1. Alliance Complete Care Model
Evolving our managed care organization towards more integrated and effective “whole person care”

2. Preparing for a Special Needs Plan: Using Population Health
Investing in and utilizing analytics
Integrated care
Social Determinants of Health
Holistic person centered care
Interdisciplinary care teams
Improved outcomes

3. What is Population Health
The health outcomes of a group of individuals, including the distribution of such outcomes within the group
An approach to health that aims to improve the health of an entire human population
Population Health Management
Coordination of care delivery across a population to improve clinical and financial outcomes through disease management, case management and demand/access management
[1] Kindig D, Stoddart G. What is Population Health? American Journal of Public Health, 2003,93.

4. 80% of Health Outcome Determinants Are Not Clinical
2017 © Copyright ZeOmega. All rights reserved. 11
Socioeconomic
Physical Environment
Personal Behaviors
Clinical Care
Source: Robert Wood Johnson Foundation, Health Affairs, 2014
Whole
Patient Care Programs

5. Alliance Complete Care
Population Health
Advanced Analytics and Reporting Tools
Improved Consumer Health Outcomes
Social Determinants
Interdisciplinary Team
Consumer Engagement
Interventions and Supports
Risk Stratification
Automating Business Processes
Care Management Software
Automated Workflow
Text Analysis
Fraud and Abuse Analysis

6. Alliance Data Analytics Model
MicroStrategy
Enterprise Reporting
Behavioral Health Claims
Pharmacy Data
Institutional and Professional Claims
Social Determinants
ILI Housing
Criminal Justice Data
Geospatial Data
John Hopkins Clinical Groupers
Care Management
Provider Data
Consumer Demographics
Consumer Eligibility
Financial Data
Teradata Aster
Advanced Analytics
Future NC-HIE and ADT Data
Alliance Enterprise Data Warehouse

7. Alliance Complete Care
Population Health
Advanced Analytics and Reporting Tools
Improved Consumer Health Outcomes
Social Determinants
Interdisciplinary Team
Consumer Engagement
Interventions and Supports
Risk Stratification

8. Social Determinants of Health
Housing
Transportation
Economic/employment security
Language/literacy
Food security
Education

9. Consumer Engagement & Self-Management
Appointment reminders
Regular phone connection
Wellness tools
Behavior change
Technology to track changes

10. Population Health and Risk Stratification
How do we identify patients that have high behavioral health needs?
Cost?
Risk?
Utilization?
Need?
Acuity?
Diagnostic complexity?
Disease burden?
Community tenure?

11. Community Days and Utilization

12. Community Tenure 30% of people served account for 91% of expenditures
Top 20% of people served account for nearly 100% of out-of-community placements

13. High Intensity Youth TFC Predictive Analytics
Identified 75 youth at high risk for out-of-home placement
Identifying health needs, e.g. asthma
25 were unknown to case management
Create specific interventions to effect different outcomes
Tiered Case Management and High Fidelity Wraparound
Social determinants
Consumer/family engagement
Connection to primary care

15. Expected Outcomes Increased stable/supporting family system
Increased educational opportunities
Increased involvement in pro-social activities
Decreased legal involvement
Improved health
Decreased out-of-home placement
Improved community tenure
Decreased cost of care

16. Complex IDD/TBI Interventions and Supports Engagement/Self-Management
Reorganize care coordination to care team, multi-disciplinary approach to better address whole person care, inclusive of health
Take long-term services and supports approach to care
Engagement/Self-Management
Identify technologies that support individuals to live independently

17. Complex IDD/TBI Social Determinants of Health
Create financial sustainability of benefits and resources including financial planning and managing resources in benefit plan, including a savings resource that could address unmet needs for those on the Registry of Unmet Needs
Create incentives to transition members from ICF to community housing settings

18. Expected Outcomes
Higher quality of life in least restrictive, most socially inclusive environment of choice
Increase whole person health services and supports facilitated by cross disciplinary care management
Development of financial resources, plans, and support to pay for long-term needs
Decrease cost of care

19. Alliance Complete Care
Advanced Analytics and Reporting Tools
Improved Consumer Health Outcomes
Interdisciplinary Team
Automating Business Processes
Care Management Software
Automated Workflow
Text Analysis
Fraud and Abuse Analysis

20. Analytics to Enhance Business Processes
Text Analytics/Call Center/Patient Notes Review
Screening for unauthorized PHI release/unallowable words
Develop scale to evaluate call notes for threatening key words
Ensure severity level in call note is consistent with risk assessment
Ensure call disposition/resolution matches the call urgency

21. Analytics to Enhance Business Processes
Fraud and abuse analytics
Provider excluded/double billing
Improbable billing day
Improbable patient
Billing for deceased patients
Clinical use cases
Care Management software

22. Care Management Solution
Provides a clinical workflow to support standard case management and medication management
Trigger key events for patient care
Aggregates all relevant patient Information which can be made available to individual, Care Managers, providers, pharmacists
Provider and member portals for improved experience and outcomes

23. Care Management Solution
Track outcome measures
Facilitate complex care analytics including gaps in care
Results:
66% reduction in avoidable admissions
61% reduction in average length of stay
50% increase in adult preventative care
40% increase in administrative efficiency
25% reduction in FTEs

24. Multi-Disciplinary Teams
Community Relations
Peer Support
Pharmacy
Complete Care UM
Medical
Provider/ Service Expertise
Evaluation

25. Summary Next progression of how we offer whole person care
Foundation is data and analytics to improve care, health outcomes, and business effectiveness
Creation of multi-disciplinary teams to manage care
Position Alliance for Special Needs Plan