Thought Leaders in Population Health Speaker Series Overview
The webinar series offered participants informative and insightful guidance on how population health strategies are transforming the health care paradigm as the industry moves towards the measurement and management of integrated delivery systems such as accountable care organizations (ACOs).
How Health Information Exchanges Are Supporting Population Health Management: Thought Leaders in Population Health Webinar Speaker Series
This webinar, held on January 29, 2015, examined Health Information Exchanges’ (HIEs) support for population health management and coordinated care efforts for lessons learned, and utilize the panelists’ national perspectives to explore the range of additional potential. Our speakers, Lee Barrett, Executive Director, Electronic Healthcare Network Accreditation Commission, and Irene Koch, Executive Vice President and General Counsel, Healthix, Inc. discussed the development and transformation of HIEs both in the private and public sectors, and address different approaches taken by HIEs to integrate disparate IT systems.
Analyzing Trends in Utilization Management: A Focus on Regulations
On August 5, 2015, we examined the evolution of utilization management (UM) programs over the past three decades, with a detailed overview of how this managed care function is regulated. Among other issues, the webinar highlighted the impact of the Affordable Care Act and other regulatory reforms on the ways that health plans make “medical necessity” determinations and how the appeals process works when a “denial” of care occurs. The webinar also offers an overview of RegQuest™, a new regulatory compliance tool created by EBG Advisors and Schooner Strategies. This resource provides health plans, regulators and others with invaluable information regarding current regulations and laws. RegQuest is the first comprehensive resource on the topic since URAC’s Utilization Management Guide was published in 2005. Our speakers included Moderator: Bob Atlas, Strategic Advisor and President, EBG Advisors, Inc. and Speakers: Cheri Lattimer, RN, BSN, CEO, Consulting Management Innovators (CMS) and Garry Carneal, JD, MA, President and CEO, Schooner Strategies.
The Challenges and Rewards of Integrating Behavioral Health into Primary Care
Although mental health and substance abuse (behavioral health) services have historically been segregated from traditional medical care, its impact on patients’ well-being, physical health and cost-of-care has become increasingly critical to improving clinical quality outcomes while significantly decreasing financial costs by tens of billions of dollars. During our webinar, hosted on October 13, 2015, speakers Steven R. Daviss, MD, DFAPA, Chief Medical Officer at M3 Information, LLC, and Charles A. Coleman, PhD, Senior Sponsor of IBM’s Population Health Insights and Programs Management of IBM’s Healthcare Solutions Board discussed the advances in policy and practice regarding the integration of behavioral health with physical health, as well as some of the gaps in identifying, aggregating, and analyzing data critical to a more holistic and comprehensive view of the individual. This webinar was moderated by Mark E. Lutes, Member of the Firm and Chair of Epstein Becker Green’s Board of Directors.
An Overview of How Care Management Interventions Will Improve Health—An Examination of Trends, Solutions and Outcomes
This webinar took place on January 28, 2014 and highlighted emerging practices and other value-based purchasing programs that are being deployed by provider systems to generate shared savings. The webinar was led by two population health thought leaders from TCS Healthcare Technologies: Deborah Keller, RN, BSN, director of client services; and Pat Stricker, RN, MEd, senior vice president of clinical services. During the session the speakers:
- Described care management interventions, including newer, complex, condition management strategies being adopted by provider systems and plans.
- Identified key interventions such as health risk assessments, care plans that support the management of comorbidities, readmission prevention, and more.
- Highlighted integrated approaches to launch, track and benchmark a successful program in the ACO and other settings.
- Critically examined IT solutions that make a difference at the provider system level and review potential pitfalls.
- Reviewed select stakeholder engagement strategies for patients, participating providers, and others.
- Explained the impact and management of key regulatory and delivery system changes.
Examining Provider Reimbursement and Payment Models Within Emerging Population Health Management Systems
This webinar focused on recent activities by the Centers for Medicare and Medicaid Services (CMS), state governments, private payers, and other stakeholders to update or create new provider payment strategies. Speakers addressed these changes by highlighting key value-based purchasing programs initiatives that are being deployed to generate shared savings and how provider systems can anticipate and respond to this changing financial landscape. The webinar was hosted on February 26, 2014, and featured Joel V. Brill, MD, AGAF, chief medical officer for Predictive Health. Thomas Hutchinson, Strategic Advisor, served as moderator.This session provided an update on emerging clinical, financial, and reimbursement issues, including:
- Alternative financial and risk-bearing models;
- Potential impact of CMS payment policies on private sector programs;
- Breaking down silos to redesign care delivery;
- What providers need to consider for transitioning to value-based reimbursement; and,
- Updates on the Medicare Sustainable Growth Rate (SGR) debate and federal legislation.
The Population Health Alliance Framework—A Tool for Population Health Success
The webinar provided a dynamic overview of the way traditional programs such as utilization management, disease management, wellness and case management are being re-defined and implemented within a “population health” framework. The webinar, which was hosted on March 25, 2014, was led by Frederic S. Goldstein, interim executive director and chair of the board, Population Health Alliance. Mark E. Lutes, Strategic Advisor and Chair of Epstein Becker Green’s Board of Directors, served as moderator. During the session, Mr. Goldstein:
- Provided a short history of the term “population health”
- Highlighted the population health framework and delivery system used by the Population Health Alliance
- Detailed some of the key activities that support population health programs
- Assessed how to best achieve meaningful clinical and financial outcomes
Defining the Scope of Population Health Management
The term Population Health Management (PHM) is referred to in several health care reform initiatives. Although the understanding of this term differs among professionals and other healthcare stakeholders, we could see this phrase as a call to action for collaboration in working together to improve health outcomes in the communities we serve. This session focused on what Population Health Management covers and what it does not. The webinar, which was hosted on April 22, 2014, was led by Cheri Lattimer, RS, BSN, Executive Director, Case Management Society of America (CSMA) and National Transitions of Care Coalition (NTOCC). Doug Hastings, Strategic Advisor, served as moderator. During the session, Ms. Lattimer discussed:
- Key elements of PHM programs
- Interface of care coordination strategies with PHM initiatives (e.g., transitions of care, medical home, accountable care organizations, and other activities)
- Opportunities and challenges associated with population health driven programs
- Future opportunities to optimize PHM and care coordination programs
How Will “Big Data” and “IT Integration” Impact Population Health Management Strategies?
One of the hallmarks of emerging population health strategies is leveraging data and analytic tools to promote better clinical and financial outcomes for patients and payors. The speakers reviewed the proliferation of health care data sources and the challenges of integrating this disparate information. This webinar examined the rise of big data and other innovative computational methods that should improve how information is shared and disseminated in terms of data capture, speed, interoperability, accuracy, analysis and visualization. The webinar, which was hosted on June 24 2014 was lead by Shibani Pokras, MPH, Principal, Product Offering, Health Economics & Outcomes Research, Real-World Evidence Solutions, IMS Health and Jerrold Hill PhD, Director, Real-World Solutions & Health Economics and Outcomes, IMS Health. Mark E. Lutes, Strategic Advisor and Chair of Epstein Becker Green’s Board of Directors, served as moderator. Ms. Pokras and Mr. Hill discussed:
- How big data is getting bigger and the need to access more processing power and storage to harness this information.
- Highlighted how to link effectively multiple sources of data (e.g., EMR, charge master, claims, mortality) to generate actionable information (e.g., dashboards, reports) to best treat and coordinate care.
- Reviewed ways to build and optimize relational database management systems to accommodate larger and more complex IT system requirements.
- Showcased several individual therapy areas including acute coronary syndrome, where data challenges and opportunities are being addressed head-on to improve outcomes.
- Identified best practices to implement business intelligence and data warehouse tools that promote population health programs .
What Role Do Patient Engagement Strategies Play in Promoting Population Health?
The speakers examined different approaches to target, engage, and modify individual behaviors to lead a healthier lifestyle. Kathleen Ann Fraser, RN-BC, MSN, MHA, CCM, CRRN, President, Case Management Society of America (CMSA); and Ben Gardner, Founder and President, Linkwell Health, a leading technology-enabled content marketing company serving health plans shared examples of ways to engage high-risk and chronically ill groups so as to achieve meaningful clinical and financial outcomes, during the July 31, 2014 webinar.Ms. Fraser and Mr. Gardner discussed:
- Methods to promote better eating and exercise
- Avenues to promote healthy behaviors and address chronic disease head-on
- Ways to improve medication adherence
- Approaches to optimize provider involvement in patient care over the continuum
- Strategies to benchmark positive change in targeted populations and provide meaningful feedback loops to the patients
Population Health Strategies for Employer-Based Coverage
The webinar, hosted on August 26, 2014, assessed how employers and other health plan sponsors are developing new programs to promote enhanced clinical and financial outcomes for the groups and populations they manage. In particular, speakers will highlight how the Affordable Care Act (ACA) is influencing population health management strategies for employer-based coverage. Led by two thought leaders from the Health Care Incentives Improvement Institute (HCI3): Francois de Brantes, MS, MBA, Executive Director; and Douglas Emery, MS, Program Implementation Leader, Western Region and Gretchen K. Young, Senior Vice President, Health Policy, The ERISA Industry Committee (ERIC). Adam Solander, Strategic Advisor, served as moderator. Mr. de Brantes, Mr. Emery and Ms. Young discussed:
- How ACA’s Cadillac tax on health benefits is changing the way employers pay for insurance coverage and how employees access and use insurance and wellness benefits.
- How employers are creating and implementing new incentive programs to align prudent purchasing with proper care management techniques.
- Emerging legal and reporting requirements based upon ACA and state requirements.
The Impact of the Affordable Care Act on Population Health Management
The webinar, hosted on September 30, 2014, assessed how much progress the federal and state governments have made expanding health care coverage and bending the cost curve. Specific insurance reforms to the individual and small group markets were examined along with emerging trends such as the role of accountable care organizations (ACOs), patient accessibility issues, and the drive towards integrated population health solutions. The webinar featured Gary Cohen, JD, a former key official from the U.S. Department of Health and Human Services (HHS). Cohen played a central role in the implementation of the Affordable Care Act (ACA) over the past several years. The presentation focused on key challenges that still lay ahead, including:
- The need to stabilize the federal eligibility and enrollment platform;
- Outreach to and enrollment of harder to reach populations;
- Establishment and launch of the SHOP exchanges; and,
- Ensure the “backend” payment system is working before the second open enrollment period begins on November 15, 2014.
In addition, Cohen also provided a report on the ACA’s progress as well as an overview of narrow networks, transparency and access to coverage.
Moving to an Integrated Population Health Management Model
The webinar, held on October 30, 2014, highlighted several approaches to manage populations to promote better clinical outcomes, more cost savings and enhanced patient satisfaction. Sarika Aggarwal, MD, Senior Vice President and Chief Medical Officer of Fallon Community Health Plan, and Julie O’Brien, RN, BSN, MS, Senior Vice President and Chief Operating Officer of Alicare Management led the session. Mark Lutes, Chair of Epstein Becker Green moderated. Over the past 10 years, the medical management system has undergone rapid transformation. The session focused on key strategies to improve population health, including topics like:
- The evolution of utilization management programs
- An overview of care management interventions to address complex medical, social and behavioral needs
- The need to include prevention and wellness services
- The goal of integrating traditional medical services with mental health and substance abuse programs
The Impact of Value-Based Purchasing and Other Employee Initiatives on Population Health
The webinar, held on November 20, 2014, discussed several approaches for population health managers to reduce costs and improve health care. Laurel Pickering, MPH, President & CEO of the Northeast Business Group on Health, and David Lansky, PhD, President & CEO of the Pacific Business Group on Health led the session. Adam Solander of Epstein Becker Green moderated. The webinar explored the activities of some well-known employer coalitions and discussed how they are designing and implementing value-based purchasing initiatives. The speakers also focused on:
- Standardizing and reporting on performance measurements
- Identifying the next wave in value-based purchasing
- Assessing the impact of the ACA and other health care reform initiatives on employers
- Establishing mental health parity standards
- Engaging consumers in informed decision-making
- Moving towards an integrated delivery system, including ACOs
Can Population Health Management Interventions Help State Medicaid Plan Offerings? – Thought Leaders in Population Health Webinar Series
This webinar, held on December 18, 2014, discussed whether or not population health interventions can help state Medicaid Programs, as well as serving as a vehicle to integrate mental health interventions into mainstream medicine. Joe Parks, MD, Director, Missouri HealthNet, a Division of the Missouri Department of Social Services, covered:
- Focused on how state Medicaid programs are utilizing case management and other population health management interventions to improve clinical and financial outcomes.
- How to best implement meaningful population health programs where federal, state and local agencies often need to fund, pay for and coordinate care together.
- Highlighted key activities occurring in the State of Missouri, including its medical home and managed care initiatives to integrated care to Missourians who are enrolled in Medicaid.
- Offered some key public policy, legal and operational observations about how Medicaid has evolved in the past and where it is heading into the future.
The Consumer Perspective on Health Care Delivery—Challenging Pre-Existing Notions and Navigating the New Landscape
The webinar “The Consumer Perspective on Health Care Delivery—Challenging Pre-Existing Notions and Navigating the New Landscape,” featured noted health care communication expert Chuck Alston, senior vice president, director of public affairs, MSL, Washington, D.C. (Publicis’ strategic engagement group), and advisor to the Robert Wood Johnson Foundation on the health care quality portfolio. During the September 24, 2013 webinar, Alston, a specialist in health care systems communications, shared the learning from focus groups and his national experience as to how health systems can best communicate with consumers/patients on medical evidence with shared decision making. The presentation challenged many of the pre-existing notions suggesting the best ways to communicate with consumers, patients and their families.
Assessing the New Mobile Environment—Slaying the Dinosaurs to Achieve Better Population Health
The webinar, “Assessing the New Mobile Environment—Slaying the Dinosaurs to Achieve Better Population Health,” featured Robert M. Kolodner, MD, vice president and chief medical officer, ViTel Net, and formerly the second National Coordinator for Health IT – the “U.S. health IT czar.” In the October 16, 2013 webinar, Dr. Kolodner provided a candid overview and assessment of how public and private sector initiatives are making a difference in the emerging electronically-driven and remote monitoring health care marketplace. He also discussed how leveraging mobile health IT can optimize population health management strategies.
Measuring Success—Evaluating the Clinical and Financial Efficacy of Population Health Management Strategies
The third session, “Measuring Success—Evaluating the Clinical and Financial Efficacy of Population Health,” featured Thomas Wilson, PhD, DrPH, epidemiologist and founder of Trajectory Healthcare, LLC, and co-founder and board chair of the nonprofit organization Population Health Impact Institute. In this informative November 20, 2013 session, Dr. Wilson focused on the advent of more complex care management interventions and emerging population health management strategies as well as the need for health leaders to understand the changing business, clinical and financial landscape. The session helped to explain how to design and create programs that promote comparative effectiveness and transparency.