Poindexter's Points:
Advanced Plan for Health's News and Updates

June 2018
In The News
Leadership Lowdown

We are thrilled to welcome Debra Machos to the Advanced Plan for Health (APH) team. In her role as Sr. Vice President of Strategic Product Development and Management, Debra will work hand in hand with our valued clients to ensure mutual success with our Client Services team. She also will have her eye on evolving client needs and market changes to ensure APH’s Poindexter platform continues to adapt and innovate ahead of the industry.

A decisive, action-oriented and relationship-building leader, Debra is a highly effective and analytical healthcare executive experienced in strategy, operations, technology and client relations. She manages large-scale change through establishing a vision and engaging teams to execute. Her strong financial acumen and exceptional critical thinking skills bring expertise in designing and implementing effective solutions and product innovations.

Prior to joining the APH team, Debra was recruited by Children’s Health to serve as the VP Strategy, Planning and Business Development, and identify, develop and operationalize new access points to meet growth objectives. She led a team of internal consultants in identifying opportunities, evaluating strategic value, performing due diligence and prioritizing resource investments. Debra identified strategic expansion opportunities, developed a model for pediatric-focused acute care access points and served as a subject-matter expert for major process improvement initiatives.

Read more of Debra’s bio here.
Dr. Barbara Rutkowski and Joy McGee-Cory Featured in BrokerWorld

We’re thrilled to share that our Joy McGee-Cory and Dr. Barbara Rutkowski, EdD, MSN, CCM have an article featured in BrokerWorld in June:


The article focuses on a concerning trend identified via Poindexter wherein clients and their members have experienced unexpected and very unpleasant surprises following certain complex surgical procedures – usually spine-related. The surprises are coming in the way of bills for intraoperative neurologic monitoring (IONM).

"In one case, the billing technician was not a physician, and the member’s bill for monitoring services was an unreasonable, non-negotiable $120,000.”

Recap From The Road
The SouthWest Benefits Association (SWBA) 43rd Annual Benefits Conference in May was heavily focused on employee benefit best practices in relation to data analytics, actionable intelligence and cyber security. Here are a few of the highlights one of our delegates, Rick Scheel, noted relative to our industry: 

Attendees learned about the relevance of data analytics in relation to managing high-cost claimants. According to one presentation by Boeing’s Jason Parrott , titled “Looking to the Horizon: Healthcare Benefits Strategies for Today and the Future,” “77% of employers rate monitoring and managing high-cost claimants as their top strategic priority for the next five years.” The root cause of many issues related to high-cost claimants became more clear as the presentation went on, and it was stated that “50% of patients reported confusion and not understanding what doctor told them,” during their consultation, while “61% of Self-Referrals get it wrong, resulting in 33% higher costs.”

The presentation served as a reminder that employers are having to become more and more responsible for ensuring efficient communication and timely intervention in order to improve the health of their high-cost claimant populations.

This means that employers are relying more and more on advanced and predictive analytics to identify those within their population who should be prioritized for support. This insight is allowing them to take the strategic steps necessary to reign in costs associated with high-cost claimants (and those predicted to be high-cost claimants) through means such as clinical support and coordination of care.

As a result of targeted analytics and coordination, one employer (Dean Foods) saw “87.7% of [its] members identified through Real-Time Intercept,” which allows them to intervene early in the process. Ultimately, the plan saved “$756 Average PEPY” in gross savings year one.
Another presentation by Hobby Lobby’s Jessica McHargue titled, “Communications that Deliver Results” provided some key success factors for best practices in actions supported by the actionable data discussed above:

KEY SUCCESS FACTORS

  • Meet people at their point of need AND
  • Understand how people feel and function at point of need
  • Be expert enough to help
  • Be confidential and safe
  • Stick with them – allow return calls
  • Fix things they can’t fix

The results they experienced, which are undoubtedly in large part due to Hobby Lobby’s commitment to implementing actionable intelligence and efficient management of their high-cost claimants are encouraging and are listed below:

Employees Are Happier - Net Promoter Score (NPS): 74

Results Are Better - 20% Or More Increase in Point Solution Utilization

Total Costs Are Less

  • In Network Utilization Greater
  • Less Waste
  • Fewer Re-admissions

At APH, we pride ourselves in delivering actionable, quality current state and predictive analytics that support powerful and informed targeting and lasting improvements in outcomes.
If you have any questions for Rick Scheel related to his experience and learnings at this conference, please feel free to reach out to us at (888) 600-7566 or marketing@mypoindexter.com .
Blog Insights

More and more frequently, our current and prospective employer group clients will ask us what we see as the most effective avenues to support employees and members who have been identified through analytics for outreach and support. How do they “take the final mile” for those with chronic conditions and co-morbidities, inappropriate ER utilization, gaps in care, medication risk(s), potential pain script issues, and predicted events such as hospital admissions, re-admissions, heart attacks, strokes and more.

To continue reading click here.

By Jason Rudy, Data Scientist / Programmer and Matt Lewis, Programmer / Product Manager

Fundamentally, machine learning is a set of techniques that allows the training of computer programs using example data. In the healthcare field, machine learning, coupled with large sources of patient / member data, can help generate predictions around population health, cost of care, events such as hospital admission and readmission, and give insight into the potential for individuals to experience specific outcomes and conditions (e.g. heart attacks, strokes, chronic kidney disease).

To continue reading click here.
Featured Research
Important update on RISE / APH Research Participation Opportunity – Medicare Advantage Plan Analysis
We would like to extend a sincere thank you to all of the Medicare Advantage Plans who have raised their hands to be a part of this important Medicare Advantage Plan research project, and for your continued strong support of this important initiative. We also want to thank so many of you for sharing your feedback on the initial proposed research approach and the timing. As a result of the feedback received, we are adjusting our approach and timing for the research project. Below is a summary of the feedback and the adjustments.

Many of the plans who have signed up to participate to date have indicated a preference to receive benchmarking information within their individual Opportunity Assessment report rather than being benchmarked against other plans as part of the study. In light of this, we are re-focusing the overall research to highlight advanced and predictive analytics commonality across participating plans, as well as unique findings. We will leave the benchmarking findings for the individual Opportunity Assessments that each participating plan will receive.

We have also been asked to push out the research data receipt deadline to better accommodate participating plans in requesting and receiving the needed data. Many have suggested that it may take until Q3 or Q4 of 2018 to get through their IT queue for the files. We understand the internal complexity involved in these data requests, so APH and RISE are committed to work with participating plans until data has been received. Due to the extended timeline for data receipt, we are looking into the best RISE conference for the presentation of these findings, and are currently aiming for an early 2019 research findings presentation.
If you are interested in signing up to participate in light of these adjustments, please feel free to reach out to Denis Cremin at Advanced Plan for Health at deniscremin@mypoindexter.com . Denis will assign each participating plan a point of contact at APH to guide them through the research onboarding process. Onboarding starts with putting in place data sharing and non-disclosure agreements, then submitting your data sets.
APH, On the Road
Upcoming Tradeshows and Conferences

June 14-15 l Phoenix, AZ
 
Attendees will gain a new perspective on reducing healthcare costs while improving quality at the industry’s premier event for Utilization and Care Management professionals. In its third year, this innovative conference takes an intensive look at the new problems plans are facing this year, while providing insights and best practices that will enable them to fine-tune Utilization and Care Management initiatives. Leading experts will deliver an original, broad-based picture of how to balance cost containment with improved outcomes.

July 16-18 l Minneapolis, MN

The HCAA TPA 2018 Summit focuses on the information and process needs of benefit administrators and the self-funded industry. It additionally offers break-out sessions for attendees in Leadership, Sales/Marketing, Operations and Emerging Leaders paths. 

September 23-25 l Austin, Texas

The SIIA National Conference & Expo is the world’s largest event focused exclusively on the self-insurance / alternative risk transfer marketplace and typically attracts more than 1,700 attendees from around the U.S. and from a growing number of countries around the world.
The APH team would welcome the opportunity to meet you in person at any of our scheduled tradeshows and conferences. Contact us here , email us at marketing@mypoindexter.com or call (888) 600-7566 to arrange a time to meet with us.