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© 2014 Health Catalyst Creative Commons Copyright © 2014 Health Catalyst Creative Commons Copyright Dr. Greg Spencer & Luke Skelley Data Driven Care: The Key to Accountable Care Delivery from a Physician Group Perspective
© 2014 Health Catalyst Creative Commons Copyright Today’s Agenda Why a regional physician group is heavily investing in analytics and data warehousing Crystal Run Healthcare’s strategy to turn data into improved care as well as financial viability in the future How Crystal Run manages across its patient population who are covered by 24 payer entities Some of the preliminary challenges and successes engaging clinicians in the use of data The importance of an adaptive data architecture to turn clinician questions into actionable results
© 2014 Health Catalyst Creative Commons Copyright POLL QUESTION #1 What best describes the group you belong to? Health Plan Physician Group Provider Organization Vendor Other
© 2014 Health Catalyst Creative Commons Copyright Crystal Run Healthcare Physician owned MSG in NY State, founded providers, 16 locations Joint Venture ASC, Urgent Care, Diagnostic Imaging, Sleep Center, High Complexity Lab, Pathology Early adopter EHR (NextGen®) 1999 Accredited by Joint Commission 2006 Level 3 NCQA PCMH Recognition 2009, 2012
© 2014 Health Catalyst Creative Commons Copyright Crystal Run Healthcare Single entity ACO April 2012: MSSP participant December 2012: NCQA ACO Accreditation 25,000 commercial lives at risk MSSP 10,400 attributed beneficiaries 82% primary care services within ACO
© 2014 Health Catalyst Creative Commons Copyright Crystal Run Healthcare The mission of Crystal Run Healthcare is to improve the quality and availability of, and satisfaction with, health care services in the communities we serve. To accomplish this goal, the practice emphasizes both traditional medical excellence as well as responsiveness to consumer needs through service excellence and patient empowerment.
© 2014 Health Catalyst Creative Commons Copyright The Goal: The Triple Aim Improve the health of the population Enhance the patient experience of care Reduce, or at least control, the per capita cost of care
© 2014 Health Catalyst Creative Commons Copyright Crystal Run Strategy and Objectives Embrace goals of Triple Aim Physicians play a crucial role in driving change in healthcare Focus on providing coordinated care Population health management is critical Competition from hospitals and health plans is occurring Coverage area is expanding, and needs to expand further Physicians and their teams need to work together for the best of their patients A strategic pillar is to be the practice of choice for physicians, patients, and employees
© 2014 Health Catalyst Creative Commons Copyright Crystal Run Governance Model Establish data warehouse priorities Set policies for data access, information security and privacy Develop process for setting data definitions and standards Coordinate with Partners eCare leadership JOINT CLINICAL AND FINANCIAL GOVERNANCE MODEL Hal Teitelbaum, MD, JD, MBA Managing Partner & CEO Hal Teitelbaum, MD, JD, MBA Managing Partner & CEO Michelle A. Koury, MD Chief Operating Officer Greg Spencer, MD Chief Medical & Chief Medical Info Officer Mary DeFreitas Chief HR Officer Erlene Washington Senior VP of Finance & Accounting EDW EXECUTIVE SPONSORS Greg Spencer, MD CMO & CMIO Jonathan Nasser, MD Medical Director Miguel Hernandez Technology Director Lou Cervone BI Director EDW Steering Committee EDW GOVERNANCE
© 2014 Health Catalyst Creative Commons Copyright Crystal Run Care Management Strategies Embedding Care Managers at different offices, medical homes and hospitals Identify high-risk patients from registries and PCP/ team referral Implement evidence based protocols Use EHR and mobile / home devices
© 2014 Health Catalyst Creative Commons Copyright Crystal Run Quality Structure 27 divisions each headed by its own physician specialist Manage quality efforts and information Work with Best Practice Council (quality committee) to define registries Report to practice-level committee for quality and patient safety
© 2014 Health Catalyst Creative Commons Copyright © 2014 Health Catalyst Proprietary and Confidential 12 Why Crystal Run is heavily investing in analytics and data warehousing
© 2014 Health Catalyst Creative Commons Copyright POLL QUESTION #2 If you are a health plan, physician group, or provider organization, do you currently exchange clinical and claims data with these other constituents?
© 2014 Health Catalyst Creative Commons Copyright Crystal Run Data Analytics Strategy Implementing formal quality improvement methodology Implementing EDW with multiple data sources Implementing analytical applications Daily financial reporting Order tracking: In-house vs. Sent out Claims Data Integration RVUs Standardization
© 2014 Health Catalyst Creative Commons Copyright Crystal Run Analytics Current State Quality improvements heavily dependent upon data Using simple analytical tools – Excel, Access, Tableau Time and effort spent on manual data entry and extraction is excessive and poorly scalable Decisions about what data to use based on amount of disruption vs. value Data entry/analysis not done at Top of Licensure Reporting quality metrics resource intensive – kept it simple
© 2014 Health Catalyst Creative Commons Copyright Physician Dashboard
© 2014 Health Catalyst Creative Commons Copyright Physician Dashboard
© 2014 Health Catalyst Creative Commons Copyright © 2014 Health Catalyst Proprietary and Confidential Turning data into improved care & ensuring financial viability in the future
© 2014 Health Catalyst Creative Commons Copyright Dr. J. 15 Cases $60,000 Avg. Cost Per Case Mean Cost per Case = $20,000 $40,000 x 15 cases = $600,000 opportunity Total Opportunity = $600,000 Total Opportunity = $1,475,000 $35,000 x 25 cases = $875,000 opportunity Total Opportunity = $2,360,000 Total Opportunity = $3,960,000 Cost Per Case, Vascular Procedures Physician Variation Analysis
© 2014 Health Catalyst Creative Commons Copyright Crystal Run Results Reduced hospital admissions 4+% in one year Improved mammogram rates from 60-65% to greater than 75% Achieved less than 9% rate of A1Cs > 9 Blood pressure control in hypertensive patients improved to greater than 75%.
© 2014 Health Catalyst Creative Commons Copyright Improved Quality Breast Cancer Screening Mammography
© 2014 Health Catalyst Creative Commons Copyright Outcomes: Avoidable Admissions # Avoidable Admissions 17% Monthly Quality Trend
© 2014 Health Catalyst Creative Commons Copyright Outcomes: Readmissions 30 Day Readmission Rate for Medicare
© 2014 Health Catalyst Creative Commons Copyright Total cost difference 2012 pre-pathway 791 patients $595, post-pathway 817 patients $368,160 TOTAL COST SAVINGS $227, 760 PEG-filgrastim use in Breast cancer patients (equalized as cost per patient treated)
© 2014 Health Catalyst Creative Commons Copyright Reducing Pharmaceutical Costs PEG Filgrastrim cost per patient before and after breast cancer pathway
© 2014 Health Catalyst Creative Commons Copyright A Culture Of Efficiency: Improving Access 41,823 fewer visits 30,206 more patients “Created” 12 physicians
© 2014 Health Catalyst Creative Commons Copyright Variation Reduction Spread Reduction in Charges DIAGNOSISDEPARTMENT% CHANGE PPTOTAL $$ CHANGE CHFCardiology-6%-$53,457 DiabetesPCP/Endocrine-17%-$844,755 Thyroid NoduleEndocrinology-26%-$304,224 Otitis ExternaENT-2%-$2,373 GERDGI-20%-$178,381 CholelithiasisGeneral Surgery-7%-$11,408 COPDHospitalists-20%-$9,215 HTNPrimary Care-16%-$943,002 HyperlipidemiaFP/IM-19%-$1,150,376 HA/MigraineNeurology-10%-$208,054 Breast CancerOncology-7%-$393,622 Lateral EpicondylitisOrthopedics-8%-$27,647 AsthmaPediatrics-10%-$24,570 AsthmaPulmonology+3%+$26,238 Renal MassUrology-4%-$62,812 TOTAL-$4,187,658
© 2014 Health Catalyst Creative Commons Copyright Variation Reduction Spread Improving Access DIAGNOSISDEPARTMENTCHANGE IN VISITSCHANGE IN PATIENTS CHFCardiology DiabetesPCP/Endocrine-3, Thyroid NoduleEndocrinology-1, Otitis ExternaENT GERDGI CholelithiasisGeneral Surgery HTNPrimary Care-3, HyperlipidemiaFP/IM-2, HA/MigraineNeurology Breast CancerOncology Lateral EpicondylitisOrthopedics-84-4 AsthmaPediatrics AsthmaPulmonology-66+1,132 Renal MassUrology-11-6 TOTAL-12,889+1,783
© 2014 Health Catalyst Creative Commons Copyright © 2014 Health Catalyst Proprietary and Confidential Managing patient populations across payer entities
© 2014 Health Catalyst Creative Commons Copyright Crystal Run’s payer mix 24 Payer Entities No dominant payer, so little to no leverage for discounts, etc. No dominant payer, so payers need to contract with Crystal Run to effectively do business in the area Complicates data analysis due to limited population/statistics by payer
© 2014 Health Catalyst Creative Commons Copyright Payer Challenges Having data-focused payer conversations about shared savings Need claims data to support risk contracting Multiple payers limits ability to do valid statistical modeling Collaborating with multiple plans to develop shared savings model
© 2014 Health Catalyst Creative Commons Copyright Living in Two Worlds Improvements in quality reduces costs to benefit of payer Reduction in patient visits offset by increase in patient volume Hospitals acquisition of physicians not based on value but to protect referrals Triple Aim is a threat to hospitals Hospitals have to align optimal patient care vs. optimal reimbursement
© 2014 Health Catalyst Creative Commons Copyright © 2014 Health Catalyst Proprietary and Confidential Clinician Engagement: Challenges & Successes
© 2014 Health Catalyst Creative Commons Copyright Clinician Engagement Data used in physician recruitment and retention Data also used to support alignment and/or acquisition decisions Sharing physician performance data helps affect behavior even if no penalty or not tied to a quality effort Sharing physician data makes outliers come to consensus Not all physician practices focus on value Younger physicians sometimes avoid change more than older ones
© 2014 Health Catalyst Creative Commons Copyright It’s All About the Data The limitation is data. The doctors need performance data They have metrics to measure care ~ 80% of Business Intelligence’s time spent gathering versus analyzing data 90/10 of data capture time to analysis time.
© 2014 Health Catalyst Creative Commons Copyright Crystal Run EDW Requirements Fast to implement and fast to ROI Capable of easily expanding to add new data sources Library of analytical applications Vendor with healthcare experience and expertise Data model conducive to healthcare data Ability to become self sufficient Long term business partner
© 2014 Health Catalyst Creative Commons Copyright © 2014 Health Catalyst Proprietary and Confidential Adaptive Data Architecture: Turning clinician questions into actionable results
© 2014 Health Catalyst Creative Commons Copyright Provider-Payer Collaboration ProviderPayer Case mix analysis Utilization review Care management Regulatory measures Physician profiling Prior authorizations Contracting Prevent readmissions Evidence based guidelines Admission notification Discharge notification Risk stratification Case management Utilization review Wellness programs Consumer transparency Claims data Clinical data Care gap notification Physician profiling Case management Evidence based guidelines Wellness programs Consumer transparency Regulatory measures
© 2014 Health Catalyst Creative Commons Copyright Provider Payer Data Sharing ProviderPayer Case mix analysis Utilization review Care management Regulatory measures Physician profiling Prior authorizations Contracting Prevent readmissions Evidence based guidelines Admission notification Discharge notification Risk stratification Case management Utilization review Wellness programs Consumer transparency Care gap notification Physician profiling Case management Evidence based guidelines Wellness programs Consumer transparency Regulatory measures Claims data Clinical data
© 2014 Health Catalyst Creative Commons Copyright Crystal Run EDW Architecture
© 2014 Health Catalyst Creative Commons Copyright Catalyst Apps and Claims Data Key Process Analysis Executive Dashboard Integration Tool Cohort Builder Comorbidity Analyzer Readmissions Explorer Population Explorer Claims Data
© 2014 Health Catalyst Creative Commons Copyright Driven by business and clinical need Rapid development and deployment of data sources Built incrementally (i.e., less expensive) Ownership transferred to client with technical support as needed Align with access roles and data stewardship jurisdictions Applications support Healthcare Analytics Adoption Model Catalyst Data Warehouse Advantages
© 2014 Health Catalyst Creative Commons Copyright Healthcare Analytic Adoption Model Level 8 Personalized Medicine & Prescriptive Analytics Tailoring patient care based on population outcomes and genetic data. Fee-for-quality rewards health maintenance. Level 7 Clinical Risk Intervention & Predictive Analytics Organizational processes for intervention are supported with predictive risk models. Fee-for-quality includes fixed per capita payment. Level 6 Population Health Management & Suggestive Analytics Tailoring patient care based upon population metrics. Fee-for-quality includes bundled per case payment. Level 5 Waste & Care Variability Reduction Reducing variability in care processes. Focusing on internal optimization and waste reduction. Level 4 Automated External Reporting Efficient, consistent production of reports and adaptability to changing requirements. Level 3 Automated Internal Reporting Efficient, consistent production of reports and widespread availability in the organization. Level 2 Standardized Vocabulary & Patient Registries Relating and organizing the core data content. Level 1 Enterprise Data WarehouseCollecting and integrating the core data content. Level 0 Fragmented Point Solutions Inefficient, inconsistent versions of the truth. Cumbersome internal and external reporting.
© 2014 Health Catalyst Creative Commons Copyright POLL QUESTION #3 On a scale of 1-5, with 5 being very advanced, how far along is your organization in using data to guide your quality and cost initiatives?
© 2014 Health Catalyst Creative Commons Copyright Organizational Structure Goals Provides steady state domain oversight GUIDANCE TEAM Refines Work Group output and leads implementation CLINICAL IMPLEMENTATION TEAM Provides clinical forum to develop clinical content and analytics feedback WORK GROUP Supports development of clinical content and analytics feedback CONTENT AND ANALYTICS TEAM Provides overall governance and prioritization of initiatives SENIOR EXECUTIVE LEADERSHIP TEAM ENSURE THAT… Workgroups are created with institutional priority Appropriate leadership is engaged in prioritization Organizational barriers between team members are removed
© 2014 Health Catalyst Creative Commons Copyright Organizational Teams Women & Children’s Clinical Program Guidance Team Pregnancy SAM Pregnancy MD Lead RN SME Knowledge Manager Data Architect Application Administrator RN, Clinical Ops Director Guidance Team MD lead (e.g., Pregnancy MD Lead) Subject Matter Expert Data Capture Data Provisioning & Visualization Data Analysis Normal Newborn SAM Normal Newborn MD Lead RN SME Gynecology SAM Gynecology MD Lead RN SME Permanent Teams Integrated Clinical and Technical members Supports Multiple Care Process Families
© 2014 Health Catalyst Creative Commons Copyright 47 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
© 2014 Health Catalyst Creative Commons Copyright Crystal Run EDW Teams EDW data acquisition ● Systems programmers ● Database administrator ● Clinical SME’s EDW data architecture and integration services ● BI director ● Data architects ● Business development ● Project manager ● Clinical SME’s
© 2014 Health Catalyst Creative Commons Copyright Catalyst Resource Deployment Installation Improvement Independence Engagement Time Level of Engagement Technical Director Engagement Executive Primary owner Secondary owner SOW# 1 SOW# 2 SOW# 3 SOW# 4 SOW# 5+ Support
© 2014 Health Catalyst Creative Commons Copyright The Analytic Organization’s Journey
© 2014 Health Catalyst Creative Commons Copyright
© 2014 Health Catalyst Creative Commons Copyright AHIP Institute 2014 June 11-13, 2014 in Seattle, WA AHIP’s Data Analytics Forum will provide valuable insights on how stakeholders in the health care system utilize big data to enhance care quality, reduce costs, make better business decisions, and streamline operational processes. Please join Luke Skelly and Health Catalyst at Booth #911
© 2014 Health Catalyst Creative Commons Copyright © 2014 Health Catalyst Proprietary and Confidential Questions?
© 2014 Health Catalyst Creative Commons Copyright Seed Questions What are some of the barriers you’ve run across in acquiring claims from payers? What internal challenges do you see payers or providers facing in developing a data driven culture? How does Health Catalyst support a population health management approach using claims data from non-acute care settings (home health, skilled nursing facilities, etc.)
© 2014 Health Catalyst Creative Commons Copyright Contact Information Dr. Greg Spencer, CMO Crystal Run Healthcare Luke Skelley, VP Health Catalyst
© 2014 Health Catalyst Creative Commons Copyright Survey Questions On a scale of 1-5, with 5 being the highest, how satisfied are you overall with the quality of this webinar? What do you wish the presenter had spent less time on? What do you the presenter had spent more time on? What topics would you like to see in future webinars from Health Catalyst? On a scale of 1-5, how interested are you in a demonstration of Health Catalyst Solutions? What additional comments do you have?
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