1. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics © 2014 Health Catalyst www.healthcatalyst.com Proprietary and ConfidentialFollow Us on Twitter #TimeforAnalytics John L. Haughom, MD May 2014 The Power of Data: Igniting, Scalable and Sustainable Change

2. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Healthcare: The Way It Should Be Part One – Forces Driving Transformation Chapter One – Forces Defining and Shaping the Current State of U.S. Healthcare Chapter Two – Present and Future Challenges Facing U.S. Healthcare Part Two – Laying the Foundation for Improvement and Sustainable Change What will it take to successfully ride the transformational wave? Part Three – Looking into the Future What will it take to successfully ride the transformational wave? 2 http://www.healthcatalyst.com/ebooks/healthcare-transformation-healthcare-a-better-way/

3. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Poll Question 1. On a Scale of 1-5, how would you rate your organization’s ability to manage complexity? a. 5 – 8% b. 4 – 26% c. 3 – 45% d. 2 – 17% e. 1 – 4% 3

4. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Implementing an Effective System of Production in Healthcare Analytic system Content system Deployment system Scalable and sustainable outcomes

5. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Analytic System Components 5

6. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Using Data Appropriately Micromanage Kill the Messenger (denial, shift blame) Fear Filter the data (game the system) Scherkenbach’s Cycle of Fear

7. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Using Data: Learning vs. Acountability 7 Accountability Knowledge used by consumers, regulators, other physicians, etc. May encourage gaming the system Reward centric Accountability Knowledge used by consumers, regulators, other physicians, etc. May encourage gaming the system Reward centric Learning Knowledge used by care delivery organizations and improvement teams Nourishes intrinsic motivation Result centric Learning Knowledge used by care delivery organizations and improvement teams Nourishes intrinsic motivation Result centric Measure, manage & improve the system Suboptimize Game the number Berwick DM, James B, Coye MJ. The connections between quality measurement and improvement. Medical Care. 2003; 41(1Supplement): 30-38.

8. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics less transformation Provider Patient Bad Debt DiagnosisProcedure Facility Encounter Cost Charge Employee Survey House Keeping Catha Lab Provider Census Time Keeping more transformationenforced referential integrity Enterprise data model FINANCIAL SOURCES (e.g. EPSi, Lawson, PeopleSoft) ADMINISTRATIVE SOURCES (e.g. API Time Tracking) EMR SOURCES DEPARTMENTAL SOURCES (e.g. Apollo) PATIENT SATISFACTION (e.g. NRC Picker) EDW

9. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics EMR SOURCE Oncology Diabetes Heart Failure Regulatory PregnancyAsthma Labor Productivity Revenue Cycle Census PATIENT SATISFACTION SOURCES (e.g. NRC Picker) DEPARTMENTAL SOURCES (e.g. Apollo) FINANCIAL SOURCES (e.g. EPSi, Lawson, PeopleSoft) ADMINISTRATIVE SOURCES (e.g. API Time Tracking) less transformationmore transformation Dimensional data model Redundant data extracts

10. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Metadata: EDW Atlas security and auditing Common, linkable Vocabulary Financial Source Marts Administrative Source Marts Departmental Source Marts Patient Source Marts EMR Source Marts HR Source Mart Diabetes Sepsis Readmissions Less transformationMore transformation FINANCIAL SOURCES (e.g. EPSi, Peoplesoft, Lawson) ADMINISTRATIVE SOURCES (e.g. API Time Tracking) ADMINISTRATIVE SOURCES (e.g. API Time Tracking) EMR SOURCE DEPARTMENTAL SOURCES (e.g. Apollo) PATIENT SATISFACTION SOURCES (e.g. NRC Picker, Press Ganey) PATIENT SATISFACTION SOURCES (e.g. NRC Picker, Press Ganey) Human Resources (e.g. PeopleSoft) Human Resources (e.g. PeopleSoft) Late-Binding™ Data Warehouse

11. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics ACADEMIC STATE Early versus late binding of Data SOURCE DATA CONTENT SOURCE MARTS CUSTOMIZED DATA MARTS DATA ANALYSIS OTHERS HR FINANCIAL CLINICAL SUPPLIES INTERNAL EXTERNAL ACADEMIC STATE OTHERS HR FINANCIAL CLINICAL SUPPLIES RESEASRCH REGISTRIES QlikView Microsoft Access/ ODBC Web applications Excel SAS, SPSS Et. al OPERATIONAL EVENTS CLINICAL EVENTS COMPLIANCE AND PAYER MEASURES DISEASE REGISTRIES MATERIALS MANAGEMENT 1 Data rules and vocabulary binding points early binding low volatility vocabulary or business rules? late binding high volatility vocabulary or business rules? 23456

12. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics DATA CAPTURE Acquire key data elements electronically Assure data quality Integrate data capture into 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 data warehouse Build visualizations for use by clinicians Generate external reports (e.g., CMS) Automating data gathering

13. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Population Health Management Paradigm shift Acute care-centric management Inpatient Outpatient Home Clinic care Hospice Cemetery Skilled nursing facility Inpatient Home health care Population-centric management

14. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics 14 Home (patient portal) * To Invasive Care Processes Clinic Care non-recurrent Clinic Care chronic Clinic Care chronic Acute Medical IP Med-Surg Acute Medical IP Med-Surg Acute Medical IP ICU Invasive Medical Invasive Surgical Diagnostic work-up Bedside care Triage to treatment venue Substance preparation Invasive* subspecialist Chronic disease subspecialist Screening & preventive Symptoms Population Health Management Anatomy of Healthcare Delivery Diagnostic algorithms Indications for referral Indications for intervention Triage criteria Diagnostic Algorithms, Triage Criteria, Referral & Intervention Indications Utilization management knowledge assets Substance selection Clinical supply chain management Procedure Treatment and monitoring algorithms Admission order sets Supplementary order sets Pre-procedure order sets Post- procedure order sets Discharge Bedside care practice guidelines, risk assessment and patient injury prevention protocols, bedside care procedures, transfer and discharge protocols Treatment and monitoring algorithms Health maintenance and preventive guidelines Standardized follow-up Standardized follow-up Post-acute care order sets IP (SNF, IRF) Home health Hospice Post-acute care order sets IP (SNF, IRF) Home health Hospice Management of Preventive, Ambulatory, Acute Medical, Invasive & PAC Modules Prevention and treatment knowledge assets Clinical ops procedure guidelines and patient injury prevention Post-procedure care

15. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics15 Population Health Management Clinical Integration hierarchy - care process families Hyperlipidemia Acute Myocardial Infarction (AMI) Percutaneous Intervention (PCI) Coronary Artery Bypass Graft (CABG) Cardiac Rehab Ischemic Heart Disease care process family Home Outpatient Clinic CareInpatientSNFHome HealthHospice Coronary Atherosclerosis

16. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Population Health Management Clinical Integration hierarchy - clinical programs Vascular Disorders care process family Heart Rhythm Disorders care process family Heart Failure care process family Ischemic Heart Disease care process family Cardiovascular clinical program HomeOutpatientClinic CareInpatientSNFHome HealthHospice

17. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics 17 Clinical Integration hierarchy Clinical programs – ordering of care Primary Care careprocessfamiliese.g.,Diabetes CVCV careprocessfamiliese.g., Heart Failure W&CW&C careprocessfamiliese.g.,Pregnancy GIGI careprocessfamiliese.g., Lower GILower GIDisorders Resp- iratory careprocessfamiliese.g., Obstructive Lung Disorders Neuro Sciences careprocessfamiliese.g., Spine Disorders Musculo- skeletal careprocessfamiliese.g.,Joint Replace- ment SurgerySurgery careprocessfamiliese.g., Urologic Disorders GeneralMedGeneralMed careprocessfamiliese.g., Infectious Disease OncologyOncology careprocessfamiliese.g.,BreastCancer Peds Spec careprocessfamiliese.g.,Peds CV SurgCV Surg Mental Health careprocessfamiliese.g.,Depression

18. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Primary Care CareProcessFamiliese.g.,Diabetes CVCV CareProcessFamiliese.g., Heart Failure W&CW&C CareProcessFamiliese.g.,Pregnancy GIGI CareProcessFamiliese.g., Lower GILower GIDisorders Resp- iratory CareProcessFamiliese.g., Obstructive Lung Disorders Neuro Sciences CareProcessFamiliese.g., Spine Disorders Musculo- skeletal CareProcessFamiliese.g.,Joint Replace- ment SurgerySurgery CareProcessFamiliese.g., Urologic Disorders GeneralMedGeneralMed CareProcessFamiliese.g., Infectious Disease OncologyOncology CareProcessFamiliese.g.,BreastCancer Peds Spec CareProcessFamiliese.g.,Peds CV SurgCV Surg Mental Health CareProcessFamiliese.g.,Depression Diagnostic Clinical Support Services (workflow models) (e.g., pathology and laboratory medicine, diagnostic radiology) Diagnostic Clinical Support Services (workflow models) (e.g., pathology and laboratory medicine, diagnostic radiology) Ambulatory Clinic Clinical Support Services (workflow models) (e.g., primary care clinics, chronic disease specialty clinics, subspecialty clinics) Ambulatory Clinic Clinical Support Services (workflow models) (e.g., primary care clinics, chronic disease specialty clinics, subspecialty clinics) Acute Medical Clinical Support Services (workflow models) (e.g., Emergency Care, ICU/CCU/NICU/PICU, General Med-Surg) Acute Medical Clinical Support Services (workflow models) (e.g., Emergency Care, ICU/CCU/NICU/PICU, General Med-Surg) Invasive Clinical Support Services (workflow models) (Interventional Medical [e.g., cath lab, interventional radiology, GI lab, L&D, rad onc] and Surgical [e.g., amb, IP]) Invasive Clinical Support Services (workflow models) (Interventional Medical [e.g., cath lab, interventional radiology, GI lab, L&D, rad onc] and Surgical [e.g., amb, IP]) Therapeutic Clinical Support Services (workflow models) ( e.g., pharmacy, transfusion medicine, respiratory therapy, physical, occupational, speech therapy) Therapeutic Clinical Support Services (workflow models) ( e.g., pharmacy, transfusion medicine, respiratory therapy, physical, occupational, speech therapy) Clinical Integration construct Clinical support services – delivery of care

19. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Value Stream Protocols to Help Prevent Patient Harm 19

20. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Mapping – admin codes to clinical

21. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Population Health Management 21 Medicare FFS payments by venue – 2008-2012 OutpatientClinic CareInpatient SNF Home HealthHospice $ 152 Billion 11.8% 372 Billion 28.7% 447 Billion 34.5% $ 133 Billion 10.3% $ 90 Billion 6.9% $ 48 Billion 3.7% LTCH/IRF $ 53 Billion 4.1% $ $

22. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Top 10 care process families account for over 40% of the opportunity Top 32 care process families account for 80% of the opportunity Care process families by resources consumed (high to low) Percent of total resources consumed Inpatient per case KPA

23. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics In Summary… Organizations need a comprehensive framework to help them implement a solid strategy and foundation for the future The Three Systems (Analytic, Deployment, Content) is an example of a comprehensive framework that can lead to future success Use data primarily for learning rather than judgment The late binding data model is the quickest to set up, cheapest to maintain, and most importantly, offers the flexibility required to support continuous improvement Automating data distribution allows frontline workers to become self- service gatherers and analyzers of data The Anatomy of Healthcare Delivery and Clinical Integration Hierarchy can help organizations focus their improvement efforts and maximize value for the investment 23

24. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Coming Attractions (next webinar) The Analytic System: Bringing it all together Understanding variation and the role of SPC charts in quality improvement A thoughtful approach to improvement Finding meaningful patterns in the data Demonstration of the power of modern analytical tools We have come along way, and yes, clinicians can use these tools! 24

25. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Poll Question 2. On a Scale of 1-5, how effective is your organization’s analytical strategy and capability (as described today)? a. 5 – 4% b. 4 – 16% c. 3 – 31% d. 2 – 35% e. 1 – 14% 25

26. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Poll Questions 3. Does your organization have a robust strategy to identify high value improvement opportunities? a. 5 – 14% b. 4 – 13% c. 3 – 37% d. 2 – 30% e. 1 – 6% 26

27. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics Thank You Upcoming Educational Opportunities Data Driven Care: The Key to Accountable Care Delivery from a Physician Group Perspective Date: May 29 th Presenter: Dr. Gary Spencer, CMO, Crystal Run Healthcare, Luke Skelly, Health Catalyst Register at http://healthcatalyst.com/http://healthcatalyst.com/ Accountable Care Transformation: The Four Building Blocks of Population Health Management Date: June 4th, 2014 Presenter: Dr. David Burton, MD, Chairman, Health Catalyst Time: 1:00 - 2:00 PM ET Register at http://healthcatalyst.com/http://healthcatalyst.com/ Healthcare Analytics Summit Join top healthcare professionals for a high-powered analytics summit using analytics to drive an engaging experience with renowned leaders who are on the cutting edge of healthcare using data-driven methods to improve care and reduce costs. Date: September 24th-25th Location: Salt Lake City, Utah Save the Date: http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014 For the New World of Healthcare, A Declaration of Independence Is Only the Beginning On April 28, 2014, Dr. Daniel Craviotto, Jr. published an editorial in the Wall Street Journal, “A Doctor’s Declaration of Independence,” in which he argued that it is time to “defy healthcare mandates issued by bureaucrats not in the healing profession.” Read Dr. Haughom’s response on how the medical profession needs to move beyond frustration and cynicism to create a vision for a better, more effective healthcare system. http://healthcatalyst.com/http://healthcatalyst.com/ For Information Contact: John.Haughom@healthcatalyst.com

28. © 2014 Health Catalyst www.healthcatalyst.com Follow Us on Twitter #TimeforAnalytics 28 Obtain unbiased, practical, educational advice on proven analytics solutions that really work in healthcare. The future of healthcare requires transformative thinking by committed leadership willing to forge and adopt new data-driven processes. If you count yourself among this group, then HAS ’14 is for you. OBJECTIVE MOBILE APP Access to a mobile app that can be used for audience response and participation in real time. Group-wide and individual analytic insights will be shared throughout the summit, resulting in a more substantive, engaging experience while demonstrating the power of analytics.