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Richard Cramer, Informatica’s Chief Healthcare Strategist and Maury DePalo, Director of Edgewater’s Healthcare Practice, will discuss the challenges of identifying, integrating, delivering, and governing the diverse sources of performance data necessary to enable and measure the shared risks and rewards of accountable care delivery models.
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Let’s Talk Healthcare with Informatica and Edgewater: A Foundation for Achieving
Value-Based Healthcare
Maury DePaloDirector, Healthcare Practice
Edgewater
Michelle BlackmerDirector, Healthcare Product Marketing
Informatica
Richard CramerChief Healthcare Strategist
Informatica
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Transitioning from Current Operating Models -- An Iterative Approach for Incremental Implementation
Data Needs
Analytic Capabilities
Process Needs
Assess the Current State
Envision theFuture State
Increasing Capabilities on Each Cycle through the Process
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Use Case 1 - Reporting & AnalyticsIntegrating Clinical & Financial Performance & Risk Management
By Time Frame
By
Ser
vice
Typ
es
Inpatient
Outpatient
Professional Fees
Radiology
Laboratory
By Practice Area, By Physician
Primary Care: Dr. Jamieson
Specialty Care: Dr. Rubenstein
Year over Year, Quarterly Performance & Tracking
PMPM / Utilization / Adherence to Std / Clinical Risk / Financial Risk DOS Procedure Submit Amt Paid Amt
3/30/2006 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ 3/30/2006 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 55.00$
Claim Total 150.00$ 150.00$
5/19/2007 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ 5/19/2007 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 55.00$
Claim Total 150.00$ 150.00$
7/30/2009 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ 7/30/2009 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 45.00$
Claim Total 150.00$ 140.00$
12/10/2010 CPT 88174 Cytopathology (Liquid-Based) 45.00$ 45.00$ 12/19/2010 CPT 77057 Screening Mammography, Bilateral ... 105.00$ 95.00$ Claim Total 150.00$ 140.00$
Claim Nbr: 2006-1001-00101
Claim Nbr: 2007-1310-00322
Claim Nbr: 2009-1561-00451
Claim Nbr: 2010-1833-00729
ProviderSpecification
PatientSpecification
ProviderPeer Group
ServiceSpecification
LocationSpecification
OtherSpecification
Normative Data
Provider A
Provider B
Provider C
Provider D
Result A
Result B
Result C
Result D
?
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Use Case 2 – Patient & Physician AttributionCollaborative, Patient-Centered Care
HospitalPrimary
Care Groups
Physical Therapy
Rehab
SNF, LTCSpecialty Groups
Payers
Shared Accountability – Shared Risks & Rewards – Coordinated Delivery Platform
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Use Case 2 – Patient & Physician Attribution
• Establishing a Performance Track Record• Baseline of Effective, Efficient Patient Care & Favorable Outcomes
• Which Patients, Which Services, What Outcomes, What Costs?
• Quality Efficiency Value• Evidence-based Rationale for Components of Shared Value Proposition
• Value Added at Each Step in Coordinated Process of Encounters to Outcomes
• Primary Building Blocks• Models: Data, Process, Business, Populations & Practices• Technology: Data Capture, Quality Control, Integration, Transformation,
Aggregation, Analytics
• Defining Accountability• Who is accountable, and for what?• Shared accountability – measure team and individual performance against industry
or institutional standard (structures, processes, metrics)
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Learn More…….• Register for the second webinar in the series:
A Foundation for Achieving Value-Based Healthcare
Wednesday, November 14, 2012
11:00am PT / 2:00pm ET
http://vip.informatica.com/?elqPURLPage=10576
• Click here to view our first webinar, Journey to the Future of Healthcare Delivery
• To join future webinars in the series,click here
