19891989 Staff developed and supported innovative Staff developed and supported innovative clinical, financial, and marketing clinical, financial, and marketing applications for applications for SysteMetrics/McGraw-Hill SysteMetrics/McGraw-Hill (New York, NY)(New York, NY)

19921992 HCIA, Inc. (Baltimore, MD): staff responsible HCIA, Inc. (Baltimore, MD): staff responsible for for HCIA’s Provider Profiling Business Unit HCIA’s Provider Profiling Business Unit which led which led company’s IPO in February 1995.company’s IPO in February 1995.

19951995 The Delta Group founded by former HCIA The Delta Group founded by former HCIA staff staff to specialize in improving the clinical, to specialize in improving the clinical, financial, and financial, and market performance of market performance of healthcare organizations.healthcare organizations.

PresentPresent The Delta Group offers web-based provider The Delta Group offers web-based provider profiling products to leading healthcare profiling products to leading healthcare organizations organizations across the country. across the country.

COMPANY HISTORYCOMPANY HISTORYCOMPANY HISTORYCOMPANY HISTORY

HOSPITAL HOSPITAL ORGANIZATIONSORGANIZATIONS HOSPITAL HOSPITAL ORGANIZATIONSORGANIZATIONS

University HealthSystem Consortium (UHC)University HealthSystem Consortium (UHC)

Henry Ford Health SystemHenry Ford Health System

Baycare Health SystemBaycare Health System

Iowa Health System Iowa Health System

Trinity Health System Trinity Health System

SunLink Healthcare CorporationSunLink Healthcare Corporation

Galaxy Health AllianceGalaxy Health Alliance

Maine Health AllianceMaine Health Alliance

Sagamore Health NetworkSagamore Health Network

TEACHING HOSPITALS &TEACHING HOSPITALS &ACADEMIC INSTITUTIONSACADEMIC INSTITUTIONSTEACHING HOSPITALS &TEACHING HOSPITALS &ACADEMIC INSTITUTIONSACADEMIC INSTITUTIONS Massachusetts General Hospital (Harvard)Massachusetts General Hospital (Harvard)

Brigham & Women’s Hospital (Harvard)Brigham & Women’s Hospital (Harvard)

Yale-New Haven HospitalYale-New Haven Hospital

Mary Hitchcock Memorial Hospital (Dartmouth)Mary Hitchcock Memorial Hospital (Dartmouth)

Vanderbilt University Hospital Vanderbilt University Hospital

Robert Wood Johnson University Hospital Robert Wood Johnson University Hospital

University of Notre Dame University of Notre Dame

Medical College of Virginia HospitalsMedical College of Virginia Hospitals

University of Alabama-Birmingham HospitalUniversity of Alabama-Birmingham Hospital

Erlanger Medical CenterErlanger Medical Center

Oregon Health Sciences University HospitalsOregon Health Sciences University Hospitals

PHYSICIAN PHYSICIAN ORGANIZATIONSORGANIZATIONSPHYSICIAN PHYSICIAN ORGANIZATIONSORGANIZATIONS

Partners Community Healthcare (Harvard) Partners Community Healthcare (Harvard)

HealthCare Savings (North Carolina Medical Society)HealthCare Savings (North Carolina Medical Society)

Morton Plant Mease PHO (Physicians Health Alliance)Morton Plant Mease PHO (Physicians Health Alliance)

Presbyterian Medical GroupPresbyterian Medical Group

Preferred Health ServicesPreferred Health Services

Heritage Health SystemHeritage Health System

Mid-Valley CareNetMid-Valley CareNet

OTHEROTHERORGANIZATIONSORGANIZATIONSOTHEROTHERORGANIZATIONSORGANIZATIONS

Tennessee Hospital AssociationTennessee Hospital Association Oregon Association of Hospitals and Health SystemsOregon Association of Hospitals and Health Systems CSC Healthcare GroupCSC Healthcare Group Cambio Health SolutionsCambio Health Solutions Peat MarwickPeat Marwick Ernst & YoungErnst & Young Physcape (MGMA)Physcape (MGMA) PrudentialPrudential BC/BS of AlabamaBC/BS of Alabama Ford, Chrysler & General Motors (MHA)Ford, Chrysler & General Motors (MHA)

PARADOS®

Provider Profiling SystemProvider Profiling System

PARADOS®

Provider Profiling SystemProvider Profiling System

Physician Hospital Practice AnalysisPhysician Hospital Practice Analysis

ORYX Clinical Performance AnalysisORYX Clinical Performance Analysis

Hospital Competitive Positioning AnalysisHospital Competitive Positioning Analysis

Hospital Quality Outcomes AnalysisHospital Quality Outcomes Analysis

Hospital Planning and Marketing Analysis Hospital Planning and Marketing Analysis (2004)(2004)

Physician Office Practice AnalysisPhysician Office Practice Analysis

Continuum of Care AnalysisContinuum of Care Analysis

APPLICATIONS OF PARADOS® APPLICATIONS OF PARADOS®

Clinical Resource Management and Quality Clinical Resource Management and Quality ImprovementImprovement

Knowledge-Based Managed Care Contracting Knowledge-Based Managed Care Contracting

Provider Network Evaluation and MonitoringProvider Network Evaluation and Monitoring

Strategic Planning, Marketing & Public RelationsStrategic Planning, Marketing & Public Relations

$750,000 Increase in Financial Performance

$415,000$415,000Operating RoomOperating Room

$185,000$185,000LaboratoryLaboratory

$150,000$150,000 Supplies Supplies

“Using The Delta Group’s PARADOS Provider Profiling System, we were able to improve our financial performance by $750,000 by altering practice patterns and policies in laboratory, operating room, and medical/surgical supplies. Importantly, The Delta Group’s software and consulting services allowed us to achieve a favorable managed care position in the marketplace.”

Jeff Judd, CEO The McDowell Hospital (65-bed general, acute care hospital) North Carolina

Severity & RiskSeverity & RiskAdjustmentAdjustment

Clinically Adjusted Data AccountsClinically Adjusted Data Accountsfor Differences in Patient:for Differences in Patient:

Clinically Adjusted Data AccountsClinically Adjusted Data Accountsfor Differences in Patient:for Differences in Patient:

• Severity (stage of disease)Severity (stage of disease)

• Intensity (resource need)Intensity (resource need)

• Complexity (type of CCs)Complexity (type of CCs)

• Severity (stage of disease)Severity (stage of disease)

• Intensity (resource need)Intensity (resource need)

• Complexity (type of CCs)Complexity (type of CCs)

Adjusted Data Provides an Accurate Adjusted Data Provides an Accurate Unit of Measure for:Unit of Measure for:

Peer and Benchmark ComparisonsPeer and Benchmark Comparisons

Adjusted Data Provides an Accurate Adjusted Data Provides an Accurate Unit of Measure for:Unit of Measure for:

Peer and Benchmark ComparisonsPeer and Benchmark Comparisons

Accurate Outcome Comparisons RequireAccurate Outcome Comparisons RequireIndicator-Specific Adjustment MethodsIndicator-Specific Adjustment Methods

Accurate Outcome Comparisons RequireAccurate Outcome Comparisons RequireIndicator-Specific Adjustment MethodsIndicator-Specific Adjustment Methods

• Charge/Cost:Charge/Cost: APS-DRGAPS-DRG™ Relative Charge/Cost Weights

• Length of Stay:Length of Stay: APS-DRGAPS-DRG™ Relative LOS Weights

• Mortality Rates:Mortality Rates: Risk-Adjusted Mortality IndexRisk-Adjusted Mortality Index™

• Complication Rates:Rates: Risk-Adjusted Complications IndexRisk-Adjusted Complications Index™

• Readmission Rates:Rates: Risk-Adjusted Readmissions IndexRisk-Adjusted Readmissions Index™

• Charge/Cost:Charge/Cost: APS-DRGAPS-DRG™ Relative Charge/Cost Weights

• Length of Stay:Length of Stay: APS-DRGAPS-DRG™ Relative LOS Weights

• Mortality Rates:Mortality Rates: Risk-Adjusted Mortality IndexRisk-Adjusted Mortality Index™

• Complication Rates:Rates: Risk-Adjusted Complications IndexRisk-Adjusted Complications Index™

• Readmission Rates:Rates: Risk-Adjusted Readmissions IndexRisk-Adjusted Readmissions Index™

Indicator-Specific Severity & Risk-Adjustment Methods Indicator-Specific Severity & Risk-Adjustment Methods Are Required to Accurately AssessAre Required to Accurately Assess

Variation in Clinical & Financial Outcomes Variation in Clinical & Financial Outcomes

Indicator-Specific Severity & Risk-Adjustment Methods Indicator-Specific Severity & Risk-Adjustment Methods Are Required to Accurately AssessAre Required to Accurately Assess

Variation in Clinical & Financial Outcomes Variation in Clinical & Financial Outcomes

Risk-Adjusted Readmissions Index(RARI)

Risk-Adjusted Readmissions Index(RARI)

Standard logistic regression was used to model risk of an Standard logistic regression was used to model risk of an unanticipated readmission to the same hospital within 30 unanticipated readmission to the same hospital within 30 days of discharge for specific diagnoses and proceduresdays of discharge for specific diagnoses and procedures

Predictive variables used for risk of readmission werePredictive variables used for risk of readmission were::o ageageo sexsexo presence or absence of comorbidities “and” complicationspresence or absence of comorbidities “and” complicationso presence of cancer (except skin cancer)presence of cancer (except skin cancer)o DRG cluster (risk associated with principal DRG cluster (risk associated with principal

diagnosis/procedure)diagnosis/procedure)o total number of comorbiditiestotal number of comorbidities

Source: “Risk-Adjusted Clinical Quality Indicators: Indices for Measuring and Monitoring Rates of Mortality, Complications, and Readmissions.” Quality Management in Health Care, Volume 9, No. 1, Fall 2000, pp. 14-22.

Risk-Adjusted Mortality Index(RAMI)

Risk-Adjusted Mortality Index(RAMI)

Standard logistic regression was used to model risk of death Standard logistic regression was used to model risk of death during a hospital stay for specific diagnoses and proceduresduring a hospital stay for specific diagnoses and procedures

Predictive variables used for risk of death werePredictive variables used for risk of death were::o age, sex, raceage, sex, raceo presence or absence of comorbidities (not complications)presence or absence of comorbidities (not complications)o presence of cancer (except skin cancer)presence of cancer (except skin cancer)o DRG cluster (risk associated with principal DRG cluster (risk associated with principal

diagnosis/procedure)diagnosis/procedure)o total number of comorbiditiestotal number of comorbidities

Source: “Risk-Adjusted Clinical Quality Indicators: Indices for Measuring and Monitoring Rates of Mortality, Complications, and Readmissions.” Quality Management in Health Care, Volume 9, No. 1, Fall 2000, pp. 14-22.

Risk-Adjusted Complications Index(RACI)

Risk-Adjusted Complications Index(RACI)

Standard logistic regression was used to model risk of post- Standard logistic regression was used to model risk of post- surgical and post-obstetrical complications during a hospital surgical and post-obstetrical complications during a hospital stay for associated diagnoses and proceduresstay for associated diagnoses and procedures

Predictive variables used for risk of complications werePredictive variables used for risk of complications were ::o ageageo sexsexo presence or absence of comorbidities (not complications)presence or absence of comorbidities (not complications)o presence of cancer (except skin cancer)presence of cancer (except skin cancer)o DRG cluster (risk associated with principal diagnosis/procedure)DRG cluster (risk associated with principal diagnosis/procedure)o total number of comorbiditiestotal number of comorbidities

Source: “Risk-Adjusted Clinical Quality Indicators: Indices for Measuring and Monitoring Rates of Mortality, Complications, and Readmissions.” Quality Management in Health Care, Volume 9, No. 1, Fall 2000, pp. 14-22.

The Need to Clinically Adjust Inpatient Information 

$5,897

$11,352

$9,017

$5,270

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

Patient #1 Patient #2

DRG 127: Heart Failure & Shock

Principle Diagnosis: Congestive Heart Failure Secondary Diagnoses:

Patient #1 Patient #2 Acute Bronchitis Stroke Clinical Demand Index: .654 Clinical Demand Index: 2.154

Actual Charge

Clinically Adjusted Charge

$5,897 / .654

$11,352 / 2.154

CDI Norm: 1.000

All Payer Severity-adjusted DRGs(APS-DRGs™)

All Payer Severity-adjusted DRGs(APS-DRGs™)

Developed by HSS, Inc.Developed by HSS, Inc.(participated in original Refined-DRG research with CMS—formerly (participated in original Refined-DRG research with CMS—formerly HCFA)HCFA)

Incorporates most recent CMS severity research (SDRGs)Incorporates most recent CMS severity research (SDRGs) Use principal and secondary diagnosis to indicate the severity Use principal and secondary diagnosis to indicate the severity

of a patient’s illness to predict inpatient resource needof a patient’s illness to predict inpatient resource need Use occurrence and degree of surgery as a discriminating Use occurrence and degree of surgery as a discriminating

variable; occasionally use patient’s age and discharge statusvariable; occasionally use patient’s age and discharge status Applicable for all hospitalized patients, regardless of age, type Applicable for all hospitalized patients, regardless of age, type

of illness, or payer categoryof illness, or payer category Comprised of 1,076 clinically homogeneous statistically stable Comprised of 1,076 clinically homogeneous statistically stable

groupsgroups Reviewed by clinicians to ensure clinical integrityReviewed by clinicians to ensure clinical integrity

Source: “All Payer Severity-adjusted DRGs (APS-DRGs): A Uniform Method to Severity-adjust Discharge Data.” Topics in Health Information Management, Winter 1997.

APS-DRG™ Patient Classification System

APS-DRG™ Patient Classification System

SeverityClass Description Clinical Examples

0 No CC or Major CC: Heart failure & shock w/o CC

1 At least 1 CC: Heart failure & shock w/ hypertension

2 At least 1 Major CC: Heart failure & shock w/ acute renalfailure

Source: “All Payer Severity-adjusted DRGs (APS-DRGs): A Uniform Method to Severity-adjust Discharge Data.” Topics in Health Information Management, Winter 1997.

Differences in Patient Risk for Adverse Differences in Patient Risk for Adverse Events within the Same Severity ClassEvents within the Same Severity ClassDifferences in Patient Risk for Adverse Differences in Patient Risk for Adverse Events within the Same Severity ClassEvents within the Same Severity Class

DRG 107: Coronary Bypass w/Cardiac Catheterization(Severity Class 2)

68.0%

11.0%

57.0%

34.0%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Complications Risk

Mortality Risk

Risk of Adverse Outcome

Patient A

Patient B

PARADOS® Clinical, Financial & Market Indicators:

(Includes Severity & Risk-Adjustment where Appropriate)

PARADOS® Clinical, Financial & Market Indicators:

(Includes Severity & Risk-Adjustment where Appropriate)

Charges Costs Gross Margins Lengths of Stay Mortality Rates Complication Rates Readmission Rates ORYX Core Measures

Market Share Patient Origin Patient Outmigration Demographics Lifestyle Characteristics Acute Morbidity Projections Acute Use Rates Planning Indicators by MD,

Employer, and Health Plan

PARADOS® ORYX Core Measurement Sets*:

PARADOS® ORYX Core Measurement Sets*:

Acute Myocardial Infarction (AMI 1-9)Acute Myocardial Infarction (AMI 1-9)

Heart Failure (HF 1-4)Heart Failure (HF 1-4)

Community Acquired Pneumonia (CAP 1-5)Community Acquired Pneumonia (CAP 1-5)

Pregnancy & Related Conditions (PR 1-3)Pregnancy & Related Conditions (PR 1-3)

FUNCTIONALITY OF PARADOS®FUNCTIONALITY OF PARADOS®

Provides online access to evidence-based guidelines Provides online access to evidence-based guidelines (EBGs) developed by the Institute for Clinical Systems (EBGs) developed by the Institute for Clinical Systems Improvement (ICSI)Improvement (ICSI)

Easily sorts, finds, filters, graphs and trends dataEasily sorts, finds, filters, graphs and trends data

Compares to national benchmarks of top performing Compares to national benchmarks of top performing providersproviders

Compares to national, regional, or local peer groupsCompares to national, regional, or local peer groups

Customizes service lines and payer groupingsCustomizes service lines and payer groupings

Drills-down to the diagnosis, procedure & patient levelDrills-down to the diagnosis, procedure & patient level

Creates PDF and comma-delimited files for ease of Creates PDF and comma-delimited files for ease of distribution & customizationdistribution & customization

ConsultingConsulting

CONSULTING SERVICES CONSULTING SERVICES

Management consulting Management consulting in executive in executive summary formatsummary format

Medical management consulting Medical management consulting led by led by practicing physicianspracticing physicians

Lean Six Sigma training Lean Six Sigma training in seminar formatin seminar format

Dwight Wooster, MDDwight Wooster, MD James Kennedy, MDJames Kennedy, MD Michael Langley, MDMichael Langley, MD William Hill, PharmDWilliam Hill, PharmD Judy Homa-Lowry, RN, MSJudy Homa-Lowry, RN, MS Linda Easterly, MS, BSNLinda Easterly, MS, BSN Cynthia Whitaker, BS, RRACynthia Whitaker, BS, RRA Henry Dove, PhDHenry Dove, PhD

MEDICAL MANAGEMENT MEDICAL MANAGEMENT CONSULTINGCONSULTINGMEDICAL MANAGEMENT MEDICAL MANAGEMENT CONSULTINGCONSULTING

LEAN SIX SIGMA TRAININGLEAN SIX SIGMA TRAINING

Conducted by Master Black Belts certified by Conducted by Master Black Belts certified by The George Group The George Group

Integrates Lean techniques for “minimizing Integrates Lean techniques for “minimizing complexity and eliminating waste” with Six complexity and eliminating waste” with Six Sigma methods for “improving quality and Sigma methods for “improving quality and reducing variation”reducing variation”