NAM WORKSHOP SERIES ON HIGH-NEED PATIENTS A Synthesis Peter Long, - - PowerPoint PPT Presentation

NAM WORKSHOP SERIES ON HIGH-NEED PATIENTS

A Synthesis

Peter Long, PhD, Blue Cross of California Foundation Planning Committee Chair October 21, 2016

Topics

• 1. Where we started?
• 2. Where we’ve been?
• Recap from workshops 1 and 2
• Workshop 2 – present
• 3. Recap from today
• 4. Main themes and

conclusions

• 5. A path forward

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Where we started?

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Peterson Center NAM BPC CMWF HSPH Collective goal: Advance our understanding to better manage health of high-need patients through exploration of patient characteristics and groupings, promising care models and attributes, and policy solutions to sustain and scale care models.

Where we’ve been?

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Feb’ 15: Initiative Launch July ‘15: Workshop #1 Jan ’16: Workshop #2 Oct ‘16: Workshop #3

March ‘17: NAM publication

• Review and dev’t of

patient taxonomy

• Review of care models
• Identification of areas of
• pportunity for policy

action

You are here.

Recap: Workshop 1

• At the first workshop, we framed the problem and

issues:

• Who are “high-need patients” and what are their shared

characteristics, needs, and challenges?

• What do successful care models for the treatment of these

patients look like?

• What are challenges with the sustainability, spread, and scale of

these successful programs?

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Recap: Workshop 2

• At the second workshop, we delved deeper into:
• Existing data on high-need patients
• Insights into patient characteristics and care utilization
• Data sources, including limits and opportunities of available data
• Segmentation of patients
• Synthesis of what we know
• Utility of segmenting patients to target care
• Potential implications for care delivery and policy
• Distilling key design elements of successful care models
• Common design elements across care models
• Barriers to broad adoption
• Considerations for spread and scale of care models
• Strategies
• Barriers

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Recap: Additional Workgroup Activities

• Convened taxonomy

workgroup to review existing approaches and provide guidance on adaptation and application in practice.

• Reviewed literature on care

model to identify promising models and attributes.

• Mapped care models to

different high need patient segments.

• Identified areas of policy
• pportunity.

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Recap from today…

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A number of promising innovations in care delivery have emerged based on a review of research on caring for high-need patients, but they face systemic barriers to replicating and sustaining the key practices. To make progress – and address one the most expensive and challenging populations for the current health care system— bold action is needed to improve the policy environment and care

• delivery. It is essential to create a policy and regulatory environment built around

payment models that incentivize coordinated care and support the integration of clinical care and social services. Health systems would benefit from a “taxonomy” to segment high-need patients and match the appropriate interventions, as well as a set of key measures to support value-based payment. NEW YORK, MONDAY, APRIL 3, 2017

Bold action needed to im prove care for high-need patients, reduce costs

U.S. .S. N News

Main Themes and Conclusions

• The high-need patient population is diverse, complex,

expensive, and transient.

• One size doesn’t fit all. We need to strike a balance between

standardized and customized approaches to care.

• Segmenting patients is one tool to target care and should be

tested in more real-world settings in conjunction with care models that have been shown to work.

• The solutions (e.g., tools, data, care models, policies) must

extend beyond the medical because social and behavioral factors are essential to address.

• In order to be actionable, policy solutions must account for

existing system constraints and complexities (e.g., integration

• f medical + social, financing of care models).

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A path forward

• More research and better data are needed to bolster the

evidence base for care models that work.

• There are major policy barriers to broad implementation of

what we already know DOES work.

• - In the meantime, action is needed now –
• Health systems need to work with payers to better identify

and target high-need patients and test new practices (i.e., taxonomy).

• Payers need to actively support the adoption of care models

(or specific elements) that we know work.

• Policymakers and payers need to continue progress toward a

value-based system, using alternative payment models (including those that work within FFS structure) to support more effective care for high-needs patients.

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Now, we turn to you to receive your feedback and counsel.

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