Care Management Engagement Analytics Yvette Neri-Hernandez, BCBS AZ - - PowerPoint PPT Presentation

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Care Management Engagement Analytics Yvette Neri-Hernandez, BCBS AZ - - PowerPoint PPT Presentation

Aug 21, 2023 104 likes •281 views

Care Management Engagement Analytics Yvette Neri-Hernandez, BCBS AZ and Mary Henderson and Penny Monical, BHI Our Speakers Today Yvette Neri-Hernandez Mary Henderson Penny Monical Manager, Analytics Senior Vice President, Product Manager,

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Care Management Engagement Analytics

Yvette Neri-Hernandez, BCBS AZ and Mary Henderson and Penny Monical, BHI

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Our Speakers Today

Yvette Neri-Hernandez Manager, Analytics and Data Science, BlueCross BlueShield

  • f Arizona

Mary Henderson Senior Vice President, Product Strategy and Innovation Penny Monical Product Manager, Strategy and Innovation, BHI

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Proprietary & Confidential Proprietary & Confidential | 3

Agenda

  • Health Plan Introduction
  • Analytics and Data Science Team
  • Care Management Program
  • whYzen Integration
  • whYzen Demo
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Health Plan Introduction

BlueCross BlueShield of Arizona

  • Not-for-profit
  • Independent licensee of BCBSA
  • 1.5 million covered Lives
  • More than 1,500 employees

Phoenix Tucson Flagstaff Chandler

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Health Plan Introduction

37.2% 7.2% 6.7% 4.7% 23.5%

Federal Employee Program

Segmentation of Business

Local, Blue-Administered

CHS/Network Rental

13.1%

BlueCard Small Group

7.6%

Large Group Individual < 65 Medicare Advantage/ Medicare Supplemental

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Proprietary & Confidential Proprietary & Confidential | 6

  • Finance
  • Operations
  • Customer Service
  • Provider Relations
  • Sales and Marketing
  • Clinical Affairs
  • Consumers/Members
  • Providers
  • Employers
  • Benefits Consultants
  • Third Party

Administrators

Our Analytics and Data Science Customers

External Audiences Internal Plan Constituents

Note: Bold italicized text indicates Current whYzen use cases at BCBS AZ.

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  • Provider Reimbursement
  • Fee Impacts and

Implementation

  • Hospital Negotiations
  • PCMH Programs
  • Value-Based Care

Arrangements

  • Population Health
  • Clinical Algorithms
  • Medical Management

System

  • HEDIS/QRS Measurement

and Analytic Strategy

Analytics That Inform Better Decisions

Clinical/Quality Provider Performance

Program Evaluations Performance Analytics Reports

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Care Management Analytics for Our Care Management Programs

Healthy Low Risk At-Risk Chronic Disease Complex Case Management

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Care Management Program

Identify Members Screen Establish Goals Evaluate and Improve Measure Outcomes Outreach

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Care Management Program

Current Identification Triggers

  • Inpatient notifications/precertifications

– Behavioral health admissions – Pediatric admissions – Multiple and readmissions

  • High cost claimants
  • Frequent Emergency Department utilizers
  • Pending claims
  • Health Information Exchange (HIE) data

Identify Members Screen Establish Goals Evaluate and Improve Measure Outcomes Outreach

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Care Management Program

Measuring Program Outcomes

  • Develop population cohorts

– Engaged vs. non-engaged – Levels of engagement

  • Review and measure program goals

– Reduced admissions and readmissions – Reduced ED visits – Closed care gaps – Improved medication and adherence – Increased PCP visits Identify Members Screen Establish Goals Evaluate and Improve Measure Outcomes Outreach

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Proprietary & Confidential Proprietary & Confidential | 12

whYzen Integration of AZ’s Care Management Data

whYzen

Wellness Disease Management Case Management Utilization Management

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whYzen Integration in Action

Member_ID YrMo cm_prg cm_status DM_prg DM_ status DNC_ Status DNC_Dt xxxxxxx67-01 2019/09 TOC Case No Mbr Response xxxxxxx73-01 2019/09 Screening Reviewed xxxxxxx95-01 2019/09 Asthma Disenrolled xxxxxxx55-01 2019/09 TOC Case No Mbr Response xxxxxxx59-01 2019/09 Complex CM Goals Met/Issues Addressed CHF Education xxxxxxx27-04 2019/09 TOC Case No Mbr Response xxxxxxx00-01 2019/09 TOC Case Goals Met/Issues Addressed xxxxxxx83-01 2019/09 COPD Education xxxxxxx44-01 2019/09 TOC Case No Valid Demographic Info xxxxxxx79-04 2019/09 TOC Case Goals Met/Issues Addressed xxxxxxx49-03 2019/09 TOC Case No Mbr Response Diabetes Education Y 10/7/2019

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whYzen Analytics

  • Executive Dashboards
  • Guided Analytics
  • Interactive Analytics
  • Risk-Adjusted Plan Benchmarks
  • Automated Narratives
  • Published (Static) Reports
  • Report Scheduler
  • Data Extracts
  • Mobile Enabled
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whYzen at Work

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Thank you