1. SNP Alliance Annual Leadership Forum Integrating Policy into Practice
Improving Health Equity and Building Solutions
Urban Service Area Focus
Amy Helwig, MD, MS
Chief Quality Officer and Vice President, Quality Performance,
UPMC Health Plan
November 3, 2017

2. Data Collection and Analysis for SNP Population
Large Network Anchored by UPMC
UPMC Clinical Enterprise
UPMC Health Plan
Contracted Network and Partners
More than 3.2 million members strong

3. Developing Quality Disparities Analytic Tools

4. What is the impact of Shared Savings on Quality and Disparities?
Shared Savings (SS) scores higher than non-Shared Savings for every race & ethnicity

5. All Races and Ethnicities: Shared Savings (SS) vs
All Races and Ethnicities: Shared Savings (SS) vs. Rest of Network (RON) Shared Savings scored higher than non Shared Savings for every individual metric for all races & ethnicity

6. How does Shared Savings affect the Urban and Rural Disparity?
Shared Savings reduces the urban / rural disparity
+0.7
+3.0

7. Using Analytics to Target Lead Hot Spots
Identifying Pediatric Members At Risk for Lead Exposure
Lead Hot Spot
Census Blocks in Central Pittsburgh
Identifying Opportunity
Disparities in the diabetes eye exam were found to be driven primarily by members clustered in practices with low compliance, as opposed to by socioeconomic characteristics.
Using Analysis to Tailor Strategy
To address the DM eye exam gap in care…
Target providers/provider groups with current low compliance
Educate providers and assist with data collection and member tracking to help identify low compliant members
Facilitate partnerships between medical home practices and eye specialists for easy referral

8. Using Analytics to Identify Opportunities and Tailor Strategy
Distribution of Poverty and HEDIS Diabetes Eye Exam Gaps within Allegheny County
PCMH practices
Identifying Opportunity
Disparities in the diabetes eye exam were found to be driven primarily by members clustered in practices with low compliance, as opposed to by socioeconomic characteristics.
Using Analysis to Tailor Strategy
To address the DM eye exam gap in care…
Target providers/provider groups with current low compliance
Educate providers and assist with data collection and member tracking to help identify low compliant members
Facilitate partnerships between medical home practices and eye specialists for easy referral

9. Community Human Services and HUD Initiative
Solutions to Improve Urban Health Equity
Having a Home Matters
Community Human Services and HUD Initiative
Program to provide stable housing and an assigned medical home to those who qualify.
PCP and specialist visits doubled after program enrollment
Unplanned medical costs decreased after housing was established
Need paper citation here

10. Solutions to Improve Urban Health Equity
Special Needs Program (SNP) Serious Mental Illness (SMI)
High-Risk Model
Community care team provides member-centric enhanced and community-based care management to vulnerable population, especially those with high medical expenses, through an integrated whole health population management approach that addresses both medical and behavioral conditions and needs
In urban counties, a team of high-risk care managers focused on this population
Engages members with complex behavioral health, physical health and
psychosocial needs
Member-centric services
Intensive care/service care management coordination
Promote optimal engagement, coordination and continuity of care
Service delivery focuses on providing tools, education, and resources that activate individuals to be more informed and effective managers of their health and health care

11. Solutions to Improve Urban Health Equity
Enhanced Care Program (ECP) for Vulnerable Population
Multidisciplinary team works to address the medical and psychosocial needs for special needs patients
Intensive case management
Social work
Mental health intervention
Increased accessibility to a primary care provider
Outcomes for first 2.5 years – Improvement in Quality of Care
Emergency Department utilization and unplanned care encounters fell
Decreased trends in admissions and total medical costs
Significant increase in pharmacy due to improved adherence
Improvement in quality metrics related to diabetes, hypertension and preventive cancer screenings

12. DISCUSSION QUESTIONS