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Integrating Quality Data to Improve Care

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Presentation on theme: "Integrating Quality Data to Improve Care"— Presentation transcript:

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


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