How ACOs Can Lower The Cost Of Treating Their Sickest Patients

Greg Miller of PopHealthCare, a health solutions company at the marcus evans ACO & Payer Leadership Summit Spring 2017, discusses how ACOs, health plans and other risk bearing entities can better assess their membership and manage the cost of treating their sickest patients.

Interview with: Greg Miller, Chief Growth Officer, PopHealthCare

“Risk bearing entities including Accountable Care Organizations are faced with three major challenges: assessing and documenting members’ acuity levels, achieving defined quality metrics and effectively managing the 8-10 percent of their membership that accounts for approximately 60 percent of total medical spend,” says Greg Miller, Chief Growth Officer, PopHealthCare.

PopHealthCare is a health solution company attending the marcus evans ACO & Payer Leadership Summit Spring 2017, taking place in Dallas, Texas, April 27-28.

How can ACOs address these issues in an efficient way? What does PopHealthCare propose?
Typically, an ACO or health plan would have to work with several different vendors to obtain the services that PopHealthCare provides. These services cover three of the largest concerns facing risk bearing entities: revenue, quality and medical spend. By combining risk adjustment and data analytics, in-home examinations to assess and document a patient’s acuity level and an in-home chronic care management program that focuses on the most costly and time consuming patients under one company, PopHealthCare allows risk bearing entities to streamline their data exchanges and reduce “vendor fatigue” for the organization, providers and members through consolidated communication and technical support.

How can sophisticated analytics paired with delivering the “right” care at the “right” time in the “right” setting decrease your total medical cost?
The access to data has improved significantly over the last several years. Employing sophisticated analytics, predictive modeling and member stratification, like those offered by PopHealthCare, has allowed risk bearing entities to take a fresh and in-depth look at their membership. By doing so they have improved the accuracy of their risk adjustment, increased the closure of gaps in care and managed the chronic patient population more effectively. Historically health plans have focused on identifying their most costly patients and deployed resources to impact the care of that membership. Unfortunately, the most costly members this year may not be the most costly members next year. We suggest using multiple sources of data, risk factors and data points to identify the patients that are driving medical spend with the lowest regression to the mean and most impactable conditions.

Identifying who these members are, where they live, their current chronic conditions and how they access care is the first step. Now the hard work begins. You have to deploy the appropriate resources to engage the members in their care, educate them on their disease state(s) and establish personal health goals. We know this population is the most complex and time consuming that providers have to manage. To manage them effectively they will need an up-to-date care plan, regular medication reviews, environmental assessments, updated advance directives, continuous education, personal goal setting and 24/7 access to a healthcare provider. Unfortunately, most provider offices do not have the financial or human capital to deliver this intensive care. Let alone the process, workflows and infrastructure to support it.

PopHealthCare’s CareSight Program is an in-home chronic care program that assists health plans and ACOs maximize the quality and financial impact on their most challenging population. This program focuses on delivering the “right” care at the “right” time in the “right” setting. It is also flexible, meeting the specific needs of the health plan or ACO. The PopHealthCare care team can work in collaboration with an existing primary care provider or serve as the primary care provider, assuming full responsibility for patients that may be home bound, unable to access care in a traditional setting or just unwilling. In both scenarios there is a dedicated care team that builds a relationship with the patient and his or her family/support structure. The member is educated on their disease state and actively engaged in their care plan. The care team also completes regular medication reviews, environmental assessments, ensures advance directives are up-to-date and provides 24/7 access. Updates from health care provider home visits and other pertinent information is communicated to the primary care physician when an existing PCP relationship is in place. Follow-up appointments with the PCP will be scheduled as needed.

PopHealthCare’s CareSight program has demonstrated strong results related to medical cost, accurate coding/documentation and quality. The success of the program can be credited to identifying the right patients and wrapping the appropriate resources around them to ensure they are accessing the “right” care at the “right” time in the “right” setting.

About The ACO & Payer Leadership Summit Spring 2017
The ACO & Payer Leadership Summit is the premium forum bringing senior level executives from both public and private health insurance plans, ACOs, and integrated hospital systems together with solution providers. Taking place at the Four Seasons Resort & Club Dallas at Las Colinas, April 27-28, the Summit includes presentations on consumer-driven innovation, the next generation of managed care contracting, data-driven decision-making, and care models in support of value-based care.

For more information please send an email to alejandrad@marcusevansmx.com or visit the event website at http://events.marcusevans-events.com/aco_payer_interview_greg-miller-pophealthcare/

The Healthcare Network – marcus evans Summits group delivers peer-to-peer information on strategic matters, professional trends and breakthrough innovations.

Please note that the Summit is a closed business event and the number of participants strictly limited.

About PopHealthCare
PopHealthCare is an industry leader who partners with payers and providers to deliver proven risk adjustment, HEDIS, and high-risk population management programs. Through our robust suite of solutions, we offer both cutting edge analytics as well as the actual delivery of solutions, resulting in enhanced revenues, improved quality scores, lower medicals costs, and improved member satisfaction. PopHealthCare contracts on a value basis, driving rapid and demonstrable results, and delivering strong ROIs. For more information, visit www.pophealthcare.com.

About marcus evans Summits
marcus evans Summits are high level business forums for the world’s leading decision-makers to meet, learn and discuss strategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity to individually tailor their schedules of keynote presentations, case studies, roundtables and one-on-one business meetings. For more information, visit www.marcusevans.com.