1. Data Analysis for Disease Management
presented by:
Michael Mina
Senior Statistical Analyst
Medical Mutual of Ohio
October 13, 1999

2. Presentation Overview
Brief Disease Management Overview
MBSD DM Responsibilities
Competitor DM Data Issues
Possible Enhancements to MBSD DM Processes
Disease Management Resources

3. Brief Disease Management Overview
Disease management is the process of coordinating and managing members who have chronic conditions and health management services along the full spectrum of health care delivery while striving to improve both clinical and economic outcomes through altering patient and provider behavior.

4. Brief Disease Management Overview (cont’d)
Population based - different levels of severity
Education, Assistance
Help patients control their own disease
Concerned with quality of life, not cost alone

5. Brief Disease Management Overview (cont’d)
Insurance companies usually understaffed for this purpose
Disease Management programs often vendor-based, with vendors focused on a specific disease

6. Brief Disease Management Overview (cont’d)
MMO DM programs include:
Breathe Easy (Asthma, COPD)
Heart Sense (Congestive heart failure)
Transplanting Health (Organ transplant)
BabyLink (Perinatal education)
Outpatient Diabetic Education

7. MBSD DM Responsibilities*
07/16/96
MBSD DM Responsibilities
Identify diseases to manage
Process information for vendor usage
Invite providers to participate
Determine effectiveness of DM efforts
Outcomes reporting
Over/underutilization measures *

8. Tools Used by MBSD
DB2 / QMF / SQL
SAS
Access
Oracle

9. DB2 / QMF / SQL Above terms often used interchangeably
DB2 - Relational Database Management System (RDBMS)
QMF - Query Management Facility
SQL - Structured Query Language
Easy access to data

10. DB2
Relational Database

11. DB2 (cont’d)

12. DB2 (cont’d)

13. DB2 Production systems - PReview, CMS, CPIMS
Data storage - claims, premium, dependents
Standard RDBMS for MMO data warehousing / data mart efforts
Note: In the industry as a whole, outcomes reporting is a force behind data warehousing
DB2 used widely inside and outside MMO BP pay-at-pump

14. QMF Manages queries Some reporting and formatting capabilities
Can create procedures (procs) containing instructions for running multiple queries
More effective programming

15. SQL Queries - mini computer programs
“The most difficult area of data warehousing is the translation of simple business analyses into SQL” Ralph Kimball Ph.D., CEO Red Brick Systems

16. SQL (cont’d)
SELECT DISTINCT SUB_ID, DEP_NBR FROM CORP.INPAT WHERE YR_MO= AND PAT_AGE>= AND SPEC_CD=‘C1’ ORDER BY 1, 2

17. SAS SAS is a company with many products
Very powerful statistical analysis software
MMO has about 10 SAS programmers
Goodyear has over 700 SAS programmers and a SAS data warehouse
SAS is used by GE Card Services with an Oracle data warehouse

18. Access Microsoft database Very versatile
Easy to create reports with downloaded mainframe data
Very widely used
Small business database of choice
But also used by NCB ($80 billion bank) for Sales & Incentive program

19. Oracle Very powerful, very widely used RDBMS
Uses PL/SQL version of SQL
MMO uses Oracle for HEDIS reporting
Used by Yahoo! and other database-driven web sites

20. Identify Diseases to Manage
Based on Population Analysis (SAS)
Look for:
High patient volume
High cost

21. Process Information for Vendor Usage
Initial and subsequent targetings
Standardized methodology based on DB2
Select claims related to disease state
BabyLink: by Rx; Others: medical claims by dx
Identify distinct members from claims
Select all claims for those members (comorbidities)
Get member, provider, PCP information
Methodology documented and flowcharted

22. Invite Providers to Participate
Problems with provider address quality
DB2/QMF/SQL and Access programming used to improve information quality
DB2: standard in-network provider addressing
Access: “smart” formatting of mailing labels
“Clean” and “proper” addresses still an issue

23. Determine Effectiveness - Outcomes Reporting
Vendor outcomes reporting based upon enrolled population
MMO outcomes reporting
Days/1000, Cases/1000
ER visits/1000, Office visits/1000
coming soon: Readmissions/1000

24. Determine Effectiveness - Outcomes Reporting (cont’d)
MMO outcomes reporting
disease state outcomes for patients
overall outcomes for patients
overall outcomes for all MMO members

25. Determine Effectiveness - Outcomes Reporting (cont’d)
Breathe Easy: Started with SAS, ran out of space
Met deadline with a workaround
Change in specifications
Tried DB2 this time, still ran out of space

26. Determine Effectiveness - Outcomes Reporting (cont’d)
Vertical partitioning
Another way to organize data
85% space savings over previous process
Process enabler
Data mart
DB2 + Vertical Partitioning + Data Mart + Access = Success!

27. Determine Effectiveness - Outcomes Reporting (cont’d)
Process still under development
New specifications easier to implement
Disease assignment module (5 SQL queries)
Separate BH outcomes from Medical

28. Determine Effectiveness - Over/Underutilization Measures
What is a readmission? Ask me in a month!
Developed in DB2 using claims, not PReview
Access reports used to test methodology
Process: review results > modify SQL query > rerun query > import results into Access > review results
Can ultimately be run from data mart

30. Competitor DM Data Issues - Aetna
Managed care data warehouse since 1996
Combines some functions of PReview, HEDIS
Standard reports, member mailings
Chronic disease registry
Data warehouse soon to have web browser front end

31. Competitor DM Data Issues - Anthem BCBS
Data warehouse since 1991
Excellence in Business Information Award
Outcomes reporting, HEDIS reporting, fraud
“We did this not just to get into a leadership position but as a matter of survival” Joe Bruscato, Chief Data Warehousing Architect, Anthem BCBS

32. Possible Enhancements to MBSD DM Processes
Currently use FFS inpatient, outpatient, professional claims for targeting, outcomes
exception: BabyLink
Likely inclusions
Rx claims (major medical, freestanding)
encounters
Redundancy to ensure validity
e.g., asthma dx and one Rx and one refill

33. Possible Enhancements to MBSD DM Processes (cont’d)
Data mart schema for other DM programs
Evaluation of Data Mining/ Business Intelligence products

34. Disease Management Resources

39. Recap Brief Disease Management Overview MBSD DM Responsibilities
Competitor DM Data Issues
Possible Enhancements to MBSD DM Processes
Disease Management Resources

40. Thank you for coming!