welcome and market observations
Post on 20-Oct-2014
447 views
DESCRIPTION
TRANSCRIPT
2014 Partners Summit Welcome & Market Observa;ons
Las Vegas, NV
Who’s Here for the Partners Summit?
! Approximately 100 guests
! 40 health plans
! 10 external speakers
! Several provider organiza?ons
! Industry alliances and associa?ons
! Consul?ng, analy?cs and marke?ng firms
! Leading healthcare journalist and author
! Top Wall St analyst
2
Who’s Not Here?
3
Any of the es+mated 500+ Elvis impersonators in Las Vegas today
Welcome Outcomes Health!
4
Why Outcomes Health?
5
Analy;cs & Data Management
Member Engagement
Chart Retrieval & Clinical Review
Exper;se & Consulta;ve Approach
• Superior client-‐facing transparency & repor?ng technology tools • Sophis?cated analy?cs to priori?ze member chart chases • Ability to license soNware (coding & abstrac?on)
• Expanded geographical footprint & scope for in-‐home clinical care visits
• Expanded member outreach with dedicated clinical resources
• Industry leading geographical footprint for retrieval, coding & abstrac?ons
• Increased capacity & scale, including offshore opera?ons center
• Deep domain exper?se in quality measurement & risk adjustment for Medicare Advantage & Managed Medicaid
Altegra Health at a Glance
6
Los Angeles Phoenix
San Juan, PR
Mt Laurel
Miami Lakes
Chicago
Minneapolis
Headquartered in Miami Lakes, FL, with eight regional offices & opera;ng in all 50 states, Puerto Rico, & the Philippines
Atlanta
Manila, Philippines
ALTEGRA TEAM – over 3,100 total team members
Altegra Health Vision
7
To be the most trusted and valued partner in helping
healthcare organiza?ons improve their performance
and the health and well being of the individuals they serve.
Market Observa;ons
! Near term uncertainty about health care reform
! ACA requirements & ?melines up for grabs
! CMS 2015 Advance No?ce
! Medicare Advantage rates
! Home assessments
! Transi?on from RAPS to EDPS
! Long Term Perspec?ve
! Con?nued growth in Medicare, Medicaid and Dual segments
! Increasing dominance of government-‐funded health care
8
Market Observa;ons
! Health Insurance Exchanges/Marketplaces
! Slightly nega?ve to neutral near term financial impact
! Plans posi?oning to par?cipate more broadly long term
! ACA provides for a “permanent” risk adjustment program
! Some similari?es to Medicare
! Significant similari?es to Medicaid
! Risk adjustment payment transfer
9
Market Observa;ons
10
Individual and Small Group Market Risk Adjustment Payment Transfer Formula
Market Observa;ons
! Quality (HEDIS – STARS)
! Fully incorporated into the health plan RCM/finance narra?ve
! Has the complete aeen?on of the health plan C-‐suite
! Implementa?on, execu?on and ?melines challenging
! Provider abrasion and ‘data intermediary’ complica?ons
! Healthcare Data Analy?cs
! Increasing emphasis on internal and outsourced capabili?es
! Na?onal Provider Iden?fier (NPI) challenges abound
! Predic?ve modeling, screening and targe?ng more cri?cal
11
Market Observa;ons
‘I fell out of bed, hit my head, slipped down the stairs, rolled out the front
door, and crashed into my car’
12
Market Observa;ons
‘I fell out of bed, hit my head, slipped down the stairs, rolled out the front
door, and crashed into my car’
Guess what?
13
Market Observa;ons
‘I fell out of bed, hit my head, slipped down the stairs, rolled out the front
door, and crashed into my car’
There’s an ICD-‐10 code for that!
14
Market Observa;ons
! ICD-‐9 to ICD-‐10 Transi?on
! 14,500 ICD-‐9 codes increasing to 70,000 ICD-‐10 codes
! Industry readiness unclear, par?cularly among providers
! Financial impact unknown to many
! Demand for coders rising rapidly
15
“The industry is thousands of coders shy of the figure necessary to fully support the transi?on to ICD-‐10 before, during, and aNer Oct. 1, 2014. Demand has been slowly increasing during the last 90 days and will skyrocket in the fourth quarter of 2014.”
