Driving Value in Healthcare through Transparency CHPRMS Discussion - - PowerPoint PPT Presentation
Driving Value in Healthcare through Transparency CHPRMS Discussion December 4, 2014 Overview of Castlight Health Brief platform demonstration Distinctive Search Analysis Agenda Role of Transparency for Providers Centers of Excellence
CHPRMS Discussion December 4, 2014
Overview of Castlight Health Brief platform demonstration Distinctive Search Analysis Role of Transparency for Providers Centers of Excellence Discussion
Great healthcare builds great business
New technology will revolutionize enterprise healthcare to help deliver the best outcomes for American families
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It’s a top 3 business cost that rises per year
spend is wasted US enterprises spend more than per year on healthcare
Castlight empowers
businesses to cost- effectively manage their healthcare spend and empower employees and their families to make informed choices with a clear understanding of costs and likely outcomes
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Price of preventive primary care visit
Raleigh: Average: $165 Range: $113 - $225 Charlotte: Average: $199 Range: $60- $241
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Price of lipid panel
Raleigh: Average: $17 Range: $15 - $38 Charlotte: Average: $24 Range: $15- $139
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Price of lower back MRI
Raleigh: Average: $917 Range: $743 - $2,443 Charlotte: Average: $1,813 Range: $743- $3,017
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No correlation of cost with quality
$4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000 Below Average Above Average Delivery Quality
Cost vs. Quality: Pregnancy & Delivery (Chicago) $17,000 $5,325
Sources: Pricing Data from Castlight Claims; Quality Data from Leapfrog Group
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Customers
Fortune 500 customers
Industries
in engaging all their employees in a prescriptive way
Success with Leading Companies
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“We want our employees to understand their benefits” “We need to decrease healthcare costs” “We want our employees to get the higher quality care” “We are implementing advanced benefit designs and need help” “We are focused on increasing employee engagement”
What we are hearing from our clients…
Challenges that employers are facing
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Distinctive Search
Optics into specific patterns and behaviors
Understanding what your population cares about and is searching for leads to:
Healthcare is essentially a talent issue. If you're trying to attract and retain employees, you need to understand what they care about in order to provide competitive benefits.
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Search trends differ by age group
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Men and women communicate differently
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And search for different services
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We consume healthcare differently by region
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Healthcare consumerism doesn’t work doctor’s hours
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What are users in North Carolina searching for?
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 Bunion Removal Teeth Nerve Conduction Test Nutrition Anemia Pediatric Gastroenterologist Visit COPD Insomnia Orthodontics MinuteClinic North Carolina search rate compared to overall US search rate
Top 10 searches that North Carolina users search for the most compared to the rest of the country
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Searchers spend less for common services
On average, Castlight searchers spent…
labs MRIs
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Providers are adjusting to the “new normal” of healthcare with different strategies
Vertical and horizontal consolidation Launching a health plan Developing new revenue streams New reimbursement & delivery § 598 M&A’s in 2013 à$52.7 billion value1 § 34% have health plan § 20% intend by 20182 § 2nd opinion, telemedicine, travel-benefit medicine § 500 physician-
ACOs
novel reimbursement models
edge by playing to strengths
implementation grants
select services
commercial revenue
negotiating power
population health
Intelligence, 2014;
All strategies can be strengthened or enabled with healthcare IT-based transparency
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Benefit and transparency platforms present
Challenges with rising costs and domestic leakage Transparency as “learning lab” for behavioral change
From…
No employer relationship and network exclusion Direct engagement with employers to address needs No ability to engage patients on price or quality Ability to trial novel delivery models
…to
Provider employees 1 Self- insured employers 2 Patients 3
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Providers need to balance benefits strategy with their business strategy
1
B A C
Domestic facility use Health plan strategy “Right pocket, left pocket” § Employee use of
strategic priority to increase volume and occupancy § Employee trust in “home institution” crucial for reputation § Reduced utilization saves costs BUT also reduces revenue § Payments on domestic use may be higher for their
than CMS patients § Incentive to maintain high quality AND low cost referrals § Must balance employee vs. health plan customer demand to ensure new customers
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Castlight has experience with large provider systems
Indiana University Health § State’s largest hospital network with 25,000 employees Providence Health System § Washington State’s largest health system with 44,000 employees Goals in new transparency market Employer goals: § Reduce inappropriate use § Address gaps in care Provider goals: § Enhance online presence § Validate pricing § Drive domestic use by employees § Improve high value service lines Castlight solutions § ID inappropriate use like non-emergent ER § Alert gaps in care § Submitted rates § In-network search results only § Additional, shared quality data § Castlight Reviews § “Self-cleaning
1
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While employers express four major unmet needs with providers on population health…
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“Providers refer patients to their golf buddies for surgery because that is who they know. They don’t review quality data or check if they are in-network.”
Unmet needs Employer quotes Non-threatening patient- experience High quality, in- network referrals Outcomes- aligned incentives More access to quality data
Source: Castlight Market Analysis (2014)
“People with high cholesterol are told to eat Cheerios and
we must change how we incent providers.”
“We set up a mobile mammogram – cost over $100,000. You believe or don’t believe it saves money. But women are now engaged with their care.”
“I struggle with quality data. I know providers can share more data but it should be validated by a 3rd-party so providers are not grading themselves.”
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…they are already starting to innovate programs and employ solutions on their own
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Source: Castlight Market Analysis (2014)
Onsite clinics Telehealth / 2nd
Health guides Reference-based benefit
§ Not always done with health plans § Customized to cost or quality § Enabled by transparency tools § Regional benchmarks § Expanding to more services § Proven to reduce costs
Narrow networks / COEs
§ Individual coaches to steer patients to high value care
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Spot pricing benefits both patients and providers…
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California Medical – Main Campus Price Depends on Time of Day8am – 4pm $372 4pm – 8pm $295 8pm – 12am $250
MRI of lower back
Learn more
Different prices for services based on time or location
Patient Lower co-payment Provider More off-peak volume Employer Lengthen employee deductible phase Payer Minimal (if any)
Potential impact for stakeholders
Note: future product concept and not available today
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…while patient reported outcomes improve quality data and the shopping experience
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OutcomesSurgical Outcomes
95% of patients recommend Dr. Workman for this surgery
Knee Replacement Hip Replacement ACL Repair
55% of patients reported that their health was improved after surgery
Patient Reported Outcomes after Hip Replacement Surgery (5 patients)
Overall Health Ability to do daily activities Pain Fatigue
Greatly Improved Much WorseNote: future product concept and not yet available today
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§ Physician or caregiver access to Castlight § Enables clinician to “shop” for patient § Enables provider to manage value of all referrals in risk sharing, ACO, or health-plan models Third party access § Analytics on pricing, consumer behavior, or other § Reports to develop strategy, and execution plan to drive pricing, market campaign, or innovation § Insight on relative position in marketplace Provider reports § Analysis of out-of-network referral & utilization § View of location, referring physician, and extent of
§ ID lowest value areas & ways to improve Referral pattern analysis
Product concepts: Providers have repeatedly requested solutions to address other needs
Note: all are future product concepts and not available today
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Driving more value out of a COE program
Castlight’s COE approach:
effective facilities
Increase engagement, education, and utilization of COE services
Direct Castlight works with employers to drive more value
programs
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Search.
Search for a planned surgery in the Castlight application.
Choose.
Browse facilities designated as COEs at the top of search results.
Act.
Utilize educational content about COE procedures and program benefits.
Direct employees to Centers of Excellence
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Two types of COE programs offered today
TPA network
(e.g., Blues Distinction)
Vendor network
(e.g., Health Design Plus)
Procedures: Dependent upon health plan § Supported by vendor § Option to customize CL search: § Standard sort, facility flags, spotlights & messaging § CL education content § Custom sort & facility flags, spotlights & messaging § CL education content Other services: § Can add 2nd opinion and/
§ Standard CL analytics (e.g., non-COE specific) § Can add 2nd opinion and/
§ Standard CL analytics § Additional analytics provided by vendor Castlight will also explore COE programs directly offered by provider systems to meet the needs of our employer clients
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Castlight supports over 20 COE procedures
Castlight- supported procedures:
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Open discussion
Any questions?
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Castlight’s Clinical Team
Full time Clinicians
Part time specialists
Dena Bravata, MD, MS CMO & Head of Product Internal Medicine Columbia Medical School, Stanford Hospital & Clinics Cathie Markow, BSN, MBA Quality Expert Hartwick College, Northeastern University Howard Willson, MD, MBA Enterprise Sales Support Emergency Medicine
The Wharton School Swedish Medical Center
Clinical Product Development Internal Medicine George Washington Med., Stanford Hospital & Clinics Ning Tang, MD Clinical Product Development Internal Medicine Harvard Med School,
UCSF David Lim, MD, PhD Provider Relations Infectious Disease Columbia Med School, Johns Hopkins Hospital, UCSF Gabriella Kellerman, MD Educational Content Mount Sinai School of Medicine, UCSD Anita Cosgrove, RN, JD Provider Relations 23 and Me
Strategic Analytics Internal Medicine Johns Hopkins Med School Stanford Hospital & Clinics
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✔ Measures are evidenced-based and align with national standards ✔ There is a regional or national benchmark for comparison ✔ Data are personalized and reported in a way that’s relevant to a user’s need e.g., condition or procedure ✔ Users have the ability to apply their preferences in how they prioritize the different types of information ✔ The source of the data and methodology for how to use the data is available and written in a consumer-friendly way ✔ There is information that helps a user understand their treatment
Castlight Quality Checklist
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Bridges to Excellence (Source: Bridges to Excellence Program)
Regional Collaboratives
Minimally Invasive Procedure (Source: Ethicon Endo Surgery) Patient Experience Castlight users and multiple sources (e.g., Angie’s List)
List of Quality Sources - Physicians
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Surgical Safety Outcomes (Source: CMS Hospital Compare)
Based on relatively rare events that should never happen including:
Medical Condition (source: CMS Hospital Compare)
Based on mortality and readmissions for:
Procedure volumes (Source: CMS Hospital Compare)
Imaging Appropriate Utilization (Source: CMS Hospital Compare)
Maternity (Source: LeapFrog)
Child Asthma Care (Source: The Joint Commission) Patient Experience (Source: HCAHPS)
Complete List of Quality Sources - Hospitals