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Predictive Analytics for Healthcare Organizations

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Presentation on theme: "Predictive Analytics for Healthcare Organizations"— Presentation transcript:

1 Predictive Analytics for Healthcare Organizations
Tony Jurek Balaji Apparsamy Yasim Kolathayil Morgann Carlon 30-Sept-2014

2 Introduction

3 Contents Introduction and Kick Off 3
Importance of Analytics for Healthcare Organizations 6 Case Study: The Impacts of Analytics at BayCare 14 Enabling Analytics for ACOs 20 Summary – What Next 26 Q&A 29

4 Team resumes Role – Engagement Director Role - Director
Tony Jurek Director Deloitte Consulting Minneapolis Tony is Director in the Information Management practice of Deloitte Consulting. Tony advises healthcare clients in the Business Analytics space Balaji Apparsamy Director, Data Management & Enterprise Web Applications BayCare Health System Clearwater, FL Balaji provides strategic leadership and governance over long term data strategy to increase the competitive advantage for Baycare. Leadership over patient centric CRM solution to improve on patient engagement, care coordination to reduce care gaps and financial risks Role – Program Manager Role – Consultant Yasim Kolathayil Manager Deloitte Consulting Dallas Yasim is a Manager in the Information Management practice of Deloitte Consulting. Yasim is currently focused on providing value to health care clients in the business intelligence (BI) and business analytics space. Morgann Carlon Consultant Deloitte Consulting Minneapolis Morgann is a Consultant in the Information Management practice of Deloitte Consulting. Morgann is currently focused on healthcare analytics strategies for her clients.

5 Importance of Analytics for Healthcare Organizations

6 What does “Analytics” Mean to You?

7 Six Trends Shaping Healthcare
Healthcare organizations are experiencing the “perfect storm” at the intersection of changing demographics, technological innovation and governmental regulation. Expanding Definitions of Health Consumer health technologies Medical expense management Direct-to-consumer tools and decision support Genotypic diagnostics and targeted therapeutic interventions Rising Pressure in Policy, Politics, and Economics Online platforms for collective action Focus on cost reduction and improved health outcomes Communities of interest become communities of action Demanding Demographics Personalized health information Individualized risk assessment Personal health records Genetic screening Healthcare Organizations Converging Relationships Open platforms for innovation Connects outsiders to specific projects inside companies Encourages cross-disciplinary and external collaboration Streamlines expert sourcing Increasing Transparency Technology shapes health behavior New technologies integrate layers of data OTC diagnostics provide real-time feedback Advancement of data analysis Simulations anticipate risk Patient self-care Public health preparedness Expanding Connectivity: Anytime, Anywhere Mobile health Delivery of information and services Peer-to-peer health management Adherence support and self care Sensing technologies Collection of biometric data The Result – More data from more sources creates new challenges and opportunities

8 Analytics Can be a Game Charger for Healthcare Organizations
Take an Enterprise View Start with the End in Mind Use the Right Solutions for the Job Leaders Need 360O Insight Focus on Excellence Market Excellence Clinical Excellence Operational Excellence Financial Excellence You can’t manage what you don’t measure – metrics that matter Understand what separates areas to better bring them together One-Size Does Not Fill All Focus on the Future 1-2 Yr. Target Maturities 2-3 Yr. Target Maturities 3-5 Yr. Target Maturities Don’t “rip and replace” but “leverage and lift” the value of the systems you already have Alignment across functions makes everyone successful Not Everything Looks Like a Nail Focus on Value Deloitte Products & IP Vendor Technologies Deloitte Advice and IC Partner Network Solutions, not tools bring the pieces together and drive new insights Align projects and partners with shared risk and shared reward

9 Key is understanding the two sides of Analytics
Descriptive Analytics Reporting After the fact performance measuring Static Should be insightful Predictive Analytics Future facing Trending Pattern Analysis Scoring to determine “Next Best Action” Cohort Determination Should also be insightful Hindsight Insight foresight

10 An 360o Enterprise-View of a Healthcare Organizations Challenges
Value Based Care Population Management Care Coordination Disease Management Re-Admissions Analytics Market Demographics Sizing & Segmentation Brand & Identity Access & Pricing Research and Development Project & Trials Management Applied Research Translational Research Innovator Foundation Human Resources Technology & Facilities Accounting & Finance Governance & Compliance Supply Chain Mergers & Acquisitions Patient Satisfaction Quality & Safety Market Demographics Value-Based Care Alliances & Partnerships Research & Development Developed Advanced Clinical Financial Operational CEO CFO CMO COO Quality & Safety Clinical Effectiveness Perioperative Care EHSS & HITS Alliances & Partnerships Joint Ventures Physician Integration Strategic Affiliations Mergers & Acquisitions Strategy & Growth Valuation & Pricing Post-Merger Integration Patient Satisfaction Environment & Setting Clinical Integration Mobile Health Accounting & Finance Close, Plan & Report Cost Accounting & DSS Revenue Cycle Performance Human Resources HR Transformation Bus. Model Transformation Compensation Alignment Governance & Compliance Governance & Controls Security & Privacy ICD-10 Tax Optimization Supply Chain Sourcing & Procurement Logistics & Distribution Demand Management Technology & Facilities Infrastructure & Architecture HIT and ERP Shared Services Real Estate & Facilities

11 Deloitte Health Analytics Product Portfolio
Our balanced product portfolio is designed to impact key issues in healthcare, while maximizing value, aligning with the core business, maintaining a competitive position, and enabling innovation. Market Issue Impact Product Portfolio Intellect Clinical Excellence Sustainable Margin Revenue Excellence Improve business processes, clinical effectiveness and efficiency, patient safety, productivity to lower cost, while maintaining and improving quality Isolate and quantify revenue leakage Insight Value Based Care/ Population Health Management Improve population health management and outcomes Reduce unwarranted variation Improve care coordination and risk stratification Leverage evidence based guidelines and best practices Miner Research Excellence Real World Evidence Improve signal exploration and surveillance Support comparative effectiveness analyses, pharmacovigilance, and other use cases for R&D & outcomes analysis Improve clinical and translational research/medicine Enable personalized medicine Total Cost Intellect Health System Intellect Sustainable Margin and Quality Dashboard Clinical Intellect Clinical Care Optimizer Readmission Optimizer Quality Optimizer Performance Intellect PI Workbench Operations Optimizer Procedure Cost Analysis Revenue Intellect Revenue Financial Analysis Insight Provider Performance Management Patient Engagement Contracting and Reporting Care Management Outcomes Miner Signal Exploration Statistically Nuanced Analytics Comparative Analytics Precision Miner Biomarker Hypothesis Generation & Validation Gene Based Matching Cohort Identification Descriptive Analytics Drug Exposure / Response Analysis Population Miner Research Knowledge Management

12 Oracle Enterprise Healthcare Analytics + Deloitte Analytic Applications
A powerful combination of capabilities to help meet the demands of the information driven healthcare environment Security Metadata Delivery Exception Management System Business Rules Oracle EHA Apps Conformed Data Mart (HCD) OBI-EE/Java Source Data Extract OHADI: Application Toolkit Reporting All Sources Interface Tables OHADI: WIL EHA Healthcare Data Model ConvergeHealth By Deloitte Apps Exec Ad Hoc Query Validation, Standardization, and Transformation Clinical Financial Administrative Research OLAP Clinician Data Mining Custom Applications Master Data Interface (MDI) MDM: Term. MPI Unit of Measure NLP De – identification Master Data MDM Loaders Master Data Management & Other Services “Real” Time Researcher MDM ETL OHADI: Interface tables > HDWF, business rules, MDM, and metadata management Source Independent OHADI: HDWF > Applications MDM, Conformance, Metric Definition, Benchmarks, etc. Source Dependent HDWF 3NF EDW Applications: Reports, Dashboards, Scorecards, etc.

13 Case Study: Impacts of Analytics at BayCare

14 Introduction BayCare Health System is a leading community-based health system in the Tampa Bay area. Composed of a network of 11 not-for-profit hospitals, outpatient facilities and services such as imaging, lab, behavioral health and home health care, BayCare provides expert medical care throughout a patient's lifetime. With more than 280 access points conveniently located throughout Tampa Bay, BayCare connects patients to a complete range of preventive, diagnostic and treatment services for any health care need. In 2013, BayCare provided $243.5 million in community benefit, which includes $ million in traditional charity care

15 Readmissions Identification of consistent process (or lack of it) to capture data that causes potential readmission, and make it available at the right time, right place for right people Common Causes Lack of coordination of care between settings Estimated high volume related to social issues Lack of compliance with prescribed therapy Prevention Readmission flag on EMR Standard discharge procedure and patient education Discharge phone calls and follow up Improved patient experience People Process Technology

16 Readmissions - Impact Reduction of readmission is a spectrum of process, that leads to the transformation of providing care to the patients Patients One fifth of the Medicare patients are readmitted within 30 days Huge cost impact on unplanned readmissions within 30 days Hospitals Reductions in reimbursements Penalties and risks due readmission trends Three fourth of the readmissions are preventable Fee for Service Value based (PHM)

17 Analytics & Predictive Modeling
BayCare Strategy Digitization Integration Data Collection Analytics & Predictive Modeling Act on Data Financial Sustainability Pharmacy EMR Scorecards EDW Analytics Financial HIE DM&A Capabilities Data Creation Data Storage Data Movement Data Usage Data Retirement DG Population Management Labs KPI Registration Clinical Dashboard Predictive Outcomes

18 2014 Accomplishments Beginning of the journey, in the right direction
Standard method to identify patients at High Risk for Readmission Implemented Interdisciplinary Plan of care EMR ‘task’ to Case Manager and Social Worker when patient identified as High Risk for Readmission Monitor Home Care admits and Pilot rollouts Next stage Transition of Care Management Process model Ongoing monitor and improvements

19 Enabling Analytics for ACOs

20 Analytics can address the critical needs of ACOs
1. Integrated Patient Care management 2. Accountability and Organizational Effectiveness 3. Population Health Management 4. Safety and Quality Reporting Compliance 5. Technology adoption Critical ACO needs Integrated Patient Care management Access to a holistic 360 degree view of patient data and analyze data overtime to identify trends and spot gaps in care coordination and delivery Use predictive modeling techniques and solutions to prevent adverse events and readmissions 5. Technology adoption Creation of sophisticated technology platform allowing for longitudinal view of patients and more practice of evidence based medicine Analytics system focus on acquiring clinical data and facilitating a care management workflow Population Health Management Enables risk stratification and can identify the subpopulations that are most at risk Summarize and explain population level outcomes data to budget for the healthcare expenses of a defined population Accountability and Organizational Effectiveness Defines shared accountability among the ACO leadership to provide collaborative care Measures organizational effectives and key capabilities across excellence areas enables organizational savings and growth opportunities. How analytics can help ACOs address these critical needs Safety and Quality Reporting Compliance Enables ACOs to measure the quality and compliance metrics for CMS shared savings Reporting capabilities and detailed metrics are required to operate, manage and measure an ACO

21 Integrated care coordination by ACO
Analytics enables a 360 degree view of patient and spot gaps in care coordination and delivery Sample metrics to measure patient engagement, satisfaction, plan of care and membership analysis Integrated care coordination by ACO Proactive Plan of Care and Follow-up Patient/ Care Giver Experience Patient Engagement Patient/ Membership Analysis Medication Reconciliation 30 Day Post Discharge Physician Visit Measure of Processes of Care (MPOC-28) Plans Of Care Compliance Communication with Nurses Communication with Doctors Call Center - Hold Time Responsiveness of Hospital Staff Member Insurance Affiliation Dual Eligibility Employer Affiliation YTD Total Medicare Membership Growth Termed Group Count Success of Member Education Patient Education/Outreach Participation Patient Channel Responsiveness Young Adult Health Care Survey (YAHCS) Improved patient engagement and care coordination

22 Analytics enables shared accountability among the ACO leadership to provide collaborative care
Key Capabilities CMO At Risk Population Evidence Based Medicine/ Gaps in Care Patient Safety Population Health Management Proactive Plan of Care and Follow-up Quality Improvement Patient Engagement Patient Satisfaction Preventive Health Healthcare home effectiveness Practitioner Satisfaction CEO ACO Dashboards Executive Management Information System (EMIS) Revenue Cycle COO Operational Efficiency Organizational Analysis Transitions and Communication Reimbursement Security and Privacy Cost of Care Practitioner Satisfaction Provider Utilization Patient/Membership Analysis Patient Safety Quality Improvement Supply Utilization Measures Purchasing & Contract Compliance Measures Inventory Management Measures Key Capabilities CMO CFO COO CMIO CEO CFO Cost of Care Financial Performance Financial Risk Market Share Regulatory Risk Reimbursement Patient/Membership Analysis Purchasing & Contract Compliance Measures CMIO Technology Adoption Security and Privacy Evidence Based Medicine/ Gaps in Care Note: The capabilities that are in bold are shared across the excellence areas Note: The capabilities that are in bold are shared across the excellence areas

23 Management Objectives
Analytics enables ACOs to budget for the healthcare expenses of a defined population Population Health Management Objectives Key Questions Analytics Impact Does clinician have the capability to evaluate health risks based on year over year comparing assessments? Is clinician auto notified of new or conflicting info requiring resolution? Can analytics deconstruct the patient groups to examine and manage population sub groups? Comprehensive understanding of patient health/risk Consumer health segmentation Patient cohort identification & Stratification Epidemic monitoring Health Assessment What are the cost drivers, at risk individuals in the population? Can analytics make predictions for given patient groups to offer most effective intervention? Can the at-risk patients be prioritized and offer tailored interventions? Track population trends Clinical campaign management & targeted outreach Chronic disease management Risk-pool stratification Shared decision making Risk Stratification Are the at risk patients receiving timely care? Is physician receiving real time patient and population data at point of care? Does the clinician have access to decision making tools to provide best possible care? Improved patient health status Improved patient satisfaction Personalized patient care Evidence based intervention Enables use of social media Patient- Centered Intervention Does ACOs have tools to measure outcomes and patient satisfaction to compare against national and local benchmarks? Does the conclusions make sense? Does ACOs have access to scorecard to understand and improve performance? Improved patient outcomes Financial reporting Risk and regulation compliance Quality & compliance reporting Clinical performance management Reimbursement reporting Impact Evaluation and Outcomes Measurement

24 Accountable Care Metrics
Reporting capabilities and detailed metrics are required to operate, manage and measure an ACO Reports will provide valuable information allowing ACOs to track performance and identify areas for improvement.  Regulatory Metrics Outcomes Metrics Guidelines Metrics Efficiency Metrics Clinical Process Metrics Payer Metrics Payer Mandated Metrics Outcomes Metrics Physician Metrics Process Metrics Claims for Reimbursement Metrics ACO ACO Reports Accountable Care Metrics Reporting capabilities are required to collect and submit quality and safety data to CMS and private payers.

25 Sophisticated analytics platform enables longitudinal view of patients and practice of evidence based medicine Physician / Patient Engagement Data Integration & Management Core Applications & Workflow / Automation Data Analytics & Content 1 2 3 4 5 Connectivity, Security and Interoperability Connects to all the data producers, provides access to data consumers, and validates access rights. Core Applications and Workflow / Automation Orchestrates the execution of activities the constitute the care continuum, gathering contextual information from both the transactional systems as well as the data-warehouse. Data Integration and Management Retrieve data from the data producers, in both structured and unstructured form, and transform it to align with core application data requirements as well as end user analytical needs. Physician/Patient Engagement Key interfaces for both patients and physicians to facilitate their interactions with the VBC system, leveraging workflow & analytics to enhance engagement and satisfaction for both these stakeholders. Data Analytics and Content Using self-actualizing trends and business solution specific heuristics analyzes transactional data and creates enriched information. Data delivery occurs via screen-reports and services/API.

26 What Next

27 Unprecedented Market Changes Are Creating New Challenges for Healthcare Providers
The evolution occurring in the industry is driven primarily by four macro-drivers: Heightened consumer expectations on value, simplicity, and transparency Ubiquitous technology adoption (e.g. Web, Mobile, Social) combined with always-on consumers Transparency in cost & quality Shift from volume to value (e.g., P4P, risk sharing) HC Delivery Realignment of relationships and scope of services across healthcare industry Risk shifts from Health Plans to Providers Players are seeking new ways to create and deliver value (e.g., disintermediation of traditional players) Rise in government programs (e.g., Medicare, Medicaid, Duals, and HIX) Heightened regulatory oversight These macro trends make it imperative for industry leading provider organizations to adapt to change enabled by their best in class people and processes

28 The Unified Data Platform – Oracle and Deloitte
Where do investments in technologies like Oracle EHA, and Deloitte’s Analytical Applications fit in this future view? ConvergeHealth by Deloitte Level 2 View – Data Source/Producers Data Consumers Data Brokering Data Ingestion/Enrichment Data Collection Oracle HDM DBMS Oracle - OBIEE Oracle - OBIEE ConvergeHealth by Deloitte Oracle MDM ODI Data Quality

29 Healthcare organizations should enable advanced analytics to provide integrated patient care

30 Q&A

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