Tag Archives: Rich Moyer

Milliman MedInsight releases employer group reporting solution for health plans

Milliman has announced the formal launch of its new MedInsight Employer Group Reporting (EGR) Solution. The MedInsight EGR Solution is designed for health plans to support the key function of client reporting; helping a health plan’s employer clients accurately understand the value they receive from their benefit spends and also providing realistic performance comparisons with other employers in the region.

MedInsight is Milliman’s popular healthcare analytic platform used by over 250 health plans, employers, at-risk providers/accountable care organizations (ACOs), state governments, community health coalitions, and third-party administrators (TPAs).

The MedInsight EGR Solution delivers clients the benefits of confidence and control, while reducing the time and energy required to achieve them. As an extension of the MedInsight Analytic Platform and a beneficiary of our MedInsight Data Confidence Model, it means that health plans and TPAs can feel confident the information they are providing is accurate and meaningful, even as it’s made available to employer clients through a self-service portal.

Milliman expects many of its existing commercial health plan licensees of MedInsight to add the EGR Solution to bolster client reporting capabilities.

With user-friendly dashboards, a preconfigured reporting library, and easy-to-publish summary performance reports, the MedInsight EGR Solution helps health plans satisfy employer reporting needs easily and confidently.

“The employer clients of health plans are demanding more transparency on the value of healthcare being provided to their employees,” said Rich Moyer, Milliman principal. “We believe the MedInsight EGR Solution will be a very effective tool for health plans to deliver healthcare information to their employer clients. The EGR portal is easy to use and integrated with the health plan portal MedInsight clients currently use.”

Specifically, the MedInsight EGR Solution helps health plans and TPAs demonstrate the value they provide, by reporting on data that will help employers make decisions related to:

• Managing current and future cost trends
• Quality of healthcare services provided to employees
• Wellness programs and population health management

The ability to effectively meet employer clients’ ever-increasing demands for information and transparency comes with competitive benefits for MedInsight clients. It strengthens relationships with employers and provides the meaningful information actually required to bend cost trends and improve health. And by including innovative features like the Health Waste Calculator and population health groupers, MedInsight is providing them with value-add that extends to their employer clients.

Medicaid population management

Moyer-RichardIn previous blogs, we’ve discussed population management concepts and given specific examples of pediatrics, accountable care organizations (ACOs), and clinical populations. In this blog we turn to the Medicaid population. Medicaid has unique characteristics because of the nature of the financing and because of the social demographics of the population served. This population is going through big changes because of Medicaid expansion and the advent of programs that may resemble some of the characteristics of Medicaid, such as subsidized rates through the federal and state exchanges.

A key to analyzing this population is to create homogeneous sub-populations. There are several ways to define the subpopulations:

• Program: Children’s Health Insurance Program (CHIP), Temporary Assistance for Needy Families (TANF)/Aid to Families with Dependent Children (AFDC), Aged, Blind, and Disabled (ABD) Medicaid (duals), waiver programs.
• Type of delivery model: Managed care and fee-for-service.
• County: Rates are typically defined at the county level for managed care and care delivery is organized around counties.
• Special populations: Pregnant women, children, mentally ill.

There are specific issues that drive the metrics and analysis for Medicaid recipients, including:

• High levels of emergency room (ER) use: This population has much higher ER usage rates, which often reflect access and sociodemographic issues.
• Maternity: This population has higher rates of maternity and has wider variability in maternity outcomes.
• Behavioral health: Managing behavioral health is a more important component of care.
• Community resource access: Population wellness is much more dependent on additional community resources such as case workers, food banks, and social workers.

It’s important to focus on the key issues that drive the results for the population and to create metrics that reflect these key issues and characteristics. Below are some sample metrics that should be tracked and improvement goals developed.

This article first appeared at Milliman MedInsight.

Recent analyses of interventions for avoidable emergency department visits

Over the past several years there has been substantial interest in reducing avoidable emergency department (ED) visits. A wide variety of strategies have been employed to achieve these reductions, including:

  • Benefit design changes such as increasing visit copays or putting limits on the reimbursement of number of unnecessary ED visits by a single patient
  • Provider incentives through programs such as patient-centered medical homes (PCMHs) to reduce the avoidable ED rate
  • Structural delivery system changes to emphasize urgent care facilities and after-hours primary care

 
Many of these interventions rely on analytics based on the avoidable ED algorithm from New York University (NYU), which uses a probabilistic algorithm based on primary diagnosis code to identify the likelihood of avoidable ED visits within populations. Several analyses have now been done that analyze the effectiveness and/or the safety of these interventions.

The first analysis was done by the Washington state Health Care Authority (HCA). It cites an over 10% decrease in ED utilization and ED per member per month (PMPM) costs in the first six months of a program instituting seven best practices for Medicaid enrollees in the state. The best practices included the electronic exchange of information between emergency departments, patient education of ED utilizers, sharing of lists of frequent ED utilizers, development of ED care plans, guidelines and monitoring of narcotic prescribing, and the periodic review of feedback reports. For more information on this program, read HCA’s report, Emergency Department Utilization: Assumed Savings from Best Practices Implementation.

The second is a peer-reviewed study by ED physicians, whose conclusion is that the NYU ED algorithm does a relatively poor job in identifying an individual patient’s need for an ED visit. In this study they compared presenting complaint data with ED discharge diagnosis run through the NYU ED algorithm. They found that the presenting complaint predicted poorly whether the visit should have been avoided and that doing so could have safety consequences. While arguably the NYU ED algorithm wasn’t designed to guide individual patient decisions, the article is thought-provoking and undoubtedly can be cited as an argument against ED visit interventions. Read this recent article in the Journal of the American Medical Association (JAMA), “Comparison of Presenting Compaint vs. Discharge Diagnosis for Identifying ‘Nonemergency’ Emergency Department Visits,” for more information.

I’d expect many more articles to be published about these interventions in the coming months and years. It will be important for informatics to be aware of these evaluations.

This article first appeared at Milliman MedInsight.

Double the ACOs

Yesterday, Health & Human Services announced 89 new accountable care organizations (ACOs), doubling the number of Medicare ACOs.

With this in mind we’ve pulled together all of our ACO research into a single location. Here you go:

 
Also, this video offers a nice overview of the ACO concept.

Full steam ahead for Medicare/Medicaid EHR incentives

As reported in Modern Healthcare, the Centers for Medicare and Medicaid Services (CMS) has provided nearly $4.5 billion in electronic health records (EHR) incentive payments. About $2.4 billion of that is under Medicare, which started EHR incentives in May 2011. The rest is under Medicaid, which began EHR incentives in January 2011. Hospitals have received the bulk of the total in both programs, about $3.1 billion. The program has more than 225,000 active accounts. The EHR incentive program is part of the American Recovery and Reinvestment Act of 2009, which authorized $19 billion for the EHR incentive program.

For a couple of Milliman perspectives on the EHR program, check out this paper on state healthcare data exchanges which points out how:

Community-based data pooling initiatives in Minnesota, Massachusetts, Oregon, Washington, and Wisconsin (commonly known as Chartered Value Exchanges or CVEs) have already shown that, at least using administrative data, it is possible to bring stakeholders to the table, get appropriate infrastructure in place, and begin using community health data to improve quality and transparency. These organizations may serve as models or building blocks for more meaningful use of EHR data nationally.

It’s also worth taking a look at this 2009 research report, “The Convergence of Quality and Efficiency and the Role of Information Technology in Healthcare Reform,” which discusses how EHR can move beyond administrative efficiency to become a decision support tool for physicians.

You can download the latest EHR program data from CMS here.