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HealthBridge is one of the nation’s largest and most successful health information exchange organizations. An Overview of HealthBridge’s Shared Data Analytics.

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Presentation on theme: "HealthBridge is one of the nation’s largest and most successful health information exchange organizations. An Overview of HealthBridge’s Shared Data Analytics."— Presentation transcript:

1 HealthBridge is one of the nation’s largest and most successful health information exchange organizations. An Overview of HealthBridge’s Shared Data Analytics Infrastructure Randy Woodward Director, Business Intelligence Systems March 16, 2012 1

2 “Best of Breed” Partners 2  Enterprise Master Patient Index (eMPI)  IBM’s Initiate™  Clinical & Claims Data Repository & Clinical Analytics  PluralSoft’s CareQuotient™  Semantic Data Normalization  Clinical Architecture’s Symedical™  Claims Data Grouping Engines  OPTUMInsight’s Symmetry™

3 3

4 4 Initiate™ by IBM Overview

5  Proven Patient and Provider data models  Configurable identity matching algorithms and matching thresholds, by data source  Efficient data stewardship, governance, and data quality resolution tools  Enables collaborative data stewardship  Alerts for data quality issues  Custom business rules  Tools to locate and correct duplicates  Tools to identify and resolve potential duplicates and links  Tools to identify and resolve patient data quality issues via pre-configured analytics 5 IBM - Initiate

6  Proven standards-based integration  Integration toolkit for loading patient data  HL7 v2 and HL7 v3 support  Web Services in support of SOA environments  Support for Integrating the Healthcare Enterprise (IHE) HL7 v2 & v3 Profiles: o Patient Identifier eXchange (PIX) o Patient Demographic Query (PDQ) o Audit Trail and Node Authentication (ATNA) o Patient Admission Management (PAM) 6 IBM - Initiate

7 7 Symedical™ by Clinical Architecture Overview

8 8 Clinical Architecture - Symedical  Free-standing semantic normalization tool  Critical capability to improve interoperability, and enable aggregation of disparate data sources – operates across all data structures  “Out-of-the-box” mapping includes LOINC, RxNORM, CPT, ICD-9/10, NDC  Supports namespace and site specific terminologies  Maps in advance when terminologies are known  Maps terms dynamically at run-time when they're not known  Monitors and manages multiple maps remotely with powerful workflow tools

9 9 Clinical Architecture - Symedical  Mapping algorithms that learn  Recognition of new and changed terms and workflow tools to manage  Leverage configurable algorithms to fine tune results  Role / Site based user security  Fully audited environment  “Rosetta Stone” – Enables terms to be mapped to/from standard and non-standard lexicons  Application: EPIC to EPIC translations (e.g., Hospital A lab test catalogue to or from Hospital B lab test catalogue utilizing LOINC coding as the common link)

10 10 CareQuotient™ by PluralSoft Overview

11 11  Highly flexible DIMENSIONAL model for storing conformed/normalized data  Can store non-coded data and later transform that data when translation maps are available  Optimized data structure for reporting and aggregation  Extensible data model, supports the addition of future data requirements and related reporting  Platform for data marts & OLAP cubes  Data model supports clinical & claims data PluralSoft - CareQuotient

12 Information Domains People & Organizations Lab Orders & Results Medications & Prescription Information Patient Provider Payer Staff Facility Immunization Radiology & Documents Referrals & Authorizations Medical Conditions (Allergies, Family- social-medical history) Encounters Appointments Master Data (ICD, CPT, DRG, HCPCS, CCS, CRG …), Geography Revenues (Charges, Grants..) Products Member Enrollment Medical & Rx Claims Revenue (Ins. Billing) Utilization Provider Payer Legend: Clinical Observations & Vital Signs (EHR Template/Flow Sheets ) Expenses (Payroll, Supplies, Infrastructure, …) 12

13  14 chronic disease conditions and preventative care measures:  Diabetes  Asthma  Hypertension  Ischemic Vascular Disease (IVD)  Coronary Artery Disease  Congestive Heart Failure  Chronic Pain  Depression  Tobacco Use Cessation Counseling and Advice  Breast Cancer Prevention  Cervical Cancer Prevention  Colon Cancer Prevention  Childhood Immunizations  Preventive Care and Screening 13 PluralSoft - CareQuotient

14 14 PluralSoft - CareQuotient  264 clinical measures including HEDIS, NQF, and PQRI  Clinical measures can be customized  360 standard reports & dashboards  Standard reports & dashboards can be customized  Leverages existing investments in hardware and software infrastructure  Built on the Microsoft Business Intelligence stack

15 Diabetes Measures – Sample Chronic Disease - Physical health 15

16 Diabetes Measure Drill Through - Sample 16

17 17 Patient Scorecard – Sample Managing Comorbidity (physical & mental) + Preventive Care

18 18 Provider Scorecard – Sample Performance across physical & mental health, Chronic & Preventive Care

19 19 Symmetry™ by OPTUMInsight (formerly Ingenix) Overview

20 Symmetry Suite  Universal language and business standard for health care analytics in the marketplace  Only product suite in the market providing comprehensive health care analytic solutions through “component” engines on an integrated platform A complete toolkit for health care management and analytics Clinical Resource Measurement Risk Assessment and Predictive Modeling Quality Measurement ERG EBM Connect ETG PEG PCQ Connect Provider Measurement & Engagement 20

21 Episode Treatment Groups Episode Risk Groups Procedure Episode GroupsEBM Connect PCQ Connect  Symmetry Suite – common analytics platform for:  Care quality improvement  Care cost management  Physician performance ratings  Minimized total cost of ownership  Industry recognized common methods and analytics  8 of top 10 health plans  20 of top 25 health plans  24 BCBS plans  Transparent, not a Black Box  Flexible for your needs Symmetry Suite 21

22 Episode Treatment Groups (ETGs) Episode Treatment Groups Claims data Diagnosis codes Drug codes Procedure codes Claims data, grouped by episode  Episode Treatment Groups  Foundation for clinical resource use and efficiency analyses analysis by episode to support:  Transparency  Health care measurement  Incentives for increased value and high quality care  Organize health care data (experience) into episodes of care related to the treatment of a medical condition for a given patient  The market leading episode of care grouper  Over 200 health plans and other health care organizations covering over 160 million individuals 22

23 Episode Risk Groups (ERGs) Episode Treatment Groups Claims data Diagnosis codes Drug codes Procedure codes Claims data, grouped by episode  Episode Risk Groups  Population-based health risk assessment  Predict current and future health care usage for individuals and groups  Predicts a member's current (retrospective) and future (prospective) need for health care services and associated costs  Clinically-relevant – robustly prioritize multiple conditions and co-morbidities  Adoption  Over 100 health plans and other health care organizations covering over 115 million individuals Episode Risk Groups Risk score for each individual Administrative Age, gender 23

24 Evidence Based Medicine (EBM Connect) EBM Connect Claims data Diagnosis codes Drug codes Procedure codes Administrative Enrollment records Laboratory results Disease registry Members who qualify for EBM conditions and their compliance  EBM Connect  Foundation for quality measurement: assesses compliance of delivered care with evidence-based medicine and care guidelines  Identifies gaps between clinical evidence and health care practice  Unnecessary or potentially harmful diagnostic tests or treatments  Patients with indications of poor disease control  Potentially harmful drug-to-drug or drug- to-disease interactions  Identifies both high-performing physicians and areas to recommend improved physician compliance with prescribed care  Adoption  30 Health plans and other health care organizations covering over 100 million individuals 24

25 Procedure Episode Groups (PEGs) Episode Treatment Groups Claims data Diagnosis codes Drug codes Procedure codes Claims data, grouped by episode  Procedure Episode Groups  Industry-first foundation for enhanced analysis by procedure to support  Transparency  Provider measurement  Incentives for increased value and high quality care  Analyze the cost and quality of surgical providers, procedures, and related services Procedure Episode Groups Risk score for each individual Procedure codes CPT HCPCS NUBC 25

26 Provider Cost & Quality (PCQ Connect) Episode Treatment Groups Claims data Diagnosis codes Drug codes Procedure codes Claims data, grouped by episode EBM Connect Members who qualify for EBM conditions and their compliance PCQ Connect Peer Groups Attributed episodes of care, by severity group Attributed quality measures – EBM conditions and compliance Administrative Enrollment records Laboratory results Disease Registry  PCQ Connect  Foundation analysis for physician measurement  Network management  Transparency  Tiering  P4P  Centers of excellence 26

27  Adjust for Severity  Provides multiple methods to reflect underlying differences in the types of cases addressed and the severity of a patient’s condition  Manage outliers  Provides different methods to identify outliers, and the ability to include, exclude, or set the cost to the threshold value to account for and treat outlier episodes appropriately  Define peer groups  Provides standard methodology for creating peer groups within the same region and specialty  Attribute properly  PCQ Connect correctly attributes the right cost and quality measures to the right provide Advantages of PCQs 27

28 Symmetry Applications Business Application ETGPEGERGEBM Connect PCQ Connect Provider Performance Measurement Disease / Care Management Member / Population Risk Assessment Financial Performance and Trends Providers, Employer Groups, and Consumer Information Sharing 28

29 29 Thank You!


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