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3m — Technical Presentation (July 2022)
43 slides from 3m's technical presentation, Jul 26, 2022
Slide 1: Lunch and learn: Meet the experts: CRGs and PFEs
Lunch and learn: Meet the experts: CRGs and PFEs David Gannon, 3M HIS Lisa Turner, 3M HIS July 26, 2022
Slide 2: Agenda
Agenda • Meet the speakers • Clinical Risk Groups (CRG)/Patient Focused Episodes (PFE) • Overview and use case • Intro to methodology • Recent developments and what’s next • Q&A The information presented herein contains the views of the presents and does not imply a formal endorsement for consultati
Slide 3: Meet the speakers
Meet the speakers Lisa Turner – Clinical Analyst David Gannon - Product Owner and Engineer Lisa has been working on 3M patient classification David has been working on 3M patient classification methodologies dating back to 1994 with National methodologies dating back to 1996 when he joined Associati
Slide 4: CRGs Clinical Risk Groups
CRGs Clinical Risk Groups Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 5: Overview and use case
Overview and use case Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 6: 3M Clinical Risk Groups – Overview and use case
3M Clinical Risk Groups – Overview and use case • A population-based classification system that describes the health status and burden of illness of individuals in an identified population based on diagnoses and procedures reported from patient claims and encounters during an extended time period, s
Slide 7: 3M Clinical Risk Groups – Overview and use case
3M Clinical Risk Groups – Overview and use case 3M CRGs can be used by payers, managed care organizations, hospitals, disease management and similar firms, researchers from academic and government organizations, and anyone else who seeks to understand or manage population-wide patterns of utilizatio
Slide 8: 3M Clinical Risk Groups use in risk adjustment
3M Clinical Risk Groups use in risk adjustment Risk Adjustment CRGs • “the statistical process that takes into account • a clinically-driven, whole-person approach to measuring a the underlying health status and health patient’s burden of illness + spending of the enrollees in an insurance plan • as
Slide 9: 3M Clinical Risk Groups use in Shared Savings Program
3M Clinical Risk Groups use in Shared Savings Program • Ohio has implemented the Comprehensive Primary Care (CPC) program, a team-based care delivery model led by a primary care practice that comprehensively manages a patient’s health needs. Practices must adhere to activity requirements as well as
Slide 10: 3M Clinical Risk Groups use in quality measures – PPA
3M Clinical Risk Groups use in quality measures – PPA https://thlcportal.com/home © 3M 2022. All Rights Reserved. 3M Confidential. 10
Slide 11: Intro to methodology
Intro to methodology Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 12: 3M Clinical Risk Groups - Definition and examples
3M Clinical Risk Groups - Definition and examples Definition Examples v2.2 The 3M™ Clinical Risk Groups classification 11900 Pregnancy without Delivery, without Other Significant Illness methodology describes the health status and burden of 20800 Major Trauma Diagnosis, with or without Other Signifi
Slide 13: 3M Clinical Risk Groups – Assignment process
3M Clinical Risk Groups – Assignment process Phase I. Claims and encounter information is processed and edited or “validated for use,” and a disease profile and history of past medical interventions is created. Phase II. For each organ system, the most significant primary chronic disease is identifi
Slide 14: 3M Clinical Risk Groups – Assignment process
3M Clinical Risk Groups – Assignment process At the broadest level, the 3M CRGs are organized into ten health status groups: Severity 3M CRG health status group Example(s) Base 3M CRGs Number of 3M CRGs levels History of Major Organ 9 – Catastrophic Conditions 10 4 40 Transplant Lung malignancy + 8
Slide 15: Recent developments and what’s next
Recent developments and what’s next Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 16: 3M Clinical Risk Groups – Recent developments
3M Clinical Risk Groups – Recent developments • V2.2 most recent and new version in 2021 includes: o Reclassification of Hypertension o Reclassification of Diabetes o Revised criteria for health status group 8, Malignancy in Active Treatment o Other revised or new Diagnostic Subgroups (DSGs), Episod
Slide 17: PFEs Patient Focused Episodes
PFEs Patient Focused Episodes Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 18: Overview and use case
Overview and use case Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 19: 3M Patient Focused Episodes – Overview and use case
3M Patient Focused Episodes – Overview and use case • A population-based classification system that identifies episodes based on diagnoses and procedures reported from patient claims and encounters during an extended time period • More specifically, a categorical clinical classification system that
Slide 20: Patient Focused Episodes – Overview and use case
Patient Focused Episodes – Overview and use case 3M PFEs can be used by organizations interested in improving system-wide health care performance, provider profiling and payment reform. Examples include large integrated delivery systems, payers, accountable care organizations, government agencies, e
Slide 21: 3M Patient Focused Episodes - Post acute care service rates
3M Patient Focused Episodes - Post acute care service rates Researchers used PFEs to report PAC facility admission rates by geographical location, identifying variation and potential areas for improvement “Hospitals are responsible for arranging an appropriate post- discharge setting for a patient…
Slide 22: Intro to methodology
Intro to methodology Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 23: 3M Patient Focused Episodes – Definition and examples
3M Patient Focused Episodes – Definition and examples Definition PFE Examples (n = 453) Patient-focused Episodes (PFEs) are a categorical Event-Based Episodes (n = 330) clinical model that defines episodes of care to reflect Inpatient Surgical Event (n = 120) a patient’s total burden of illness, not
Slide 24: 3M Patient Focused Episodes – Event-based episodes
3M Patient Focused Episodes – Event-based episodes Triggered by a significant healthcare event • Hospital inpatient event classified by APR DRG • May be split into separate PFEs by diagnosis or procedure when patterns of post-acute care differ • Example: APR DRG 021 Craniotomy → PFEs 0211, 0212, 021
Slide 25: 3M Patient Focused Episodes – Event Based Episodes
3M Patient Focused Episodes – Event Based Episodes Services Used to Assign CRG Post-Event Services Choose Services Institutional Services □ Inpatient Hospital Facility (FI) Data Prior to Leading Trigger Trailing Time □ Skilled Nursing Facility (FN) Trigger Event Window Window Window □ Extended Care
Slide 26: 3M Patient Focused Episodes – Cohort-based episodes
3M Patient Focused Episodes – Cohort-based episodes Includes members who share a common disease, condition, or characteristic • Cohort episodes are defined in a time window • Includes all costs – no arbitrary attempt to divide costs into comorbidities • Cohort PFEs therefore suitable for the most co
Slide 27: 3M Patient Focused Episodes – Cohort-based episodes
3M Patient Focused Episodes – Cohort-based episodes Example of Cohort Windows, Episodes Choose Services Cohort Window (User Choice)Jan Feb Mar Apr May Jun Institutional Services □ Inpatient Hospital Facility (FI) Chronic 180 days DSG COPD □ Skilled Nursing Facility (FN) □ Extended Care Facility (FX)
Slide 28: Recent developments and what’s next
Recent developments and what’s next Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 29: 3M Patient Focused Episodes – Recent developments
3M Patient Focused Episodes – Recent developments • v2.0.1 new in 2022: o New Episode flag to identify Post Acute Care Facility SNF Admissions • Activities toward future development includes: o Expanded weights across episodes, by payer type o Additional Post Acute Care event useful metrics o Target
Slide 30: Q&A
Q&A Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 31: Resources
Resources Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 32: Detailed patient classification material for customers at support.3mhis.com
Detailed patient classification material for customers at support.3mhis.com The Goal Search for “Patient Classification Methodologies” The Impact © 3M 2022. All Rights Reserved. 3M Confidential. 32
Slide 33: Methodology enhancement requests for customers at support.3mhis.com
Methodology enhancement requests for customers at support.3mhis.com (user)r The Goal (user)r The Impact © 3M 2022. All Rights Reserved. 3M Confidential. 33
Slide 34: Contact Information
Contact Information CRG/PFE Product Owner: David Gannon - degannon@mmm.com Analyst: Lisa Turner – ljturner@mmm.com Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 35: Appendix CRGs – Additional use and logic detail
Appendix CRGs – Additional use and logic detail Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 36: 3M Clinical Risk Groups use in capitated payment
3M Clinical Risk Groups use in capitated payment Why Pay by CRG? • Since 2008, NY Medicaid has used CRGs to calculate case mix- • More fairly reimburse plans with a more adjusted MCO capitation rates severe case mix of members • PMPM base rate x risk score = PMPM payment • Variation in reimbursement
Slide 37: 3M Clinical Risk Groups use in children’s hospital research
3M Clinical Risk Groups use in children’s hospital research • Researchers used CRGs to conclude that the greatest growth in inpatient Defined by CRG growth at 28 children’s hospitals was in the cohort of children with chronic conditions in two or more body systems -- Berry et al., JAMA Pediatrics, 2
Slide 38: 3M Clinical Risk Groups – Aggregations for flexibility in use
3M Clinical Risk Groups – Aggregations for flexibility in use CRG Aggregations v2.2 Concurrent 10 Health Status 26/54 ACRG3s 120/299 ACRG2s 211(base)/680 ACRG1s 366(base)/1,338 CRGs (including severity) © 3M 2022. All Rights Reserved. 3M Confidential. 38
Slide 39: 3M Clinical Risk Groups – Aggregation example
3M Clinical Risk Groups – Aggregation example • CRGs can be rolled up at several levels of aggregation, at either the base or base + severity level Aggregation Example: person with illnesses in 3 body systems CRG v2.2: number of groups level CRG assignments for this individual Concurrent Version Pro
Slide 40: Appendix PFEs – Additional use and logic detail
Appendix PFEs – Additional use and logic detail Health Policy Executive Summit 2022 Solve problems. Establish strategy. © 2022 3M. All rights reserved.
Slide 41: 3M Patient Focused Episodes – payment middle ground
3M Patient Focused Episodes – payment middle ground • Episode = A single comprehensive unit of service for The Split of Financial Risk Between Payer and Provider the treatment of a patient Depends on the Unit of Payment • Episodes rendered: Financial Risk Financial risk • Across a specified time int
Slide 42: 3M Patient Focused Episodes – Post acute care service cost
3M Patient Focused Episodes – Post acute care service cost “How do I calculate casemix- “We multiply our volume of episodes times the benchmark adjusted expected values? spending per episode. Let’s look at health status 7 as an example. We see that spending on hospital outpatient care is Where are w
Slide 43: 3M Patient Focused Episodes – Logic process
3M Patient Focused Episodes – Logic process Classifier Determine Estimator patient’s Aggregator Identify patient episode health Expected episodes Actual spending status spending • Based on type of • Dynamically • Based on Clinical • 330 event-based Risk Groups financial indicator calculated based ep