Care Management with Case and Disease Management through Population Health Analysis. PowerPoint Presentation

Care Management with Case and Disease Management through Population Health Analysis. PowerPoint Presentation

2019-02-15 1K 1 0 0

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How was Population Impacted?. By. Pariksith. Singh, M.D.. Proverbial Story. Objectives. To define and discuss :. Population Health Analysis. Risk Stratification. Working Pieces. Our Unique Approach. ID: 752002

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Presentations text content in Care Management with Case and Disease Management through Population Health Analysis.

Slide1

Care Management with Case and Disease Management through Population Health Analysis. How was Population Impacted?

ByPariksith Singh, M.D.

Slide2

Proverbial Story

Slide3

ObjectivesTo define and discuss :Population Health Analysis

Risk StratificationWorking PiecesOur Unique Approach

Slide4

Population Health Analysis

Studying and Analyzing the Whole population of a communityORThe Population being taken care by a group of providersORParticular Sub-group of the population

Slide5

POPULATION RISK STRATIFICATIONPareto Principle

Or 80/20 Rule

Very High -5%

High-15%

Equals-

20%

Moderate- 30%

Low- 50%

Equals-

80%

Slide6

POPULATION RISK STRATIFICATIONLow- 50%

Slide7

POPULATION RISK STRATIFICATIONModerate 30%

Slide8

POPULATION RISK STRATIFICATIONVery High 5%

High 15%

Slide9

Internal Care Management Team

CCC- works with both CCM and DM

Slide10

Internal Care Management Team

Slide11

Internal Care Management Team

Slide12

CCM/ DM ImpactAverage 24000 nurse reviews per year across the IPA averaging a 1% request for Coverage Determinations across the population.Delegated Projects:

Humana: Averaging 70K auths per yearUHP: Averaging 1242 Part A

auths

per year (hospital and SNFs)

Slide13

Opportunity Days: Our hospitalist program totaled 516 to their 1140US

Them

Slide14

Working Pieces

Slide15

Data SetsClinical

Financial or OperationalInternal or External Sources

Slide16

COPD in population managementCOPD is associated with significant economic burden. In the European Union, the total direct costs of respiratory disease are estimated to be about 6% of the total health care budget, with COPD accounting for 56% of this cost of respiratory disease. In the United States the estimated direct costs of COPD are $29.5 billion and the indirect costs $20.4 billion. COPD exacerbations account for the greatest proportion of the total COPD burden on the health care system.

Any estimate of direct medical expenditures for home care under-represents the true cost of home care to society, because it ignores the economic value of the care provided to those with COPD by family members.

Slide17

Capturing associated Diagnosis on COPD population managementIn the seminal study by Fletcher and coworkers, chronic bronchitis was not associated with decline in lung function*. However, subsequent studies have found an association between mucus

hypersecretion and FEV1 decline, and cough and sputum production is associated with increased mortality in mild to moderate COPD. In younger adults who smoke the presence of chronic bronchitis is associated with an increased likelihood of developing COPD

*COPD/GOLD_Report%202016.pdf

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Goals Specific to COPD ManagementMaintain control of the disease following evidence Medicine guidelinesPrevent chronic and troublesome symptomsMinimize the need for hospitalization

Provide optimal pharmacotherapy with minimal or no adverse effectsMeet the patients’ and families’ expectations of and satisfaction with CHF careMaintain normal activityMinimize the need for hospitalization

Minimize the need for emergency room visits

Identify ,evaluate and treat early symptoms of decompensation

Optimization of gold guidelines on the evaluation and management of COPD

Slide19

Identification of membersMembers are identified for the COPD Management Program through several referral and administrative data processes which include, but are not limited to:Our Health Risk Assessment (HRA). All new members receive a comprehensive health risk assessment within 90 days of joining

practice. The Member’s responses trigger inclusion into a Disease Management program for the specific diseaseData mining through claim and encounter data, lab data, pharmacy data and data collected through the UM management process

HCC Reports

Data supplied by CMS

Hospital discharge data

Compliance Department and State and Federal Agencies

Referrals: Case Management receives referrals via telephone, fax, data extracts, medical rounds, or confidential secured email requests.

Self-referrals from Members or caregivers

Referrals from practitioners, including Behavioral Health vendor

Referrals from Member Services inquiries

Referrals from Appeals & Grievances

Referrals from UM

Referrals from Discharge Planners

Referral from Case Management Program

Referrals from Health Education (Coaching) Program

Slide20

CLEAR VISION REPORTS

Diagnosis Description

Vascular Disease

Renal Failure

Chronic Obstructive Pulmonary Disease

Polyneuropathy

Major Depressive, Bipolar, and Paranoid Disorders

Diabetes with Chronic Complications

Angina Pectoris/Old Myocardial Infarction

Diabetes without Complication

Drug/Alcohol Dependence

Diabetes with Renal or Peripheral Circulatory Manifestation

Angina Pectoris

Benchmark

14.61%

14.17%

13.82%

9.22%

7.45%

10.53%

7.40%

14.20%

1.97%

6.72%

2.63%

Your Population

Percent

29.34%

24.71%

21.46%

16.85%

16.53%

16.51%

15.79%

14.51%

13.05%

13.02%

10.54%

Count of

2016.

Clearvision

reports 1 HP

HCC

111

Grand

Total of

Dx

related to HCC 111

 

Description

Chronic Obstructive Pulmonary

Disease related to Chronic

Bronchitis

 

 

Total %

30

3044

Slide21

Whole CommunityCommunity Lectures

Online Global Outreach

Slide22

Our Unique ApproachHealthcare Approach

Slide23

Thank you!

Questions?


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