Post on 24-Jun-2022
Webinar SeriesSession 2:
Optimizing Your Communicable Disease Outbreak Management
Workgroups comprised of subject matter experts from HMA and
HealthEC met over several months in 2019 to discuss ways in which
healthcare consulting and advisory services such as those offered by
HMA and population health management (PHM) and analytics
applications such as those offered by HealthEC could be leveraged more
effectively by government agencies, healthcare providers, and payers to address critical needs in select focus
areas.
1. Health Equity
2. Communicable Disease
Outbreak Management
3. Opioids Program Supports
4. Supports to Small/Midsize
Health Plans
5. VBP Contract Supports
6. MCO/ACO Performance
Management
7. HHS Service and Data
Integration
Health Performance Accelerator™
Tailored consulting and advisory services that can be coupled
with tailored PHM and analytics platform deployments
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HMA - HealthEC Collaboration
Opportunity Focus Areas Outputs
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Jenifer Leaf Jaeger, MD, MPH
Senior Medical Director - HealthEC
Desmond Banks, PhD, MPH
Senior Consultant - HMA
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Today’s Speakers
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• The COVID-19 pandemic has revealed the inadequacy of the data to management and analytics infrastructure currently deployed at the state and local levels to prepare for, respond to, transition out of, and provide for ongoing surveillance to prevent major outbreaks of infectious diseases
• Ideally, state and local public health agencies would have a cohesive suite of information systems connected as needed
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The Challenge
PREPARE
SURVEIL
RESPOND TRANSITION
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• $500 million in funding for public health information system modernization authorized by the CARES Act
• In conjunction with other funding such as MMIS funding, creates what could be a once-in-a-generation opportunity for public health and other agencies to invest rapidly in information technology that enable moreeffective communicable disease management
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Funding Channels
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Surveillance Preparation
Response Management
Transition Management
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The Solution
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Only six stateshave released COVID-19 testing data by race/ethnicity:
1. Delaware
2. Illinois
3. Indiana
4. Kansas
5. Nevada
6. Utah
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Why Surveillance, Preparation, Response & Transition Management are Important
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Optimal surveillance requires data on all three:oTesting
oCases
oDeaths
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Why Surveillance, Preparation, Response & Transition Management are Important
Failure to include testing data can lead to skewed results:
o A higher number of cases and/or deaths in Population A versus Population B could be
attributable to disproportionately higher number of tests conducted among Population A
versus Population B.
▪ It can be difficult to accurately identify health disparities without optimal surveillance.
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Representative Sample: “How well does this sample population represent the overall population?
o Age
o Sex
o Race & Ethnicity
o Education
o Income
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Why Surveillance, Preparation, Response & Transition Management are Important
Representative Sample = High External Validity = Generalizable Resultso “This sample/subset of the populations is representative of the overall population, so we can
conclude that the data/outcomes for this sample/subset with be generalizable to the overall population”.
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Why Surveillance, Preparation, Response & Transition Management are Important
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Why Surveillance, Preparation, Response & Transition Management are Important
As of September 2, 2020
Incidence Rate238,643 / 4,119,973 = 5.8%
Fatality Rate8,091 / 4,119,973 = 0.2%
Case Fatality Rate8,091 / 238,643 = 3.4%
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Why Surveillance, Preparation, Response & Transition Management are Important
White = 60.8% Hispanic = 17.5% Black = 14.6%
47.8%
30.4%
8.7%
7.3%
Overall Illinois State Population Demographics
24.3%
27.0%27.4%
14.9%
26.6%
1.7%
45.9%
20.2%
As of September 2, 2020
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Why Surveillance, Preparation, Response & Transition Management are Important
47.8%
30.4%
8.7%
7.3%
24.3%
27.0%27.4%
14.9%
26.6%
1.7%
45.9%
20.2%
Illinois COVID-19 Testing and Cases by Zip Code
Zip Code # Tested # Positive Cases Incidence Rate (%)
60004 17,033 578 3.4%
60007 7,398 520 7.0%
61801 45,568 225 0.5%
61822 20,341 210 1.0%
62859 750 29 3.9%
62865 331 28 8.5%
As of September 2, 2020
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Impact and Strategy
COVID-19 Positive
Risk Stratification
Disease Patterns
Disease Surveillance
COVID-19 Assessments
Outreach/Telemedicine
Social Determinants of Health (SDoH)
Medication Therapy Management (MTM)
Care ManagementBusiness Intelligence
Analytics
HealthEC Platform
OPERATIONS
Plan uses platform to support/improve operations
Platform provides functionality to support reporting (KPI, metrics, regulatory)
for plan operations
HMA/HealthEC
support each other
in the engagement
Consulting/advisory services are geared to improving operations using HealthEC’s platform
or outputs as needed.
• Provider
management
• Claims processing
• Quality
management
• TPL management
• UM
• Financial
management
• Program integrity
• Care management
• PHM
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• Predict and model the impact of COVID-19 on members, providers, service utilization, and costs
• Tailor care management strategies and protocols
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Analytics & Modeling
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• Rapid implementation allows your organization to assess the risk of vulnerable populations to allocate the right resources
• Comprehensive chronic care management and supplemental patient assessments
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Rapid Response Package
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Outbreak Objectives
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✓ Truly proactive population health
management
✓ Optimization of care management protocols
✓ Timely development of care plans and timely
action on care plan changes
✓ Improved compliance monitoring
✓ Better modeling of financial impacts
✓ More precise documentation and reporting of
the outbreak’s impact on quality and other
performance measures
• Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) guidelines, published research, global field experience, and our predictive data analytics were incorporated into our risk stratification model:oAge, selected for all person's 65+ years of age; highest mortality risk persons
80+ years of age
oCo-morbid conditions: cardiac disease (hypertension, coronary artery disease, and congestive heart failure), diabetes, pulmonary disease
oRisk Score: Johns Hopkins Prospective and Likelihood of Hospitalization Score, Hierarchical Condition Category (HCC), C3 score for Oncology
oAdditional factors: smoking, obesity, exposure risk, immunosuppression
oAdmissions, ER visits, Cost, and Frailty Indicator (Johns Hopkins) data
COVID-19 High Risk Stratification
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Intervention WorkflowCOVID-19 high-risk patient lists uploaded into HealthEC’s population health management (PHM) platform.
High-risk patients are stratified to prioritize outreach and assessment.
The COVID-19 Patient Risk Assessment Survey generates a risk score mapping to 1 of 4 risk levels and associated Action Plans.
Action Plans are managed within the Care Plan for each patient.
Recommendations are linked to Goals and Interventions within the COVID-19 Program with alerts for scheduled follow-up.
Data on utilization and costs of this COVID 19 cohort of patients is analyzed and correlated to interventions as they are recorded
• Geo-maps are produced mapping high-risk patients and COVID-19-positive patients by ZIP code, provider or facility.
• COVID-19 test results (positive & negative) are used to identify susceptible and infected members for ongoing care management, cluster analysis, assist in resource allocation.
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© 2020 HealthEC, LLC | Confidential & Proprietary 20
Care Manager COVID-19 Workflow
Care manager selects patient
from the list to bring up
assessment.
Care manager
administers assessment.
System generates a patient-level
COVID-19 risk score.
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Care manager selects COVID-19 program to bring up the
COVID-19 assessment list.1
3
4
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Actionable Intervention WorkflowCOVID-19 Risk
ScoreActionable Intervention Required Action Due
≥ 9
ACTION 1: Call medical provider AND go to local emergency room
for further evaluation. Symptoms may be related to COVID-19 or other
severe condition requiring immediate evaluation.
Today
5 ‒ 8
ACTION 2: Stay at home, monitor symptoms, and contact care
coordinator or medical provider within next 24 hours or with any
worsening; take steps to prevent spread within your home.
Tomorrow
2 ‒ 4
ACTION 3: Stay at home, monitor for symptoms, and contact your
care coordinator or medical provider within next 24 ‒ 48 hours or with
any worsening; take steps to prevent spread within your home.
2 Days
0 ‒ 1
ACTION 4: Stay at home, monitor for symptoms, and contact your
care coordinator or medical provider if symptoms worsen; take steps
to prevent spread within your home.
Reassess
in 1 Week
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Intervention Screen
Interventions can be edited using the pencil icon
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High-risk and COVID Positive Geo-mapping
Clicking on “High Risk Patients” and
“COVID-19 Positive” data layers shows
the locations and relative
concentrations of high-risk members in
relation to COVID-19-positive members.
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Q & A
24Confidential & Proprietary | © 2020 HMA and HealthEC. All Rights Reserved.
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Upcoming Webinars
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Tuesday 9/8Thursday 9/10
Tuesday 9/15 Thursday 9/17 Tuesday 9/22
Appendix
26Confidential & Proprietary | © 2020 HMA and HealthEC. All Rights Reserved.
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Retrospective Analysis Predicting Future Resource Needs
Monitor encounters, ADTs, lab resultsRemote monitoring: thermometers and pulse oximeters
Weeks 31 4 8 322 16High-risk Patient
• 65-year-old male
• Hypertension
• Diabetes
• COVID-19 positive
True incubation period Immune status followed by antibody titers
Infectious period followed by viral load testing
Data query
High-risk pts identified
Initial C/O: COVID-19 survey & assessment
Trigger is COVID-19 test, regardless of whether positive or negative
CM program initiated
First symptoms indicate need for testing
COVID-19 test COVID-19
test positive
Look back after Trigger
• • • • • • • • • • • •
Serial antibody titers ( )and serum testing of viral load ( ) to be repeated at decreasing frequencies as determined by provider
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The patient assessment for
COVID-19 is adapted for HealthEC’s mobile
app.
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Mobile Assessments
SAMPLESAMPLE
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