CISummit: Zach Henderson, Data-tastick: A Deep Dive on Data Driving Networks

© Health Market Science 2013, All Rights Reserved

Zach HendersonClick icon to add picture

SVP, Healthcare Markets

Connected Insight Summit

DATA-TASTICK

A Deep Dive on Data Driving Networks

© Health Market Science 2013, All Rights Reserved

It’s time to get excited about data…

We all think of

Data

in different ways

© Health Market Science 2013, All Rights Reserved

If you’re like me, as a bunch of 1s and 0s flowing through the pipes of healthcare processing streams…

3

© Health Market Science 2013, All Rights Reserved

To many, it’s simply the content in spreadsheets…

4

© Health Market Science 2013, All Rights Reserved

For some, data is a little more simple than that…

5

© Health Market Science 2013, All Rights Reserved

Data often gets front page billing…

6

© Health Market Science 2013, All Rights Reserved

And some think of “Data” quite differently…

7

© Health Market Science 2013, All Rights Reserved

Data is sometimes frustrating…

8

© Health Market Science 2013, All Rights Reserved

And data became worse when it got “Big”

9

© Health Market Science 2013, All Rights Reserved

But when we finally understand Data, it is great!

10

We are in the Healthcare track at this conference after all

BUT LET’S GET MORE SPECIFIC

© Health Market Science 2013, All Rights Reserved

Type of Data Benefits Caveats

Prescription/Rx Claims

• Concentrated sources… easier to collect• Excellent for tracking retail pharma products• High coverage with weekly updates available• Known denominator

• Only usable for retail tracking• Variable correlation between Rx activity and medical activity

Medical Claims

• Tailored to diagnosis and procedure codes of interest• Covers both retail and non-retail settings• Best for identifying “splitting” behavior of procedures • Closest correlation to actual referral networks

• Severely fragmented• Difficult to source• No standard denominator/total• Latency

What types of data are available?

12

© Health Market Science 2013, All Rights Reserved

Where do medical claims come from?

Payers

+4,000

835

State Databases& Collaboratives

Office Practice Management Software

+500

Claims Switches/Clearinghouses

837

+50

© Health Market Science 2013, All Rights Reserved

• UB-04• Institutional claims for services provided by hospitals, hospices,

and long-term care facilities (e.g. SNFs) are billed on Uniform Bills (UB-04 or CMS-1450, formerly UB-92)

• All services are summarized by revenue codes

• For inpatient claims, UB-04 describes procedures primarily by ICD-9 procedure codes

• For outpatient claims, UB-04 describes the services and supplies provided by using CPT and HCPCS codes

• 1500• Professional claims for services provided by physicians, labs,

ambulances, and DME vendors are billed on CMS 1500 forms (HCFA 1500 or 1500 forms)

• CMS 1500 always describes the services and supplies provided by using CPT and HCPCS codes

Types of Claims Forms (UB-04)

14

© Health Market Science 2013, All Rights Reserved

Medical Claim Form

15

174 9

197 7

Drug Name & Strength, NDC: 12345-6789-01

01 06 03 01 06 03 11 1 99211 1 $$ $$

01 06 03 01 06 03 11 1 90782 1 $$ $$

01 06 03 01 06 03 11 1 J9010 1 $$ $$

123-45-6789 xxx xx

John Brown, M.D.111 Hospital DriveAnytown, USA 12345

123-45-6789 xxx xx

• Glean useful information:› Physician ID,

diagnoses and procedure codes, facility ID, etc

Drug Name & Strength, NDC: 12345-6789-01

01 06 03 01 06 03 11 1 99211 1 $$ $$

01 06 03 01 06 03 11 1 90782 1 $$ $$

01 06 03 01 06 03 11 1 J9010 1 $$ $$

123-45-6789 xxx xx

John Brown, M.D.111 Hospital DriveAnytown, USA 12345

123-45-6789 xxx xx

174 9

197 7

Diagnosis Code:ICD-9-CM code for appropriate diagnosis or nature of illness

Office Visit Code:CPT code for services provided to an established patient

Procedure Code:CPT code for an injection

Required: Drug CodeAppropriate HCPCS Drug Code

for medication administered

© Health Market Science 2013, All Rights Reserved

We almost forgot the most important part…

16

174 9

197 7

Drug Name & Strength, NDC: 12345-6789-01

01 06 03 01 06 03 11 1 99211 1 $$ $$

01 06 03 01 06 03 11 1 90782 1 $$ $$

01 06 03 01 06 03 11 1 J9010 1 $$ $$

123-45-6789 xxx xx

John Brown, M.D.111 Hospital DriveAnytown, USA 12345

123-45-6789 xxx xx

174 9

197 7

Drug Name & Strength, NDC: 12345-6789-01

01 06 03 01 06 03 11 1 99211 1 $$ $$

01 06 03 01 06 03 11 1 90782 1 $$ $$

01 06 03 01 06 03 11 1 J9010 1 $$ $$

Patient Information:The details on the unique patient

© Health Market Science 2013, All Rights Reserved

But that is HIPAA data!!!

Patient 123456

Date of Birth

First NameLast Name

17

Magical Encryption/De-identification

© Health Market Science 2013, All Rights Reserved

So what?

SpecialistPatient 123456

Cardiac SurgeonPatient 123456

PCPPatient 123456

WHY DO YOU CARE?

19

© Health Market Science 2013, All Rights Reserved

Grow system/ACO through acquisitions, partnerships and recruitment

10% 20% 30%

Understand where there is opportunity to grow referrals

Identify areas of patient leakage

70%

20%

10%

Know where splitters are “splitting”

First off, healthcare companies can do a lot with data

© Health Market Science 2013, All Rights Reserved

Physician to Physician relationships are important

Medical claims data can be used to derive physician-physician relationships based on shared patients for a disease state of interest.

Analytic methodologies can leverage longitudinal tracking of patients across physician visits by leveraging an anonymized patient ID.

A pair of physicians that share a statistically significant number of patients within a specified time window are assumed to have a professional relationship.

Is it a leap?

© Health Market Science 2013, All Rights Reserved

Example Network for a Service Line

22

Georgia network

Atlanta networkZoom in to portion of Atlanta network

Dr. Ruth O’Regan

Dr. Ashesh Jani

Dr. Monica Rizzo

Relationships for Dr. O’Regan

© Health Market Science 2013, All Rights Reserved

Barbara VizyFamily Practice3690 Orange PlBeachwood, OH

A Provider Centric View of Competition in Cleveland

Dr. Michael WalkerSurgery, Orthopedic9500 Euclid AveCleveland, OHOrtho National Rank - 9

Xian JinInternal Medicine9500 Euclid AveCleveland, OH

Ranjit TamaskarInternal Medicine20000 Harvard AveBeachwood, OH

Strength of Relationship

10

10

Andrew BrobbeyInternal Medicine25701 N Lakeland BlvdEuclid, OH

8

7

Walker

Jin

VizyBrobbey

Tamaskar

10

7

8

10

© Health Market Science 2013, All Rights Reserved

Shows a Referral Source that has relationship with 2 different systems

Dr. Ranjit TamaskarInternal Medicine2000 Harvard AveBeachwood, OH

Michael WalkerSurgery, Orthopedic9500 Euclid AveCleveland, OH

William PetersilgeInternal Medicine20000 Harvard AveBeachwood, OH

Strength of Relationship

10

6

Tamaskar

WalkerPetersilge

10

6

© Health Market Science 2013, All Rights Reserved

Now that you can “see” how the data relates, it’s time to put data into action

25

Zach Henderson

SVP, Healthcare Markets

QUESTIONS

26