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Integrated Data Framework & Analytics for APCD JOHN BACKHOUSE Executive Director iWay Software (Global), Information Builders Presented by: Bruce Eckert,

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Presentation on theme: "Integrated Data Framework & Analytics for APCD JOHN BACKHOUSE Executive Director iWay Software (Global), Information Builders Presented by: Bruce Eckert,"— Presentation transcript:

1 Integrated Data Framework & Analytics for APCD JOHN BACKHOUSE Executive Director iWay Software (Global), Information Builders Presented by: Bruce Eckert, MBA, CPHIMS, FHIMSS National Practice Director, Beacon Partners

2 Healthcare Spending Growth

3 Healthcare Expenditure in USD

4 Healthy Life Expectancy at Age 60 Developed by the World Health Organization, healthy life expectancy is based on life expectancy adjusted for time spent in poor health because of disease and/or injury

5 Healthy Lives National average and state distributionInternational comparison, 2007 Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, Infant Mortality Rate Infant deaths per 1,000 live births ^ Denotes years in 2006 and 2008 National Scorecards. Data: National and state—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2003–2008; Mathews and MacDorman, 2011); international comparison—OECD Health Data 2011 (database), Version 06/2011.

6 Transitioning to Integrated Accountable Care Triple Aim ACO PCMH Primary Care Initiative Clinically Integrated Networks  PQRI  Value-Based Purchasing  Healthcare Improvement Institute  LeapFrog  Beacon Challenge Grants

7 Population Health

8 “ “ The use of a variety of individual, organizational and cultural interventions to help improve the illness and injury burden and the health care use behavior of defined populations. – Dr. Michael Hillman, Marshfield Clinic

9 Outliers Best Practices Alerts Predictive Risk Assessment UtilizationOutcomes Pricing Transparency ANALYTICS

10 All Payer Claims Databases Healthcare’s “Biggest” Data

11 Growing National Trend for APCD

12 Selected Data Elements in the APCD Connector/Risk Adjustment for ACA Indicator Purchased thru HIX, Actuarial Value, Tobacco Use Division of Insurance NAIC Code Group Insurance Commission GIC ID Group Insurance Commission GIC ID CHIA for Total Medical Expense, Cost Trends and Relative Pricing Non Claims Payments, Payment Arrangement Type Connector and DOI Monthly Premium, Employer ZIP, Family Size Connector, DOI and GIC Market Category Code Connector, DOI and GIC Market Category Code All Payer Claims Data Base Private and Public Payers Connector, CHIA and DOI Employer Contribution Connector, CHIA and DOI Employer Contribution Health Policy Commission Total Medical Expense

13 Consumers Employers Providers Researchers Population Health Insurance Payers Medicaid Health Reform

14 APCD Challenges Data Standards Data Integrity Privacy and Security Self Service Policy Audit Controls Data Integration ICD9 to ICD10 Analytics Data Governance Guided Ad Hoc Data Dictionary Data Steward/ Custodian

15 Total Cost of Care Total Cost of Care Trend Graph Utilization Utilization Trend Graphs Inpatient Utilization Outpatient Utilization ER Utilization Readmissions, Potentially Preventable (per population) Readmissions, Potentially Preventable (per admission) Readmissions, All Cause 30 Day (per population) Readmissions, All Cause 30 Day (per admission) Provider Density Chronic Conditions Illness Burden Illness Burden Graph All Payer Claims Database, Data sets

16 16 Files and Selective Elements Provider File Claims Files Product File Member File Personal Health Info (encrypted) Subscriber and member names and social security numbers Patient Demographics Age, gender, relationship to subscriber Type of Product HMO, POS, Indemnity Type of Contract Single person, family Coverage Type Self-funded, Individual, Small group Service/prescribing provider Name, Tax ID, Payer ID, NPI, Specialty code, City, State, Zip code Billing Provider Name, payer ID, NPI Medical Claims Pharmacy Claims Dental Claims Service Information Service and paid dates, paid amount, admission types, diagnosis and procedure information All-Payer Claims Database 16

17 Powerful, effective, and easy to use data analytics module with portal and self service World class data management of claims and associated data (e.g. HIE, benchmarks, research) into a multi mastered domain and information repository Supports industry standard (e.g. HIPAA/5010) transactions for 837 and related claims transactions. Industry tested data model and multi-domain (Payer, Provider, Patient) mastered information repository. Data quality, patient matching, standardization, and enrichment algorithms APCD Solution

18 Provides extensive coding data validations/cross walks including ICD9- CM, ICD-10 (GM/AM/CA), CPT-4, HCPCS, SNOMED, LOINC, DRG, RxNorm, NDC… Data Steward Portal to support Data Governance workflows for data remediation 360 degree view of claims, payers, patients, providers, and facilities Scalable and extensible to handle high data volumes required by state wide APCD system Technology agnostic solution that can operate in on-site or cloud- based solution. APCD Solution - continued

19 19 OmniPatient™ All-Payer Claims Database

20 20 Omni-Patient – APCD Solution

21 21 Omni-Patient – APCD Solution

22 22 Omni-Patient – APCD Solution

23 23 Omni-Patient – APCD Solution

24 24 Omni-Patient – APCD Solution

25 Data Dictionary

26

27 Womens’ Health Categories

28 Continuity of Care Document Selection

29 CCD

30 ** Information Builders Confidential ** APCD Management Empower All Users to Understand APCD by any Parameter Analyze Patient Population

31 ** Information Builders Confidential ** Health System Performance Scorecard Identify Top/Bottom Performers, Alerts, Measure Performance Through Self-Service Parameterize Anything Broadcast metrics across dimensions to see outliers w/o knowing what to ask Broadcast metrics across dimensions to see outliers w/o knowing what to ask Automatic drills/roll ups based on custom dimensions Near Real Time Alerts Personalize any gadget based on metric and dimension Determine impact of readmissions on financial metrics and population health Determine impact of readmissions on financial metrics and population health

32 Physician Cost Efficiency Determine Cost by Age, Time, Payer, Chronic Disease Determine highest costing procedure groups and how they correlate to readmits, LOS – drill to encounter detail Based on service line and physician, determine by demographics, time, payer, chronic disease, what is the cost of care vs revenue ** Information Builders Confidential **

33 Summary

34 Information Builders Healthcare Solutions About Us A leading independent global software provider  Market leader in large-scale business intelligence deployments  Market leading provider of integration technology  Leading edge data integrity and governance solutions Our top priority is Customer Success  Superior engineered software  Highest-rated customer service Leader in solutions that enable the transformation to accountable care 360° View of Patient 360° View of Patient Efficient Patient Flow Clinical Best Practices Financial Mgt. Fragmented Care Integrated Care Omnipatient & Enterprise Analytics

35 35 Information Builders Healthcare Customers

36 36 Information Builders’ Partnership with Beacon Partners Marrying a world-class data integration, data integrity and analytics healthcare solution with best-practice healthcare expertise to ensure we comprehensively address your needs with best-practice project management & deployment methodologies throughout the entirety of the program

37 37 A Leader in Strategic Healthcare Consulting Services Exclusive focus on healthcare since its inception in successful diverse implementations Strategic Advisory Group – Ex. CIOs, Administrators, Clinicians Dedicated practices with deep experience in most major vendor EHRs Deep background and experience with Accountable Care, Population Mgmt., HIE, and Analytics in many settings

38 38 Population Health Deployment Approach Ensure your State’s APCD system flexes to accommodate future requirements Focus on business drivers as the primary goal of the project  Pricing transparency  Provider utilization performance  Utilization patterns  Access disparities Target users  Regulators  Researchers  Payers  Providers  Public

39 Project management Carrier relationship management Implementation services Data file submission support Testing and data validation Technical Support Analytics and report creation Training Comprehensive Service & Support

40 40 Implementation Plan With “Early CMS/SSP Visibility” Wave 1 – High priority quick wins and immediate visibility  Pre-wave Solution Assessment to fully define business drivers and facilitate design, development, and deployment  Install OmniPatient and WebFOCUS components and establish access on all data sources  Create appropriate metadata and define cross- platform joins/drills for CMS Shared Services data sets  Configure ACO Metrics within PMF for Population Management Wave 2  Mastering of Data Sources by Domains (e.g., Medicare, Medicaid, Payers, HIEs, TPAs)  Registries/Datasets, KPIs Wave 3  Data Model extensions  Establish Data Governance  Ongoing revisions based on newly-identified business drivers  Wrap up of open “use cases” Use Wave Investment Planning to Roll Out in Defined Waves

41 Copyright 2014, Information Builders and Beacon Partners, Inc. Questions? Thank You! For more information, please contact: Bruce Eckert John Backhouse


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