Sun Health, CMS, Population Health and Jennifer Drago

by Fred Goldstein

PopHealth Week will be featuring Jennifer Drago EVP of Population Health at Sun Health. This week’s show will focus on some of the innovative programs that Sun Health offers in the seniors market including their Care Transitions Program  which has a CMS Community-based Care Transitions Program (CCTP) contract. CMS just  Community-based Care Transitions Programrenewed the Sun Health CCTP contract and increased the number of patients to be managed.

The CCTP  “tests models for improving care transitions from the hospital to other settings and reducing readmissions for high-risk Medicare beneficiaries.”  There are currently 72 sites participating in the CCTP pilot.

Per CMS:

  • Approximately 2.6 million seniors, or 1 in 5 are readmitted within 30 days
  • The cost of these readmissions is over $26 billion per year
  • The goal is to reduce readmission 20% per year
  • The program is to run for 5 years
  • The budget was estimated at $300 million over 5 years

To date 29 of the total 101 CCTP-funded sites have withdrawn or been ended.

The CMS First Annual Report stated that of the 48 programs started in 2012 only four programs made statistically significant gains in reducing the ratio of readmissions to discharges from the participating hospitals.

PopHealthWeek-logo-TWTTR-sqBut there is more to this story.

As with other CMS programs there are some concerns regarding the study methodology. The argument against the current methodology, which measures re-admissions within 30 days as a percent of discharges may penalize hospitals, or communities that have worked to reduce hospital discharges in total. Because of the reduction in discharges, these initiatives may not show a reduction in 30 day readmits as a percent of discharges but would better reflect this changes by looking at a population based measure of re-admissions.

Some reference posts on the program are noted below:

  • http://www.medicaringcommunities.org/medicaring-blog-cms-cctp-metrics-have-seious-flaws/
  • http://medicaring.org/2014/12/16/protecting-hospitals/
  • http://www.n4a.org/blog_home.asp?display=16

Join us as we discuss Sun Health and their innovative approach to Senior Health, Care Transitions and the CCTP program.

PopHealth Week: The Monthly Wrap with Fred, Doug and Gregg

By Fred Goldstein

Join Gregg Masters @2healthguru, Doug Goldstein @eFuturist, and me @fsgoldstein as we discuss recent news and issues in population health. This week’s show will focus on Evolent Health and their recently announced IPO as well as the Quantified self and health care data, who’s using it, and what are some of the issues the industry and we face.

Here’s some background on the two topics:

Topic 1 – Evolent Health Announces Their IPO

Evolent Heath announced their IPO this past month. Here is some information on Evolent from their website (www.evolenthealth.com)

A PARTNERSHIP DRIVEN BY A GREATER PURPOSE

Evolent Health helps progressive health care systems lead, build and own the path to value-based care. No matter your current state of transition, we partner with you to drive real, lasting transformation from the inside out.

OUR COMPANY

Founded in 2011 by UPMC Health Plan and The Advisory Board Company, we are a high-growth firm headquartered in Arlington, Virginia. Across multiple Evolent and partner system sites, our 750-member team of experts works shoulder-to-shoulder with provider leadership to shape the future of health care. Evolent is proud to partner with leading providers and physician organizations in over 25 markets across the country.

OUR OFFERING

Evolent provides the integrated technology, tools and team to advance value-based care. Our work begins with the Blueprint, an immediately actionable strategic roadmap that defines target markets, assesses needed clinical and operational capabilities, and is supported by a detailed business case. We implement the Blueprint through our Market Facing Solutions, which accelerate the path to value and embed and connect crucial capabilities through a Value-Based Services Organization:

  • Tailored clinical programs, patient engagement tools, quality and risk coding, and specialized care teams to deliver Population Health Performance
  • High performance network optimization and management, backed by proven physician compensation models and integrated specialty partnerships foundational to Delivery Network Alignment
  • Leadership, scalable back-office infrastructure, and analytics and reporting teams required for Financial And Administrative Management
  • Organizational governance and design, physician-led practice transformation, and change management to drive “inside-out” System Transformation
  • Data integration, clinical and business content, EMR optimization, and value-business applications through our purpose-build technology solution—IdentifiSM

From Evolent’s S-1:

Financials

2013               2014

Revenue         $40.3M           $100.9M

Loss                 $32.8M           $52.3M

Assumptions

They believe the current market opportunity is $10B and will be $46 by 2020, that health expenditures will increase from $2.1T to $3.2T by 2020, value based care will increase from 10% to 50%, the provider sponsored health plan market will grow to 15% of the total health plan market and they estimate $1T in waste in the system.

A good blog on the topic was posted by Stephanie Baum of MediCity News: ‘6 Takeaways from Evolent Health $100 Million IPO Registration

Also an interesting piece from Rock Health on who might be next for an IPO.

Topic 2 – Quantified Self, Data, Privacy and Meaningful Use

The second issue we’ll discuss is the quantified self, and the incredible growth in personal data that is being gathered and used from wearable devices and other sources.

The Washington Post had a recent article entitled ‘The Revolution will be Digitized‘ by Arianna Eunjung Cha, posted May 9, 2015.

And from the Kojo Annamdi Show on NPRThe Digital Fingerprints We Leave Behind Online’ with some interesting information and statistics.

There have been numerous data breaches including this one: ‘CareFirst Data Breach.’

And the recent hacking of an adult dating site and sharing of intimate details online.

Issues like who owns the data, whose using it, its value, the ‘No MU without Me‘ campaign and others will be addressed. So join us at 12 pm Eastern at www.pophealthweek.com and follow us on twitter @pophealthweek.

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Frederic S. Goldstein is President and Founder Accountable Health, LLC, Past Board Chair, Board of Directors, Population Health Alliance, and co-founder of PopHealth Week.

 

Some Thoughts on Population Health, its Definition(s) and the Providers Role

By Frederic S. Goldstein

As providers move rapidly into what they call population health, it is becoming clear that there are many definitions  of population health and many people who state they provide population health management. David Kindig, MD has pointed out, it’s time to provide more specificity to delineate what population health is, and what providers and others are doing within population health.

Dr. Kindig proposes that we use the term “Total Population Health” to define programs that seek to improve the health of all individuals while we re-name the services offered by providers which tend to be clinical in nature and focus more on the care of individuals as “Population Medicine.”  I think this delineation is a good way to define the difference.  In fact I have used a slide for years to illustrate this point,  When looking at the social determinants of health: community, transportation, safety, environment, access to foods, etc and considering the obesity epidemic and its precursor to Type 2 diabetes, heart disease and other chronic illnesses.  Here it is,

Is this the classic lazy American?

Can the Healthcare System Fix This?

Or is this a lack of sidewalks, an unsafe neighborhood? And what role should/can providers play in this?

I believe the providers should focus on Population Medicine, better caring for chronic diseases and providing acute medical care and leave the social determinants, which are well outside the walls of the care system, to others with more expertise. An area of low hanging fruit is the inefficiencies, abuse and fraud in the healthcare system identified by IOM (see slide 3).  Now there’s a good place to start as one moves to Value Based Payments and capitation.

The thinking of Dr. Kindig is also similar to the Accountable Health Organization approach that David Nash and I wrote about last year.

What do you think?

 

From This Week in Accountable Care to PopHealth Week

By Gregg A. Masters, MPH

Accountable Health, LLC in association with Health Innovation Media the producer of three Internet radio shows focused on innovation in health[care] delivery, finance and business model re-design including This Week in Health Innovation, This Week in Oncology and ‘This Week in Accountable Care are collaborating to re-brand and re-launch This Week in Accountable Care as ‘PopHealth Week’.

Accountable Health LLC

The PopHealth Week Internet radio show will focus on the emerging Population Health issues, trends and key developments. Fred Goldstein (@fsgoldstein), CEO Accountable Health, LLC and Gregg Masters, MPH (@2healthguru), Founder and CEO Health Innovation Media serve as principal co-hosts of each the show and tap thought leaders, entrepreneurs and academicians pioneering the continued development (both practice and theory) of this emerging space and any derivative plays they in turn stimulate. We’ll be joined periodically (on our month end wrap-up shows ofHealth Innovation Media what’s hot in the news) by our co-host Douglas Goldstein aka @eFuturist.

Our first show ‘Population Health or Population Medicine: What Gives?‘ is scheduled May 20th 2015 at 12 Noon Eastern/9AM Pacific Time with the Founding and current Dean of the Jefferson School of Population Health David Nash, MD, MBA. All future shows are scheduled and will be available via www.pophealthweek.com.

The radio show is accessible both live and on demand. The latest episode ‘Population Health or Population Medicine: What Gives’? is available here:

For more information or to schedule participation on air contact gregg@pophealthweek.com or fgoldstein@pophealthweek.com; and do follow us on Twitter via @PopHealthWeek for real time program announcements and newsworthy tweets.

Some thoughts about this venture:

“Population health while a buzzword meaning different things to different people,, is in fact a defined approach that can have a profound positive impact on health care quality and costs.  I am excited to be working with Gregg to provide listeners with knowledge, actionable advice, news and trends to move this field forward.”

Fred Goldstein @fsgoldstein

“Merging our curated content focus on accountable care and the ACO industry with the broader environment of population health and medicine markets only makes sense as we continue to move from a volume driven to value and outcomes oriented culture of healthcare delivery and finance. I am thrilled to work with Fred Goldstein at Accountable Health, LLC to launch this timely joint venture.”  

Gregg Masters @2healthguru

Join us for an entertaining and informative series about the emergence of the population health, its associated derivatives, including documented best practices as we collectively pursue a sustainable healthcare economy.