Population Health and the NCM Care Transformation Collaborative of R.I. NANCY MAMO, MANAGING DIRECTOR, POPULATION HEALTH ANALYTICS, BCBSRI MAY 5,

2 Population Health – What Is It Google Definitions: An approach to health that aims to improve the health of an entire population Stratifies and segments critical population groups for outreach and intervention to promote compliance with evidence-based medicine, improved care coordination and lower utilization. The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort

3 Why Is Population Health Management So Important Recently has gained attention from mainstream organizations because: Healthcare reimbursement is changing Emphasis clearly is shifting from volume to value Organizations that focus on providing patient-centered, quality healthcare across a population will come out ahead. Need to deliver the right care at the right time in the right setting to impact cost and utilization

4 Goal of Population Health Management Will become a required core competency for provider organizations in a post-fee-for-service payment environment The need to manage health care costs Reduce the frequency of health care crisis and costly ED visits and hospitalizations Improve the overall patient experience by improving access to care Promote patient engagement and empower patients to better self- manage their health and participate in the decision making process.

5 How Data Has Changed Healthcare Proper collection and use of data is key Integration of data sources on a more real time basis Healthcare traditionally has been reactive instead of proactive Predictive modeling allows for us to predict the use/cost of a member based on past experience

6 Data Automation and Integration Makes Population Health Feasible, Scalable, Sustainable Automated and Ongoing Data integration Analysis Reporting Communications Define Population Identify Care Gaps Stratify Risks Engage Patients Manage Care Measure Outcomes

7 What We Have Found 14 % of our population has the following conditions: Diabetes, CHF, CAD, COPD, Asthma These members drive about 39% of our overall costs Behavioral Health plus any of these conditions raises the risk exponentially CHF – not the highest prevalence Highest overall PMPM Highest inpatient per thousand Highest ER per thousand Changed our criteria to include those members with CHF in our CCM lists

8 NCMs Will Help Drive Success Your focus on the high-risk patients who generate the majority of health utilization and costs will help to drive down utilization and cost Through your work, you will make a difference

9 Questions