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© 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Population.

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Presentation on theme: "© 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential © 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Population."— Presentation transcript:

1 © 2013 Health Catalyst Proprietary and Confidential © 2013 Health Catalyst Proprietary and Confidential Population Health Management David A. Burton, MD

2 © 2013 Health Catalyst Proprietary and Confidential Outpatient Population Health Management Emphasis on the Continuum of Care Home Clinic Care Hospice Cemetery Skilled Nursing Facility Inpatient Home Health Care

3 © 2013 Health Catalyst Proprietary and Confidential Population Health Management Paradigm Shift Acute Care-Centric Management Inpatient Outpatient Home Clinic Care Hospice Cemetery Skilled Nursing Facility Inpatient Home Health Care Population-Centric Management

4 © 2013 Health Catalyst Proprietary and Confidential Poll question OutpatientInpatient 1 2 OutpatientInpatientHospice Home Health 3 OutpatientInpatientHospice Home Health Clinic Care 4 SNF 5 OutpatientInpatientHospice Home Health Clinic Care Other combination

5 © 2013 Health Catalyst Proprietary and Confidential 5 Home (Patient Portal) * To Invasive Care Processes Ambulatory Non-recurrent Ambulatory Recurrent Acute Medical IP Med-Surg Acute Medical IP Med-Surg Acute Medical IP ICU Invasive Medical Invasive Surgical Diagnostic Work-up Bedside care Procedure Triage to Treatment Venue Substance Preparation Post-procedure Care Substance Selection Invasive* Subspecialist Chronic Disease Subspecialist Substance Selection Screening & Preventive Symptoms Population Health Management Anatomy of Healthcare Delivery Treatment and Monitoring Algorithms Admission Order Sets Supplementary Order Sets Pre-Procedure Order Sets Clinical Supply Chain Management Pre-Procedure Order Sets Clinical Supply Chain Management Post- procedure Order Sets Discharge Bedside care practice guidelines, risk assessment and patient injury prevention protocols, bedside care procedures, transfer and discharge protocols Treatment and Monitoring Algorithms Health Maintenance and Preventive Guidelines Standardized Follow-up Standardized Follow-up Post-acute care order sets IP (SNF, IRF) Home health Hospice Post-acute care order sets IP (SNF, IRF) Home health Hospice Management of Preventive, Ambulatory, Acute Medical, Invasive & PAC Modules Module-Focused Knowledge Assets Diagnostic algorithms Indications for Referral Indications for Intervention Triage Criteria Diagnostic Algorithms, Triage Criteria, Referral & Intervention Indications Population-Focused Knowledge Assets

6 © 2013 Health Catalyst Proprietary and Confidential Population Health Management 6 Clinical Integration hierarchy - Care Processes Hyperlipidemia Acute Myocardial Infarction (AMI) Percutaneous Intervention (PCI) Coronary Artery Bypass Graft (CABG) Cardiac Rehab Care Processes HomeOutpatientClinic CareInpatientSNFHome HealthHospice Coronary Atherosclerosis

7 © 2013 Health Catalyst Proprietary and Confidential7 Population Health Management Clinical Integration hierarchy - Care Process Families Hyperlipidemia Acute Myocardial Infarction (AMI) Percutaneous Intervention (PCI) Coronary Artery Bypass Graft (CABG) Cardiac Rehab Ischemic Heart Disease Care Process Family HomeOutpatientClinic CareInpatientSNFHome HealthHospice Coronary Atherosclerosis

8 © 2013 Health Catalyst Proprietary and Confidential Population Health Management Clinical Integration hierarchy - Clinical Programs Vascular Disorders Care Process Family Heart Rhythm Disorders Care Process Family Heart Failure Care Process Family Ischemic Heart Disease Care Process Family Cardiovascular Clinical Program HomeOutpatientClinic CareInpatientSNFHome HealthHospice

9 © 2013 Health Catalyst Proprietary and Confidential 9 Clinical Integration hierarchy Clinical Programs – ordering of care Primary Care CareProcessFamiliese.g.,Diabetes CVCV CareProcessFamiliese.g., Heart Failure W&CW&C CareProcessFamiliese.g.,Pregnancy GIGI CareProcessFamiliese.g., Lower GILower GIDisorders Resp- iratory CareProcessFamiliese.g., Obstructive Lung Disorders Neuro Sciences CareProcessFamiliese.g., Spine Disorders Musculo- skeletal CareProcessFamiliese.g.,Joint Replace- ment SurgerySurgery CareProcessFamiliese.g., Urologic Disorders GeneralMedGeneralMed CareProcessFamiliese.g., Infectious Disease OncologyOncology CareProcessFamiliese.g.,BreastCancer Peds Spec CareProcessFamiliese.g.,Peds CV SurgCV Surg Mental Health CareProcessFamiliese.g.,Depression

10 © 2013 Health Catalyst Proprietary and Confidential 10 Clinical Integration hierarchy Clinical Support Services – delivery of care ordered Primary Care CareProcessFamiliese.g.,Diabetes CVCV CareProcessFamiliese.g., Heart Failure W&CW&C CareProcessFamiliese.g.,Pregnancy GIGI CareProcessFamiliese.g., Lower GILower GIDisorders Resp- iratory CareProcessFamiliese.g., Obstructive Lung Disorders Neuro Sciences CareProcessFamiliese.g., Spine Disorders Musculo- skeletal CareProcessFamiliese.g.,Joint Replace- ment SurgerySurgery CareProcessFamiliese.g., Urologic Disorders GeneralMedGeneralMed CareProcessFamiliese.g., Infectious Disease OncologyOncology CareProcessFamiliese.g.,BreastCancer Peds Spec CareProcessFamiliese.g.,Peds CV SurgCV Surg Mental Health CareProcessFamiliese.g.,Depression 12 Clinical Programs (Ordering of Care) Clinical Support Services (Delivery of Care) Diagnostic Clinical Support Service (work flow models) (e.g., Pathology and Laboratory Medicine, Diagnostic Radiology) Diagnostic Clinical Support Service (work flow models) (e.g., Pathology and Laboratory Medicine, Diagnostic Radiology) Ambulatory Clinic Clinical Support Service (work flow models) (e.g., Primary Care Clinics, Chronic Disease Specialty Clinics, Sub-specialty Clinics)) Ambulatory Clinic Clinical Support Service (work flow models) (e.g., Primary Care Clinics, Chronic Disease Specialty Clinics, Sub-specialty Clinics)) Acute Medical Clinical Support Service (work flow models) (e.g., Emergency Care, ICU/CCU/NICU/PICU, General Med-Surg) Acute Medical Clinical Support Service (work flow models) (e.g., Emergency Care, ICU/CCU/NICU/PICU, General Med-Surg) Invasive Clinical Support Service (work flow models) (Interventional Medical [e.g., cath lab, interventional radiology, GI lab, L&D, rad onc] and Surgical [e.g., amb, IP]) Invasive Clinical Support Service (work flow models) (Interventional Medical [e.g., cath lab, interventional radiology, GI lab, L&D, rad onc] and Surgical [e.g., amb, IP]) Therapeutic Clinical Support Service (work flow models) (e.g., Pharmacy, Transfusion Medicine, Respiratory Therapy, Physical, Occupational, Speech Therapy) Therapeutic Clinical Support Service (work flow models) (e.g., Pharmacy, Transfusion Medicine, Respiratory Therapy, Physical, Occupational, Speech Therapy)

11 © 2013 Health Catalyst Proprietary and Confidential Heart Rhythm Disorders Vascular Disorders Ischemic Heart Disease Heart Failure CARDIOVASCULAR Care Process Families Clinical Program ICD9 Volumes I-II 17,674 Diagnosis Codes ICD-9 Volume III 3,903 Procedure Codes 2013 CPT ® Code Set 9706 Codes CPT-4 Code Groupings ICD9 Procedure Code Groupings ICD9 Diagnosis Code Groupings CABG PCI AMI ACS Care Processes

12 © 2013 Health Catalyst Proprietary and Confidential Population Health Management 12 Medicare 2011 fee-for-service payments by venue OutpatientClinic CareInpatientSNFHome HealthHospice $ 31.7 Billion 12.3% 77.6 Billion 30.1% 90.6 Billion 35.1% $ 29.7 Billion 11.5% $ 18.4 Billion 7.1% $ 10.1 Billion 3.9%

13 © 2013 Health Catalyst Proprietary and Confidential c

14 © 2013 Health Catalyst Proprietary and Confidential c

15 © 2013 Health Catalyst Proprietary and Confidential c

16 © 2013 Health Catalyst Proprietary and Confidential Poll question How does your organization prioritize improvement projects Respond to desires of highest volume physicians with loudest voices Respond to regulatory and accreditation imperatives Based on pre-defined strategic criteria (including objective and subjective factors) Other

17 © 2013 Health Catalyst Proprietary and Confidential Our Philosophy: Be Systematic 17 Late-Binding Late-Binding Data Warehouse PlatformData Warehouse Platform Data Warehouse, Architecture, Metadata Management, Security, and Auditing Analytic Applications Analytic Applications Key Process Analysis, Dashboards, Advanced Analytics Services Installation Services,Installation Services, Critical Improvement ServicesCritical Improvement Services Systematically Integrate Data and Measure Systematically Apply Evidence and Standardize Systematically Change Process and Behavior

18 © 2013 Health Catalyst Proprietary and Confidential 18 Metadata: EDW Atlas Security and Auditing Common, Linkable Vocabulary Financial Source Marts Administrative Source Marts Departmental Source Marts Patient Source Marts EMR Source Marts HR Source Mart Diabetes Sepsis Readmissions Less Transformation More Transformation Catalyst Adaptive Data Warehouse Catalysts Adaptive Data Model Departmental Sources (e.g., Apollo) Patient Satisfaction Sources (e.g., NRC Picker, Press Ganey) Patient Satisfaction Sources (e.g., NRC Picker, Press Ganey) Human Resources (e.g., PeopleSoft) Human Resources (e.g., PeopleSoft) Financial Sources (e.g., EPSi, Peoplesoft, Lawson) Administrative Sources (e.g., API Time Tracking) Administrative Sources (e.g., API Time Tracking) EMR Source (e.g., Epic, Cerner) EMR Source (e.g., Epic, Cerner)

19 © 2013 Health Catalyst Proprietary and Confidential Catalyst approach Metadata-driven platform 22 Content-driven applications 33 Application families Foundational Applications Discovery Applications Advanced Applications Late-Binding Data Warehouse Platform Data Acquisition Engine and Storage Metadata Engine Late-Binding Data Bus

20 © 2013 Health Catalyst Proprietary and Confidential Cluster = Hub Hospital/Region, Medical Group, Health Plan, Section/Division Clinical Integration Leadership Team (CILT) 20 Administration Vice-Chair CNO Vice-Chair Cluster CMO Cluster CNO Cluster Administrator CMO Chair Chief Information Officer Chief Knowledge Officer Chief Information Officer Chief Knowledge Officer Cluster #1 Cluster #2 Cluster #3 Cluster # … Cluster #N Cluster CMO Cluster CNO Cluster Administrator Cluster CMO Cluster CNO Cluster Administrator Cluster CMO Cluster CNO Cluster Administrator Cluster CMO Cluster CNO Cluster Administrator

21 © 2013 Health Catalyst Proprietary and Confidential CV Clinical Program Guidance Team 21 Nurse Director Vice-Chair CV Physician Chair* CV MD Lead CV Nurse Lead CV Administrator Cluster #1 Cluster #2 CV MD Lead CV Nurse Lead CV Administrator Cluster #3 CV MD Lead CV Nurse Lead CV Administrator Cluster #4 CV MD Lead CV Nurse Lead CV Administrator Ischemic* MD Chair Heart Failure MD Chair Rhythm Disorders MD Chair Vascular Disorders MD Chair * One of the Clinical Implementation Team chairs also serves as the Guidance Team chair (Ischemic MD Chair in this example)

22 © 2013 Health Catalyst Proprietary and Confidential Clinical Implementation Team (CIT) Heart Failure Care Process Family 22 CV RN Director Vice-Chair Heart Failure MD Chair Cardiologist Heart Failure MD Lead CV Nurse Lead Facility #1 Facility #2 Heart Failure MD Chair CV Nurse Lead Facility #3 Heart Failure MD Chair CV Nurse Lead Facility #4 Heart Failure MD Chair CV Nurse Lead

23 © 2013 Health Catalyst Proprietary and Confidential CIT Work Group 23 CIT Chair (MD) Scientific SME Clinical Operations Director Front Line Clinical Ops Workflow SME Provider/Patient Education Team Clinical Application Steward Administrative Application Steward * CMIO, CQO, Chief Patient Safety Officer, or Chief Analytics Officer provided individual has requisite qualifications and skills Data ArchitectData Architect Knowledge Manager Subject Matter Expert Data Capture Workflow Analysis Data Provisioning Data Analysis

24 © 2013 Health Catalyst Proprietary and Confidential 24 Workgroup Roles DATA CAPTURE Acquire key data elements Assure data quality Integrate data capture into operational workflow DATA ANALYSIS Interpret data Discover new information in the data (data mining) Evaluate data quality DATA PROVISIONING Move data from transactional systems into the EDW Build visualization for use by clinicians Knowledge Managers Data Architects (Analysis) Knowledge Managers Data Architects (infrastructure) Data Architects (Visualization) Application Administrators (e.g., EMR Administrators, Financial System Administrators) Subject Matter Expert Data Capture Workflow Analysis Data Provisioning Data Analysis

25 © 2013 Health Catalyst Proprietary and Confidential Poll question Which clinical organizational teams do you have Executive team responsible for prioritization and governance of clinical improvement initiatives Domain governance teams (e.g., CV Clinical Service Line teams) Clinical implementation teams (e.g., Heart Failure improvement team) Infrastructure personnel/work groups to support clinical improvement teams

26 © 2013 Health Catalyst Proprietary and Confidential Implementation flow diagram

27 27 Kickoff Mission Cohort Discover Data Analysis and Review BMJ Best Practices Building Multiple Potential AIM statements AIM Statement Supplement BMJ content Refine Cohort Refine Metrics Develop Draft Visualizations Develop Recommended AIM statement #1 Implementation Design Cluster Reps Obtain Front Line Input Finalize Cohort Develop Additional metrics based on feedback Develop Additional Visualizations to support PDSA cycle Launch Approval Cluster Reps Obtain Front Line Input Improvement Plan Implementation Plan Develop cluster rep assignments, and deliverables Results Review Collect cluster rep feedback Prepare Initial Results from AIM statement #1 Summarized report for historical review Refine, recommend AIM statement #2 Standard organizational work Monthly Tasks and Checkpoints 7 Steps (Work Streams) Gather Knowledge Assets Define Cohort Select AIM Statement Select, Build, Refine Metrics Develop Implementation Plan for Process Improvement Implementation Measure Progress Select Initial Metric Build and Refine

28 © 2013 Health Catalyst Proprietary and Confidential 28 Pregnancy

29 © 2013 Health Catalyst Proprietary and Confidential 29 Surgical Services

30 © 2013 Health Catalyst Proprietary and Confidential 30 Discharge from hospital to post-hospital service

31 © 2013 Health Catalyst Proprietary and Confidential 31 Pressure injury prevention

32 32 Slide Decks Handbooks Standard organizational work MD Contract TemplatesMD Contract Templates Team ChartersTeam Charters Job DescriptionsJob Descriptions Job Family Grids Meeting AgendasMeeting Agendas Project Status Reports Deployment Process Outlines Compensation Grids

33 © 2013 Health Catalyst Proprietary and Confidential Poll question How prepared do you feel to implement population health management and shared accountability (e.g., ACO) strategies?

34 34 Thank you


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