Iggbo-HEDIS White Paper_v10

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HEDIS WHITEPAPER | JANUARY 2017

Shaiv Kapadia, MD | Blake Wehman, MHA

Abstract

“Gaps in Care” is a term used to describe the delta (difference) between the average rate of

care received by members of both commercial and government payers and the members

receiving care at the 90th percentile. Historically, there has been a delta greater than ten

percentage points between the average and the excellent1. As a result, the National Committee

of Quality Assurance (NCQA) created a set of clinical measures to monitor in an attempt to

close “Gaps in Care.” The measures are collected and reported to the Healthcare Effectiveness

Data and Information Set (HEDIS), which NCQA describes as follows:

“A set of standardized performance measures designed to ensure that purchasers and

consumers have the information they need to reliably compare the performance of health care

plans.”2

As a result of the NCQA’s HEDIS measures, insurance payers have built programs specifically

to address these measures. This includes Comprehensive Diabetes Care, which includes the

following measures3:

1. Hemoglobin A1c (HgA1c)

2. Urine Microalbumin

3. Retinal Eye Exam

4. Blood Pressure

Problem Statement

Every year there are 4,300 to 9,600 preventable deaths due to poorly managed diabetes. If all

diabetics received the best care available, nine cases out of 10 could be prevented. Proper

diabetes prevention and management would save the US Healthcare System $570 million per

year by avoiding unnecessary medical procedures.

Today, healthcare systems targeting diabetes have proven that increased outreach and

monitoring can help close gaps in care. Specifically, ensuring that patients have their annual

HgA1c, retinal exam and urine microalbumin evaluated directly correlates to improved

1 http://www.ncqa.org/publications-products/other-products/quality-profiles/focus-on-diabetes/addressing-the-quality-gaps 2http://www.hopkinsmedicine.org/johns_hopkins_healthcare/downloads/Tips%20to%20Improve%20Your%20HEDIS%20Measures-final3-29-12.pdf 3http://web.southcarolinablues.com/UserFiles/scblues/Documents/Providers/HEDIS%20Measure%20Provider%20Matrix%20O32415.pdf


outcomes. Therefore, many payers contract with disease management vendors today to help

improve the outcomes of their members.

Iggbo is transforming this disease management space with an on-demand network of collectors,

equipped to close all three gaps in care necessary to monitor and provide comprehensive

diabetic care.

Background

Iggbo is an on-demand network of highly qualified healthcare professionals ranging from

phlebotomists to registered nurses. While Iggbo primarily offers on-demand venipuncture, the

network capabilities include (but not limited to) blood pressure, weight measurement, and drug

screening. Iggbo’s on-demand network of healthcare professionals give market segments,

ranging from health systems to laboratories to payers, instant reach and access with a

sustainable variable cost model.

Problem Statement

The problem payers face is with implementing a plan to close the gaps in care identified from

their HEDIS reports. As exhibited below in Figure 1, many payers are struggling with managing

the care of their members, especially their diabetics. Although payers are aware of the

staggering direct and indirect costs mismanaging patients has for their health plan, there are

few that take on the operational resources necessary to manage their members to the 90th

percentile. For diabetic patients, as an example, one out of every three inpatient days for

patients battling cardiovascular, neurological and renal conditions are due to patients battling

diabetes. To make matters more difficult, the prevalence of diabetes in American continues to

rise (see Figure 2 below).

Figure 1: Average Medicare Health Plan Score (Majority Between 3 & 4)


Therefore, more Americans battling diabetes is related directly to the increased investment

payers have to make in disease management programs. Although payers clearly understand

the downstream costs of poorly managed diabetic members, there’s still an average rating of

comprehensive diabetic care amongst health plans of 3.01-4.0. It’s a combination of member

education, operational costs for payers, and member non-compliance that is preventing payers

from delivering the care they aim to provide.

Figure 2: Prevalence of Diabetes in The United States of America

Solution

Iggbo’s mission is to deliver personalized medicine to everyone by optimizing and streamlining

current systems of care. Health insurance companies, for years now, have received offers from

disease management companies aimed at reducing their costs, increasing their revenues from

HEDIS reimbursements, improving outcomes, and various other population health management

metrics. The common threads among all companies focused on population health

management are:

The return on investment ($3 earned for every $1 spent; $5, etc.) The implementation cost ($10,000/month to implement; $1mm annual costs, etc.)

What makes Iggbo’s solution to the marketplace unique is that it is a broad solution that can

address HbA1c, blood pressure, retinal exams and various other metrics while requiring no

implementation costs. Iggbo’s online portal can be primed for use quickly – and the network can

be embedded with tools that the payer can leverage for the right labor at the right place at the

right time. Iggbo’s on-demand network of collectors help payers achieve their goals. The

calculator below was built to help outline the returns payers can achieve through Iggbo.


Figure 3: Sample Iggbo HEDIS Calculator

IGGBO ASSUMPTIONS % NUMBER OF MEMBERS COLLECTED

TOTAL IGGBO COST

GROSS REVENUES TO PAYER

% OF WOMEN FULL CDC PACKAGE + BCS*

10% 20,625.00 $3,609,375.00 $8,043,750.00

% OF WOMEN FULL CDC PACKAGE NO BCS

50% 103,125.00 $13,921,875.00 $35,681,250.00

% A1C ONLY 20% 41,250.00 $1,650,000.00 $4,702,500.00

% RETINA EXAM ONLY 20% 41,250.00 $1,650,000.00 $1,320,000.00

% OF MEN FULL CDC PACKAGE 50% 84,375.00 $11,390,625.00 $29,193,750.00

% A1C ONLY 25% 42,187.50 $1,687,500.00 $4,809,375.00

% RETINA EXAM ONLY 25% 42,187.50 $1,687,500.00 $1,603,125.00

MAX TOTAL MEMBERS SERVED 375,000.00

MAX COSTS $35,596,875.00

MAX REVENUES $ 85,353,750.00

MAX PROFITS $ 49,756,875.00

* Comprehensive Diabetes Care (CDC) and Breast Cancer Screening (BSC)

Understanding the above table helps both the payer’s HEDIS team and the Iggbo project

management team calibrate their expectations and goal. To calculate the savings in the sample

above, Iggbo collects the information in the table below:

PAYER BREAKDOWN #

TOTAL NUMBER OF MEMBERS 6,000,000

% DIAGNOSED WITH DIABETES 25%

GROSS TOTAL DIABETIC MEMBERS 1,500,000

% MEMBERS: WOMEN 55%

% OVER 40 75%


% MEMBERS: MEN 45%

GROSS WOMEN TOTAL 3,300,000

WOMEN OVER 40 2,475,000

GROSS MEN TOTAL 2,700,000

From here, Iggbo can begin to calculate the goals for each measure based on the national

benchmarks set by the NCQA that year, as exhibited below:

HEDIS MEASURES METHOD INCENTIVE 90TH PERCENTILE

A1C COLLECTION Venipuncture or Siemens POC Device $114 90%

RETINOPATHY SCREEN RetinaVue or IRIS $38 90%

NEPHROPATHY SCREEN Urine collection $32 80%

BLOOD PRESSURE Blood Pressure Cuff $147 80%

BMI ASSESSMENT Height ruler and scale $15 95%

BREAST CANCER SCREENING SureTouch device $44 90%

MAX POTENTIAL PER MALE MEMBER

$346

MAX POTENTIAL PER FEMALE MEMBER

$390

AT RISK DIABETIC BREAKDOWN

DELTA TO REACH INCENTIVES

MINIMUM COLLECTIONS NEEDED

NET MEN NET WOMEN

NET WOMEN OVER 40

% WITH OUTSTANDING A1C

15% 225,000.00 101,250.00 123,750.00 92,812.50

% WITH OUTSTANDING RETINA SCREEN

10% 150,000.00 67,500.00 82,500.00 61,875.00


% WITH OUTSTANDING NEPHROPATHY SCREEN

5% 75,000.00 33,750.00 41,250.00 30,937.50

% WITH OUTSTANDING BLOOD PRESSURE

10% 600,000.00 270,000.00 330,000.00 247,500.00

% WITH BMI ASSESSMENT

5% 300,000.00 135,000.00 165,000.00 123,750.00

% WITH OUTSTANDING BREAST CANCER SCREENING

10% 2,475,000.00 N/A N/A 247,500.00

Iggbo can determine the members with gaps-in-care for specific measures, the projected

earnings per member if the incentives are achieved, and the costs of Iggbo per collection.

With the combination of Iggbo’s seamless online ordering system and its compliance messaging

system, the payer’s HEDIS team can simply deploy the on-demand collectors to close the

necessary gaps-in-care. There are no costs for implementation and Iggbo charges for the

collection on a per collection basis; however, Iggbo also offers shared savings models where

payment is collected after the results are returned. In either model, the costs are significantly

less than the incumbents in the market. As result, Iggbo provides payers the following, all at a

reduced cost:

• Optimized operations and outreach

• Enhanced patient outcomes

• Unlock previously unreachable STARS/HEDIS reimbursements

Results

Iggbo implemented its on-demand network for a regional payer managing their state’s Medicaid

population (and their Medicaid-Medicare dual eligibles) and realized immediate results. An

Iggbo pilot project was introduced, scoped and implemented, at no cost to the payer in less than

three weeks. Iggbo created individual account for fifteen individuals who were able to close 20%

of their gaps-in-case. The payer’s HEDIS team were provided daily goals and quotas. Through

the first two-weeks, every individual met their daily quota. At the conclusion of the pilot, the

payer surpassed their goal of securing a neutral rating and unlocking previously unattainable

reimbursements from HEDIS and STARs.

Iggbo drove 90% compliance through its Glidepath messaging platfromplatform. As depicted

below, Glidepath provided patients the opportunity to easily and seamlessly reschedule their


appointments. In addition, the system sent reminder messages through a variety of channels in

order to meet all communication preferences.

Figure 4: Iggbo’s Compliance Messaging System Glidepath

By leveraging Iggbo’s on-demand workforce, the health system was able to provide a mobile,

flexible catchment in one of America’s densest metropolitan statistical areas that was both

convenient for the patient and compliant with the system’s laboratory protocols. The Iggbo

Solution Scorecard was built to illustrate the net-impact the Iggbo model had on the system. The

Scorecard is a financial calculator linked back to the aforementioned Iggbo PHM Calculator. It

demonstrates the health system’s true cost savings and earnings from implementing Iggbo

across their entire HEDIS service line.

IGGBO SOLUTION SCORECARD

OUTREACH SUCCESS 90%

NUMBER OF PATIENTS WITH GAPS IN CARE 2250

TOTAL PATIENTS SCHEDULED PER DAY PER MEMBER 3

NUMBER OF TEAM MEMBERS 15

ELIGIBLE DAYS TO CLOSE GAPS IN CARE 45

TOTAL PATIENTS SCHEDULED 2025


TOTAL PATIENTS COMPLETED 1923

IGGBO COMPLIANCE 98%

BASELINE HEDIS RATING 79%

NET HEDIS RATING POST-IGGBO 94.96%

AVERAGE REIMBURSEMENT PER A1C GAP CLOSED $120

NUMBER OF A1C PATIENTS 1500

GROSS REIMBURSEMENT PER A1C $180,000

IGGBO COSTS + OPERATIONAL EXPENSES PER PATIENT $50

TOTAL EXPENSES $75,000

NET PROFIT $105,000

The result of the Iggbo implementation was a projected net-HEDIS rating of 94.96%, nearly

four points above the neutral rating. The average incentive payment from NCQA to payers

for closing gaps-in-care for A1c collections averages $140.00. It is projected that the payer

actualized potential revenues of $180,000 – much of which was previously unattainable.

Conclusion

The American health care system has focused on the Triple Aim for nearly two decades: reduce

costs, increase quality and improve outcomes. Through Iggbo’s on-demand network of

healthcare labor, payers can accomplish this goal, as proven by Iggbo’s case study with a payer

tasked at closing its gaps-in-care in record time. In this case study, Iggbo was able to unlock

incentives for the payer previously thought to be unattainable – and is projected to be a key

operational tool in their upcoming year.

To see how Iggbo can help your members, download our calculator here and contact Iggbo at [email protected].

For more information about how Iggbo can help you or your system, please contact Iggbo at [email protected].

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Iggbo-HEDIS White Paper_v10

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