1. Population Health Management
Products & Services
June 2017

2. Our Approach to Population Health
We provide a wide array of out-of-the-box applications to support common use cases, from care management to quality measures to performance monitoring in risk-based contracts. This is a common starting point for organizations early in their journey.
As organizations advance, they build a team who can ask deeper questions of the data, pushing beyond the abilities of these applications. Advanced users benefit most from the underlying capabilities of the platform, which supports ad hoc analysis, custom tools, machine learning and more.
Health Catalyst® provides a simple, pragmatic approach for how to get started with some quick wins for those who are just beginning— and a long-term strategy to succeed in an at-risk, value-based environment, with technologies and services
There are a 100 competing definitions of population health, from vendors to provider organizations. We think the effect is to make population health seem a lot harder than it is actually. Fundamentally, we’re all in it with the goal of improving quality and reducing cost.
In the near term, we all need to worry about how to succeed in the context of risk-based contracts. I’ve included the definition of population heatlh management here from Partners HealthCare, which is an organization that we have partnered with to leverage their insights in this space, in no small part because they began the journey to population health management almost a decade ago. I want to highlight some of the buzzwords that I know we all care about. “Shifting aware from fee for service.” “Entering alternative payment systems.” Investing in areas important to those new models that may not be reimbursed broadly under FFS. Partners has managed to do these things while doing well in the process and we know that’s a huge focus.

3. A Simple, Unifying Framework
The Journey to Population Health Management 3A
Payment Transformation 1 2
Infrastructure Investments
Opportunity Identification
Ensure financial sustainability while straddling FFS and FFV
Aggregate and enhance data for analysis; most organizations start with available claims and the largest clinical sources
Evaluate contractual requirements, available data, strategic priorities, and cultural readiness to prioritize efforts 3B
Care Transformation
And to do that, you need to—at the highest level—do a couple things:
invest in infrastructure (this is most commonly a data infrastructure but we’d encourage you not to overlook things like governance),
decide where you’re going to take your first steps, based in part on what you see in your data, but also critically by looking at your contracts and strategic imperatives and
start the work of payment and care transformation.
Fundamentally we’re doing this in the interest of improving care
But while we straddle the FFS and FFV worlds, we need to make sure we’re taking the right steps to be financially sustainable on the journey
Develop the infrastructure to provide more effective care

4. Health Catalyst Analytics Platform
Principle #1: Infrastructure Investments
Health Catalyst Analytics Platform
Subject Area Data Marts
Applications
Present actionable data to deployment teams
Community Care
Dashboard
Financial
Management
Explorer
Heart Failure
Our ability to aggregate disparate sources is unparalleled in the market (we were recently named Best in KLAS in healthcare business intelligence and analytics)
The ability of the platform to enhance data and support custom analysis are among the most appealing to our advanced PHM users
Subject Area Mart Designer
Create and manage content
Linking & Standardization
Common Linkable Identifiers, Patients, Labs, Encounters, Diagnoses, Medications, etc.
Content
Population Definitions (800+), Hierarchies, Comorbidities, Risk Stratification, Attribution
Atlas
Provide insight into analytics system source metadata
Source Marts
EMR
Financial
Patient Sat. HR
Administrative
Claims
Source Mart Designer
Accelerate analytics with single source of truth
EMR
Financial
Patient Sat. HR
Administrative
Claims
e.g. Epic, Cerner
Allscripts
e.g. EPSi,
Peoplesoft,
Lawson
e.g. Press Gainey,
NRC Picker
e.g. Lawson,
PeopleSoft
e.g. Kronos,
API Time Tracking
e.g. Medicare
Private Payers

5. Sources Library Sources Available On Roadmap 149 28 2 18 3 24 3 11 2
EMR
(e.g. Cerner, Epic, Meditech)
Financial/ Costing
(e.g. Lawson, EPSI)
Billing
(e.g. McKesson,) HR
(e.g. Peoplesoft, API)
Claims
(e.g. QXNT, CMS)
Clinical Specialty
(Lab, Rad, Rx, Clinical Op Systems)
HIE
(Health Information Exchanges)
Patient
Satisfaction
(Press Ganey)
Other
(External Benchmarking, home grown systems) 2 18 3 24 3 11 2 12 2 25 7 29 1 2 1 6 7 22
Available
On Roadmap

6. Data is Necessary, But Not Sufficient
Principle #2: Opportunity Identification
Data is Necessary, But Not Sufficient
Organizational strategic plan
Contractual requirements for existing VBP arrangements
Data Discovery and Gathering
Stakeholder interviews with key VBP leaders
Topics focus on: existing governance, analytic maturity, existing financial imperatives, and the infrastructure to drive change
Readiness Assessment
Claims data is typically the first, critical input. However, depending on data availability this review may include other sources
Tools may include KPA, PMPM Analyzer, or CAFÉ®. Leading Wisely supports monitoring
Data Analysis
Opportunity analysis represents a critical and iterative competency that your PHM team will be required to support
Data is a critical input to the process, but these other inputs help the organization to prioritize initiatives

7. Ensure You’re Financial Sustainable
Principle #3a: Payment Transformation
Ensure You’re Financial Sustainable
Start with Coding and Quality Measures 1
Cash Received
Does coding accurately reflect the risk of your population? (HCC Insights)
Are you being compensated for your efforts to improve quality? (Measure Insights)
Once you’ve taken risk, your primary levers to succeed are: 1) ensuring you’re getting paid, 2) reducing utilization, and 3) reducing costs
For organizations early in their journey, cash received (coding and quality measures) should be the starting point because it is a “win-win” in FFS and FFV
As you advance, you will want to incorporate utilization management and cost reduction
Are your efforts to reduce uncompensated care supported by data? (Propensity to Pay)
Are you continuing to keep a pulse on revenue cycle issues? (Rev Cycle Suite) 2
Actual Utilization
M(PMPM Analyzer, Bundled Payments for all)
Are you aware of your performance on your risk-based contracts, by payer and on KPIs?
Can you identify negative or positive trends and opportunities for improvement?
Are you aware of the highest priority areas to focus clinical improvement initiatives?
This slide shows how we’d go about approaching this – I’ve just flipped that graphic on its side
Your first key imperative is around your cash position
Investments here benefit you in FFS and FFV, so this is effort that’s a win-win
As it relates to population health specifically, the think we’d encourage you to take a look at is coding. Are you accuately coding your population’s risk? This is critical because that score reflects the intensity of services that CMS is willing to pay you for in the context of your contracts.
Secondarily, do you have a quality measure strategy? Most organizations have not insignificant dollars tied to performance on these metrics, but too many aren’t aware of the magnitude or the effort they need to take to ensure they’re successful there. You need to get a handle on your approach.
The final note that I’d make is that revenue cycle strategy is only becoming more critical. Whatever you do on the pop health front should be connected to your overall effortsin this space.
Let’s move on to utilization management. This topic requires more consideration because it’s not the same win-win. If you drive down utilization in FFS, you lose. If you drive utilization in FFV, you win. If I can leave you with one piece of advice here it’s to use data to help you make more informed decisions.
It’s easy to overlook something as simple as getting a handle on where you stand in your at-risk contracts, by payer, and by KPI, but it’s that information that’s going ot help you make smart choices about where to improve in the context of existing contracts and to weigh that against broader implications for your bigger book of business.
Most of the levers we have to drive down utilization are on the clinical side, but that does’t mean that we shouldn’t be using data to make informed decisions about the greatest opportunities to perform more effectively against benchmarks or reduce unwarranted variation, particularly in those key VBP contracts
Finally, while cash received and utilization are typical “pop health” topics, I want to take a minute to talk about cost of care.
If you’re an organization wants to go back and proactively negotiate contracted utilization rates, you’re going to be best positioned with cost information. That’s why we’d encourage you to keep an eye on this imperative—even if it’s not specific to population health—because it certainly will help your strategy 3
Cost to Deliver Care
(Activity-Based Costing)
Are you able to track costs at a grain that allows for insight and improvement

8. Lay the Groundwork for Better Care
Principle #3b: Care Transformation
Lay the Groundwork for Better Care
Start with Care Management, Plan for Populations 1
Ensure the sickest, most costly patients are well managed
Are you able to identify high cost/high need and risking risk patients? (Patient Stratification)
Do you have point-of-care tools to steward team member workflow (CM workflow tools)
Can you monitor the return on your engagement efforts? (Care Team Insights)
In care transformation, it typically makes the most sense to start with care management and quality measure work
As you advance and seek more opportunities to drive down utilization, you will need to seek population-level opportunities for improvement 2
Leverage analytics to support a comprehensive primary care strategy
Are analytics meaningfully underpinning your PCMH work by providing support for the management of broad quality requirements? (Community Care)
Do you have tools to easily segment and monitor patients based on clinical condition or other variables for focused campaigns? (Precise Patient Registries)
Do you have tools to engage and manage your employees’ health? (Catalyst4Health)
This slide shows how we’d go about approaching this – I’ve just flipped that graphic on its side
Your first key imperative is around your cash position
Investments here benefit you in FFS and FFV, so this is effort that’s a win-win
As it relates to population health specifically, the think we’d encourage you to take a look at is coding. Are you accuately coding your population’s risk? This is critical because that score reflects the intensity of services that CMS is willing to pay you for in the context of your contracts.
Secondarily, do you have a quality measure strategy? Most organizations have not insignificant dollars tied to performance on these metrics, but too many aren’t aware of the magnitude or the effort they need to take to ensure they’re successful there. You need to get a handle on your approach.
The final note that I’d make is that revenue cycle strategy is only becoming more critical. Whatever you do on the pop health front should be connected to your overall effortsin this space.
Let’s move on to utilization management. This topic requires more consideration because it’s not the same win-win. If you drive down utilization in FFS, you lose. If you drive utilization in FFV, you win. If I can leave you with one piece of advice here it’s to use data to help you make more informed decisions.
It’s easy to overlook something as simple as getting a handle on where you stand in your at-risk contracts, by payer, and by KPI, but it’s that information that’s going ot help you make smart choices about where to improve in the context of existing contracts and to weigh that against broader implications for your bigger book of business.
Most of the levers we have to drive down utilization are on the clinical side, but that does’t mean that we shouldn’t be using data to make informed decisions about the greatest opportunities to perform more effectively against benchmarks or reduce unwarranted variation, particularly in those key VBP contracts
Finally, while cash received and utilization are typical “pop health” topics, I want to take a minute to talk about cost of care.
If you’re an organization wants to go back and proactively negotiate contracted utilization rates, you’re going to be best positioned with cost information. That’s why we’d encourage you to keep an eye on this imperative—even if it’s not specific to population health—because it certainly will help your strategy 3
Use data to unearth opportunities for systematic improvements
Do you have the ability to identify variability and areas for improvement at the clinical program level to drive systematic improvement? (Clinical and Operational Apps)
Are you able to identify the greatest areas of inappropriate utilization? (Patient Harm)

9. Population Health Management Products1 2 3A 3B
Infrastructure Investments
Opportunity Identification
Payment Transformation
Care Transformation
Data Operating System aggregation of clinical, claims, and other sources, across multiple organizations & systems supports attribution, predictive modeling and closed-loop analytics
Open web services API support for data exchange and embedded integration
Key Process Analysis
Patient Stratification
Population Explorer
Bundled Payments
Comparative Benchmarking (CAFÉ)
HCC Insights – coding validation
MACRA Measures & Insights
PMPM Analyzer for CMS and VBC
Activity-Based Costing (CORUS® Suite)
Care Management Suite
Gaps in Care for Primary Care Offices (Community Care)
Precise Patient Registries
Disease Management (Full suite of clinical applications for Heart Failure, COPD, Diabetes, etc.
Core
Extended

10. Three Systems for Improvement
Leadership, Culture, and Governance
Financial Alignment
What should we be doing?
How are we doing?
How do we change?
Where do we focus?
How are we financially compensated?

11. Click to view case study
Managing Half a Million Risk-Contracted Lives: Partners HealthCare Population Health Strategy
Click to view case study
Established a multi-disciplinary governance and sponsorship approach
Developed and implemented a strategic PHM framework
Implemented advanced ACO / shared risk population health analytics platform
Built strong base of end-user engagement and support “ ”
“The breadth and depth of the changes required to transform care delivery present numerous daunting challenges. Our experience suggests that partial approaches will not constrain cost growth. Organizations committed to value-based purchasing need to plan for the long haul.”
~ Sree Chaguturu, MD, Vice President Population Health Management Partners HealthCare
Partners HealthCare– “Managing Half a Million Risk-Contracted Lives: Partners HealthCare Population Health Strategy”
Published 10/2015
Setting
Partners HealthCare in Massachusetts—an integrated delivery system with two large academic medical centers (Massachusetts General Hospital and Brigham and Women’s Hospital), multiple inpatient and outpatient facilities, and more than 6000 physicians—was an early adopter of the ACO approach to care delivery.  
Partners founded a large ACO to manage risk-based reimbursement models and, in 2011, signed accountable care contracts within all major payer categories. These contracts placed a significant percentage of the organization’s revenue at risk. In fact, Partners is currently at risk for costs for nearly 500,000 lives.
Complication
A robust analytics system that could operate across the ACO was essential to managing these populations—and Partners lacked such a system at the outset. The organization did not have the ability to efficiently integrate and analyze multiple data sources from across the ACO—including clinical data, claims data and financial data—to effectively manage costs and risk. Partners’ existing analytics environment was fragmented into three separate data warehouses and numerous other smaller repositories, making it extremely difficult to obtain the integrated views required.
Turning Point
Partners recognized a need to define new organizational structures and processes for delivering care under the new value-based purchasing paradigm. The ACO also required a more sophisticated analytic environment to help manage risk and optimize value. They therefore embarked on a system-wide initiative to reengineer business processes and align the organization’s operations with value-based principles.
Resolution
Partners developed and implemented a strategic framework for population health management  that can serve as a model for health systems throughout the United States. This framework consists of:
A new entity to guide the population health management effort. Partners created the Division of Population Health Management (PHM) to work closely with leadership at member institutions to collaboratively design and execute a system-wide accountable care strategy. Through the Division’s efforts, Partners established a multi-disciplinary governance and sponsorship approach that resulted in a high level of user adoption and engagement. 
New multi-disciplinary care models (called the integrated care management program, or iCMP) to increase the organization’s capacity to manage the health of populations while also reducing growth in healthcare costs.
An elegant framework (the Internal Performance Framework) to promote collaboration and align incentives among providers across the care continuum.
An Advanced ACO and population health analytics platform. Consisting of an enterprise data warehouse (EDW) and advanced analytics applications, this platform delivers the insights needed to manage risk-based contracts. The Partners team is specifically using the platform to help them understand their overall business trajectory, assess performance, manage utilization, and control costs.

12. KLAS: Population Health Management 2016
POPULATION HEALTH MANAGEMENT 2016 The Training Wheels Are Off – KLAS Dec 2016 Performance Report

13. Our Differentiators
Best in KLAS in healthcare business intelligence and analytics T
The depth and breadth of our out-of-the-box solutions to address common analysis needs, paired with a highly flexible architecture to support advanced used cases and custom analysis
Our ability to bridge near-term imperatives and long-term needs. We meet you where you are today, but provide a robust foundation for long-term success.

14. Thank You