1. Integrating Data Analytics Technology and Services to Maximize Quality-Based Payments for Hospitals
October 2015

2. Readmissions, HAC and VBP Penalties
3% + 1% + 1.5% = up to 5.5% in Penalties for 2015
2016: Only 799 of 3,400+ hospitals avoided a penalty. Hospitals lost a combined $420 million
New Jersey was the most penalized state with 97% of eligible hospitals receiving a penalty
Hospitals at risk of losing <3% of Medicare Payments
Readmissions Reduction Program
Hospital Acquired Condition (HAC) Reduction Program
Hospitals penalized 1% of Medicare Payments if HAC Score in lowest 25%
2015: 700+ hospitals had payments docked - CMS estimates payments lost is ~$330 million
Value-based Purchasing (VBP) Program
Cuts or bonuses of <1.5% Medicare payments
2015: 1,714 hospitals will get bonuses, 1,375 hospitals reductions
Total VBP payment shifts for FY15 will reach $1.4 billion

3. Financial Impact of Readmissions, HAC and VBP Penalties
Average 2016 Penalty: -0.61%
Readmissions Program
FY 2015
FY 2016
FY 2017
3-Year Total
Medicare Revenue $100K
$610,000
$1,830,000
Medicare Revenue $250K
$1,525,000
$4,575,000
VBP Program
Combined
$300,000
$900,000
$750,000
$2,250,000
HAC Reduction Program 
$1,000,000
$3,000,000
$2,500,000
$7,500,000
Average 2015 Penalty: -0.30%
HAC Penalty: -1.00%

4. Capabilities Needed to Reduce Preventable Readmissions
98%
NJ hospitals penalized by Medicare
Predicting risk of readmission for Ambulatory Sensitive Conditions to target resources
Model incorporates LACE, BOOST and proprietary elements to identify High Risk Patients upon admission
Facilitating care coordination and discharge planning to reduce readmissions
Analytics leverage BOOST and Project RED to significantly impact “Transitions in Care”
Alerting the Emergency Department of recent discharges to prevent readmission
.03%-2.65%
Range of hospital penalty #1
N.J. leads nation for number of hospitals penalized for high readmissions

5. Capabilities Needed to Reduce Hospital Acquired Conditions
Collecting and preparing data for infectious disease measures and hospital penalty calculations
Predicting HACs with variables that are important predictors for hospital acquired conditions such as pressure ulcers
Calculating potential HAC/HAI penalties

6. Capabilities Needed to Improve Value-based Purchasing Scores
Predicting patients that qualify for VBP measures in real-time so interventions can be made to improve care and scores
Providing alerts on gaps in documentation and care to enable targeted interventions
Forecasting reimbursements with a VBP calculator so strategies can be implemented in advance to improve scores
Providing scorecards to track VBP measures against CMS targets and benchmarks

7. Overall Quality/Performance Improvement Challenges
Process and Change Management Challenges
Lack of industry best practices
Limited care coordination personnel
Poor patient engagement
Lack of commitment from care partners – community and providers
Inadequate discharge processes
Slow adoption of QI technology
IT Challenges
Multiple IT application systems
Multiple, disparate data sources, feeds, code sets
Migrating to HIS vendor's data warehouse
Working around unstructured (text) data
Lack of data governance

8. Overall Keys to Success in Readmissions, HAC ands VBP Programs
Operational Strategy
Clinical Transformation
Clinically Integrated Network Strategies
Operational Strategy
Process & Performance Improvement
Transition of Care Management
Digital Transformation
IT Strategy and Governance
Clinical IT Strategy
Enterprise Data Warehouse Strategy
Data aggregation and normalization
Organizational Transformation
Provider Engagement
Organization Design
Enterprise Training & Communications
Change Management
Financial Transformation
BI, Reporting & Analysis
Managing Risks

9. IT Should be Integrated with Expert Managed Services
A successful strategy includes better care continuum integration across three key areas
ACCESS TO CARE
Transfer process
Referral sources
Direct admission access (ED)
PATIENT CARE DELIVERY
Quality clinical outcomes
Intensive care unit utilization
Physician involvement
Low cost alternatives to admission (CDU or telehealth)
POST DISCHARGE MGMT
Discharge follow up process
Managed care program appropriateness
Sub-acute follow up process
Identify patients for high risk of return

10. Analytics and Reporting
Measures Calculation/Reporting
Measures Framework
Predictive Analytics
Hospital Measure Programs
Custom Measures
Predictive Engine
Readmissions
HAC/HAI Surveillance
Risk Stratification and Population Health
Operational impact
LOS
ED Throughput
Utilization and Cost Analytics
Analytics & Visualization
EDW
Real-time Analytics
Inpatient Analytics
Population Health Analytics
Data collection from all available sources
Electronic Interface
Meds
ADT
EMR
Labs
Ambulatory
HIE
Custom
Claims
HCAHPS

11. Senior Manager, North Highland
Thank You
Presenter Contact Information
Ivan Cheng
Senior Manager, North Highland
(Office)
(Cell)
Raj Lakhanpal, MD
CEO, SpectraMedix
Ext 301 (Office)
(Cell)