Using Technology & Data Infrastructure to Realize the Potential of SIM Reforms
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The document discusses a company called RowdMap Inc. and its proprietary Risk-Readiness assessment tool. The tool analyzes newly released public data from CMS to evaluate providers' ability to take on insurance risk. It benchmarks providers' practice patterns for unnecessary spending and no-value care to determine their readiness for different risk-based payment models. The document provides examples of how the tool can be used to identify high-value providers, optimize insurance networks, and guide providers in selecting appropriate risk arrangements.
![All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis.
Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents
without the prior written consent of the Company, is prohibited.
10
Everything you need to Belly Up
[Referrals: http://1.usa.gov/1FzoEOV]
[Variation: http://go.cms.gov/1D8j7LE]
[Shared Savings: http://go.cms.gov/1Hh8vx0]
[Medicare FFS Part B: http://go.cms.gov/OCmyoy]
[Medicare FFS Part D: http://bit.ly/1mGyBxk]
[Medicaid: http://go.cms.gov/1z7b5ic]
[Dartmouth: http://bit.ly/1GXvlJp]
[Behaviors: http://1.usa.gov/1PzcisT]
[Health Data All Stars: http://bit.ly/1GAsVC3]
GET STARTED
Risk-Readiness SM](https://image.slidesharecdn.com/rowdmapkysim09-151006011901-lva1-app6891/85/Using-Technology-Data-Infrastructure-to-Realize-the-Potential-of-SIM-Reforms-10-320.jpg)
Using Technology & Data Infrastructure to Realize the Potential of SIM Reforms
- 1. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited.
- 2. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. 2 Get to know gov data especially variation & risk Rank your markets and docs by Risk-Readiness Match your docs & markets w/ the right arrangements Build your business & negotiate around this KY SIM Risk-Readiness SM
- 3. 3 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. CMS: 50% of FFS will be gone by 2018 CMS is releasing new, powerful data to support their goals of transitioning providers in to Pay for Value New Powerful Data on Every Provider, Market and Health Plan in the US
- 4. 4 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. At the core of Risk-Readiness SM is Unwarranted Variation: Every provider has a unique practice pattern that informs Risk-Readiness SM Providers often Perform Better against These Metrics than Traditional Payer Evaluations Apply the Dartmouth Atlas for Unwarranted Variation methodologies to the newly released CMS data. This research has been repeatedly validated over the last 30 years and we now have a national data set to apply the methodologies at a large scale. This doctor has lower utilization and unit costs But this doctor is making money for whoever owns the risk Often, physicians with practice patterns that create value for whoever owns risk do not receive the right compensation from traditional payer utilization review and actuarial analysis
- 5. 5 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Hospital Marketshare by Major Clinical Categories Provider Group Marketshare by Major Clinical Categories Physician Marketshare by Major Clinical Categories Decrease market share of this group for ortho Circulatory Respiratory Unnecessary Spend in Louisville By condition across hospitals, groups and physicians Win Is a Virtuous Cycle where Providers with Less Unnecessary Spend Have More Membership System goal is virtuous cycle where providers with lower rates of unnecessary care have higher market share. Fastest path may come from payers, employers and new network design and optimization. Increase market share of this group for ortho
- 6. 6 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Market Is Consolidating around Narrow Networks often Using This Data Payers buying providers who mitigate unnecessary spending and private equity groups accelerating groups to this. The newly released data can identify hidden value in providers.
- 7. 7 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. New Public Data Shows Risk-Readiness SM and Drivers for Groups, Individual Physicians Practice patterns for unnecessary spending and no-value care benchmarked nationally and regionally inform government programs and payer-based risk arrangements Great profile for aggressive risk Tread carefully on path to risk Match appropriate risk arrangements based on provider practice patterns and Population characteristics within a geography
- 8. 8 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. Population Health Reporting Plan from prevalence & physician supply Unnecessary Costs Reporting Manage clinical care and costs Payer Report Cards Negotiate with insurers using government benchmarks KY SIM Four ways to Risk-Readiness SM Every group, physicians, hospital and post-acute center in KY Risk-Readiness SM Reporting Match your performance to the right arrangements
- 9. 9 All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. SIM TRENDS Risk-Readiness SM US CTO on using this public data: “Visionary Genius” This Is Real, a National Trend Payers are using public data for risk and design Risk-bearing providers are getting in the game
- 10. All contents are proprietary to RowdMap, Inc. and are being provided on a confidential basis. Any use, reproduction or distribution of this information, in whole or in part, or the disclosure of any of its contents without the prior written consent of the Company, is prohibited. 10 Everything you need to Belly Up [Referrals: http://1.usa.gov/1FzoEOV] [Variation: http://go.cms.gov/1D8j7LE] [Shared Savings: http://go.cms.gov/1Hh8vx0] [Medicare FFS Part B: http://go.cms.gov/OCmyoy] [Medicare FFS Part D: http://bit.ly/1mGyBxk] [Medicaid: http://go.cms.gov/1z7b5ic] [Dartmouth: http://bit.ly/1GXvlJp] [Behaviors: http://1.usa.gov/1PzcisT] [Health Data All Stars: http://bit.ly/1GAsVC3] GET STARTED Risk-Readiness SM