tools that enable patient participating in their healthcare goalsPopulation HealthAnalytics
24 NextGen care coordination goals Improve care quality and patient safety for decreased hospitalizations and re-admittanceIncrease staff efficiency by reducing time required to develop care planGreater focus on patient goals and expected outcomesEstablishes clear, organized and specific interventions to improve patient careImproved patient compliance with their prescribed care plans through automated communications and clinical decision supportOur goals for the care coordination seriesAre to provide improve quality & patient safety to avoid re-admissions or unnessary hospitalizationTo increase staff efficiency by providing a central location where care planning & documentation can occurTo provide greater focus on patient’s goals & expected outcomes by establishing clear and organization steps and interventions for them to followBy providing the ability to fully document the patients care plans, it will improve patient compliance and provide for improved communication.
25 Care coordination workflow Identify care team members and define rolesEnter, review and modify referral informationIdentify barriers to care:patient disabilities and limitationsother issues impacting patients ability to comply with care planReview and modify current care plan and track progressLog and review all patient-related communications, including:phone callsstext messagesPatient communications documented by various categories and filtered to show all or selected data
26 Manage the shared care plan Standardized care plan accessible to and modifiable by designated providers, case managers and caregiversCustomized to patient needs:Health maintenanceChronic care managementComplex casesAdvanced directivesIncludes patient directed goalsPatient preferences and directivesPlanned provider and patient interventionsBarriers to care
27 Templates that advance PCMH & Collaborative Care Enhanced care coordination templates provide efficient and reliable care coordination among multiple providers to provide safer and more effective healthcare
28 Proactive Patient Engagement Before I move on the demo, I would like to show few screen shots to give you flavor of our application and point out how we address the 3 challenges that we discussed in the beginning.
29 Proactive instead of Reactive Today you see patients when they are sick or due for an appointmentThey call you to make an appointmentAs we shift from volume-based to value-basedcare, providers need to focus on:Proactive patient engagement for preventative careKeeping patients from falling through the cracksQuality reporting for an ever-increasing volume of measures and mandates
30 Really important NextGen Population Health differentiators Fully integrated with NextGenEHREPMPatient PortalDashboardNo interfaces required!But wait…there’s more!With other PH vendors…Patient receives an alert to schedule appointment for a mammogramWhen patient calls to schedule the appointment, reception pulls up the patient chart but there is no info in the patient record regarding the alert and why the patient is callingBut…NextGen is fully integrated so all patient info is integrated within the workflow, The receptionist will have all information about the alert sent for each patient contacted
31 NextGen integration no interfaces required NextGen Practice Management and NextGen Ambulatory EHR streamline workflowDisplay outcomes performance in NextGen DashboardCreates alerts on patient chart with triggering eventAlert cleared when appointment is keptChart notes added in Practice Management with reasons for outreachFollow-up documentation goes directly into EHREvidence-based quality measures leveraged using NextGen Health Quality Measures (HQM)Data mining capability within PM and EHRWithin a single system, NextGen ambulatory solutions to streamline client workflow, capturing and documenting all activity and communication for future reporting requirements.Were able to do this by including chart notes to the practice management system to include reasons for out reachWe provide follow- up documentation directly into the EHRWe leverage evidenced based quality measures by using HQMAnd of course we are able to data mine across the practice management and EHR products
32 Pre-programed notifications are automatically sent to your patients “Set it and Forget it”While you are away on vacation…2,500 automated flu shot reminders have just been sent from your NextGen® Ambulatory EHR to a targeted group of patientsDuring the week, 50 patients schedule their flu shotsPre-programed notifications are automatically sent to your patientsBack at the office…2500 flu shot reminders are send from your NextGen EHR in a week and 50 patients are administered flu shots
33 Target patients for follow-up and preventative care Hypertensive patients for blood pressure controlDiabetic patients with A1C levels greater than sevenWomen age 55, who require pap smears and mammograms in MayMen, age 60 who require prostate exams in SeptemberTo begin with you can zero in patient for follow-up visits or preventive care e.g.Hypertensive patients for blood pressure controlDiabetic patients with A1C greater than 7Women age 55, who require pap smear and mammograms in May
35 Program alerts using a stratified approach These alerts have been automatically programmed in your NextGen EHRAs these patients schedule appointments, all encounters are documented and tracked in your EHRYou can generate reports as you need themCongratulations…!!!You have just met an important Meaningful Use 2 requirementLeveraging technologyMeeting with high-risk patients is not the only way Reid Hospital approaches population health management. The hospital also uses an electronic population health tool from NextGen Healthcare to query which clinic patients have not had an annual wellness checkup and contact those patients to schedule visits. This allows the organization to reach out to low-risk and high-risk patients alike and transition them into proactive care. Additionally, Reid Hospital plans to use the tool to identify populations with chronic conditions for which regular interventions are known to improve quality and reduce the likelihood of patients becoming high-risk. For example, the technology will help the hospital track hemoglobin A1C measurements for diabetic patients and proactively alert patients when any anomalies are detected.Reminders: “Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care”Secure Messaging: “Use secure electronic messaging to communicate with patients on relevant health information for 5% “
36 The patient profiler for simple stratification Diabetic patients with A1C greater than 7Women age 50, require pap smear and mammograms in May
37 The patient profiler for more complex stratification Identify male patients age 40 who have:Diabetes with history of high A1CHigh blood pressure and Hyperlipidemia with high total cholesterol and LDLNo foot or eye exam for last 6 months andNo booking for next 2 months
38 ROI, NextGen client Infinity Primary Care Expected Revenue ProjectionReminders sent: 10,000 per month (calculated on full provider participation)Roughly three patients contacted for each provider per day% Patient of patients responded: Between 20 – 45%; average of 33%Approximate revenue per visit: $95Generating one additional visit per day for each providerAdditional Annual Revenue: $3,420,000To summarize the benefits of our first release here are few quotes from our clients who are using NextGen’s Population Health solution..
39 Infinity Primary Care success story “NextGen Population Health fills an important gap between patient communication and patient health management. In the past, we would dedicate hours of staff time attempting to contact a small percentage of patients. Now, we use a stratified approach to engage our at-risk patients with a single click. NextGen Population Health has improved the way we care for our patients.”30% Average response rate3 Patients contacted daily per provider10,000 patient reminders monthlyPatrick StevensonDirector of IThttps://www.youtube.com/watch?v=YnO8_QYSzugPop health, anticipate increasing our revenue by several million dollars, Maybe we will have a diabetes clinic, AC1 that hasn’t been checked in the last monthInfinity Primary Care were one of the first clients to get mass adoption of the Patient Portal. Today they are doing the same with Population Health, using it in conjunction with EHR and Portal to proactively reach out to their patients. They say that it takes the randomness out of care management. In addition to improving care they anticipate greatly enhanced revenue for doing the right thing.Amlitore network in SE michagan 13 location 55 dr and 80 residentsInvolved with several quality initiatives including BCBS & NCQA’s PCMH & MUShow AR, Dashboards outreach compliance dashboardsNeed a way to manage quality care more efficientlyCEO allows us to target patients that have chronic disease hypertension CHF diabetes list goes on and on allowing us to change our approach to prevent and chronic care proactive instead of reactiveStarts with PP text message and notification to come into the office and laically to come into the office and takes the randomness and guess work out of follow upStandardization is big to, documenting how many patient we contacted why, how much time we spend wich is nearly ZERO because everything is automatedSet it and forget it. With a a click of a few buttons you can contact 10,000 or more patients per month. Maybe we will have a diabetes clinic, AC1 that hasn’t been checked in the last month etcWe anticipate increasing our revenue by several million dollars.Pop health helping us provide more timely and quality care
40 ROI roughly ½ million $ additional annual revenue Activity and VariablesAnnual ProjectionsNumber of providers32Number of patients reached at 200/month/provider76,800Response Rate33%Potential Appointments25,344Number of additional appointments (from previous year) Capacity for 3 additional patients per week4,992Average profit (stated as income) per visit$95.Average profit for all new visits$474,240
41 Data Integration & Analytics Coming soon….Data Integration & AnalyticsIntegration with Payer data (CCLF)Integration with third-party Risk Stratification (Statictical and Predictive modeling) toolsDashboards:Chronic ConditionPayer AnalysisCare CoordinationEnhance care coordination workflows in NextGen EHR with population health data (outreach & gaps in care)Actionable Patient Registry with Referral ManagementPatient EngagementEnhance patient communication methodsGather survey and remote monitoring data from patientsIn the end we would like to share with you our plans to take the solution to next level….We will be focusing on 3 key areas of population health management – Data Integration , Care Management & Patient EngagementUnder data integration :We will be extending the population profiler across continuum of care by integrating with payers data and HIE in the community for collaborative care.Once the data is available across the continuum we will be incorporating risk scoring and implementing care management workflow to manage high risk patients for better care and decrease cost. Along with this we will be integrating with the latest Dashboard from NextGen and BI reporting tools.In parallel we are working on latest technologies to enhance patient engagement and reduce non-compliance e.g. mobile app for follow-up visit reminders and medication adherence. We are also looking into integrating with remote health monitoring devices to gather clinical data for alerts to providers and patients.ABC
42 Ready to take a deeper dive? We will now demonstrate how easy NextGen Population Health is to use Kim Root will now show you various features and functionalityIts up to you to just dip your toe or take a deeper dive with fully automated outreach across your entire patient population.
43 Let’s see NextGen Population Health in Action Live Demo presented by Kim Root NextGen Application Specialist
44 NextGen Population Health results Healthier clinical and financial outcomes Outreach communications is the first step in managing chronic conditionsIncrease revenue from additional patient encounters and treatment opportunitiesImproves patients engagement which is essential to meet health reform requirementsAugments EHR to meet ACO, PCMH, and MU2 criteria
45 Questions?Before I move on the demo, I would like to show few screen shots to give you flavor of our application and point out how we address the 3 challenges that we discussed in the beginning.
46 NextGen Population Health Resources Population Health web pageWatch for future monthly population health webinars demosWhite paperDemoVideoBrochureContact your sales representativeRequest a live demo
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