1. Integrating Quality Data to Improve Care
Dan Housman
Managing Director and Co-Founder
October 20, 2010

2. Outline/Agenda
About Recombinant
What is driving Clinical Intelligence in healthcare?
Why Recombinant and IBI are partnering
Case study – Piedmont Healthcare
Demonstration
Discussion

3. About Recombinant
Best of breed software/analytics company focused 100% on secondary uses of clinical data
Core Competencies
Life science data warehousing & integration services
Translational research & quality reporting solutions
Data strategy, governance & compliance consulting
Open Source implementations & extensions
Core Values
Pragmatism
Effective Communication
Trust

4. Ecosystem

5. AMC - Personalized Medicine Vision

6. Perfect Storm Opportunity
Why Adopt Now?
Accountable Care Organization
Personalized Medicine
Meaningful Use
HITECH/HIPAA Restructuring
EHR Adoption
(e.g EPIC)
DW Solution Maturity 10 Years

7. Data Access Needed for Quality Measurement Frameworks
PQRI
HEDIS/P4P
Meaningful Use
Core Measures
Six Sigma
Board Reporting
Balanced Scorecard
Provider
Bonus
Program
Physician Incentives
System
Incentives
Report Library
Chronic Disease Mgmt.
Preventative Medicine
Patient Satisfaction
In Patient/Hospital
Operations
Ad-hoc queries
Compliance
Quality
Management

8. Data management solution map

9. Why IBI and Recombinant are partnering

10. Why IBI and Recombinant together?
Capabilities
Needs
Expertise in healthcare data sets
Packaged healthcare modules
Packaged data models, reference data (measures), report library
Implementation partners (healthcare focus)
Packaged reporting on IBI platform (future)
Consulting services (governance/strategy)
Custom healthcare BI development services
Packaged development tools
Packaged BI software
Advanced analytics/ad-hoc data mining
Advanced BI (ad-hoc mining) tools
Adapters to key source systems
Broad usage outside “clinical”
Broader capability reach
Solution partner/application community
Adapter library

11. IBI Recombinant Partnership
Information
Builders as
BI framework
Information
Builders
Recombinant
ETL Integration
Information
Builders /
Open Source
Integration

12. ACOs/Analytics

13. Bending the curve? ACO models…
“In God we trust; all others must bring data.” W. Edwards Deming
2010
Payment
Reform
2013?

14. Reducing “gaps” from transitions in care
Did heart failure visits have sufficient out patient follow-up?
Episode
Outpatient
Inpatient
Outpatient
Diagnosis
Health Need
Patient
Perception
Procedure
Results &
Outcomes
AP/AR
Claims
Processing
Episode of care

15. Teams need measures & benchmarks
For now what’s “hot”
Figure out how to analyze clinancials to reduce costs
Reduce 30 day readmits with care co-ordination/six sigma
Reduce chronic disease costs for “high risk” (diabetes, CAD)
Use groupers that payers use (ETG, MEGGS, Prometheus) or prepare for CMS grouper
Join the ACO collaborative led by The Dartmouth Institute and Brookings
Near future
Sites supporting open benchmarking as it evolves
Best practice pathways will evolve from collaborations
An open source CMS grouper and open analytics are planned

16. Avoid Reinventing the Wheel

17. Recombinant Goal

18. Data Needed for Typical Report

19. Preventative Medicine
Operations
Denominators (panels, locations)
Practice snapshots
EHR adoption
Visits/utilization
Report Library
Chronic Disease Mgmt.
Preventative Medicine
Patient Satisfaction
In Patient/Hospital
Operations
Ad-hoc queries

20. Chronic Disease Management
Diabetes
Asthma
CAD
CHF
Report Library
Chronic Disease Mgmt.
Preventative Medicine
Patient Satisfaction
In Patient/Hospital
Operations
Ad-hoc queries

21. Dashboard Measures

22. Preventative Medicine
Adult/Pediatric immunizations
Cancer screening (Pap, Mammogram, Colonoscopy)
Lab order completion
Report Library
Chronic Disease Mgmt.
Preventative Medicine
Patient Satisfaction
In Patient/Hospital
Operations
Ad-hoc queries

23. Recombinant Data Model Overview

24. Data Trust Subject Area Model
Master Data
Interventions
Observations
Events
High Content
Compiled
Finance
Patient
Vocabulary
Equipment
Location
Provider
Organization
Devices
Medications
Clinical Decision Support
Procedures
Problems
Diagnosis
Notes
Patient Reported Outcomes
Clinical Trials
Biomarkers
Narratives
Labs
Orders
Incidents
Insurance Membership
Appointments
Meta Data
Registration
Experiments
Images
Biomaterial
Omics
Internal Analysis
Core Measures
External Analysis
Good Citizenship
Claims
Billing 24

25. Data Trust Data Model: Entities

26. Case Study – Piedmont Health

27. Piedmont Clinic – Current State
4 Acute Care Hospitals
671 Physicians
250 Employed Primary Care
90 Employed Cardiology
Other Employed Specialists
Hospitalists, Transplant Surgeons, CT Surgery
Balance of Independent Practices
No health plan

28. Piedmont Clinic (Brief History)
Traditional PHO formed in 1980s - contracting
Part of larger Atlanta Holding Company
(Promina)
Participated in Full-risk capitation
Left Promina around 2002
Clinic restructured around Financial Integration Model
Experience with measuring quality essentially mirrored hospitals
Added Patient Satisfaction (Office based)
20% financial risk

29. Evolution to Clinical Integration
New CEO 2008
Studied Memorial Hermann
MDs frustrated with quality data (limited to hospital) and financial risk
Required new governance
Adopted PQRI to improve quality both inpatient and outpatient
3 Quality Specialists “detailed” practices on CPT-II codes

30. Jan 2010 launched new web portal and CIT
Phase I (Jan-June 2010)
Jan 2010 launched new web portal and CIT
Combination of Clinical Integration and Financial Integration
Collect claims data from each MD in clinic and associated CPT II (PQRI) codes
All claims, all patients
670 docs represent 150+ DIFFERENT practice management systems, Billing clearing houses
4 technical support + Recombinant to develop “back end” claims loading process, coding metrics, etc

31. Clinical Data Agents

32. Clinical Integration Trust (CIT) – Phase 1

33. Add Population Management Dashboards
Phase II
Add Population Management Dashboards
Integrate data across providers (PQRI, EMR) and hospitals (EPSI)
Had to “map” patients to providers
2 visits in 2 years
Building risk adjustment model
Adding metrics related to Efficiency and Cost / Utilization
Based on CMS metrics and methodology

34. Clinical Integration Trust (CIT) – Phase 2

35. Results Metric % Improvement Community Acquired Pneumonia (Hospital)
78% to 92% since 2007
Congestive Heart Failure (Hospital)
83% to 90% since 2007
SCIP (Hospital)
80 to 93% since (100 pts per yr)
Colon Cancer Screening (Ambulatory)
+10% since Jan 2010 (958 more pts)
Pneumovax age > 65 (Ambulatory)
+25% since Jan 2010 (50 more pts)
Diabetes BP Control (Ambulatory)
+12% since Jan 2010 (700 more pts)

36. Questions/Feedback discussion