Partnering for Population Health: Strategies to Promote Collaboration Among the Patient, Provider and Employer

Partnering for Population Health:
Strategies to Promote Collaboration Between the Patient,
Provider and Employer
Christina Arenz
Regional Vice President
Strategic Solutions, Value-Based Care
Conifer Health Solutions
1 ©2014 Conifer Health Solutions, LLC. All Rights Reserved.

Christina Arenz
Regional Vice President
Strategic Solutions, Value-Based Care
Christina Arenz currently serves as Regional Vice President of
Strategic Solutions for Conifer Health Solutions Value-Based Care
business line. In this role, she is responsible for leading a team of
transformation experts who are tasked with developing forward-thinking
advantage as the industry shifts from volume to value-based care. She works with
a variety of clients including employers, healthcare systems, medical management
organizations, PHOs, ACOs and TPAs.
solutions that give Conifer Health clients a strategic
Ms. Arenz came to Conifer Health Solutions in 2012, following the company’s
acquisition of InforMed, LLC, where she had served as an Account Manager since
2010. During her career, she has had key roles in operations, finance, project
management and process improvement. Christina has also served as a Human
Resources leader who was responsible for all aspects of people management for a
community-based, acute care hospital.

Who We Are
Conifer Health Solutions combines deep-rooted healthcare operational and financial
management experience with innovative, high-touch services and technologies that
simplify the healthcare experience.
Our Purpose
Provide the Foundation
for Better Health
Our Values
Unity. Integrity. Service. Respect.

Our Footprint FACTS
Conifer Health Corporate Office &
Revenue Cycle Management Operations
Key
 National Scale with Local
Presence
 Service clients in 40+ states
 20 Service Centers
 700+ clients
 12,000+ employees
 Breadth & Scale
 $25+ billion net revenue
processed annually
 19+ million patient touch-points
annually
 4+ million managed lives
 $17+ billion medically
managed spend
 1+ million clinical admission
reviews
 60,000 patient satisfaction
surveys annually
Conifer Health – Service Centers
Revenue Cycle Management Client Locations
Patient Communications Client Locations
Value-Based Care Client Locations
Patient Communications
& Engagement Office
Value-Based
Care Office

Stakeholders in Healthcare
Historically working in isolation
• Cost of care
• Quality of care
• Access to care
Consumers
• Financial challenges
• Government mandates
• Patient quality/safety
• Accountable care
Providers
• Cost containment
• Wellness improvement
• Population health management
Health Plans
• Financial risk management
• Health information exchanges
• Regulatory mandates
Employers

Commons Challenges
 People are ill
 Chronic and often complicated cases
 Costs for care are high
 Consumers are unsure how to access to healthcare
system; or lack appropriate access

Partnering for Population Health
Stakeholders Now Share Common Goals
 Lowering cost of care delivery
 Improving quality of care
 Achieving best outcomes

Every Stakeholder Plays a Role
Providers, payors, plan
sponsors and individual
members all play a part in
connecting the disparate
elements of the healthcare
industry to increase
profitability, create
efficiencies, improve
patient outcomes and
enable individuals to better
manage their personal
health.

Transforming how care is delivered
And engaging the care team and individuals to improve the health
of populations
Align with
providers to
achieve
clinical
performance
Deliver
patient-centered
care
across the
continuum
and
population
Assume risk
appropriatel
y and
successfully
manage
financial
performance
Partnering to Break Down Walls
Coordinating to build cooperative relationships

Holding the Alliance Together
Data
Data Sources Data Processing and Analytics Different Views/Interfaces
 EMRs
 HRAs
 Medical Claims
 Rx Claims
 Lab Results
 Health Histories
 Nurses
 Care Coordinators
 Eligibility
 Physician Offices
 Imaging Links
 Other
Global Healthcare
Data Center and
Reporting
 Health management
 Financial management and
reporting
 Patient and physician
portals
Health Information
Exchange
 Nurses/Care Coordinators
 Administrators/Managers
 Physician Offices
 Individual Patients
 Others
Includes users at self-insured
employers, providers, care
managers, health plans

Population Health Management
 Risk Stratification
 Population’s Conditions
 Predictive Modeling
 Provider/Plan
Performance

Content and Patient Education, Community-based resources

Four Steps to Reach Commons Goals
 Get the disparate data in one place
 Identify the trends/issues throughout an entire
population
 Identify the individuals driving risk/cost and
connect them with a nurse/care coordinator
 Decrease in financials will naturally follow

Getting the Data in One Place
A Longitudinal Record
In this example:
 Five most frequent diagnoses being
treated
 12-month history of medications,
emergency room use and hospital
stays
 Names of top five physicians seeing
the patient most frequently
 Adherence with standards of practice
for the management of any chronic
illness
 Compliance with preventative
screenings and chronic care issues

Clinician Desktop

Care Management Platform

Personal Health Record (PHR)

Identify the Population and the Individuals
Participant stratification levels
Percent of population
No risk Low Moderate
7% 9%
12% 13%
22%
57% 53%
25%
Benchmark Client population
Features present in high risk population
Percent of high-risk participants
89.20
%
78.30
%
76.40
%
24.20
%
23.10
%
12.30
%
100%
Poor or ineffective
utilization patterns
Condition related
to instability
High Predicted
cost
Lab results out of
range
High
restrospective…
Non-compliance
with EBM…
Total unique

How Stakeholders Come Together
Self-Insured Employers
Employers – Self Insured
 Taking on risk for covered
members
 Building partnerships with
local plan administrators &
networks
 Creating win-win for all
stakeholders using data
Members
ASC
Health
Networks
Hospital
TPAs
Care
Managers
Physician
Offices
Employer

Employers Partner with Health Systems
Employer Health Systems
Employers & Providers
 Go direct for health
& wellness programs
 Direct contracts for
care of members
Members

Provider-Owned Health Plans
Provider-Owned Health Plan
 Goes direct to members/consumers
 Enlists the help of Local plan
administrators to define network
Health System
Provider-Owned
Health Plan
Local Plan Administrators
Members/Consumers

Fool-proofing the Plan
Where we’ve seen failure
 Lack of Investment in infrastructure
 Accomplishing synergy requires investments in the right partnerships, technology and
human resources
 Unrealistic expectations
 Partnering is a long-term commitment
 Improvements in the health status of population and financial risk will not happen
overnight
 Expect 12 to 36 month timeframe for impact and results
 Starting too broadly
 The best sample set of a community is within your own four walls
 Leverage your own employees to develop a winning approach to population health
management
 Apply strategies internally to minimize risk and define measureable improvements

There are several inputs into choosing the right care
management model
What delivery model is in place in the market?
Primary care medical home | ACO | Employed physicians | No structure
What care management capabilities exists in the market?
None | Transitions of care nurses | Full care management
What population will the market be caring for? Does the population
have specific characteristics?
Population age | Chronic conditions | Behavior patterns
What payment model will the population be covered under?
P4P or penalties | Upside risk | Employee ACO | Upside/Downside | Full risk
What are the operational strengths and weaknesses of the market?
ED Through-put | Engaged physicians | Social services

Partnering for Population Health: Strategies to Promote Collaboration Among the Patient, Provider and Employer

Partnering for Population Health: Strategies to Promote Collaboration Among the Patient, Provider and Employer

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