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1 Copyright © 2010 Recombinant Data Corp. All rights reserved. Integrating Quality Data to Improve Care October 20, 2010 Dan Housman Managing Director.

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Presentation on theme: "1 Copyright © 2010 Recombinant Data Corp. All rights reserved. Integrating Quality Data to Improve Care October 20, 2010 Dan Housman Managing Director."— Presentation transcript:

1 1 Copyright © 2010 Recombinant Data Corp. All rights reserved. Integrating Quality Data to Improve Care October 20, 2010 Dan Housman Managing Director and Co-Founder

2 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 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 4 Ecosystem

5 5 AMC - Personalized Medicine Vision

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

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

8 8 Data management solution map

9 9 Why IBI and Recombinant are partnering

10 10 Why IBI and Recombinant together? RecombinantIBI CapabilitiesNeeds Expertise in healthcare data setsPackaged 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 NeedsCapabilities Packaged development toolsPackaged BI software Advanced analytics/ad-hoc data miningAdvanced BI (ad-hoc mining) tools Adapters to key source systemsBroad usage outside “clinical” Broader capability reachSolution partner/application community Adapter library

11 11 IBI Recombinant Partnership

12 12 ACOs/Analytics

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

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

15 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 16 Avoid Reinventing the Wheel

17 17 Recombinant Goal

18 18 Data Needed for Typical Report

19 19 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 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 21 Dashboard Measures

22 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 23 Recombinant Data Model Overview

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

25 25 Data Trust Data Model: Entities

26 26 Case Study – Piedmont Health

27 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 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 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 30 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 31 Clinical Data Agents

32 32 Clinical Integration Trust (CIT) – Phase 1

33 33 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 34 Clinical Integration Trust (CIT) – Phase 2

35 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 2007 (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 36 Questions/Feedback discussion

37 37 Thank You Recombinant Data Corp. 255 Washington Street, Suite 235, Newton, MA Tel: (617) Fax: (617)


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