Health Information Systems webinar series

(DESCRIPTION) Slide text, New year, new webinar platform! A diagram of platform features and specifications with a heading on the sample slide that reads, A great company is showing what interesting applications a fantastic product can bring for motivated users. The 3M logo is in the upper left of the sample slide. The main presenter is in a video box on the upper left. Slide with 3M logo in the upper left. Text, Optimizing health care reimbursement to drive value. June 2022. Background image of a provider with her hands on the arm of a patient. She has gray hair and an I.V. needle in her arm. Both wear masks. (SPEECH) Hello, and good afternoon. Thank you for joining today as we kick off our summer series with the optimizing health care reimbursement to drive value. Before we get started, I am going to go over a couple of housekeeping items. If you did join us for webinars last year and you haven't joined us yet, we do have a new webinar platform. It really is a better experience for attendees today with a lot of interactive tools. Because this is a web-based platform, we do recommend you using Google Chrome, close out of your VPN, multiple tabs, just to make sure you have the most bandwidth. Again, because this is a web-based platform, there is no dial-in number. So check your speaker settings if you are having any audio issues and do a quick refresh, that usually helps. Again, because this is an interactive platform-- excuse me, say that a couple of times quickly-- there are engagement tools. So you'll see that there's a resources section a Q&A, a survey as well as speaker bios. So please feel free to click around and see what we have going on. In that Q&A box, please feel free to ask questions, we certainly encourage them and we'll get to as many as we can at the end. In the resources section, we do have a certificate of attendance that you are able to download as well as a handout, some other resource information. And if you do want to register for our upcoming webinars, again, this is a series. We have another one in July and August. If you click on that webinar series, you can register if you haven't done so already. And we always do appreciate you completing the survey. So if you can let us know how we did, we certainly appreciate that. All right, so I'm going to go ahead and turn it over to Jeff Turnipseed who is our speaker for today. So Jeff, why don't you go ahead and take it away. (DESCRIPTION) Housekeeping slide with title, New year, new platform! Additional information: Ability to move engagement sections. Engagement tools and CC available. Text at bottom of slide, The information presented herein contains the views of the presenters and does not imply a formal endorsement for consultation engagement on the part of 3M. Participants are cautioned that information contained in this presentation is not a substitute for informed judgement. The participant and/or participant's organization are solely responsible for compliance and reimbursement decisions including those that may arise in whole or in part from participant's use of reliance upon information contained in the presentation. 3M and the presenters disclaim all responsibility for any use made of such information. The content of this webinar has been produced by the. 3M and its authorized third parties will use your personal information according to 3M's privacy policy (see Legal link). This meeting may be recorded. If you do not consent to being recorded, please exit the meeting when the recording begins. Next slide, Meet our speaker. Jeff Turnipseed is a client engagement and strategy executive at 3M Health Information Systems, with a primary focus on assisting healthcare organizations in designing and operationalizing their value-based payment (VBP) and population health management programs. Jeff helps his clients to structure their VBP programs to align incentives between payer and provider in order to improve outcomes across the continuum of care. In addition to VBP and population health management, Jeff also possesses in-depth knowledge in health plan market strategy and operations, medical economics and program design management. Copyright 3M, 2022. All rights reserved. 3M confidential. Headshot of Jeff Turnipseed. (SPEECH) Thank you so much, Lisa. And thank you to everyone who was able to join today. Really look forward to discussing how we can think about optimizing healthcare for reimbursement to drive value. And first where I wanted to start off is just a brief introduction for those of you who don't know who 3M is, a part of the larger organization. Aside from Scotch tape and Post-it notes, there's a health care division. And I work within the Healthcare Information Systems Division. (DESCRIPTION) Who are we? 3M's Business Groups. Four photos and accompanying titles and descriptive text. Safety and Industrial, Transportation & Electronics, Health Care, and Consumer. Text under Health Care, This Health Care Business Group serves the global healthcare industry and includes medical solutions, oral care, separation and purification sciences, health information systems, drug delivery systems, and food safety. (SPEECH) And so in our organization, we work with a broad cross-section of the industry, cover about a billion claims processed monthly, 54 million covered lives, 2% of GDP process to the methodologies. But most importantly, we have-- we partner with health plans, hospitals, state agencies, and also partners within that ecosystem to help drive value and optimize reimbursement in the healthcare system. (DESCRIPTION) Text, By the numbers... Additional information to what was spoken presented around the logo and text in the center, 3M Health Information Systems, 300+ active industry partnerships, 41 states use 3M methodologies as their basis of reimbursement, 30+ years in contract with CMS and other government agencies, 200+ payers use our reimbursement or population methodologies to drive value, 5,000 + hospitals leverage our coding software and automation technology. Next slide, Framework to drive value in health care. Three sections, titled, Value-Based Care, Reimbursement Optimization, Population Health. Under value-Based Care is the text, CMS expects 100% of Medicare beneficiaries to be treated within a value-based program by 2030. Five boxes below labeled, Accountable Care, Health Equity, Innovation, Affordability, System Transformation. Text below, Scale value-based program design and innovation. Under Reimbursement Optimization is the text, $760B to $935B of U.S. Healthcare spending may be overuse -- A graphic of a semi-circle over a dollar sign shows 70% in gray and 30% in red, labeled Overuse. Text below, Identify overuse -- reduce variation and increase accuracy. Under Population Health is the text, 27% of U.S. adults have multiple chronic conditions. A pie chart shows the amount. Text below, Drive high quality person-centered care that improves lives. (SPEECH) And when we think about just the overall framework to drive value in the healthcare system, it's cut across three pillars, you can almost reverse read this over on the right first, the population health, which is, if we don't execute on driving good population health, high-quality person-centered care that ultimately improves lives, all else is-- kind of fails. But in order to enable that, we need to ensure that we have appropriate value-based care that scales, and that includes an equitable way, accountable way, we need to ensure that we're enabling innovation, that affordability is in place and system transformation is enabled as well. But what we're going to focus on today is that area between, which is reimbursement optimization. And sometimes if reimbursement isn't optimized, it can skew or inhibit what the system is able to do from a population health side and also from a value-based care side. So all these things really are connected and need to be in alignment. (DESCRIPTION) Factors that drive reimbursement. A flow chart with arrows that connect: Provider competition and local practice patterns, Prices - Input costs, administrative fees and provider profits, Spending on health care, Utilization - low- and high-value care, Insurer competition, Premiums. Source: The Commonwealth Fund, Reducing Health Care Spending: What States Can Leverage, 2021. Three bullet points on the right: Prices and premiums don't adequately compensate for complexity of the whole person (i.e. clinical and social). High value care not tied to prices or premium incentives across the continuum, including the consumer. Insurer and provider competition can distort market dynamics, along with lack of transparency and interoperability. (SPEECH) When we think about factors that drive reimbursement, there's an article that was linked here the Commonwealth Fund published, just a super high level-- there are various factors that drive the ultimate reimbursement that you see. And depending upon where you sit in the system, reimbursement can mean something different to you. But on two ends of the spectrum, you have insurer competition and provider competition. And in markets where the reimbursement is being dictated by that competition, it can skew some of the dynamics here. If you have a large payer, that can dictate prices, they can be contracting with providers, or in some cases, the providers can be so large, it can work the other way around, narrow network definitions, et cetera. But when you look at the other variables about what prices are actually paid for services or, in health plans, perspective the premiums that they receive, that competition is important. What's not represented visually in this graphic is the consumer, which is-- it's all of this needs to work for the consumer and that high-value care is being properly incentivized through the system. Deliver high value care to pay for high value care, and that includes the consumer's participation in that. Ultimately, that impacts healthcare spending, and the cycle continues. (DESCRIPTION) Factors that drive reimbursement. Commercial payments as ratio of fee-for-service Medicare across the U.S., 2017. A graph with three boxes with lines through them at different heights, and error bars on the top and bottom. On the x-axis are: Inpatient facility, Outpatient facility, and Professional. On the y-axis are numbers from 1 to 2.8 in increments of .2. The box over Professional is much lower than the other two boxes. Source: Wide State-Level Variation in Commercial Health Care Prices Suggest Uneven Impact of Price Regulation, 2019. Three bullet points on right: Variation in negotiated prices within and across Commercial, Medicaid, and Medicare, case mix adjusted. Variation in prices across site of service for equivalent services. (i.e. 3M study on estimated impact of site neutral payments for outpatient surgeries in Medicare). Payment design that does not adequately bundle clinically similar services. (SPEECH) Now, there are other aspects or factors of reimbursement that are important and we're going to touch on how 3M can help shed light on this and also help reduce what we're going to talk about here on this side a little bit, which is, this article published basically captures what we know to be true. This is a well-known fact that commercial payments are significantly higher comparatively than Medicare and Medicaid. So that part isn't terribly interesting. But when you start to look at case mix adjustment within these verticals, inpatient, outpatient, and professional, what's interesting is the variation that exists within a payer across a system. So why is it that you pay more for one service and one part of the network over another? Or why is it that one health plan pays a higher rate than another? And these all have to do with those market dynamics we talked about before. But the variation in prices across site of service can cause significant amount of variation within the health-- and we'll talk about how you can identify where those exist within the system using 3M's help. Put a link here into a study about looking at the concept of site mutual payments between inpatient-outpatient. And there's also some other articles we can spin and follow up that look at side neutral payments or outpatient and professional settings as well. But there are opportunities to look at creating those optimizing reimbursement in the system in that capacity. Most importantly, we want to make sure that the reimbursement that exists within a system pays adequately and bundles clinically similar services together. If that's not happening, then there can be misalignments between the resources that it takes to deliver that service versus the reimbursement that's getting paid. (DESCRIPTION) Benefits of optimizing reimbursement. Achieving an optimal health system requires reimbursement that enable... Six boxes of text: Efficient resource allocation that controls spending growth. Comprehensive care coordination across the system. System transformation and sustainability. Equitable incentives inclusive of clinical and social factors. Alignment of quality outcomes with financial models. Investment in future innovation. (SPEECH) So what are the benefits of systems working perfectly? What would optimal reimbursement look like? One, it would be efficient and there would be allocation of those resources that control spending growth over time. Comprehensive and care coordination across the system. It would enable system transformation and sustainability. The incentives and the reimbursement would need to be equitable, that take into account clinical and social factors, social factors to a degree. And there would need to be alignment of quality outcomes with financial models. And there can be distortions of that when not done correctly across the marketplace. Last, but not least, we need to make sure that there's enough reimbursement in place to invest in future innovation. That's really the lifeblood of the system, is that it needs to continue to get more efficient, better quality outcomes, higher value. (DESCRIPTION) Risk stratification is essential. Key principles of risk adjustment are required to scale driving value in the healthcare. A bar lists: Fair, Scalable, Flexible, Accurate, and Efficient, with graphics and explanatory text below each. Information is spoken. (SPEECH) But in order to execute on optimal reimbursement, risk stratification is essential. And so at 3M, we're experts at that in our own way. And we believe that when risk stratification is done properly, it's fair, meaning that there are-- you're able to look at equitable comparisons across the health system, look at how you're paying for things and look at the outcomes aligned with that. That's a penalize error. You've got to make sure that you're looking at it equitably and that resources are being aligned properly. Two, that is scalable. We want to make sure that the methodologies that are behind paying for things are scaled to all populations. There are methodologies out there that work from Medicare but not Medicaid, or methodologies for Medicaid and not commercial Medicare, and vise versa, the mix of the two. So methodologies need to be scalable, they need to be flexible so that your financial teams, your quality teams can build benchmarks that are meaningful. Case mix adjust and taking into account social factors. Accuracy is super important. If you're not paying accurately, then you can have misalignments in the system, lining resources with payment, levels, and then efficiency as well. You want to take out that administrative burden for the system to not have to worry about clinical updates and make sure that things are being done efficiently. (DESCRIPTION) 3M HIS' Patient Classification Methodologies. Defining and measuring value, reimbursement and quality improvement. A table with headings across the top: Methodology, Applicability, Notes, Value-based care, Reimbursement optimization, Population health. Reimbursement optimization has a red line around it and all the rows are checked. Value-based care and Population health have checkmarks in all but the top two rows. The first item under methodology is: 3M All Patient Refined Diagnosis Related Groups (A.P.R D R Gs). The second item is 3M Enhanced Ambulatory Patient Groups (E.A.P.Gs). The third item is 3M Clinical Risk Groups (C.R.Gs). The fourth is 3M Patient-focused Episodes (P.F.E's). The fifth is 3M Potentially Preventable Complications (P.P.Cs). The sixth is 3M Potentially preventable Readmissions (P.P.R's). The seventh is 3M Potentially Preventable Admissions (P.P.A's). The eighth is 3M Potentially Preventable Emergency Department Visits (P.P.V's). The ninth is 3M Potentially Preventable Ancillary Services (P.P.S's). Five through nine have an asterisk, which is, 3M PPCs, PPRs, PPV, PPA, and PPS are the 3M Potentially Preventable Events (PPE). (SPEECH) So there will be some acronyms that you hear today, some of which you may be familiar with, some not. But I'll go through this list briefly and then we'll touch on them in examples later. But the first two that you see up there, APR-DRGs and EAPGs are how, in many states, and for commercial populations as well, inpatient care and ambulatory visits are paid for in-- for inpatient-outpatient facility services. Clinical risk groups are actually how we can look at the clinical risk of a person or a population as a whole, taking into account functional status. But we'll go through some examples about how CRGs can be used to optimize reimbursement from a population-productive well. Patient-focused episodes, we'll touch on as well as a kind of layer within the population health purview, if you will. But that methodology enables us to look at events or cohort-based episodes. And then the next methodologies that you see below, preventable complications, preventable readmissions, admissions, Ed visits, and ancillary services all represent potentially preventable events suite that looks at inpatient complications or readmissions back to the hospital or the Ed, or events that occur in the system that, if you reduce those events, you can essentially create a more efficient healthcare system. All of these methodologies can be used for reimbursement optimization, and we'll go through some examples. (DESCRIPTION) 3M Methodology Adoptions, Three U.S. maps with a bar across the top that labels them: All Patient Refined D.R.G's, Enhanced Ambulatory Patient Group, Population Health and Risk Groups. The states are colored dark, light patterned, white or light blue. The left-most map is mostly dark with only Louisiana in light blue. The center one has mostly white states with only Texas in light blue. The right-most one is mostly light-patterned with no light blue. Text at bottom, Note: State agencies and commercial payers can have more than one 3M methodology adopted to support reimbursement, value, or population health initiatives. Some state agencies have committed to use a 3M methodology but have not implemented yet. Population health and risk groupers include 3M, CRG, PFP, PPR, PPC, or PFE's. (SPEECH) When you look at these maps, really, what it's showing you is where there have been adoptions for 3M's methodology. So the first two maps, the US on the left, if you see a dark, shaded state that, means that a state agency has adopted the methodology as well as managed care plans in that state. And I should note on this slide that 3M works with about 85% of the providers in the country. So if you're a provider that's already working with 3M or considering it, many of you might already have access to 3M's potentially avoidable readmissions, complications, or some of our payment methodologies or APRs and EPGs embedded into your systems that you're using. So just an FYI. But this map is showing you kind of managed care in a state agency penetration. And where you don't see a dark blue is where there are one or more managed care plans using our methodologies. And if it's a light blue, that means that the states are considering it in the short term, in the near term. (DESCRIPTION) Reimbursement optimization. 3M methodologies and services enable clinical resource alignment for inpatient and outpatient care and across a population. Three boxes, headed, Promote Efficiency, Reduce Variation, and Improve Accuracy. Three bullet points under each. Under Promote Efficiency, Identify risk adjusted outliers across population, episodes, and services. Integrate payment incentives to reduce 3M PPR and PPC's, which integrate 3M APR - D.R.G. and E.A.P.G's classification. Classify and bundle clinically similar services more effectively and efficiently. Under Reduce Variation: Target contracted payment variation using case mix adjusted type and site of service. Analyze variances in utilization outcomes across the network (i.e. L.O.S., I.C.U., E.D. use, etc.) that impact facility-based cost of care. Examine margin and cost variation by site and type of service across service lines. Under Improve Accuracy: Align resources and clinical complexity using 3M A.P.R. - D.R.G., E.A.P.G., PFE, and CRG. Case mix adjusted benchmarks that scale across all payer populations (i.e. pediatric populations). Trend standardized payment rates that can compared as a % of Medicare or Medicaid. (SPEECH) So reimbursement optimization really kind of helps us achieve three things-- efficiency, promoting efficiency. We want to identify variation and reduce it and improve accuracy. So when we talk about efficiency, we're really talking about the ability of the system to a look at risk adjusted outliers, whether it be from a population perspective episode of services. Tying payment, or a small portion of that payment as an incentive to the outcomes related to the payment-- so it could be on readmissions or complications-- and then making sure that the APR-DRGs and EAPGs for the actual payment for the service are accurately bundling clinically similar services together. I'll talk a little bit about later how that can get misaligned with alternative methodologies, but we'll give you an example of that. And then reducing variation-- if there's a lot of variation as you saw in the slide talked about earlier, let's say within a commercial payers in the market, then there are different levels of incentives to provide that service. And that exists because there are different contracted rates. But if you can assist them, can reduce the variation in the system, then it can make it more predictable to manage those costs over the long term and make it more sustainable. You want to be able to analyze outcomes for this. So the APR-DRGs and EAPGs can be used to analyze service line, case mix, shifts over time. You can examine margin and cost by site of service across service lines. So there's a lot of financial and quality UI work that can be done with these methodologies. And then last but not least, we want to be accurate. And so if resources that it takes to deliver a service are not aligned with the payment and accurately captured in that and they become misaligned, there's all sorts of reasons why we don't want that to happen. But case mix adjusted benchmarks that scale. So if you're wanting to build benchmarks for pediatric populations, specialty populations, broader benchmarks for commercial Medicaid, these methodologies work for that, and then you want to look at these things over time so you can trend and standardize payment rates, one important point here is that if you use a current methodology for payment like APCs or MS-DRGs as an example, you can also use 3M's APR-DRGs or EAPGs in the inpatient/outpatient side and proxy price or pay to see what a-- we'll call it a virtual payment is-- to compare how your system's currently paying for things. So if you're paying on X, you can use APR-DRGs to give you a comparison to see where there might be opportunities to optimize that reimbursement system. (DESCRIPTION) Driving value through reimbursement optimization. An inverted pyramid divided into four rows. Text boxes appear to the right of each row. Top row, Stratify risk across population, cohort, and services. Text box to right, 1. Population -- 3M CRG. 2. Cohort (specific diseases) and events -- 3M PFE. 3. Services reimbursement -- 3M APR-D.R.G. and E.A.P.G., Second row, Identify potentially Preventable Events to improve efficiencies. Text box, 1. Readmissions and revisits to the E.D. -- 3M PPR., 2. Complications -- 3M PPC. 3. Admissions, Visits, Services -- 3M PFP., Third row, Actual to expected analysis. Text box, 1. Analyze risk/case mix adjusted unit cost and outcomes across the continuum of care. 2. Identify variations in programs, provider, payer, service line, practices, etc., 3. Create opportunity analysis across network. Fourth row, Priority areas. Text box, 1. Align opportunities with business strategy and needs. 2. Prioritize areas to improve value (reimbursement, cost, and quality). 3. Integrate actions into policy design, analytic, and decision support workstreams. (SPEECH) When we think about driving value through reimbursement-- this reverse pyramid here gives you a schematic of that-- which is, first, we want to stratify risk for the population, the cohort, or episode and services. We do that across the board. Identify potentially preventable events within the system to help you then look at the risk stratification, compared to those potentially variable and outcomes or others-- the other quality outcomes that you're measuring. Make sure that you compare actual to expected. So a risk adjusted analysis. And then obviously we want to prioritize the opportunity there after and integrate that into the work streams of your organization. (DESCRIPTION) Inpatient reimbursement optimization. 3M APR D.R.G's are the industry's leading clinical methodology for inpatient prospective payment system that resource utilization alignment and drive quality insights. A bar lists: Clinically, All populations, Flexible, Accurate, and Transparent, with graphics and explanatory text below each. Under Clinically, Classifies inpatient services based on clinical similarities and use of hospital resources by severity of illness and risk of mortality. Under All populations, Developed to work across all populations including newborns, pediatrics, and obstetrics. Under Flexible, Integrates with payment, quality, cost-efficiency programs to drive improvements in clinical outcomes and operational efficiencies. Under Accurate, Clinical categorical approach allows the clinical model enables accurate prospective payment that align with resource utilization. Under Transparent, Detailed clinical logic, hierarchies and specifications are published in APR D.R.G. Definitions Manual which are updated regularly by 3M's clinical experts. Text below, 3M's APR D.R.G. classification is also used in 3M's PFP, PFE, PPR, and PPC groupers. (SPEECH) So when we look at specifically in-patient reimbursement, 3M's methodology that's used for this is 3M APR-DRGs. We want to make sure that first, at least, when this is used, that you understand that it's clinically meaningful, it's designed for all populations. And specific to APR-DRGs, instead of just getting an actual DRG for payment or to look at it for quality of service, you can stratify that by severity of illness or risk of mortality. So you have flexibility to look at resource intensity, as well as the risk of mortality of that service delivered in the hospital. We've mentioned you can tie these back to quality cost efficiency programs to drive improvements. They're categorical, so you can roll them up and down for service lines and they're transparent. But when we talk about inpatient reimbursement at 3M, that's what we mean, using APR-DRGs. (DESCRIPTION) Comparing APR D.R.G's and Medicare D.R.G's. A table with headings on the top: Medicare Severity D.R.G's, and 3M APR D.R.G's. (SPEECH) And this slide actually gives you an illustration of how it compares to Medicare fee for service. And I won't read all these things to you, but just call-out a few of the things that are of particular note, which is that this kind of the second and third row, which is the APR-DRGs are designed for an all-patient population. And for OB, pediatrics, and newborns, they do a very good job of analyzing that particular population for payment. So that is why you see a lot of Medicaid agencies and commercial health plans adopt APR-DRGs because it helps them refine, be more accurate for services. We mentioned severity of illness. That allows you to look at minor, moderate, major extreme severity of illness. You can also look at the interaction of comorbidities, patient age for quality purposes. And the nice part about APR-DRGs some might not realize is that the APR-DRG methodology is integrated into analysis for complications and readmission. So the potentially preventable complications and potentially readmissions methodologies leverage a lot of the APR-DRG framework as foundation. So you can look at mortality, complications, and readmission all as a foundation of APR-DRGs. Again, not just to pay accurately, to optimize reimbursement and think about leveraging that for quality improvement as well. (DESCRIPTION) Inpatient reimbursement optimization. Enable admission case mix adjusted price, cost, and utilization comparison across providers and services. A table with hospitals listed in the left column and two groups of sections across the top, Average Cost of Care and Average Length of Stay. A red circle is around the top several rows under the first section. Text to right, Uncover how inpatient reimbursement is impacted by network utilization patterns and contracting design. (SPEECH) So let me-- in just a simple example here for inpatient reimbursement, which is, if you're doing business at two different hospitals, different locations in the system, you can look at your inpatient stay here. We're using average cost of care. There's a way to estimate cost using Medicare cost reports. But you could just as easily be looking at paid amount from a health plan or aggregating your data across all the health plans in your network or whatever it might be that you have access to. But the point here is that you can look at the difference between actual and expected case mix adjust that reimbursement to see where you're paying more or less. So in the first two hospitals there, we can see that they'll have this illustrated. But when you drill down into the data, the reimbursement for in-network services were higher, which are driven by specialty surgeries and deliveries. So basically, you can unpack those two hospitals, drill down and see what service lines are driving the actual variation in that difference in payments. You can also look at utilization as well. All of this to help inform better contracting design and more efficient reimbursement. (DESCRIPTION) Inpatient reimbursement optimization. Excess potentially preventable readmissions and complications can uncover quality improvement opportunities that impact total costs. A table titled Risk Adjusting Readmissions: An example from Rhode Island. Three percentages circled in red. One in the row labeled Schizophrenia, for All Severities, 18.2%. And all five columns on the row labeled Cardiac arrhythmia & conduction disorders. Under All Severities, 7.0%, Under Severities 1 through 4, 3.4%, 8.0%, 8.3%, and 27.8%, respectively. Text to right, Integrate inpatient quality outcomes with payment design to improve value. (SPEECH) Likewise, for potentially preventable readmissions, that, again, leverage APR-DRGs, you can think about, as a system, taking potentially preventable readmissions, as they have done in many states, and look at what's driving those readmission rates. So in this example here, we can see that patients admitted for schizophrenia have one of the highest, or the highest readmission rate comparatively for clinically related readmissions back to the hospital. I believe this was 30-day readmissions that they used here in this study. But also, you can stratify that by severity of illness. So as a system, you can look at which patients are hitting the hospital for clinically related events and stratify that based on severity of illness across the system. That information can be used as a health system at the state level and a health plan level to look at where you can maybe think about partnering up to make the biggest impact to keep people out of the hospital for clinically related avoidable readmissions. And also think about that from a payment design standpoint. It's possible that some of these outcomes could be used in upside/downside risk negotiations to ro-- incent hospitals in the health care system to work more efficiently to avoid these readmissions. (DESCRIPTION) Modernizing reimbursement and improving outcomes. Maryland's Total Cost of Care (T.C.O.C.) Model is designed to drive better access to high quality care statewide. A bar graph titled All Payer Outcome Trends C.Y. 2014-2018, with two bars that go below the 0% line at the top. The first one, labeled PPC, goes down to just past the -50% line. The second one, labeled Readmissions, goes down to approximately -16%. Text, All payers are included in Maryland's T.C.O.C. Model which span all patient populations. 2% of inpatient revenue tied to PPC and PPR performance. 30-day readmission rates use APR-D.R.G's to classify and adjust performance outcomes. Two text boxes, First box, Maryland Hospital Acquired Conditions (MHAC) Program. Improve hospital care and outcomes by adjusting hospital budgets on PPC rates. Second box, Readmission Reduction Incentive (RRIP) Program. Incentivizes hospitals to reduce avoidable readmission by linking rewards and penalties to improvements in readmission rates. Source: Maryland Total Cost of Care Model and Performance Statistics. (SPEECH) And this is an example in Maryland where they did just that, where they modernized reimbursement and improved outcomes across all payers in their total cost of care model, where two 2% of the inpatient revenue was tied at potentially preventable complications and readmissions and you can see the outcomes they achieve there over the four-year period. But they did look at 30-day readmission rates. And they use APR-DRGs to classify and adjust the performance outcomes. And so just give you this as an example in one state-- and this manifests sometimes differently in other states depending on public policy, but great example for you to kind of reference and anchor to. (DESCRIPTION) Outpatient reimbursement optimization. 3M E.A.P.G's are a comprehensive outpatient prospective payment system used to classify and enable effective resource utilization and drive quality insights. A bar lists: Clinically, All populations, Flexible, Accuracy, and Transparent, with graphics and explanatory text below each. Under Clinically, Outpatient data is grouped into clinically relevant categories, which supports meaningful improvement in the delivery of care. Under All populations, Not limited to the Medicare and Medicaid populations. It applies to all ambulatory patients. Under Flexible, Customize and choose among several options for bundling, including: consolidation, packaging, discounting, use of modifiers, handling medical visits and more. Under Accuracy, Bundled approach allows for payment accuracy, efficiency, and analytical clarity to support payment and quality initiatives. Under Transparent, Detailed clinical logic, hierarchies and specifications are published in E.A.P.G. Definitions Manual which are updated regularly by 3M's clinical experts. Text below, 3M's E.A.P.G's classification is also used in 3M's PFP, PFE, PPR, and PPC groupers. (SPEECH) I want to shift gears with you now. And we'll talk about outpatient reimbursement. So an outpatient reimbursement, 3M methodology we use is 3M EAPGs. They excel at clinically grouping visit-based services together for outpatient care. And so, it's, again, designed for all pocketed populations, not just for Medicaid and Medicare. So, clinically, you can apply this across your business. And then it's flexible in the sense that when you look at outpatient payment-- I'll go through a comparison of APCs in a second-- But it allows you flexibility of bundling, consolidation, packaging, and discounting, all to make sure that the payment is accurate, but that you're not overpaying for a bunch of services that are clinically related within that visit. And so it enables flexibility to design and optimize reimbursement on the outpatient side. Accurate, meaning you can tie this to quality initiatives-- I'll give you an example here in a second-- and then also transparent in terms of how things are grouped the way they are. And if licensed, you can see all the details of how something becomes an EAPG. (DESCRIPTION) Comparing Medicare A.P.Cs and 3M E.A.P.G's. A table with headings on the top: Medicare A.P.C's and 3M E.A.P.G's. (SPEECH) So APCs and EAPGs-- so APCs are the public methodology that CMS publishes. And interestingly enough, if you did not know, APCs were actually helped-- 3M helped maintain that software and still does. But we know what APCs, are but they are designed for the CMS population. A lot of health care system uses them to make payments right now and then kind of try and figure out how to make them work across their full book of business. EAPGs, on the other hand, are designed for an all-patient population, not just designed for Medicare. Per visit, we mentioned about the way in which that they can classify services more comprehensively at a visit level and offer flexibility for incentive bundling. So I would ask you to think about if you're paying on APCs right now, if you might want to consider utilizing the EAPGs maybe as a first step to compare how you're currently paying on APCs, or receiving payment on APCs, and how you can look at the resource utilization and payment under an EAPG system, because there might be some opportunities to refine that payment and optimize it, whether you're a hospital receiving payment or a health plan and making the payment. (DESCRIPTION) Outpatient reimbursement optimization. Enable visit-based unit price, cost, and utilization comparison across providers and services. A table with a red circle around the last item on the top headings row, O.P. Visit Allowed Amount % Difference from Expected. And a red box around two rows labeled Facility G and Facility H., Text on right, Uncover how outpatient reimbursement is impacted by network utilization patterns and contracting design. (SPEECH) So here's an example of this on the outpatient side where we're looking at an allowed amount for outpatient visits across two different facilities. And this example illustrates a subset of the network. So you'll see that the aggregate percentage there is 15% above expected. That means that the subset of these facilities in aggregate have receiving payments that are 15% higher than the rest of the network. But within that facility subset, there are two that we highlight here where one facility is being paid 18% more on a case mix adjusted basis than facility age. And of course, as an example, when we drill down into this, you can see what is driving that variation. In this case, the majority of that variation was due to variation in-network radiology services that were being delivered. Now, when you do these types of analyzes, you want to take into account other variables that can drive what your average allowed amount is. You want to take into account whether maybe it's a teaching or non-teaching hospital, or remove those variables so you can look at them in an equitable way. Those are all things 3M team can help your organization out with when you're thinking about building those benchmarks in New Orleans. (DESCRIPTION) Outpatient reimbursement optimization. Excess potentially preventable emergency department utilization can uncover quality improvement opportunities that impact cost of care. Three bar charts and a map of Florida with the upper left panhandle circled with the number 9.2 inside. Text above the map, PPV Rate, 9.2. Text on right, Integrate outpatient quality outcomes with reimbursement design to improve value. Source: Florida Medicaid Quality Initiatives -- PPE Dashboard, Fiscal Year 2019-2020. Statewide public dashboard risk adjusted using 3M PFP grouper which integrated CRGs. Region with highest utilization rate driven primarily by upper respiratory infections and skin trauma. (SPEECH) And this is an example in Florida from a publicly reported website linked down there at the bottom. So you can see how the state of Florida has chosen to be transparent about where potentially preventable emergency departments are-- events are occurring in the state and at what rate they're occurring on a risk adjusted basis. They also publish the managed care organization's rates here. And there is an alternative view where you can look at this by facility as well. But the point is that the state saying that there's a kind of a public utility. They want to publish where these rates are occurring so that communities can see them and the state can think about where there might be identification of best practices. Also, from about reimbursement optimization perspective, these rates and the expectation from the state is that these rates actually should improve over time. And so there is a percentage of the health plan's premium that are tied to optimizing or improving the rates of potentially preventable ED visits across the state. And so this is an example of where the data exists, but you should also look behind that as the policy and reimbursement policy that's tied to improving quality across the state of Florida. And that's very exciting. (DESCRIPTION) Promoting better health care in Florida. Drive improvements in health outcomes and equity, efficiency, and innovation that result in high quality and lower cost of care for Medicaid enrollees. A bar chart titled % of Total Admissions or Emergency Department Visits. PPA is just above 20%, PPR is just below 10%, and PPV is just above 60%. Text to right, 3 key goals, Reduce potentially preventable events (PPA, PPR, PPV), Improve birth outcomes, Improve access to in home long-term care and preventative dental services. Regional quality targets, For managed care organization performance tied to capitation rates. Performance improvement projects. Statewide with payer and provider collaboration to share best practices on impacting program goals. Source: Agency for Healthcare Administration Comprehensive Quality Strategy Report (2020). PPA = 3M Potentially Preventable Admissions, PPR = 3M Potentially Preventable Readmissions, PPV = 3M Potentially Preventable Emergency Department Visits. (SPEECH) About the ultimate aim here, which is promoting better health. So as a consumer, as I think about this, it makes you kind of want to be living in these states that are just really focused on improving outcomes, equity, efficiency, and innovation that ultimately drive higher value care for the consumers that live there. And all the things that are kind of written on here, I think that the performance improvement projects are the ones that I like to see the most, which is that there is collaboration between payer and provider to share what's working, what's not working, what are the challenging things that exist in the system to help kind of make a dent in these potentially preventable ED visits or other potentially preventable events here, but that's really the name of the game, which is not just putting out data for putting out data, but making sure that the policy, the collaboration, and the team work behind improving care is all aligned. (DESCRIPTION) Population based reimbursement optimization. 3M Clinical Risk Groups are a transparent patient-centric and clinical model that enables change, suitable to all populations, flexible, stable, and well suited for socio-clinical risk adjustment of health outcomes, service utilization, and costs. A bar lists: Person Centric, All Populations, Flexible, Stable, and Transparent, with graphics and explanatory text below each. Under Person Centric, Categorical socio-clinical model that provides actionable information (specific type of chronic or acute conditions, severity level of individual conditions). Under All Populations, Developed to work across all populations (Medicaid, Medicare, and Commercial). Under Flexible, Concurrent and Prospective models available, along with hierarchical aggregations of CRG categories. Under Stable, Categorical approach allows the clinical model to remain stable regardless of differences or service coverage or costs. Under Transparent, Detailed clinical logic, hierarchies and specifications are published in CRG Definitions Manual which are updated regularly by 3M's clinical experts. (SPEECH) So, switching gears on you another time here-- we're going to talk now about population-based reimbursement. And 3M's clinical risk groups are designed for patient-centric clinical models that scale across all populations. And they can risk adjust outcome, service utilization, and cost. Also, if there are social determinant initiatives that you have or socio-clinical models that you're designing and putting together, CRGs are a great tool to sit alongside it, as are the rest of the three methodologies. Because they are person-centric and they excel at taking in clinical risk, as well as coded social factors, as well that are captured through Z codes, they're embedded into the clinical risk assessment. They work across all populations. You can build them in prospective models for clinical models or financial models. And then they're categorical as well. So you can roll these things up at a high level and then break them down to a disease state and look at certain types of diseases within a population to really make refine targeted interventions. (DESCRIPTION) Comparing CRGs with regression-based models. A table with columns headed Clinical Categorical model (3M CRGs) and Regression-based model. (SPEECH) Now, the alternatives here in this space are what's called regression models. There are a handful out there. HTT are one of them, more of the well known. So you have the federal one and one for giants in the marketplace, HTT models. But all of these regression models are basically designed from a statistical model and uses a regression analysis to compute score. And then it backs in to what that score is based on the data that was fed into the model. And the challenge with that approach is that you're taking a data set that is historical, and you're basically making the assumption that the risk score that comes out of it will be applicable from a clinical perspective. You contrast that, and then you have to maintain that regression model over time, which can get messy, and it takes a lot of resources to do that. The clinical categorical model that are CRGs are a clinical model. It is separate from any sort of financial statistic or anything like that. It's developed by clinicians, for clinicians. And it can be used to look at the population as a whole, clinically, longitudinally across all inpatient/outpatient, professional, and drug claims. And then you can apply that clinical classification. It's separated. It sits by itself. It's stable over time. And look at clinical changes, regardless of the input of any financial data. That's nice because financial models then can sit on top of that, but it doesn't disrupt the clinical aspect of the CRG methodology. It works with it. And I'll give you some examples of how that's been applied in New York here in a second. But in a high level, clinical model is very different from a regression model. And that's the key point I wanted to get across here. (DESCRIPTION) Population based reimbursement optimization. Enable utilization and cost drivers that impact total cost of care can be uncovered across the network. A table with a box around a portion of two rows, labeled A.C.O. 3 and A.C.O. 4, under the headings CRG Risk Score, Actual Paid PMPM, Expected Paid PMPM, and Total % Difference. The Total % Difference for A.C.O. 3 is -4.8, and the Total % Difference for A.C.O. 4 is 10.5%. Text to right, Integrate whole person risk into population reimbursement to drive better accountability. (SPEECH) So when you think about applying clinical models for optimizing reimbursement, it manifests in this way. Well, we have a bunch of ACOs here in this example, where ACO 3 and 4, two completely different size of ACOs, two completely different patient mix, that CRG risk score tells you what the average resource utilization is across this network. You can see that even though ACO is smaller, ACO 4 is smaller, they have a higher clinical risk. But their performance is worse than the ACO 3. So, again, risk adjustment is important. And if you drill down into this data, here we found that multiple patients with multiple chronic conditions using inpatient and outpatient, inpatient and professional services for was driving the major variation in the spend here from a utilization and cost perspective. (DESCRIPTION) Population reimbursement optimization. Enable resource alignment across the healthcare system for event or cohort-based episodes. A graph titled Heart Failure PFE Episode - Post Discharge Spending. On the x-axis is CRG Health Status Severity and goes from 1 to 5. On the y-axis is $15,000 to $45,000. A jagged orange line starts at $15,686 at 2 and slopes up to approximately $25,000 at 5, with the text, Health Status Group 6 (Significant Chronic Disease in Two Organ Systems). A gray line starts at approximately above $20,000 at 1 and slopes up to approximately $25,000 at 4, then slopes sharply up to $41,065 at 5, with the text, Health Status Group 7 (Significant Chronic Disease in Three or More Organ Systems). Text to right. Integrate whole person risk into episodic reimbursement for greater accuracy. Text below, Sample data from 3M dataset of 14 million covered lives over 5 years. 3M Patient-focused Episodes (PFE) are risk adjusted by CRG health status. Without CRG risk adjustment which accounts for whole person risk health status group 7 would be underpaid for the episode across all severities, or health status group 6 could be overpaid. (SPEECH) Now, I'll ask-- think a little bit differently here because before, we're looking at CRGs, but in the same respect, we're going to-- you can look at episodic-based care within the system. But it's important for those of you who have episodic-based programs for bundles like hips and knees or whatever it might be, centers of excellence that you've built, if you're not risk adjusting that episodic-based care based on the whole person, clinical risk of the whole person, you run the risk of misaligned incentives or maybe comparing apples to oranges. So what this is showing you is, over time, patients with heart failure, episodic heart failure episodes over a five-year period. And the gray line represents patients that were categorized into health status group, seven, which is a patients that have three or more organ systems chronic disease. And then the orange line is health status through six, which is patients that have a significant chronic disease in two or more systems. Basically, the gray line means that they're more complex. And the orange line means there's a little bit less complex clinical complexity. This is not even taking into account social factors either, by the way. They might be outside of the clinical capture system. So just taking into account their changing clinical risk, you can see that if you didn't do that, and you paid these heart failure patients the same where you reimbursement under a bundle the same way, you would be overpaying the group that's in health status group six, and you would be underpaying the patients that are in group status seven. So if you have episodic-based reimbursement going on at your hospital, like thinking about scaling that out of health plan level, at the state level, you really want to make sure that you're risk adjusting properly in the PFE group or at 3M's design. Leverage is the clinical risk groups in order to enable that more equitable payment resource alignment across the system. (DESCRIPTION) Population reimbursement optimization. Enable better resource alignment across the healthcare system that account for clinical risk for the most vulnerable populations. Top portion of graphic fades in and out except for a box. Table on lower portion is titled Base condition - Schizophrenia, A box around the two rows under the last two columns, Weight (TANF Adult), and PMPM (NYC), are 1.449, $694.71, and 3.824, $1,833.38, respectively. Text under table, Per member per month (PMPM) based on estimated New York Medicaid CRG based payment. Text on right, Integrate whole person risk into reimbursement to drive health equity. (SPEECH) And the next slide here looks like the graphic is going away here, but I'll narrate. It's essentially telling you that when you take into account clinical risk groups, you can factor in coded SDOH codes or Z codes, or ICD-10 codes that are captured on the plane. And this is actually from New York State where the state-- if you didn't know, New York State pays on clinical risk groups prospectively to the health plans. So we actually know what we can measure what the change in payment is when homelessness is captured for a patient with schizophrenia versus when it's not reported at all. And the delta in that is a little less than three-fold on the actual weight or the CRG weight that's tied to the payment for these patients. And you can see how that translates into a significantly higher PMPM. And this is based on New York City rates. So even though your state, if you're listening, might not pay on CRGs, the point here is that the capture of the codes and the clinical risk and the social risk can matter related to payment if the policy design in a state is accounting for that and factoring that in into the payment model. (DESCRIPTION) Paying for high value care in New York State. Achieve the triple aim of improved population health, quality of care, and reducing health disparities and per capita cost. A bar graph titled 5 year trend, and labeled below, NY Medicaid D.S.R.I.P. Program, has three bars that go down from 0%. The first bar, PPA, goes down to more than -25%. The second bar, PPR, goes down to approximately -18%. And the third bar, PPV, goes down to approximately -4%. Text to right, Approximately $42 billion in managed care premiums prospectively risk-adjusted using CRGs annually. 86% of managed care expenditures are managed under a value-based program. 56% of value-based programs share financial risk with providers and include S.D.O.H. intervention(s). +/- 2.5% performance target for PPA utilization and costs annually from baseline for managed care plans. Sources: NYS Insurance Program Quality Strategy (2022), Final NYS D.I.S.R.I.P. Incentive Program (August 2021), NYS Office of Comptroller, fiscal year ending March 2021. (SPEECH) So when we talked about New York State a little bit, this is kind of capturing that in some numbers for you. So, New York state's entire aim is to pay for private health care, as it is for the entire health care system, but what does that mean? They pay $42 billion annually through numerous clinical risk groups to [AUDIO OUT] payment with the health systems down through the system in an equitable way, prospectively. 86% of the managed care, 86% of the managed care expenditures are under value-based programs. And then 56% of them share financial risk that include SDOH intervention. So that's a big one. The state enabled SDOH interventions because they're using a clinical model at the state level to help align reimbursement, quality outcomes, et cetera. And then the health plans are held accountable for these potentially preventable events, as well for incremental improvement in the system from baseline. (DESCRIPTION) 3M -- How we can help. A table with headings across the top: Workstream, Methodology Content Services (MCS) (Footnote 1), and three columns grouped under Additional Consulting Services (Footnotes 1 and 2): Value Based Programs, Reimbursement Optimization, and Population Health. Under Workstream are: 1, Project management, 2, 3M subject matter experts, 3, Methodology training and education, 4, Grouper output optimization, 5, Grouper version transition, 6, Benchmark design and best practices, 7, Reporting design and best practices, 8, Program policy design, 9, Metric design, and 10, External stakeholder education. In row 11, Supported 3M Methodologies, and in row 12, Supported CMS Methodologies. Checkmarks are in the columns for different rows. Under Methodology Content Services, checkmarks are in rows 1 through 7. Supported 3M Methodologies: CRG, PPE, PFE, APR-D.R.G., and E.A.P.G., Supported CMS Methodologies: HCC, MS-D.R.G., A.P.C., Under Value Based Programs, checkmarks are in rows 1, 2, 3, and through 10. Supported 3M Methodologies: CRG, PPE, and PFE. Supported CMS Methodologies: HCC. Under Reimbursement Optimization, checkmarks are in rows 1, 2, 3, and 5 through 10. Supported 3M Methodologies: CRG, APR-D.R.G., E.A.P.G., Supported CMS Methodologies: HCC, MS-D.R.G., APC. Under Population Health, checkmarks are in rows 1, 2, 3, and 5 through 10. Supported 3M Methodologies: CRG, PPE, and PFE. Supported CMS Methodologies: blank. Instances of PPE have footnote 3. Instances of PFE have footnote 4. Footnotes: 1 - Requires license with 3M for supported methodologies. 2 - Additional consulting services can be integrated with MCS or purchased separately. 3 - PPE includes PFP, PPR, PPC groupers. 4 - PFE includes event and cohort episodes. (SPEECH) So for those of you kind of listening to the webinar today, and you're curious how 3M can help your organization, we can do that several ways. All the methodologies that I listen to-- that I listed earlier, work in the cloud. They're kind of like Intel inside. And you can use them as a part of your workflows in a scalable way to insert them in your data warehouses, medical workflows, quality workflows, et cetera. Our subject matter experts on 3M's side can pair up with your organization in a number of different ways, but it really cuts across these work streams from training, reporting design, benchmark design. If you're building policy and you want an objective third party to listen to how that policy is being designed and offer recommendations, we can do that, designing metrics for executive dashboards or pushing out to providers or ACOs in the network in general, and then just good old-fashioned stakeholder education. And the methodology that you see here that we talked about on the 3M side, we can support. But we can also help with federal methodologies as well through the platform. (DESCRIPTION) 3M methodologies supporting materials. A screenshot of a page with a video titled 3M Methodologies: The real language of healthcare. Text below not legible, and a chart below that of resources and links. To the right of the screenshot is a table with a list of methodologies and links next to them under the heading, Fact Sheets, White Papers, and E-Guides. The methodologies listed are: 3M Methodology Content Services (MCS), 3M All Patient Refined Diagnosis Related Groups (APR-D.R.Gs), Enhanced Ambulatory Patient Groups (E.A.P.Gs), 3M Clinical Risk Groups (CRG), 3M Patient-focused Episodes (PFE), 3M Potentially Preventable Events (PPE), 3M Population focused (PPC) (asterisk), 3M Potentially Preventable Readmissions (PPR), 3M Potentially Preventable Admissions (PPA), 3M Potentially Preventable Emergency Department Visits (PPVs), 3M Potentially Preventable Ancillary Services (PPS) (asterisk). Asterisk, 3M PPCs, PPRs, PPV, PPA, and PPS are the 3M Potentially Preventable Events (PPE). 3M PPV, PPA, and PPS included as part of 3M Population-focused Preventables (PFP) grouper. (SPEECH) And I realized that on our call today, I went through some of these things very quickly. There are a bunch of links in the resources below that if you want to read more about some of these methodologies, feel free. And certainly welcome any questions that you might have. (DESCRIPTION) Q&A (SPEECH) And with that, Lisa, I'll turn it back over to you. Great. Thanks, Jeff. That was a lot of information, as you said. So we will be-- well, we have recorded today's session. And we'll be recording the rest of them in the series. So, in the next few weeks, if you do want to go back and listen to the presentation, it will be on our website soon. Before we get to our questions, if anybody is interested in more information, you can complete this poll and we'll follow-up with you after. Again, that is if you want some more information. (DESCRIPTION) Poll: If your organization would like to connect with 3M directly to discuss how we can help your organization, please select 1 or more option below, and 3M representative will follow up: 1. 3M reimbursement, methodologies (APR-D.R.G., E.A.P.G., CRG). 2. 3M population health methodologies (CRG, PFP, PPE, PPR, PPC). 3. 3M value, reimbursement, and/or population health methodology content services and consulting support. Submit. (SPEECH) But Let's go ahead and get to our questions. Let's see. So our first one is how does 3M see social risk being incorporated into reimbursement methodologies? Great question. Thank you, Lisa. So, social risk is an interesting one. And right now, I think the industry is figuring out how to standardize the collection of that information either through health risk assessments or the actual code capture on a claim. The nature in which that information is collected between a payer and provider, all of those things are being worked out now. And most of the organizations we talked to in terms of the actual capture of what we see on the claims, it is in its infancy, meaning, it's better than Medicare than it is Medicaid and commercial. But in some of the commercial data sets we've seen, it's 1% or 2% of the patient population where that data has been collected. With that said, 3M's clinical risk groups have the ability to capture the Z codes and social determinant information that's captured on the claims in its clinical risk adjustment. But what we're also seeing is that the third party companies that are out there that have the ability to look at individual level risk scores either at a community level or estimated an individual level, what their clinical, social risk is, if you will, that the clinical models and the social models are being combined to help evaluate if reimbursement is appropriate in the system. I think that, depending upon who you ask, you'll get different answers. But in terms of what is being done, we're seeing that the data is being put together, and that it's being put together at an individual level for each person where it's captured. The question is, will the policies be implemented? And will that be done in an equitable way? We believe at 3M that that's possible and that it can be done, but that it's important to keep the clinical models whole, if you will, and then factor in those social criteria in an appropriate way. That's a good question, Lisa. Great. Our next question is, can episodic and population health reimbursement strategies be complementary to one another? Yeah, another good question. They can if done responsibly. And I think the first slide in the presentation that where I had the value-based care statistic of how many CMS value-base programs actually succeeded or didn't succeed. The CMS innovation refresh that came out recently said that five out of the 50 demonstrations that they did were successful, which was not a good statistic. But the point of bringing that up is that there was a lot of innovation going on around episodes. There's a lot of innovation going on around upside/downside risk. Providers are coming in and programs. The design is complicated. It wasn't scalable. And if you think about episodic care and population care, they can work together, but the design and the scale which programs are put in place in a market need to be very thoughtful. The episodic-based programs that we see are some of the things that logically you think probably should be in an episode-- hips and knees. A lot of conversation going around maternity care, some chronic conditions. But the name of the game in terms of bundling services for episodic care needs to be, can those services really pre- and post-delivery of that care fit together? Then on top of that, need to make sure you're not double paying or double incenting with any population programs that are going on. So, can they work? Yes, but it has to be really well-thought out. And I think from what we're seeing, episodic care has its role, but it's a very specific use cases. Another good question. I guess we have one in the chat. Another question we have is-- Yeah, go ahead. Yeah, I was going to say another one from the chat is you have explained the power of deep dive data analytics. How do we convince our providers to use not only yours, but at least some form of this? Interesting. So I think if you're going to convince providers to use any type of data-- and I'm going to guess this good question could have come from a provider or a managed care plan, I'm not sure. But in either case, providers need to first see what they're presenting to them, benefits the patient, improves their quality of life. And in my opinion, you tie that to value and quality. Next it needs to-- they need to see how it would benefit them from a business perspective, which is the value-based care piece. It's important that there's not cost cutting just for cost cutting. Optimize reimbursement doesn't mean let's pay everybody less. It means let's pay accurately, equitably, responsibly, and make sure that the system is held accountable for quality. And I think if providers know that you're not just trying to take money out of their pocket, but you are trying to really improve the quality of care for their lives and their patients' lives, that's usually what works, and at least what I've seen work. So, great question. Great. Another question we have is, how can 3M methodologies be used to model payment impacts to existing reimbursement policies and methods? Yeah, that's a good one. So I touched on this a little bit earlier, but I'll try to clarify, which is, let's say your organization pays on MS-DRGs today. And as you recall from earlier in the presentation, the MS-DRGs don't do a good job of paying for pediatric populations and OB. You have to usually jerry-rig the system to make that work. Anything can complicate it. But you want to make sure that you can first understand how you currently pay. Let's say it's on MS-DRGs. And then you can integrate APR-DRGs and adjust your database and APRG, APR-DRGs which are more refined, and then look at where there are gaps and how you might be paying an MS-DRG, maybe if it's not adjusted by severity as in a refined way for your OB population, and then use that information to arm yourself with information and maybe go back to that payer. Or if it was a payer, go back to the provider and negotiate more appropriate rates for those services. Even if you didn't change off MSD-DRGs, you can still use APR-DRGs or EAPGs in the outpatient side to see where you might have some clinical misalignments in how you're paying, how services are being paid in the system. And on the CRG side, you can use CRGs as well to look at population-based metrics and outcomes for payment to see where you might have variation there as well. So in different perspectives, that could be-- those are some good kind of takeaways and approaches on how the methodologies can be used, Lisa. Any other questions? No, we actually do not have any more questions. So, again, thank you so much for all the information today. And before we close out, if you are interested in getting any more information, you can complete this poll here to let us know if you'd like us to follow-up. Again, if you would like to download the handout today or any of the other resources, you can get those in the resources section. And as always, we do appreciate you completing the survey to let us know how we did. And again, we do have two more webinars coming up-- one in July and one in August. So if you haven't gotten a chance to register for those, please do. Jeff, is there anything else you would like to say before we end today's webinar? (DESCRIPTION) That's a wrap! Thank you. (SPEECH) Oh, thank you. Thank you very much for everybody's time. I really appreciate the question and dialogue. And let us know. Just reach out if you'd like to talk more. So, thank you. Great. Thank you so much again. And we'll see you next time. Thank you. Take care.

(DESCRIPTION) Video call windows are on the left, and presentation slides are on the right. Slide, New year, new webinar platform! A screenshot of a webinar platform for 3M. It features a top center title, a Media player on the top left, Resources on the middle left, a question box on the lower left, a Meet our speaker box on the top right, and a survey on the bottom right. In between the left and right columns is a slide area. (SPEECH) Good afternoon. And thank you for joining our webinar today. Before we get started, I'm going to go over just a couple of housekeeping items just so you can get a feel for our platform. If you joined us last year, you may notice that we are using a new system called On24, which is going to provide a better user experience. This is a web-based platform. So make sure you're using Google Chrome. Close out of VPN or multiple tabs. That'll help with bandwidth. 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And also, if you want to interact with us or if you do have questions or would like a follow-up, in that middle section, you can click on Learn More and you can let us know if you want us to contact you after. And we always appreciate knowing how we did. So in the survey, we certainly appreciate you letting us know the feedback and how we did today. (DESCRIPTION) Text, Engagement tools and C.C. available. The information presented herein contains the views of the presenters and does not imply a formal endorsement for consultation engagement on the part of 3M. Participants are cautioned that information contained in this presentation is not a substitute tor informed judgement. The participant and/or participant's organization are solely responsible tor compliance and reimbursement decisions, including those that may arise in whole or in part from participants use of or reliance upon information contained in the presentation. 3M and the presenters disclaim all responsibility for any use made of such information. The content of this webinar has been produced by the. 3M and its authorized third parties will use your personal information according to 3M's privacy policy (see Legal link). This meeting may be recorded. If you do not consent to being recorded, please exit the meeting when the recording begins. (SPEECH) So without further ado, we're going to go ahead and get started with understanding your population and measuring health system efficiency. (DESCRIPTION) Logo, 3M. Science. Applied to life. Text, July 14, 2022. Two portraits of women. on the left is Lisa. Text, Lisa Edstrom, M.B.A., Senior Manager for Customer Engagement. On the right is Dawn. Text, Dawn Weimar, Senior Regional Director. (SPEECH) Our speakers today is Lisa Edstrom and Dawn Weimar. And I am going to go ahead and hand it over to Lisa to get started. Thanks, Lisa, and welcome everyone. On behalf of Dawn and I, Dawn and myself, I wanted to just welcome you, let you know that how much we appreciate your time today. There's a lot that we want to share. So I'm going to quickly set the stage with a background and basic overview of the 3M methodologies. And then I'll be turning it over to Dawn to spend most of our time today on practical applications and experience. So we have a survey that we'd like to throw out to the audience today. We don't know a lot about who's on the call. So this gives us a little bit better idea of what types of health care quality measures you're using right now. You can check all that apply on this survey. And I believe you can just hover and check your responses. (DESCRIPTION) Text, What type of health care quality measurements do you use? (check all that apply). Checkboxes for Disease specific measures, 3M Potentially Preventable Event Measures, All cause readmissions and ambulatory sensitive admissions, and We are seeking health care quality measures that better drive overall quality or cost. (SPEECH) So while you're doing that, again, checking all that apply. It looks like we don't have anything submitted yet. I'm not sure if it's working. Oh, there they go. OK, so we're starting to get some responses on that. So while those are coming in, we've got about over 90 people on the call. We've got 13 responses coming in right now, but they're rapidly stacking up. So thanks for taking a moment and filling that out. A little bit more about our agenda today, we're going to again introduce you to some of the basics of our 3M methodologies, specifically focusing on our clinical risk groups and our preventable events, such as readmissions, ER usage, things like that. We'll be talking a lot about performance measures and how using those applications can help you with managing different performance measures and maybe setting new ones, benchmarks by really looking prospectively at how you can use these methods methodologies and consulting and education to help you with that. And then, of course, quality oversight. So again, our focus really being in the area of quality and efficiency. (DESCRIPTION) The quiz question populates with colored horizontal lines for each answer. (SPEECH) Looks like we have about 65% of the folks have logged in. Let me see. And we have results. So our results, as you can see, about-- gosh, over 70% of the respondents are looking for all cause readmission and ambulatory admission-- or ambulatory sensitive admissions. We have then disease specific measures and potentially preventable as tied at 65.5. And then below, seeking health care quality measures that better drive overall quality. (DESCRIPTION) 37.9%. (SPEECH) Well, this is great because a lot of focus is going to be on those top three items. And Dawn is going to speak really specifically to those. So again, very happy to have you here. I talked a little bit about the agenda today. So I'll go over introduction and relevance. So why is this important? Again, understanding just basically the methodologies. We'll be looking at risk arrangements-- or I'm sorry risk-- gosh, I apologize because this is a new platform. So I can't see very well. There we go. OK, so 3M rate-based efficiency measures, which really help you to drive value-based care. And then finally, we want to provide you with information on how risk adjustment can help with your rate setting. And as Lisa mentioned, resources. (DESCRIPTION) Text, Agenda and keys to, number 2. sub-bullet, Potentially Preventable Events, number 3, Success stories, number 4 sub-bullet, Population health. Keys to success: C.R.G & P.P.E. characteristics, Performance measurement, Quality of care oversight. Slide, Who are we? Text, 3M's Business groups. The groups are Safety & Industrial, Transportation & Electronics, Health Care, and Consumer. The Health Care group is highlighted. Text, This Healthcare Business Group serves the global healthcare industry. (SPEECH) So first, a brief intro into who we are. I like to share and feel kind of proud that I grew up here in Saint Paul, Minnesota, which is where the global headquarters of 3M is located. And until I came 3M eight years ago, while I have over 30 years of experience in both the parent provider market here in the Twin Cities area in the Midwest, it wasn't until I joined 3M that I really learned the scope of the footprint and how 3M impacts health care not only here in the US, but around the globe. Our four primary businesses has over 20 divisions that offer us an opportunity to cross fertilize new technologies, new applications. And while the organization is large, I can attest that we're highly integrated and collaborative. So access to technologies and scientists is not unusual across all of these businesses. Within the health care business itself, we have a large medical solutions division, which supplies products and services to hospitals and clinics again around the world. We have a large oral care division, water purification, and then our health information systems division resides within the health care business group. (DESCRIPTION) The Health Care Group also includes separation and purification sciences, drug delivery systems, and food safety. Slide, By the numbers... Logo, 3M. Text, Health Information Systems. 1 billion claims have 3M methodologies applied monthly. 5,000 plus hospitals leverage our coding software and automation technology. 30 plus years in contract with C.M.S. and other government agencies. 41 states use 3M methodologies as their basis of reimbursement. 54 million covered lives impacted. (SPEECH) So while 3M be really well-known to a lot of you for our tapes, post-its, and sandpaper, the 3M HIS clinical classification methods are also widely recognized and used around the world, paying more than 200 billion each year to providers across Medicare and Medicaid and commercial products, which represents a significant-- or 2% of overall GDP is tied to 3M methodologies, over 300 active industry partnerships. And I think one of the things I like to point out within the partnerships is it's not only providers and payers that we partner with. We also work with other organizations that are focused on optimizing health care outcomes, as well as academic institutions and researchers. So these methodologies are also used internationally to support research and ongoing developments. Subsequently, the related quality measures have been implemented in over 13 states and we're continuing to grow that. (DESCRIPTION) Slide, Framework to drive value in health care. Three panels side-by-side. (SPEECH) So our work is really based on this framework that you see in front of you, which is value-based care, reimbursement accuracy, and population health. I like to say these are the pillars or the three legs to the stool that drives the work we do. So all of that work is really about value-based care. It's our work. It's what we do to support organizations that are targeted value-based design, program design, and innovation. (DESCRIPTION) Text, C.M.S. expects 100% of Medicare beneficiaries to be treated within a value-based program by 2030. Accountable Care, Health Equity, Innovation, Affordability, System Transformation. (SPEECH) And then reimbursement optimal-- or reimbursement accuracy, I should say, helps us to identify overuse, reduce variation, and then increase accuracy as well as transparency. I think it's a really important point to make that. That as we're looking more and more at transparency within health care, even transparency within how rates are set and supporting that or the data supports that. (DESCRIPTION) Text, 760 billion dollars to 935 billion dollars of U.S. healthcare spending may be overuse. (SPEECH) Population health-- we're moving through applications, clinical risk groups, assigning risks, and driving quality and improving care. So we're going to be discussing CRGs, our clinical risk groups, and that application to population health more in the presentation. (DESCRIPTION) Text, 27% of U.S. adults have multiple chronic conditions. Drive high quality person-centered care that improves lives. Relevance - Why this matters for quality and efficiency. (SPEECH) So why does this matter? (DESCRIPTION) Slide, Focus on quality and efficiencies requires appropriate tools. Risk adjustment can help payers and providers with several financial and population health functions including profiling populations, identifying or anticipating the health needs of patients and populations, intervening at the right time, and assessing performance, as well as rate setting, benchmarking, allocating resources, and underwriting. (SPEECH) Simply put, more and more patients or members are requiring targeted case management under value-based models. So the appropriate tools are needed. But we all know that it's much more complex and change is much more complex than-- and the last two years, I've put a lot of strain on both human and system capacity. To say there is change is truly an understatement. Immediately, we'll start dealing with effects of COVID. Yesterday, I was listening to a news story about some hospitals in the local market here talking about post-COVID. And really that's a premature term that they still feeling that they're in the midst of the COVID challenges. So immediately, we're dealing with those COVID outcomes or COVID challenges. Budgets are tight. Staffing is an ongoing challenge for both payers and providers. Inflation is creating more strain on organizations, populations, and individuals. And moving from reactive to proactive strategies requires not only the right tools, but proven and efficient tools. So I really want you to walk away today-- I know Dawn and I both want you to come away with an understanding of how risk management is a tool that really enables a view into the future spend care management, care delivery gaps, and meaningful population level interventions. (DESCRIPTION) Slide, Population health. Three panels. The first is titled Person-centered. Text, Promote whole person care that drive quality improvement. Enable whole person risk stratification across all populations (pediatric, maternity, adult, geriatric). 3M C.R.G., P.F.E., and P.P.E. methodologies provide person level outcomes that drive population and episodic initiatives. The second panel is titled Equitable outcomes. Text, Quantify and measure the impact on health equity and drive best practices. 3M CRGs, PFEs, PPEs capture clinical risk and quality outcomes that can be adjusted by social risk information. Integrate race, ethnicity or other demographic or social risk factors to analyze variances in health equity. The third panel is titled Prioritize resources. Text, Enable alternative payment and population-based innovation that reduce administrative burden. 3M CRGs, P.F.E., and P.P.E. clinical methodologies scale with social risk models across all populations. Support value-based systems that encourage lasting care delivery transformation. (SPEECH) These next two slides just drill down a little bit more, give you a glance of population health and value-based care applications and characteristics. So again, in the population health area, the methodologies enable you to really look at providing high-quality and whole person care, targeted care, but also with emphasis on populations and resources. So being able to prioritize your resources, stratifying your population is something that we focus on and the CRG allow you to do so. (DESCRIPTION) Slide, Value-based care. Three panels. The first is scalable design. Text, Inclusive of pediatric, maternal, adult and geriatric populations. 3M CRGs, P.F.E., and P.P.E. methodologies provide flexibility to support population and episodic programs. Enable risk adjusted design that reduces complexity and supports broad provider participation. The second panel is Outcomes focused. Text, Integrate outcomes that drive total cost of care and quality outcomes. 3M PPEs enable risk adjusted outcome-based quality improvement across inpatient, outpatient, ancillary services. Leverage simplified but flexible outcome-based benchmarks that scale across all populations. The third panel is Drive innovation. Text, Enable alternative payment and population-based innovation that reduce administrative burden. 3M CRGs, P.F.E., and P.P.E. clinical methodologies scale with social risk models across all populations. Support value-based systems that encourage lasting care delivery transformation. (SPEECH) We have also value-based care applications. So the 3M methodologies and services enable you to apply value-based programs across all populations. As you will see, the application is scalable, it's outcome-focused, and it really helps you to drive innovation and support those value-based systems that encourage lasting care and delivery transformation. (DESCRIPTION) Slide, Risk stratification is essential. Text, Key principles of risk adjustment are required to scale driving value in the healthcare. Fair, Ensures equitable comparisons are made and allocation of resources and reimbursement are aligned without penalizing care delivery to complex patients. Scalable, Enables risk adjustment that apply to population and service-based use cases, not just for a specific population cohort or service line. Flexible, Benchmarks can be designed across population risk, service case-mix, and social determinants. Accurate, Incentivizes accurate reimbursement and complete coding that align resource consumption and clinical complexity. Efficient, Minimize administrative burden to maintain clinical updates that impact risk adjustment within program design. (SPEECH) So you hear about risk. I've mentioned it a few times. And Dawn is going to talk about risk and risk stratification. The slide provides a very concise picture of how the application and the understanding of clinical risk group methodology can provide a transparent and patient-centric clinical model. It shows how it can enable you to manage that change. As we noted earlier, change is big and it's bigger than ever as we're dealing with all of those variables that we talked about a couple of slides ago. So it's suitable for all populations. It's flexible, stable. And it's really well suited for advancing socio-clinical risk adjustment. Something that I know many of you might be interested in is how do we take those clinical risk adjustment and marry that with some of the social determinants of health to provide that broad and big picture of what's going on with a population or an individual. And finally, it's efficient. And I think what you'll see is while the methodologies can sometimes look complex, once they're applied and you understand them, they really drive a lot of administrative efficiencies. And they help with program design and addressing the right care in the right place at the right time, something we're all attuned to. (DESCRIPTION) Slide, 3M H.I.S. apostrophe Patient Classification Methodologies. Text, Defining and measuring value, reimbursement and quality improvement. A table with the columns Methodology, Applicability, Notes, Value-based care, Reimbursement optimization, and Population health. The Value-based care and Population health columns are highlighted. They have checkmarks for the following methodologies. 3M Clinical Risk Groups (C.R.G.), 3M Patient-focused Episodes (P.F.E.), 3M Potentially Preventable Complications (P.P.C.), 3M Potentially Preventable Readmissions (P.P.R.), 3M Potentially Preventable Admissions (P.P.A.), 3M Potentially Preventable Emergency Department Visits (PPVs), 3M Potentially Preventable Ancillary Services (PPSs). These have the following values in the Applicability column. Inpatient admissions, Ambulatory visits, Population health and reimbursement, Event and cohort-based episodes, Inpatient hospital care, quality outcomes, Inpatient hospital care, population health outcomes, Population health outcomes, and the following values in the Notes column. Includes four severity of illness subclasses and risk of mortality, Hospital outpatient, ambulatory surgical center, other clinics, Person heath, functional status and population-based reimbursement, Includes hospital, professional, pharmacy, or other services, Includes PPRs to the Emergency Department, Included as part of 3M Population-focused Preventables (P.F.P.). Text, Copyright 3M 2022. All right reserved. 3M Confidentials. (SPEECH) So coming back full circle to the 3M framework, you can better see how patient classifications are applied. Last month my colleague, Jeff Turnipseed, some of you may have been to his webinar on reimbursement accuracy, he talks specifically about the applications that are listed there in the center pillar under reimbursement, specifically diving into the utilization of 3M APR-DRGs and EAPG methodologies. Today, we're drilling further down into the application of CRG, clinical risk groupers, and PFEs, our preventable suite, and the applicability to value-based care and population health as key levers to ensuring that care delivery improves health outcomes across your populations. (DESCRIPTION) Slide, 3M Methodology Adoptions. Three maps of the U.S.A. with states delineated. and shaded. Key, dark green, State agency and managed care ad option, light blue, State agency commitment to adopt, striped, Managed care adoption only. The map on the left is mostly dark green with a few striped, a few white and one blue state, and is labeled All Patient Refined DRGs. The map in the middle is mostly white with some dark green, a few striped, and one blue state and is labeled Enhanced Ambulatory Patient Group. the map on the right is mostly striped, with some dark green and a few white states, and is labeled Population Health and Risk Groupers. Text, Notes: State agencies and commercial payers can have more than one 3M methodology adopted to support reimbursement, value, or population health intiatives. Some state agencies have committed to use a 3M methodology but have not implemented yet. Population health and risk groupers include 3M, C.R.G., P.F.P., P.P.R., P.P.C., or PFEs. Current as of May 2022. (SPEECH) So in conclusion, we have this pretty coherent strategy. If you look from left to right, some state agency implemented more than one of these methodologies and are in support of various initiatives. From the left side, you can see that the application of inpatient APR-DRGs, and then advancing into ambulatory care and looking at the enhanced ambulatory or EAPG application and implementation. And then, finally the adoption of population health and risk groups, which is really tied to our PFEs-- or I'm sorry, our PPAs and our-- yes, our PFEs and our CRG applications. I'll be turning the discussion over now to my colleague, Dawn, who's going to show you more specifically how we use methodologies and enable rate-based efficiency measures that can create some unique and prospective applications. I think you'll see how the implementation can strengthen both your value-based care and population health initiatives. So thanks again for joining us. And Dawn? (DESCRIPTION) Text, Success stories: Tracking & incentivizing Medicaid outcomes. All examples are from publicly available sources. Analyses not published by 3M do not necessarily reflect 3M recommendations and have not been approved by 3M. They are listed here for the information of people interested in the various ways that 3M patient classification methodologies have been applied. As well, please note that listing these examples does not imply endorsement of 3M methodologies by individual authors, other organizations, or government agencies. (SPEECH) Thanks so much, Lisa. We're so glad that all of you have joined today. And I'm particularly pleased that 70% of you are familiar with 3M potentially preventable events. So I'll be going through many great examples, a brief overview of what CRGs and potentially preventable events are and some applications. So even if you have it licensed and are using it in one capacity, maybe there will be another use case that you can pick up on. And I certainly want to hit the most important points for people who may not be familiar and what differentiates us from typical quality measurements. I'm Dawn Weimar. I have quite a diverse background, a mix of clinical. I'm a pediatric nurse who cared for children with special health care needs. I've run analytics for a disease management firm. I've done software design and I've implemented bundled payment. When I was at the disease management firm, I worked with actuaries to quantify outcomes and I found that the typical approach of using disease-specific outcome measures did not drive quality improvement and cause reduction overall for the system. Disease-specific measures are good, but they are very specific to those diseases as the name would suggest. After much searching, I became acquainted with the 3M approach and bundled payment through a white paper and got involved as a consultant implementing many of these methodologies. And so I'm going to go through a lot of information quickly today. I have loaded a good number of resources in this application. And then you'll have the opportunity to ask questions or follow-up. But hopefully this will be at a pace to keep your interest and be highly informative. The major question is, do you have analytical tools that allow you to create a strategy, establish benchmarks, and then also intervene at the patient level? Further, that will actually result in driving down costs and eliminating avoidable utilization. I'll show you examples of how 3M rate-based efficiency measures, the PPEs, potentially preventable events, allow you to do both. We are going to dive into success stories. But first, let's look at a very brief primer on the 3M methodologies. (DESCRIPTION) Slide, 3M building blocks for patient classification. A graphic on the right shows puzzle pieces in a square with a purple row labeled System Quality & Efficiency across the top, a light purple row labeled Population Risk Stratification in the middle, and two green rows labeled Bundled Payment on the bottom. Text, 3M building blocks for patient classification. Proven savings and quality improvement in large scale deployments. A.P.R. DRGs & EAPGs- bundled payment at point of care. Episodes built upon per stay & per visit bundled payment. Clinical Risk Groups- clinical cohorts for population health, including S.D.O.H. Potentially preventable events (PPEs) payers publish savings and quality improvement in large scale deployments.Keys: Sophisticated patient classification methods. Systemic measures of quality. Appropriate case mix adjustment. Patient classification methodologies. 3M Health Information Copyright 2018, All Rights Reserved. 3M Confidential (SPEECH) I like this graphic because it shows the interrelatedness of all the 3M methodologies. 3M is an expert in coding and clinical classification. This graphic depicts 10-patient classification methodologies developed and owned by 3M and their relationship to one another. The methodologies have two major purposes to keep in mind, to define the products of health care and to measure health care outcomes. You'll see what Jeff Turnipseed talked about last time was inpatient bundled payment, APR-DRGs, and outpatient bundled payment, EAPGs. Also, part of our bundled payment package is an episode gripper. So we have that available. It's highly configurable for both cohort episodes and event-based episodes. So something we really want you to know is available. But then in terms of population health and quality outcomes, CRGs is really the risk adjustment tool that goes across inpatient and outpatient care. You can actually also include pharmacy data into CRGs for a more accurate picture. In addition, you can load functional health status. And CRGs are sensitive to social determinants of health, which you will see later. The potentially preventable events, I think, are the icing on the cake. They sit at the top. On the inpatient side, we have potentially preventable complications and readmissions. On the population health side or reflecting the quality of outpatient care and follow-up are potentially preventable admissions, ED visits and services. Also, within readmissions are visits to the ED after a discharge. So that's a nuance added just a few years ago to our PPR methodology. And so this is a rate-based approach, and I'll show you examples of that. And it really helps you to get a picture of health system, efficiency, how it is functioning so that providers themselves can take a look and drill down into how they can improve. The name potentially preventable implies that we don't expect that every admission or instance is absolutely preventable. We not advocate you cutting payment just because something is listed as potentially preventable. That's why we focus on a rate-based adjustment. And there's a lot of beauty in that in terms of setting a goal and letting providers drive toward that. (DESCRIPTION) Slide, Overview of the 3M C.R.G. assignment process. Text, At the broadest level, the 3M CRGs are organized into ten health status groups. A table with the columns 3M C.R.G. health status groups, Examples, Base 3M CRGs, Severity levels, and Number of 3M CRGs. (SPEECH) This is really to give you an overview of clinical risk groups or CRGs that I'll call it for short. This is a good way to get an analysis of your population and their health. And CRGs is often used for risk adjustment purposes. Your entire population is categorized by CRGs. All the health status groups are on the left hand side from 9 catastrophic condition to 0 and 1, non-users and healthy. You can see examples of each of these health statuses from organ transplant, malignancy. This is an important section here, 5, 6, 7, where you have multiple instances of chronic diseases. And some of the types of diseases you will see, like CHF, diabetes, and COPD, multiple minor chronic diseases, maybe not minor to the patient, but minor in terms of resource utilization for health care, and then single minor chronic diseases and significant acute disease. What you'll see is that our experts within clinical and economic research, we have clinicians, economists, policy people, programmers that really dive coding experts. They base the CRGs and their structure in each of these categories based on what's really needed within that cohort. So you'll see differing numbers of base CRGs. Severity levels can range from 1 to 6 severity to really identify the best cohort in terms of resource utilization and the constellation of diseases. And then the total number of CRGs. So you'll see-- here's a five-digit CRG. (DESCRIPTION) On the right, a blue box shows an example C.R.G., the top has a 5-digit code with the first four labeled the Base C.R.G. and the last labeled Severity. The base C.R.C. is further broken down into the first number, labeled the Health Status, and the next three, labeled the Diagnoses. (SPEECH) The first digit is 7, indicating health status, 7-- significant chronic disease. The three digits in the middle are the constellation of diagnoses for that patient. And then the severity for this patient is severity level two. So that's what we'll be talking about as I go through the examples. (DESCRIPTION) Slide, Texas Medicaid: results from financial incentives for MCOs Using 3M rate-based efficiency measures. Text, Testimony from the Texas Association of Health Plans. A bar chart labeled Medicaid Health Plans Reduced Potentially Preventable Events has columns with STAR and STAR-PLUS bars and show percentages of reduction from 10 to 50%. Text, Note: Star is the original Texas Medicaid managed care program; Star-Plus is the Texas Medicaid managed care program for seniors and people with disabilities. Text, Medicaid M.C.O. P4Q initiative focuses on improved outcomes for V.B.P., 3% of M.C.O. premium at risk for quality using PPEs. 10 to 25% of newly enrolled individuals do not select a managed care plan. Estimated $88 million sustainable annual savings. P.P.A.: $48 million. P.P.C.: $11 million. P.R.R.: $25 million. P.P.V.: $4 million. Dollar estimates from 3M based on data from Texas H.H.S.C., Combined Report on Quality-Based Payment and Delivery Reforms in Medicaid and the Children's Health Insurance Program, Report to the Texas Legislature, Feb. 2017, and Texas Association of Health Plans, Senate Bill 760 Public Stakeholder Forum, June 6, 2016. See also Mialwee B, Goldfieid N, Turnipseed J. Achieving improved outcomes through value-based purchasing in one state. American Journal of Medical Quality. 2017:3312. (SPEECH) Often, Medicaid programs are published publicly and we can refer to those to learn from. We will also have some commercial examples. Oh, dear. Let's see. Here we go. This is a great example from Texas Medicaid. You can see that they applied our potentially preventable events. And CRG is-- I think I keep accidentally hitting this, unfortunately. I need to move my cursor. To potentially preventable admissions, complications, readmissions, and ED visits. You can see-- this is moving by itself. I'm not even touching it now. That is so odd. You can see that there are decreases in utilization and costs in each of these areas. And Texas published the estimated savings at $88 million annual sustainable. (DESCRIPTION) Slide, Potentially Preventable Events can be reduced. The word, can, is underlined. Six panels show reductions in states. Minnesota All-Payer Readmissions down 19%, Maryland All-Payer Complications down 57%, Texas Medicaid Admissions down 21%, New York Medicaid DSRIP Readmissions down 17%, Texas Medicaid ED Visits down 3%, and M.N. High-Risk Elders Readmissions down 44%. (SPEECH) This is a great slide because it's a compilation of several state programs that have had reductions in potentially preventable readmissions, complications, admissions, and ED visits. And we will go through some of these in more detail in ensuing slides. (DESCRIPTION) Slide, Typical payer outcomes - HEDIS disease-specific measures. A table on the left lists 20 measures. Text, Quality measures: Reliant on patient contact and engagement. Labor intensive reporting, easier with EHRs, medical record checks when dollars at stake. What will help you achieve the Triple A.I.M.? Can it be achieved? YES!! (SPEECH) This is just an example of disease-specific measures. I think you are all very familiar. We're looking at asthma control medications. Oftentimes, HbA1c is measured for diabetes, not only that the tests were done, but what the scores were. But there are a few issues with this. Does 20 measures, even if you have 20 measures that you're measuring disease-specific, does that really show where the health system is efficient or inefficient? Not really. And some of the problems we often ran into with the actuaries is in order to impact the results, you have to engage the patient and get the patient to actually take action, to make an appointment or go get a lab test. So oftentimes, that's a difficulty, and then that results in low denominators. So it's hard to prove that you're making the impact that you want. And so that's why there's beauty in the 3M potentially preventable approach. So that's the strategy that we can employ. (DESCRIPTION) Slide, Paying for high value care in New York State. Text, Achieve the triple aim of improved population health, quality of care, and reducing health disparities and per capita cost. A bar chart shows of a 5 Year Trend in the N.Y. Medicaid DSRIP Program with reductions over 25% in P.P.A., over 15% in P.P.R., and almost 5% in P.P.V., Text $42 billion in managed care premiums, prospectively risk-adjusted using CRGs annually, 86% of managed care expenditures are managed under a value-based program, 56% of value-based programs share financial risk with providers and include S.D.O.H. intervention(s), plus or minus 2.5% performance target for P.P.A. utilization and costs annually from baseline for managed care plans. (SPEECH) So let's look closer at some examples, like New York State DSRIP. They used clinical risk groups to adjust their managed care rates. This is $42 billion in managed care premiums. And in fact, they saw a reduction in PPE over a five-year period. How is this accomplished? Well, it's by providing data to the very smart people who run hospitals and health care systems. And if you show them how they compare to their peers and where they need to improve, they can perform root cause analysis to discover how to remediate where their performance is worse than average. Value-based care and having payment tied to care really requires data. And let's look at a few more examples. (DESCRIPTION) Text, Better results. Fewer readmissions. 20% reduction in readmissions-or 8,800 healthy nights at home-leading to $70 million in savings, asterisk, Minnesota Medicaid and D.O.H. using 3M PPRs. Source: McCoy, et. al. Reducing Avoidable Hospital Readmissions Effectively: A Statewide Campaign. Joint Commission Journal on Quality and Patient Safety, 2014. (SPEECH) This is Minnesota Department of Health. It depicts their reduction in PPRs of 20%. (DESCRIPTION) Text, Sustainable cost savings. With better quality. $35 million in avoided costs with better primary care, reduced ER visits and readmissions, and higher continuity of care, asterisk, Wellmark Commercial ACOs in Iowa, $35 million in waste avoided, Wellmark Blue Cross & Blue Shield. (SPEECH) And then on the right hand side, Wellmark Blue Cross and Shield, its accountable care organization contracts with 13 hospitals and clinic systems. They reported saving $35 million in health care costs and decreasing potentially preventable events. So there's a commercial example as well. (DESCRIPTION) Slide, Maryland: reducing Potentially Preventable Complications. Two graphs. A bar and line graph on the left titled Maryland Trends in All-Hospital Potentially Preventable Complications moves down over five years to the right from over 53,000 to around 17,000. A bar chart on the right titled Examples of Changes in Maryland Rates of Potentially Preventable Complications, 2013 to 2014, shows reductions of various complications from 13% to 33%. Text, Between F.Y. 2010 and F.Y. 2015: 57% decrease in P.P.C. rate per 1,000 at-risk admissions from 1.92 to 0.80. Statewide PPCs reduced from 53,494 in 2010 to 17,028 in 2015. (SPEECH) Love this example in Maryland because Maryland implemented a statewide program. You may know that they have a unique financing mechanism across all businesses and payers, and they wanted to reduce potentially preventable complications. And you can see that over a five-year period, they had quite the decline in inpatient potentially preventable complications. You can see on the right that these are major complications. These are only six of the six years so that 3M offers tracking in, but septicemia, post-op wound infection, decubiti, shock, venous thrombosis. There is some thought that some of these complications typically could not be reduced, especially when you look at cancer patients and central line infections, which has been a major focus. But we've seen that when focused upon, you can impact results. And this PPCs are not as often used as some of the other methodologies. But as a clinician who worked in the hospital, I would really like to see this used more frequently, not in a penalty sort of basis, but again to inform providers of where their results may be aberrant so that they can make changes or look into root causes for why their results may be worse than their peers. And so they can make improvements because these impact patient lives as well as dollars. How did Maryland do it? They gave comprehensive definitions of possible complications to the providers. They described clinical conditions under which the complication is potentially preventable. That's within the definitions that 3M produces definitions manual for every methodology that we have. And we're always open to provider feedback. So we will always listen to questions raised. Clinical economic research is happy to do that or to look at data. This is risk adjusted by APR-DRGs. So having a risk adjustment method that is clinically credible when you're comparing providers or hospitals and state benchmarks were set. (DESCRIPTION) Text, 3M rate-based efficiency measures: Strategy, benchmarks and patient actionability, Value-based care, Population health. (SPEECH) So I mentioned that I consider these rate-based efficiency measures. That's how I like to differentiate from disease-specific. 3M has produced the stable thermometer that does measurement in a specific area and by which you can set your strategy, set your benchmarks, allow for patient actionability at the point of care, and also establish your value-based programs, care, and payment, as well as population health. And I like Liz Mccullough, the director of Clinical and Economic Research for 3M, summed it up that every quality manager knows where there is variation, there is opportunity. That's what we're looking for is opportunity to improve health care. (DESCRIPTION) Two line graphs. Text, The charts show A slash E ratios for 154 Texas hospitals (excluding low-volume hospitals). Variation in case mix-adjusted performance indicates room for hospitals to learn from each other. Chart 2.4.3 on the left shows Ranking of Hospitals by A slash E P.P.C. Stays and Chart 2.4.4. on the right shows Ranking of Hospitals by A slash E P.P.C. Cost. Each has a line through dots that begins at negative 2 on the left and rises in a curve to the right, crosses a horizontal line at 1, then curves up as it continues right. Text, Source: Texas Health and Human Services Commission. Potentially Preventable Complications in the Texas Medicaid Population, S.F.Y. 2012. Austin, TX: H.H.S.C., 2013. (SPEECH) This is a great example of how the data is sliced and diced in order to turn on the lights for providers. So these were actual charts used in the State of Texas for Medicaid. An A/E or actual to expected ratio was calculated for each of the hospitals, again, risk adjusted using APR-DRGs. In every one of the 154 hospitals, there A/E ratio is plotted on this chart. This is utilization. This is cost. Everybody above the line is worse than expected. Everyone below the line is better than expected based upon their risk mix within their hospital. And so the goal is to help these hospitals see that they can move toward that bar and maybe even get under that bar. States that have employed these or payers that have employed these, there is a sharing in terms of how can we improve our outcomes. So we encourage that. In addition, even a 10% improvement is going to save money. So that is really how a rate-based approach is set up and utilized. (DESCRIPTION) Slide, New York: Patient alerts at the point of care. Text, N.Y. Medicaid provides monthly data feeds to 25 performing provider systems serving almost 6 million people. Clinicians can see on-screen "patient alerts" during the patient visit. A chart shows a member ID and lists clinical data for the patient. (SPEECH) In New York State then, what they did is take that information and make that available at the point of care. That's very important as well. The providers who are actually interacting with the patient, it's really helpful to have a summary of the patient's clinical information. So you can tell from this that this is a 60-year-old female patient. You've got the demographics summary. You have the CRGs, which then they can interpret as health status 7. The constellation of major diseases has congestive heart failure, diabetes, and mental health issues with a severity level of 6. You can see that this patient had one potentially preventable admission and nine potentially preventable ED visits. So it's much easier for the clinician who's subject to the value-based payment arrangements to understand that this patient is having these occurrences. And what can we do to help this patient better manage their disease? Maybe better manage the exacerbations to avoid this potentially avoidable utilization. (DESCRIPTION) Slide, Applying C.R.G. status and PPRs for post discharge targeting. A chart titled Rate of PPRs per 1,000 per year. It has a column on the left titled C.R.G. health status description and a column on the right labeled C.R.G. severity of illness ranked in sub columns from 0 to 6. Text, Medical sample data roughly 2 million people. Key, Follow up visit within Red, 3 days of discharge. Blue, 7 days of discharge. Green, 14 days of discharge. Higher severity and higher C.R.G. levels have red entries. (SPEECH) So this is an example of-- in North Carolina, they use CRGs and potentially preventable readmissions to target post-discharge follow-up. And essentially, here we have the CRG three level of aggregation being used, which is simply the intersection of CRG health status with the CRG severity of illness. And you can see that all the PPR per 1,000 rates in red are the patient sections or cohorts with the highest risk of readmission. And so what this client did was prioritize follow-up for every one in the red patient cohorts to three days within discharge, and then adjusted the other patient cohorts accordingly. Everyone has scarce resources. So where can we focus? And what's important about this is it's just not based on the top health statuses. It really is the interaction of health status with the CRG's severity level. (DESCRIPTION) Slide, Why "diabetes" is an unhelpful description of health status. A chart titled Percentage Frequency by A.C.R.G. 3 of 738,452 Medicare Enrollees with Diabetes. It shows Health Status Group on the left from 1, Healthy down to 9, Catastrophic Conditions, and the Severity Level from 1 to 6 on the right. Health status 5 Severity level 1, at 5%, and health status 9, severity level 6, at 2%, are circled. Text, Source, analysis of a Medicare database. Note: cells are blank when the share of people with diabetes in that cell rounds to zero or there is no corresponding seventy level tor that Health Status Group. In a large database of Medicare enrollees, 738,452 people had diabetes (E.D.C. 424). Individual enrollees ranged from diabetes, severity 1, as their only chronic disease to people with diabetes along with a catastrophic condition, Severity 6. Copyright 3M 2020. All Rights Reserved. 3M Confidential. (SPEECH) So oftentimes, we talk about disease management programs for our diabetic population. But we're going to look at the next three slides the diabetic population, a few different views using about 200,000 Medicare members. And what you can see is that one diabetic was very different than the other diabetics. So you've got some with only single diseases or moderate chronic disease and some with catastrophic conditions. This makes a big difference in terms of how you are managing your population. (DESCRIPTION) Slide, For people with diabetes, average cost varies widely. Text, Average Relative Weight by A.C.R.G. 3 for Medicare Enrollees with Diabetes. The same chart, with health status 5, severity level 1 at 0.64 and health status 9, severity level 6 at 52.89 circled. Text, People with diabetes in A.C.R.G. 3 51 had average costs 36% below the average enrollee in the entire database, while people with diabetes in A.C.R.G. 3 96 had average costs greater than 50 times higher. Knowing someone has diabetes tells us very little about cost; we must look at the whole person. (SPEECH) This slide shows the same breakdown by ACRG3. I have a trouble saying that three. For people with diabetes, you can see that their average cost varies widely. 0.64 is the average relative weight, which is much lower than the average enrollee in this data set. And down here in this corner, if they have a catastrophic condition with severity of illness six, they're 50 times higher than the average enrollee in the population. (DESCRIPTION) Another slide with the same chart titled Percent of Total Casemix ( equals Average Relative Weight by Enrollees) by A.C.R.G. 3, with health status 6, severity level 6 at 8%, health status 7, severity levels 5 and 6 at 7 and 17%, and health status 9, severity level 6 at 11% all highlighted. Text, Of all people with diabetes in the database, the most costly 10% accounted tor 41% of total cost. The highlighted ACRGs contributed the most to total cost. The 41% figure was calculated using more detailed data. (SPEECH) And then on this slide, you can see that 10% of the population is just in four of these cohort segments and account for 41% of the cost. So CRGs really helps you to look into your population and decide where your priorities should be, and then also dig into the population at a patient level. (DESCRIPTION) Slide, Promoting better health care in Florida. Text, Drive improvements in health outcomes and equity, efficiency, and innovation that result in high quality and lower cost of care for Medicaid enrollees. 3 key goals. Reduce potentially preventable events (P.P.A., P.P.R., P.P.V.), Improve birth outcomes, Improve access to in home long-term care and preventative dental services, Regional quality targets, For managed care organization performance tied to capitation rates, Performance improvement projects, Statewide with payer and provider collaboration to share best practices on impacting program goals. (SPEECH) So another interesting example is Florida Medicaid has recently implemented CRGs and PPEs and asked their managed care plans to set targets for improvement. It's too early for results. (DESCRIPTION) Slide, Understanding population health: Florida example. Text, Of the 4.0 million enrollees, 32,000 are in C.R.G. Health Status Group 7, Chronic Disease in Three or More Organ Systems. A chart shows a horizontal bar graph, with one bar broken down into another horizontal graph focused on Congestive Heart Failure, Diabetes, C.O.P.D., with the label, Of the 32,000 people in Health Status Group 7, approximately 2,000 have heart failure, diabetes, and COPD, split roughly equally in severity levels 1 to 6. (SPEECH) But another interesting use case that Florida did using CRGs is about 100-page population health study, where they took their 4 million Medicaid enrollees and found that 70% of them are healthy. The other 31%, this shows the capability of using CRGs to really understand your population. These are the various health statuses that I showed you before. If we look at dominant chronic disease in three or more organ systems, we can further drill down into the constellation of diseases. Very common is diabetes, hypertension with other, but this slide is focused on congestive heart failure, diabetes, and COPD. So there's lots of different ways for you to slice and dice and look at data and be able to really decide on your priorities. (DESCRIPTION) Slide, Clinical Insight: Defining medically complex children. A screenshot of a research paper with a line graph that shows a growth in hospital discharges for those defined by C.R.G. Text, Researchers used CRGs to conclude that the greatest growth in inpatient growth at 28 children's hospitals was in the cohort of children with chronic conditions in two or more body systems. Berry et al., JAMA Pediatrics, 2012. The C.R.G. grouper is a powerful tool for identifying and tracking patients over time. Children's Hospital Association, Coordinating All Resources Effectively for Children with Medical Complexity, 2016 (SPEECH) This slide, 3M did much work with the Children's Hospital Association, formally called NACHRI, to be sure that CRGs were appropriate for children, especially children with special health care needs. Therefore, the Children's Hospital Association is one of the big users of CRGs. In fact, we have an Ohio pediatric hospital, ACO, that uses CRGs to really hone where they deploy population health management, care management resources. And the other comment from this study is that they found it to be very helpful for tracking health status longitudinally. I've heard that from other leaders, there's a Denver health study that makes that same point and why they chose to use CRGs. But in this study, they were able to find that children with chronic conditions were the cohort that were responsible for the most inpatient utilization growth. So risk adjustment and rate setting is also a use case for CRGs that I certainly wanted to touch on. And we're interested. If you have those use cases, we are by all means interested in how you're using this. (DESCRIPTION) Slide, Health status group distribution by L.O.B. A chart with C.R.G. status on the left from 9 down to 0, non-users, with columns on the right for Medicaid, Commercial, and Medicare, with percentages over various health statuses for Medicaid from 0.19% to 43.93%, for Commercial from 0.28% to 35.97%, and for Medicare from 1.62% to 30.42%. Text, Note: Status 2 includes deliveries, newborns and other DXes with significant acute DXes. Status 1 includes deliveries, newborns and other DXes without significant acute DXes. (SPEECH) So this is an analysis done with differing data sets, of course. But just looking at the variation and health status by line of business or by payer stream, Medicaid commercial, Medicare, however you refer to it, and you can notice that the highest percentage of chronic conditions or catastrophic is in Medicare. We know that it's within Medicaid and commercial as well. But this really turns the lights on if you're managing different lines of business perhaps within one population health department. (DESCRIPTION) Slide, Reducing expenditures and improving quality for children. Text, Integrated Care for Kids Illinois- Egyptian Health Department. Goals: Support and deliver value-based care to children in rural counties: Increase early identification and treatment of children that with higher levels of physical, behavioral, or other health-related needs for 80% of the population. Leverage integrated care coordination hubs to deliver enhanced community, social, and clinical and community support. Alternative payment model to reduce costs for emergency department visits, inpatient psychiatric care, residential substance abuse. Design shared savings model with incentives for provider, care team, and community support leveraging 3M Clinical Risk Groups. Wayne, Hamilton, White, Saline, and Gallatin counties. County population exceeds national average poverty rate. 7,900 Medicaid beneficiaries under 21. $15.6M investment 2020 to 2027. (SPEECH) This is another example of Egyptian Health Department, which is one of the participants in integrated care for kids. They are using CRGs to design a shared savings model, especially because CRGs are so well designed for sicker or more specialized populations, including pediatrics. So it's just another example. (DESCRIPTION) Slide, Risk adjustment in shared savings program: Ohio example. A chart titled Ohio Comprehensive Primary Care (C.P.C.) per member per month (P.M.P.M.) payment calculation shows Tier 1, the top 3 CRGs, at $1.80, Tier 2, the next 3 CRGs, at $8.55, and Tier 3, the last three CRGs, at $22.00. (SPEECH) Ohio Medicaid has an example where they're using CRGs, and they're using it at the health status level to stratify patients into three tiers, which affects the PMPM that's paid to PCP within the CPC and CPC for kids programs. (DESCRIPTION) Text, C.R.G. Aggregations. v 2.2. Concurrent. A pyramid with the top level labeled 10 Health Status, the next 26 slash 54 ACRG3s, the next 120 slash 299 ACRG2s, the next 211 (base) slash 680 ACRG1s, and the bottom 366 (base) slash 1,338 CRGs (including severity). (SPEECH) And so I put the CRG aggregations here because there's a lot of flexibility. And we've done all the work stratifying that for you and aggregating these CRGs so that it can be used for different use cases. In fact, for COVID, we used one of the different levels of CRGs stratification. But it just gives you another example of using CRGs for rate setting and risk. (DESCRIPTION) Slide, Risk adjustment in shared savings program: Ohio example. A bar chart titled Relative to peers: practices are ranked based on risk adjusted T.C.O.C., and bars fall to the right. A table is titled Relative to Peers: T.C.O.C. is calculated for each practice and then adjusted for differences in risk profiles across practices. The table shows Objective, What it’s applied to, and How it’s calculated for T.C.O.C. and Risk adjustment, with 3M C.R.G. listed in the Risk Adjustment how it’s calculated section. Text, Ohio rewards comprehensive primary care practices for managing total cost of care (T.C.O.C.) relative to their peers and to their own past performance. C.R.G. risk adjustment balances incentives for efficiency and access. (SPEECH) In addition, the State of Ohio uses CRGs for risk adjusting total cost of care. Each member is assigned a CRG. And then that dictates the overall risk of that practice. (DESCRIPTION) Slide, Risk adjustment for Potentially Preventable Events. Text, The 3M quality philosophy is not "this should never happen" but rather "this has happened too often. How often is too often? It depends on the patient's health status. For a commercial insurer, for example, cost of potentially preventable admissions was $0.33 P.M.P.M. for people in Health Status 1, but $111.86 for people in Health Status 9. We measure performance as actual vs expected, where expected depends on health status as measured by C.R.G., The P.P.A., P.P.V. and P.P.S. methodologies are covered in more detail in a separate training. A chart titled Table 1, Types of Patients with Different Types of PPEs, p.m.p.m. percent Commercial Plans, lists Types of patient on the left and the columns P.P.I.A, P.P.R., P.P.V., P.P.S., Total P.P.E. Enrollmees, and Total P.M.P.M., with P.P.I.A. at 0.33 for Healthy and 111.86 for Catastrophic. (SPEECH) And this is another example. Essentially, here are all the health statuses. You've got potentially preventable admissions, readmissions, visits, and services across the top. And this was data run for a commercial plan. You can see that potentially preventable admissions are much higher costs for people with catastrophic conditions than with those that are healthy. That's something that we could all assume and know that are true, but CRGs and PPEs confirms this risk. So you have the evidence you need to deploy necessary resources where they are needed. And then you can work at more granular levels as we have discussed. (DESCRIPTION) Slide, Case mix-adjusted payment: New York Example. Text, Since 2008, N.Y. Medicaid has used CRGs to calculate case mix-adjusted MCO capitation rates. P.M.P.M. base rate times risk score = P.M.P.M. payment. F.Y. 2018 base rate reflects historical average cost by region and eligibility group, trended forward with adjustments. F.Y. 2018 risk score is the historical average C.R.G. case mix Example: TANF children in Mid-Hudson region. Plan A: $198.54 times 0.9452 equals $187.66. Plan B: $198.54 times 1.0732 equals $213.08. Each plan may also receive plan-specific add-ons, e.g., quality incentives Creates strong incentive to economize while paying more to plans. that serve sicker members. (SPEECH) And then one more example. New York State uses CRGs to case mix adjust managed care payment $28 billion a year for 4.4 million members. And why? They sent that to CMS to get their approval. CRGs-- they feel more fairly reimbursed plans with more severe case mix of members. And variation in reimbursement from plan the plan is based on member health status rather than inefficiencies. Because if you look at what's currently being spent, how do you know if that's really reflective of efficient care versus not and is totally accounted for by the health status of the members? So CRGs helps you to step back and make sure you don't bake in inequities or inefficient care into your models. That's a really good point. (DESCRIPTION) Slide, S.D.O.H. affects reimbursement. Integrate whole person risk into reimbursement to drive health equity. Enable better resource alignment across the healthcare system that account for clinical and social risk for the most vulnerable populations. Two tables titled Base condition - Asthma, and Base condition - Schizophrenia, show calculations based on the primary condition, the S.D.O.H. I.C.D. 10 hyphen D.X., and the Final C.R.G., with a Weight (TANF Child or Adult) and a P.M.P.M. (N.Y.C.). The final amounts range from $263.47 to $1,833.38. One of the tables disappears from the slide. (SPEECH) Oh, that's odd. Oh, it disappears on me. Well, that first example is supposed to show that foster care doubles the relative weight, thus the PMPM within New York State for reimbursement. So for a child, that's an example of how SDOH affects the CRG assignment and therefore the payment that the provider gets. I'm glad we can see the schizophrenia example. This is a patient with schizophrenia that in the second example is also homeless. So you can see the relative weight, and thus the PMPM are almost triple because of the homelessness alongside the schizophrenia. So CRGs, if you're looking for a methodology that will help you move into the next phase, which is how do we really adjust for social determinants of health, CRGs can help you with that. (DESCRIPTION) Slide, Case mix adjustment in value based purchasing. Text, Health plans in 11 states uses CRGs in risk-adjusting measurement and payment to provider entities such as ACOs and group practices. a table lists providers on the left and columns for Members, Member Months, C.R.G. Weight, Total Paid P.M.P.M. dollars, Total Expected Paid P.M.P.M. dollars, and Total percentage difference, with Provider 2 Total Paid P.M.P.M. dollars at $477.08, Total Expected Paid P.M.P.M. dollars at $489.87, and the Total percentage difference at negative 2.6% and Provider 4 Total Paid P.M.P.M. dollars at $477.18, Total Expected Paid P.M.P.M. dollars at $424.24, and the Total percentage difference at 12.5%. Text, Apples to apples performance comparison measuring the distance from the risk adjusted expected value. (SPEECH) And this is one last example of a commercial plan that ran their data. What you can see for provider 2 and 4 is that their total paid PMPM looks very similar until it's adjusted for their risk, their case mix risk using CRGs. And then you can see their total expected is very different. One is higher and one should be much lower. So one is performing better than expected and one is performing a little worse than expected. So that's how CRGs enables you to really risk adjust your data. If you're doing any provider profiling, this will help you when providers say, well, you're not adjusting for the fact that my patients are sicker. This will help you address that. And CRGs are used for case mix adjustment to support value-based purchasing in 11 states. (DESCRIPTION) Text, Resources. (SPEECH) There's so much more I could say about clinical risk groups and potentially preventable events, and 3M's rate-based approach. You've seen many of our success stories and examples of use cases to really get your gears moving to consider how these methodologies could be applied by your organization perhaps over and above what you're already doing, how your organization can identify variation so providers can act upon it. This is very important role into your value-based objectives. So as I said, we could dive so much deeper. Please take a look at the resources we've loaded. Please contact us. We have so many published articles and papers and studies to really inform your use cases. And we're always happy to assist you with that. For now, I will turn this over to Lisa for Q&A and next steps. Thanks, everyone. Thanks, Dawn. Great-- Oh, other Lisa. Go ahead, Lisa. Oh, no, go ahead if you want to talk about some of those resources. And then we'll go over to questions. Go ahead. (DESCRIPTION) Slide, 3M - How we can help. A table with a column titled Workstream on the left with the entries Project management, 3M subject matter experts, Methodology training and education, Grouper output optimization, Grouper version transition, Payment services, Benchmarks and norms, Reporting best practices, Program design and documentation, Program policy documentation, Metrics design, External stakeholder education, Clinical documentation, coding, audit, Supported 3M Methodologies, Supported Methodologies. It has columns on the right with check marks, titled Methodology Content Services (M.C.S.), and Additional Consulting Services broken into Value Based Programs, Reimbursement, and Quality. (SPEECH) Sure. So we mentioned that there's a number of resources available to you. Again, we can set up additional time to review the methodology, the content services as part of our consulting effort. So we have that available as well as quite a few education modules. (DESCRIPTION) Slide, 3M methodologies supporting materials. A screenshot of a 3M application with links for the methodologies. A table on the right lists the methodologies as 3M Methodology Content Services (MCS), 3M All Patient Refined Diagnosis Related Groups (APR-DRGs), 3M Enhanced Ambulatory Patient Groups (EAPGs), 3M Clinical Risk Groups (CRG), 3M Patient-focused Episodes (PFE), 3M Potentially Preventable Events (PPE), 3M Population-focused (PPC), 3M Potentially Preventable Readmissions (PPR), 3M Potentialy Preventable Admissions (PPA), 3M Potentialy Preventable Emergency Department Visits (PPVs), and 3M Potentially Preventable Ancillary Services (PPSs), with links to the left to Fact Sheets, White Papers, and E-Guides. Asterisk, 3M PPCs, PPRs, PPV, PPA, and PPS are the 3M Potentially Preventable Events (PPE). 3M PPV, PPA, and PPS included as part of 3M Population-focused Preventables (PFP) grouper. (SPEECH) And then, we also allowed for-- let's see. Move in the right way here. We'll provide you with links. There's all kinds of information on our website that is customer-facing. You able to access more information and tutorials on all of the methodologies, as well as some webinars and some podcasts and white papers. So Lisa? (DESCRIPTION) Text, Questions? (SPEECH) Now over to this Lisa. [LAUGHS] Sorry about that. And thank you to you both for the information today. It's been a lot, and it's been great. So thank you so much. One question that we did have come in, as a payer or provider organization, how can I help position these methodologies with providers to gain broader adoption? It's a very good question. Hi this is Kevin Clark, 3M Health Information System Business Development Manager. I support Lisa and Dawn. That's a good question. Some of the key points that providers like to hear when using our suite-- [AUDIO OUT] Oh, we're losing him a bit. Can you still hear me? Now we can. Yes-- Oh, there you are. Start. Yup, start again. Sorry about that. So potentially preventable readmissions as opposed to all cause readmissions-- [AUDIO OUT] Seven-year-old again. I think I know where you're going Why don't you let me answer this. So one example is potentially preventable readmissions for our methodology is actually the readmission must be clinically related to the initial admission. So it's much more defensible in terms of a methodology, especially when you're impacting provider payment. It's more fair. It's clinically defensible. And so we have painstakingly gone through all of our methodologies to be sure that it is logical and clinically defensible. Readmissions is just one example. But we have many exclusions also in each of the potentially preventable admissions, readmissions, complications so that if we really think it's unavoidable in certain circumstances, we don't count those. And as I said, we are open to provider feedback. 3M has been involved in implementing these in many states statewide and did many presentations to groups of providers, and really no major pushback. Allowing providers access to some level of data is helpful. And so 3M assists with that. We'd like to see you using the same data source for the benchmark type of numbers and strategy that the plan is doing, and then that related detail going to the providers in some fashion too. So there are always problems if you have two different data sources. The plan can really have a huge impact in making sure that happens. That providers get their data, understand where their data is coming from. And 3M is always happy to support that. And Kevin, if you can speak up, then please do. Sure. Sure. Also, as it pertains to clinical risk groups, it is a very sophisticated tool for capturing the illness burden of patients, which is an area physicians look at when adopting any sort-- [AUDIO OUT] --analogies to make sure that the appropriate way for physicians to get on board with adopting these. So there's three things. There's transparency and sharing of data, necessary data, on a timely fashion. That helps potentially preventable readmissions, and they're clinically related to the original admission and the capture of the illness burden of the patients through clinical risk groups are all very good points and very well accepted by physicians in the area. Are there any others? (DESCRIPTION) Text, That's a wrap. (SPEECH) At this time, we do not have any other questions. But it's actually good timing because we are close to the hour. And so for our presenters today, we really appreciate all the information. As they mentioned, there are a bunch of resources. So make sure you download the articles and handout, as well as the certificate of attendance. If you do want to submit that for CEU, you can to an association of your choice. We also have in there the link. This was a three-part series. We have another one in August that follows up to this one. So if you do want to join us for the August session, you are more than welcome. And you can click on that link in there. And again, if you do have any questions, here is some other resources as well as the contact information for our speakers. (DESCRIPTION) Text, Thank you! (SPEECH) And so again, for our speakers today, we certainly appreciate you joining us. And if you have any other questions, please feel free to reach out, as well as if you'd like to learn more about our products and solutions in that center section, please let us know there, as well as completing the survey after just to let us know how we did. So again, thank you very much, and we hope you have a good rest of the day. Thank you to our speakers. Thank you all. Thank you. Thank you. (DESCRIPTION) Text, For More Information, Dawn Weimar, R.N., Senior Regional Director, Regulatory and Government Affairs, 3M Health Information Systems, 262-402-9614, Mobile: 262-893-0042, dweimar@mmm.com. Lisa Edstrom, M.B.A., Client Engagement & Strategy, Payer Solutions, 3M Health Information Systems, 651-336-6851, Imedstrom@mmm.com. www.3m.com/his/methodologies, 3M patient classification methodologies, www.3m.com/his/services, Consulting and related services, www.3M.com/his/vbc, Value-based care, www.3m.com/his, Health information systems Clinical and economic research.

(DESCRIPTION) A slideshow. Text, 3 M.. Science. Applied to Life. Slide, On 24 Platform Engagement Tools, a screenshot of a web page. New slide, Patient Engagement to Improve Outcomes. Carole Cusack, Director of Client Engagement and Strategy, Regulatory and Payer Solutions. (SPEECH) Good afternoon. And welcome to our webinar today, of patient engagement to improve outcomes. My name is Lisa Paulenich, and I'll be your host. Joining us today is Carol Cusack, director of client engagement and strategy. I will go ahead and introduce her here in a minute. But first, I do want to go over some housekeeping items, just so you can become familiar with the ON24 platform. (DESCRIPTION) Slide, Housekeeping items, a bullet point list. (SPEECH) So because this is a web-based platform, we do recommend using Google Chrome. Close out of VPN and multiple tabs just to make sure you're opening up bandwidth. If you are having audio issues, check your speakers settings, and do a quick refresh to clear your cache that should help with audio issues. There is no dial-in number. We do have engagement tools for again, better user experience. So if you want to make the slide area bigger feel free, we do have a resources section where you can find the handouts. We also have some other resources for you for our payers. And we also have links to listen to the previous recordings. We had a webinar in June and July, so if you're interested in watching those you can there. We encourage you to ask questions. So please feel free to ask questions throughout in the Q&A section. And then at the end, we always appreciate your feedback. So please complete that survey just to tell us how we did. (DESCRIPTION) Slide, Meet our speaker. (SPEECH) If you are interested in learning more about our speaker, there is a meet our speaker section in that platform. And in that area, you can read her bio. So if you are interested in learning more, you can meet her there. So without further ado, I'm going to go ahead and pass it over to Carol, to go over patient engagement to improve outcomes, Carol. Oh, great. Thank you so much Lisa. And welcome to everyone in webinar. As Lisa said, this is our third and final webinar of our 2022 series. If you've joined us for the previous webinars, you may find the first few introductory slides repetitive as I talked a little bit about 3M health information systems and what we do for our clients. Hopefully that background will give you some context about the topic I'll be speaking on today, which is key aspects of patient engagement that we believe are important to improving outcomes in health delivery. (DESCRIPTION) Slide, Who are we? 3 M's Business Groups, a list of four groups with pictures of people in the workplace. (SPEECH) So who are we? Well, who we are today and who will be in 15 to 18 months is changing. Today we're part of 3M Health Care Business Group. And you can see on the slide that 3M has four major business groups health being one. Now a few weeks ago, the CEO of 3M announced a planned spin off of health care business group into its own public company, of which 3M will have partial ownership. Now you might be wondering what this means, in this era of current his client joining this call. You might be wondering what the change means for our relationship. So I will give you a very simplified answer. And that is that this change will result in two world class public companies. One with a renewed focus on investment and growth in healthcare. And the other continuing its global leadership as a material science innovator. Now each will be better positioned to focus on the unique needs of its customers. And since the entire Health Care Business group will spin off. The people who research and develop our methodologies, and the people who build the technical aspects of application will all be part of the new company. So current clients can expect the same commitment to innovation around our methodologies and services that we share with you today. (DESCRIPTION) Slide, By the numbers, a graphical list of statistics. (SPEECH) So 3M Health Information Systems or HIS for short, authors industry leading clinical methodologies that are trusted by health plans, providers, and government agencies internationally. In the United States 3M methodologies are applied every month to roughly, 1 billion medical claims, which represents about 2% of the US GDP. So we offer methodologies for payment, monitoring performance, and risk adjustment, all of which identify opportunities and help us prioritize patient management. (DESCRIPTION) Slide, how we motivate high value patient care, a list of three approaches, and a picture of a woman in a wheelchair and a healthcare provider. (SPEECH) So HIS was formed in 1978, when 3M acquired an electronic coating company located in Salt Lake City, which is how we came to be headquartered there. In the 1980s, Bryan acquired a company located in Connecticut, that had just developed a reimbursement scheme for Medicare and patient payment. And I think you will all recognize that that's the diagnosis related groups of CRG. Now as a part of 3M this group has gone on to develop similar methodologies for other care settings, such as ambulatory. And other populations, such as commercial and Medicaid. And more recently, we've developed methodologies focused on identifying inefficiency in health care delivery, which are termed potentially preventable events. And we've developed clinical risk groups which are people grouper. And is used to describe with a clinical language all types of patients. Now this description can then be utilized in a population-based approach of treating broad groups of people with similar medical conditions, or at the individual level, considering each person's own comorbidities. We've also developed norms or benchmarks for these populations, which help our clients understand and improve value in health care delivery. So in essence, what 3M HIS has built over the decades is means to promote fair and accurate documentation, use that to create a clinical language and dialogue around stratification and efficiency in health care delivery. (DESCRIPTION) Slide, The new model, a picture of a man holding a toddler, a bullet point list, and a graphic titled Patient Centered Care, with a circular list of four approaches. (SPEECH) So what the industry has learned over the past several years, is that a better system of delivering care is needed. One that focuses on the whole patient as defined by both social and clinical risk. We also need a model for care delivery that's going to reimagine the continuum, to include key community partners to fill social gaps, that's going to incent strong relationships with patient managers, and provide broad access to high value services. And we'll discuss what I mean by that shortly. (DESCRIPTION) Slide, High performing primary care. (SPEECH) So high value health care delivery begins with high performing primary care and patient management. Now I'm going to share with you some blinded client data, to demonstrate how performance in primary care can vary, as well as the ways in which these differences end up affecting outcomes. (DESCRIPTION) Slide, Influencing healthcare spend, a pie chart. (SPEECH) So a few years back, we convened a panel of our clients medical directors. Our clients in my unit are payers, I should explain that. So we got the medical directors together to have a discussion around the degree of influence that primary care had on medical sense. Now, while there was a difference in opinion, which was not at all unexpected. They all landed at a number that was between 60% and 70% of expenditure. Now that makes sense if you look at this pie chart that is CMSes accounting for expenditure. You see that hospital care, professional services, and prescription drugs account for most of the dollar spent. And we know that when the primary care team is managing their patients well, there are less hospitalizations and less inappropriate use of the emergency department and low value specialty care. (DESCRIPTION) Slide, Promote directed care, a bar graph showing percent difference from expected total cost of care, comparing directed care, influenced care, and contributed care. (SPEECH) So most providers don't have a way to measure the influence they have on their patients, even if a longitudinal patient record is available, which it seldom is, we know that health care is still very scattered. That information is usually not presented in a way that allows for critical analysis. So these next two slides, will give you an example of data, we share with primary care teams, related to the strength of the primary care patient relationship. Which the data show is a strong driver of both cost and quality, as well as the patient experience across the continuum of care. Now I'm displaying the actual de-identified client data. And these data are from one primary care group with multiple practice locations. But what we can see here is consistent in similar data sets across all of our clients. So these data are measuring differences in risk adjusted total cost of care, for patients who are categorized in one of two ways. Those whose primary care providers are active in their management. And that's the data in the dark blue bars. And those patients who interact less with their primary care provider. And that's the data in the light blue bar. (DESCRIPTION) The light blue bars all display ranges in positive percentages, with the dark blue bars all in negative percentages. (SPEECH) Now within those categories as measured on the y-axis, we show the percent difference from expected in total cost of care for each group of patients, and then we aggregate up to primary care practices. Now this again, is a typical result, and it's highlighting that patients whose primary care providers are more involved in their management experience lower the cost of carrying a risk-adjusted basis. So two important points here. First, although the difference varies, the delta between the categories of directed and what we call contributed care is typically 30% to 40%, which is very large. The second point is, that the results are measured against the expected results of the population being managed. So we've risk adjusted these data accounting for differences in health profiles, and that's a very important step. Now the results are displayed by primary care practice location. And as you can see, there is a difference in what we term physician influence, within the same location. Now as the manager of one of these groups, I want to understand why the differences exist, the outcomes that the differences are generating, and the actions the practice could take to encourage improve results for the patients with higher total cost of care. So let's explore some facts about the providers and practice 3 and try to get at the heart of this variation. (DESCRIPTION) Slide, Efficient behaviors in primary care, three bar graphs for Group 3, comparing P C P Directs slash Influences and P C P Contributes. (SPEECH) As we drill down into provider practice 3, we can start to build an understanding of how the primary care behaviors can influence total cost of care. So I'm showing three data points from this practice. And we can see that the patients in practice 3, with higher touch primary care providers or those who care is directed, have a higher percentage of facility discharge follow up, a higher number of chronic care visits, which is appropriate. And as a result, their patients are experiencing a lower rate of disease progression. Now these common sense behaviors are promoting efficiency in care delivery. And the primary care teams that are not exhibiting these behaviors they're not directing the care of their patients, are leading the way to wasteful patterns in health care spending. So the key message here is, that we've got to get back to stronger patient management. Especially, with the incidence of chronic disease is on the rise. But it has to happen in a manner that that's going to incent the healthcare market to accept it. So a little bit of background on myself. I was the chief financial officer of a staff model HMO in the 1990s, so I can tell you that strict patient management was very unpopular. No one wanted to take the time to be managed. Patients saw this as an extra and unnecessary step in care delivery. So as society evolves, and the way we communicate and consume data evolves, health care delivery needs to track in the same path. And we'll talk a little bit about that at the end of the presentation. (DESCRIPTION) Slide, Outcome measures of value, a graphical list of preventable events. (SPEECH) So the example I showed, it was highlighting differences in patient management was really uncovering behaviors that generate differences in outcomes. Now sharing data regarding the influence of interventions such as follow-up care and chronic care management, helps the provider practice understand that there was a breakdown in the primary care relationship, for some of its providers, not all of its providers, but we could see the differences illustrated. But when this happens, either due to inadequate access, poor transmissions, or inadequate patient management, there's an increase in the amount of unnecessary or inappropriate services that a patient receives. And this is driving not only low value for the health care dollar, but it's also a poor patient experience. So I'm displaying the 3M potentially preventable events that our clients track and quantify. And then present to their physician partners, usually within an accountable care partnership of some level to align incentives toward improvement. So why is this type of measurement important? Because these metrics are a measurement of population and patient health outcomes, safety, efficiency, utilization, and the cost associated with avoidable care. All of which are at the heart of value-based care. Value increases when these metrics are reduced because costs are reduced and quality is improved. (DESCRIPTION) Slide, Measures of facility quality that impact patient outcomes, a graphical list. (SPEECH) So standards for value should be applied to both position care as well as facility services. The effectiveness of treatment in the setting where it took place within an event is also very important. To go step further, you should look at outcomes within an episode of care, which is considering not only the events, but also what happens in the leading in trailing windows of that service. So these data points can be measured, the patterns can be analyzed. And then you can start to look for outliers and flagged them. What are some of the patterns we're looking for that result in low value care at the facility level? Well, is there a pattern of admission to inpatient or observation from the emergency department? Are ICU days appropriately aligned with the severity of the case? Is there an excessive use of expensive ancillary services in the emergency department? That's just a few examples. Now the efficacy of transition is also very important, because poor transitions of care, lead to unnecessary adjunct service, which represent waste in the health care system. Again, it's a poor patient experience. And all of this leads to low value outcomes. So tied to the facility care is the primary care team, who should step in at the transition to make sure that the patient has what he or she needs from both a clinical and a socioeconomic point of view. Now is managing every transition a lot to ask of primary care? Well, that depends on the practice and the resources that it has. Access may be an issue for follow-up care, human resources may be an issue for outreach, there are these and many more challenges that can get in the way of patient management and optimize outcomes. So we need to enable efficiency in the management process. And that's what I'm going to speak about ways that we can use patient attributes to categorize and prioritize outreach. (DESCRIPTION) Slide, Managing clinical risk. (SPEECH) So first, I'd like to speak to the importance of measuring clinical risk in the process of patient management. It's important for the purpose of measuring and paying for outcomes, but it's also important in stratification and prioritization for the processes of care delivery. (DESCRIPTION) Slide, 3 M industry standard patient classification methodologies, a graphical list. (SPEECH) It's important to always look at values-based outcome measures within the context of risk adjustment. It's the fair and equitable approach. In the process of risk adjustment, it's important to choose a methodology that's categorical in approach. And what I mean by that is assigning every patient to one category that describes the interaction of all of his/her morbidities. And where all people in one category are clinically similar individuals. So why is this important? Well, because as I said earlier, this type of categorization is really a clinical language that can be used by all clinicians, treating and/or managing that patient. And as with any language, it can be learned and understood in a similar context every time it's used. Now contrast that with regression models that are black boxes of statistical adjustments, if you will. It's very difficult to understand the why of output. With categorical models, you can follow the reasoning for patient management, because there are rules. And the rules should be clinically-based. Now I'm showing you the Clinical Risk Groups or CRGs, which is 3M's people grouper. This is the categorical model that we developed and used with our clients, so it's the one that we base our examples on. In our analyzes, CRGs are the basis for understanding any patient or group of patients overall health. But they're also the basis for provider-performance comparison. So simply said, it's our it's our risk adjustment tool. (DESCRIPTION) Slide, Population health segments versus Medical allowed, a bar graph, showing the percent of total medical allowed for different population health segments. (SPEECH) OK, so we also use CRGs to help patient managers prioritize their care management activities. Now, again, I'm displaying some blinded client data, and it's on total cost of care by health segment. So there are hundreds of categories of CRGs for granular classification and description of patient health attributes. But we always start by examining populations role to the highest level of health status. And then we erase the medical spend for the people in those categories. It's a very quick way to understand where the care management activities need to focus. So on the X-axis, are the 3M population health segments, which span from non-users or members with no claims experience for the time frame. Which by the way are candidates for primary care outreach. And if it goes all the way up to critical members that dominate medical care. On the y-axis is the percentage of total medical allowed. And it's no surprise that the majority of the medical spend is with the more complex stations. So the focus should be on these members. Complex chronic are the dominant and higher severity chronic conditions, like higher severity diabetes, hypertension, or asthma. And the multiple complex chronic or the combination of multiple chronic diseases, like diabetes with depression, or other diseases involving multiple organ systems. So it makes sense that members in these segments cost more than healthy members. But nearly 1/2, the 47% of the total medical spend belong to 14% of the members. So it's always a very small subset of members that cost the most. So this is a typical distribution. And I'm going to show you why in a moment. Why these populations tend to be so costly, but before I do, I want to say something about COVID here, because this is where we typically get questions about the effects of COVID on the distribution. In the short answer is that COVID did not affect the distribution. And the reason for that is that within of CRG classification, the COVID diagnosis alone will not generate a chronic condition. So if you're otherwise healthy and you contract COVID would not be assigned to one of the complex chronic segments. Yet COVID when combined with other certain chronic conditions like diabetes, hypertension, COPD, for example, that will result in classification within the complex and/or multiple complex segments. So during COVID, we provided our payer clients with these analyzes to help them prioritize outreach and supplies for those patients with the multiple chronic conditions that were affected by COVID. (DESCRIPTION) Slide, Example: Preventable spend by population health segments, a graph titled Over $200M Potentially Preventable Events Allowed. Bubbles represent different population health segments, with the biggest bubble labeled Healthy, and the smallest bubble labeled Multiple Minor Chronic. (SPEECH) OK, in this slide, I'm showing the same population, still stratified by health status. But this time I'm displaying the amount of potentially preventable spend associated with each of those categories. So potentially preventable events, represent services that increase costs, and potentially indicate opportunities for care coordination and/or practice workflow optimization. So what are we looking at here? On the X-axis is the total allowed amount, and on the Y-axis is a potentially preventable event analysis, which is including events around admissions, readmissions, and Ed visits. And then the size of the bubble is relative to the size of the membership in that health segment. Now preventable cost is a major opportunity to reduce overall spend, and there's about 219 million in total allowed dollars in this example, that are tied to preventable events. And when we break that down. The largest area of opportunity is highlighted at the rate, is complex chronic and multiple complex patients. And you can see that these members are driving, not only total allowed, but also total preventable allowed dollars as well. So in total, there are about 180,000 members in these two segments. And they represent $2.3 billion in total spend, and of that there's about $130 million in preventable spend. So in the lower left, we have the health population, represented by 480,000 members. But these members are not the ones driving the preventable spend. The opportunity is within that smaller volume of the complex chronic populations, that have approximately 59% of overall preventable spend. And lastly, just a few words about the non-user group. So these data came from 2020. And it was in that year that we saw a significant jump in this category. And that was because of COVID and the restrictions that affected access. Now we know because we've studied this that when people do not seek any kind of medical care for multiple years, the majority enter the patient pool with multiple chronic conditions of a higher severity. So COVID, may have caused, or may still be causing a hidden public health crisis. Because patients did, and may still be avoiding care. So it's time to understand who the non-users are and perform outreach and get them into the care system to evaluate their status. (DESCRIPTION) Slide, Mental health slash substance abuse conditions are on the rise, a bar graph comparing January to June 2019, 11%, and January 2021, 41.1%. (SPEECH) OK, another effect of COVID-19, the pandemic and the resulting economic recession really negatively affected many people's mental health. And created new barriers for people already suffering from mental illness and/or substance abuse disorders. The CDC recently reported results from a National Health Interview, that during the pandemic about 4 in 10 adults in the United States had reported symptoms of anxiety or depressive disorder. And that was up from 1 in 10 adults in January to June of 2019. (DESCRIPTION) She returns to the previous slide, the bubble graph. (SPEECH) So why is this important for patient management? Well, if we go back to the 14% of the population, or the complex chronic patients that utilize the $100 million in potentially preventable spend. Then we can see that 48% of this population had a mental health or substance abuse condition, and spent 80% of that $100 million opportunity. So again, it's all about knowing who these people are, what their challenges are, and then using that information to prioritize their care management. (DESCRIPTION) Slide, Clinical Risk Groups and care management options, a numbered list. (SPEECH) And so presenting these data points to our client, helps them stand up as their management prioritization program. So we help them categorize the patients, and set up a program that utilizes benchmarks to identify those people who are at greater risk of having a potentially preventable event, or are in more need of outreach. And we apply those same measures to transitions of care, most notably after an inpatient stay. (DESCRIPTION) Slide, Transitions of care, a bullet point list, and a line graph titled Relationship between receipt of outpatient follow-up and risk of readmission, with the lines representing population health segments all trending upwards. (SPEECH) And I'm going to share with you now a study. So I think we all know that transitions of care as still very important, but from a care management perspective, it's also important to understand the optimal time to reach out after discharge. So I want to talk through this study performed in 2015. I put the link at the bottom of the page. This was a study completed by Community Care of North Carolina and Duke University. And it's a retrospective study using North Carolina Medicaid claims data for hospital discharge patients during the period April 2012 through March of 2013. Now what they did in this study was construct variables indicating whether patients received follow-up visits within successive intervals and whether these patients were readmitted within 30 days. They used seven clinical risk specifications, based on the 3M Clinical Risk Groups, the CRGs. And then they calculated expected readmission rates within each CRG. So a survival analysis, if you're not familiar with that. It's an analysis that models time to an event. So that analysis was applied to identify groups that appear to benefit from outpatient follow-up discharge within three, seven, 14, 21, and 30 days. And what they found was that the readmission risk correlated to health risk. And you can see that the multiple and complex patients had an overall higher rate of readmission. So it was evident that a greater focus on the transition process was needed for these groups. But you also notice that the lines for all groups jump up at the seven-day mark. And the longer the time interval after discharge, the steeper the slope of risk. So by completing this type of analysis for the population, they were able to determine that transitional care resources would be best allocated by ensuring that the highest risk patients receive follow-up care within seven days. But even within this group, the patients with multiple and complex chronic conditions needed to be prioritized. The longer they waited for outreach, the greater was the risk of readmission. (DESCRIPTION) Slide, Impact of understanding clinical risk for post discharge targeting, three tables. (SPEECH) So we thought that was a pretty powerful analysis. And we've created a similar view for our clients to use in their care management process. I'm not going to go through this again. It's something very similar in a different way. But if you're interested in learning more about this then please feel free to reach out. (DESCRIPTION) Slide, Understanding the relationship between socio and clinical risk. (SPEECH) OK, so over the past decade or so, there's been a heightened awareness to the effect of social economic challenges on health status and outcomes. Because they're so closely correlated, many payers have improved outcomes by directly solving for social challenges, such as homelessness and food insecurity. The health care sector has placed an importance on collecting data on patient social challenges. But it's not enough just to have these data. Improvement comes from using these data in the patient management process to inform efficient care delivery. (DESCRIPTION) Slide, Health inequity is a reality, an infographic showing statistics and risk factors. (SPEECH) So I've compiled a few numbers on health inequity, just to highlight the unfortunate reality in our nation today. Now according to a Harvard University study, 30% of households were cost burden in 2019. Just to add some perspective to that, that represents 37 million households, of which half were severely cost burdened, spending more than 50% of their income on housing costs. In that same year, while 40% of non-Hispanic white individuals that were 25 years or older. They had achieved a bachelor's degree, where that percentage for Blacks and Hispanics was less than 1/2. And we also know that in 2019, 17% of the US population lived in areas that are deemed as poor-food access neighborhoods. So over the past decade, we've been able to refine our understanding of how these types of social stressors impact an individual's ability to achieve optimal health. And patient management absolutely needs to include not only the identification, but the resolution of these barriers at the individual patient level. And the care team needs to be active in this effort, coalescing the information on both clinical and social needs and outcomes. (DESCRIPTION) Slide, Sources of data to analyze social risk, four bullet point lists titled Clinical Data slash Z-codes, Survey Data, Consumer Reporting Data, and Geographic Data. (SPEECH) Part of the problem is that the healthcare industry, is really doesn't have a single source of truth for gathering social needs data. There are four broad categories, which you see on the slide, but each have their pros and cons. And I want to touch on each one of these briefly, starting at the upper left. Documenting social needs through clinical data feels like a good approach, because it's validated at the point of care, before it's entered into the medical record. It applies to all populations, children, and adults alike, and it's scalable. But it requires an individual to be present for the data to be captured. And the thousands who don't show up for care might be missed. And we know that many providers have not reliably integrated social data capture into the clinical workflow. So while it may be in the medical record, its use may not be maximized. Additionally, the codes are not specific enough yet, to capture actionable social diagnoses and barriers. So moving to the right survey data, like health risk assessments also seem like a good idea, because you own the format which can typically be customized to a population. It's a potentially low lift for initial delivery. But it's subject to bias by either or both responder and questionnaire. And response rates are typically low. They're also not easily merged into other data sets. We have a lot of clients who use consumer reporting data from credit bureaus and companies like LexisNexis and TransUnion. Now this is attractive to some, because they are widely available today, and they cover broad populations. The downfall however, is that they only apply to adults. But when we've worked with our clients using these data we found that the social stressors identified for the adults were closely correlated to the children. So that hurdle can be overlooked to a certain extent. But consumer data comes at a cost. And for some organizations introduces privacy concerns. Geographic data sets are a promising way to collect social risk data, because SDoH stress scores can be closely correlated with neighborhood health factors. For example, the linkage of neighborhood disadvantage can be applied to risks of maternal mortality, cancer, asthma, or T2 diabetes. The downside of geographic data is that it's not ideal for understanding an individual's particular challenge, for the purposes of targeted care management. (DESCRIPTION) Slide, A new view of the patient, two infographics titled Social Factors, consisting of a wheel labeled Social determinants of health, and Clinical Factors, consisting of a circular list. (SPEECH) So the goal in collecting social data is the integration with clinical factors to gain a more thorough understanding of the patient's needs and the potential effect on his or her health. So the analysis of our clients' data has highlighted for us that the correlation between social risk and greater levels of health risk. Again, in health risk as measured by the presence and intensity of comorbidities. We've also seen higher use of low value services, such as emergency department usage and readmissions for these populations, because of the barriers to a patient's ability to participate in his or her own treatment. So stratification of populations using the combination of clinical and social factors facilitates responses to public health emergencies. More importantly, these types of data provide value every day in the hands of frontline healthcare workers, who are trying to develop personalized approaches to patient management. Factors such as housing instability, poor access to healthy food, and low access to care directors, play a large role in health outcomes. (DESCRIPTION) Slide, Socio-clinical risk and Potentially Preventable Events: Examples of Client Insight and Action, a bar graph, a bubble graph, and a bullet point list. (SPEECH) In fact, we know from our data that social risk is correlated with increased clinical risk. And higher utilization, including the use of the low-value services, such as potentially preventable events. But we also know that not all social factors behave in a similar manner. We know that health literacy, for example, becomes a larger factor in populations with more chronic conditions. And we know that individuals with multiple chronic illnesses generally have more financial housing and food instability. And if you look at the bubble chart to the left. Again, we see that it's the people with the multiple chronic conditions, who are utilizing the disproportionate amounts of that low value potentially preventable services. So understanding where social challenges and health outcomes intersect can help assign risk, prioritize individuals for management, and create a keratin-- I'm sorry, care plan tailored to the specific needs of the whole person more accurately. And looking at these factors through the lens of neighborhoods, that geographic view, can help you determine how and where to establish your community-based partnerships that will help fulfill the social needs. (DESCRIPTION) Slide, New models for patient management, two bullet point lists titled Telehealth and Specialists, with a picture of a woman looking at the screen of a tablet, and a picture of a team of health care providers in a surgery. (SPEECH) So I'm going to bring this to a close by going back to the beginning, when I was talking about high-performing primary care in the patient management process. So if the goal is to build strong relationships between patients and the care managers, then we need to identify as many of those relationships as possible, and establish accountability for both cost and quality outcomes. So we call this patient attribution, in our world attribution is not assignment. We have many clients who assign patients to primary care, mostly are Medicaid and NCOs. But without a requirement for the patient to see and be followed by that caregiver, we know that patients will jump around and seek care from any convenient provider. So rather than assignment, we advise attribution, which is using care patterns to determine which provider had the prevalence of patient management. When we've compared outcomes of the two approaches, we have seen as much as a 40% miss in assignment. So in other words, 40% of assigned patients were not being seen by that provider. That's a very important point in risk sharing arrangements as well. So the process of attributing patients to providers is difficult, and it has traditionally focused on the primary care office behind bricks and mortar. But the COVID-19 pandemic forced a new setting, and that's telehealth. I think we can all agree that telehealth is a new mode of delivering care, it's not going to go away. There was a JAMA article published in October of 2020, that indicated that the number of telehealth visits grew to 35% of primary care visits in 2020, from 2% the year prior. And not all of these visits came from large national players. Many came from local medical offices, they were struggling to deal with closing access to the community. So this was as much an offensive move financially as it was a play to keep services open in their neighborhoods. But they were able to make that switch in many places, and keep those services open. So the importance of locally-based telehealth is to reach as many individuals as possible and understand their health needs. If we go back early on this presentation. And we think about that growing pool of non-users, these may be a way to reach them. And again, we need to meet patients at the level where they're comfortable with or able to access healthcare services, and telehealth has some promise in that area. But we know that a lot of large national organizations are moving towards telehealth for primary care. So is this the solution to the growing shortage of primary care providers? Well, we're closely monitoring the data on this topic in our clients data sets. And it's primarily to answer the question on whether this model can or will produce the degree of patient direction that we need to realize the high value outcomes that are desired. The JAMA research found that telehealth visits were less likely to contain key preventive screenings, which we all know are critical for chronic patients. So will that change? And if it doesn't, what's the long-term implication? These are data points again, that we're watching closely. And we're paying particular attention to monitoring the results from local telehealth versus national telehealth. We're also monitoring data on specialists as patient directors. What are the pros and cons of this model? Well, specialists are physicians, highly trained in the narrow branch of medicine. They might not have the broad knowledge of primary care topics. And they may end up referring patients to an array of physicians, each treating a specific nuance of health. And if this occurs will it result in better outcomes? Or is it going to lead to low value care? Is the special team willing to or able to coordinate? Or will the patients be overwhelmed by what ends up being multiple and varied opinions? So while we know that not all specialties will fit the criteria, we're watching the critical few that might because of the nature and the frequency of patient interaction. The goal of effective patient management is not only to get as many patients aligned with care directors as possible, but also as appropriate. (DESCRIPTION) Slide, Questions? C-C-U-S-A-C-K at M M M dot com. (SPEECH) So that's the presentation as prepared, we have 13 minutes left, if anybody would like to ask a question. Sure. Thanks Carol, we do have a couple. I did have a couple questions come in just about CEUs. We do not actually provide CEUs. But if you do need a certificate of attendance, go ahead and put that In the Q&A as well, just to say I need a certificate. And I can email one to you after, that's not a problem at all, just put that in the Q&A that, Yes, I need a certificate. The questions that we do have, one is do 3M classification methodologies support quality evaluation for pediatric maternity and other complex chronic populations? Yes, they do. And if you'd like to reach out. I will put you in contact with our medical director, who can explain that much more detail. But there have been a lot of work of late that's gone into pediatric and maternal outcomes within the clinical risk groups, to really improve it as a management tool. And I'd be more than happy to send you some more information on that. Great. And if anybody does want more information in the platform, where it says ask an expert in the middle. You can certainly let us know there, if you're interested in learning more information. We do have one more question. How can our organization think about integrating these methodologies into our workflows, for either member or patient engagement? So that's a great question, and it depends on if you mean to integrate into the EMR as a workflow or into a separate care management. And I would answer both the same way, but the technical aspects of each are going to be very different. We actually can help you obtain the solutions that generate these results, and help you set them up in your organization. And we have consultants and staff that are ready to help you organize, and more importantly interpret the output. So all of our solutions are freestanding groupers. If you are familiar with the AR-DRGs, the DRGs, or any of those payment groupers the CRGs, and the potential expandable events are available in the same type of format. But again, you might need some of the expert assistance in early education on with the output needs in helping you put it into your platform, in a meaningful and informative way. Great. Well, thank you so much. This has been a great presentation. We did have a few people reach out asking for that certificate of attendance. So I will make sure I get that out to you all today. Again, my name is Lisa Paulenich. So you'll be getting an email directly from me for that. Again, to if you could complete the survey at the end just to let us know how we did, we'd certainly appreciate that. In the next few weeks, we will be having this recording also added to our website. So if you would like to listen in again, that will be available for it as well. And so Carol, again, I thank you so much today, for your presentation, and the information. I know this was a great and needed topic. So thank you very much. And thank you again to all of those of you that join today. So have a good rest of the afternoon. Thank you. Thank you, Lisa.