HealthBridge is one of the nation’s largest and most successful health

information exchange organizations.

An Overview of the HealthBridge

Data Analytics & ITInfrastructure

Keith Hepp, CEO

July 13, 2012

1

HealthBridge Background • One of the nation’s largest, most advanced and successful

health information exchanges (HIE)

• Provides HIE connectivity for Greater Cincinnati tri-state area and five other HIEs – including Greater Dayton

• Connection Statistics

• Participants: 50 hospitals, 7500 physicians, 800 practices

• Delivers 3-6 million clinical messages per month

• More than 60 million messages annually

• Clinical information for 3+ million unique patients

2

Shared IT & Data Background• HealthBridge implemented new CPC-ready Shared Community

IT Infrastructure over the last two years that can: • Patient and Physician Attribution• Translate and combine data across different IT systems• Risk stratification• Enables consistent community measures • Support quality and population health improvement • Assist plans in understanding which providers are

delivering value vs. volume

3

4

Infrastructure Components

ImpactIntelligence

Provider Claims Analytics &

Reports

Impact ProPatient

Claims Analytics & Reports

Provider & Payer Data

Translation

Master Patient & Provider

Index

Claims Analysis Tools

(Optum Symmetry)

Claims and Clinical data warehouse

CPC Required Measures

Custom Analytics &

Reports

Available Today

OptionalApplications

Infrastructure Components• Translation Tool

• Semantic Data Normalization

• Master Patient and Provider Index• Community Master Patient Index• Patient & Provider Identification

• Clinical and Claims Repository• Data Warehouse & Clinical Analytics• Covers 16 of the 18 CPC Measures

• OPTUMInsight’s Symmetry• Data Analytic Engines • Patient Attribution Methodologies

5

Match patients across data sets accurately

Combines big data sets – both clinical and claims

Helps data speak the same language

Patient Attribution, Risk Assignment, & Cost Aggregation

6

Translation

• Top half of screen is a source catalog of lab test codes & descriptions• Bottom half of screen are candidate LOINC codes for the term highlighted on the top (blue row)

PCP Attribution Methodologies• 1) Direct Assignment

• Provider is ASSIGNED as the PCP• 2) Based upon Primary Care Core (PCC) Services

• E & M Coding in claims• Provider with the highest Activity count is the PCP • If there is a tie, Provider with the highest Cost is the PCP• If there is a tie, Provider with the most recent date of

service is the PCP• 3) Most Recent PCP

• Provider who was last identified as a Primary Care Provider in the claim record

8

Tracking Patient/Provider Attribution

Attribution Method A John Doe, 1/1/12 -12/31/12

Attribution Method B Sue Smith, 1/1/12 -12/31/12

Attribution Method C Adam Doe, 1/1/12 -12/31/12

Attribution Method D Betty White, 1/1/12 -12/31/12

Attribution Method A John Doe, 1/1/13 -12/31/13

Attribution Method B John Doe, 1/1/13 -12/31/13

• Multiple attribution methods could be simultaneously used and tracked in the MPI• The Patient/Provider attribution is also time-bound with beginning and ending effective dates

9

Medical Neighborhood Tracking

Clinical and Claims RepositoryCPC Measure NQF #59Diabetes Mellitus: Ha1c Poor Control (>9%) Summary

Clinical and Claims RepositoryCPC Measure NQF #59Diabetes Mellitus: Ha1c Poor Control (>9%) Summary

Risk Stratification• Episode Risk Groups basis

• Factors in age and gender

• Prospective • Factors in projected future costs

• Retrospective

• Population Rollup

• CMS-HCC (Hierarchical Condition Categories)• Can be captured• Utilized for analytics, projections, and reporting

Episodic Risk Score Computation

14

Questions and Discussion