Harnessing Data and Analytics for Population Health...Harnessing Data and Analytics for Population Health Panelists: • Jim Adams, The Advisory Board Company • Farzad Mostashari,

Harnessing Data and Analytics

for Population Health

Panelists:

• Jim Adams, The Advisory Board Company

• Farzad Mostashari, MD, ScM, U.S. Department of Health

and Human Services

• Christopher Lloyd, MHMD Memorial Hermann Physician Network

• Colin Ward, Greater Baltimore Health Alliance

• Glenn Tobin, Ph.D., The Advisory Board Company

Moderator:

• Aneesh Chopra, The Advisory Board Company

National Population

Health Symposium

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Today’s Panelists

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Harnessing Data and Analytics for Population Health

Jim Adams Executive Director

The Advisory Board

Company

Farzad Mostashari, MD, ScM National Coordinator for Health

Information Technology

U.S. Department of Health and

Human Services

Colin Ward Executive Director

Greater Baltimore

Health Alliance

Aneesh Chopra Senior Advisor

The Advisory Board

Company

Glenn Tobin, Ph.D. Chief Executive Officer,

Crimson

The Advisory Board

Company

Christopher Lloyd Chief Executive Officer,

MHMD Memorial Hermann

Physician Network

Memorial Hermann

Healthcare System

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Different Capabilities for Different Question Types

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Be Prepared and Plan for Predictive and Prescriptive Analytics

Source: Advisory Board Company research and analysis.

Beware the

False Summits!

Degree of Competitive Advantage

Deg

ree o

f Diffic

ulty

Analyze the Actions

• Mathematical models

• Linear programming

• Constraint programming

Prescriptive:

What should we do?

3

Analyze the Past

• Reports and graphs

• Dashboards

• Drill down/around

Descriptive:

What happened?

1

Analyze the Future

• Predictive modeling

• Data mining

• Forecasting

• Simulations

Predictive:

What might happen?

2

Three levels of BI maturity, with

each level more difficult and

more advantageous than the last.

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Analytics for Population Health Management

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Be Prepared and Plan for Predictive and Prescriptive Analytics

Source: Advisory Board Company research and analysis. 1) Post-acute care.

Beware the

False Summits!

Degree of Competitive Advantage

Competencies and capabilities at

one level do not automatically

translate to the next level.

Deg

ree o

f Diffic

ulty

Analyze the Actions

• PAC1 interventions

• Performance optimization

Prescriptive:

What should we do?

3

Analyze the Past

• Readmissions

• Performance monitoring

Descriptive:

What happened?

1

Analyze the Future

• High-risk patients

• Performance under new reimbursement models

Predictive:

What might happen?

2

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Another Perspective on Analytics for PHM1

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Examples of Tools and Processes with Analytic Underpinning

Source: Advisory Board Company research and analysis. 1) Population health management.

• Contracting (pre/post)

• Performance scorecards

Administer,

Monitor, and Report

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• Risk segmentation

– High cost

– Rising risk

– Chronic conditions

• PCP attribution

• Registries

• Disease or PHM

dashboards

• Smart portals

Map and Track

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• Registries

• Assisted interventions

– Clinical decision support

– Cognitive support

Deliver Care

3

Identify Population

1

• Real-time monitoring/alerts

• Registries

• Risk reassessment

• Pathway optimization

Coordinate Cross-

Continuum Care

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• Predictive/persuasive

engagement

• Patient satisfaction

Engage Patients

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Cultural Change Key to Productive Use of Analytics

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Assess Your Culture’s Readiness for BI

Fragmented Enterprise Perspective

Big Data Advanced Analytics

• Will valid data and analytics trump politics

and “gut feel”?

• Do we offer widespread training on using

data, identifying opportunities, and

instituting change?

• Will the organization support decisions that

are automated, alerted, or assisted by BI?

• Do we have an enterprise champion?

• Will the different business areas affected

cooperate?

• Can we successfully implement changes

to address high-impact opportunities?

• Have we developed a shared vision and

strategy for the use of BI?

• Do we know when we have enough data

to make a decision?

• Do we review our assumptions and

models for currency and relevance?

• Do we have a local champion?

• Will we appropriately deal with new-

found transparency or challenge

“common knowledge”?

• Will we appropriately deal with multiple

versions of the truth?

• Do we have the authority to clean up

the source system data?


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Insights from the National Coordinator for Health IT

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Farzad Mostashari, MD, ScM National Coordinator for Health

Information Technology

U.S. Department of Health and

Human Services

Dr. Farzad Mostashari is the National Coordinator for

Health Information Technology at the U.S. Department of

Health and Human Services. To this role, Dr. Mostashari

brings a rich body of experience to continue leading the

nation in constructing a health care system that uses

information and technology to empower individuals,

and improve both the health and health care of Americans.

Dr. Mostashari first joined ONC as its deputy national

coordinator in July 2009. During his tenure in this position,

he developed a series of grant programs to promote

electronic health record adoption, furthered the

development of health information exchange, and helped

construct the workforce development program. His vision

has been instrumental in the formulation of the ONC’s

Health IT Strategic Plan, the creation of ONC’s Authorized

Testing and Certification Bodies, and will influence future

stages of Meaningful Use.

Sources and Uses of Data in an Accountable Care World

Christopher Lloyd Chief Executive Officer MHMD - Memorial Hermann Physician Network The National Population Health Symposium September 16, 2013

Health Reform Distilled

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QUALITY

COST

Needed to drive the Quality & Cost equation?

• Organizational Structure • Commitment to Evidence Based

Medicine • Dedication • Information • Partnership

The Fundamentals of Change – Accountable Care

• Everyone's role in care delivery must change • Data is paramount – and it exists • Industry payment must be altered with aligned incentives • Shared Accountability – patients too… • Outcomes!! • Clinical Integration of all parties is fundamental

MHMD Clinical Programs Committee Structure

MHMD Board of Directors

Clinical Programs Committee

H&V

Cardiology

CV Surgery

Neuro

Neurology

Neurosurgery

Woman/Child

Neonatal

OB/Gyn

Surgery

Anesthesia

Bariatrics

Orthopedics

ENT

Allergy

Medicine

Critical Care

Emergency

Ad hoc

Hospital Medicine

Post Acute

Oncology

Oncology

Contract

Imaging

Pathology

Primary Care

Adult PCP

Peds

Peer Review

Clinical Ethics & Palliative Care

Order Set Editorial Board

Informatics

Acute Surgery 4

The Necessary Interrelationship for Change

MHMD MHHS

The Functions of Population Management

• “New” data source for physicians and hospitals • Typically held by insurance companies • Indicates cost/quality opportunities

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Population Dashboard

ED Utilization

Inpatient Quality & Safety Metric Results

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50% increase

68% reduction

.5% reduction

12% reduction

13% reduction

5% increase

BASELINE Order Set

Usage e-Order Set

Usage Iatrogenic

Pneumothorax Events

PPE or DVT Events

Hospital Acquired Infections

Serious Safety Events

Order Set Results Excluding Top 5% Costs – Jan - June 2011

Overall Project Order Set No Order Set Total

Patients 1,579 1,617 3,196

Avg. Direct Costs 93% 107% 100%

LOS 4.1 4.3 4.2

Cost Variance with Order Set -15%

LOS Variance with Order Set -5%

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Order Set Results Excluding Top 5% Costs – Jan - June 2011

Overall Project Order Set No Order Set Total

Patients 1,579 1,617 3,196

Avg. Direct Costs 93% 107% 100%

LOS 4.1 4.3 4.2

Cost Variance with Order Set -15%

LOS Variance with Order Set -5%

11

Memorial Hermann Health Insurance Quality Metrics

52%

12%

11%

BASELINE

ALO

S

ER/1

000

CT/

1000

OPS

/100

0

30da

y R

eadm

it As

thm

a M

eds

Cer

vica

l CA

Bre

ast

CA

Colo

rect

al C

A

Dia

b H

bA1c

CAD

LD

L-C

Gen

eric

Rx

Adm

its/

1000

Dia

b LD

L-C

Dia

b N

eph

7day

po

st D

/C

.9%

12%

32%

63%

43%

3.4% 11% 17% 7.1%

5.6%

4.0% 0%

2.6%

Data / Metrics / Care Management

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Adult & Pedi ICU Ventilator Associated Pneumonias (VAP)

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CI Performance (2011)

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Moving Down the Road –

Driving Quality and Reducing Costs

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1

Greater Baltimore Health Alliance 2013 National Population Health Symposium

September 16, 2013

Presenter: Colin Ward

Greater Baltimore Health Alliance

Our Community

Wellness/ Prevention

Employed Physicians (GBMA)

MSO- Primary

Care

MSO- Specialty

Physicians

GBMC Hospital

Tertiary Partners

Post-Acute Partners

Gilchrist Hospice

•100 Primary Care Providers (Employed & Aligned) &

Greater Baltimore Medical Center

•CMS Shared Savings Program (July 2012) &

Cigna CAC (April 2013)

• Multiple EMR platforms & Data analysis solutions

2

3

Real Time Data For Population Health

•Compares “real time” hospital ADT data with patient panel

provided by GBHA

•Sends notification to secure email address

•Approximately one million patients in CRISP Database with

GBHA representing nearly 10%

Our Community

Wellness/ Prevention

Employed Physicians (GBMA)

MSO- Primary

Care

MSO- Specialty

Physicians

GBMC Hospital

Tertiary Partners

Post-Acute Partners

Gilchrist Hospice

Encounter

Notification System

Patient Panel

ADT “Hit”


•10 practices daily average 37 IP Discharges & 42 ED Discharges

•47 Hospitals participate – GBHA discharges come from 32

•Identifying frequent flyers

•Preventing Admissions/ Readmissions

•Transitional Care/ Medication Reconciliation

•Activating providers

•Increasing value to patients

4


•2 Fewer People

•2 Fewer Handoffs

•3 Fewer Hours

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Scalable Population Health

Management Making Data and Analytics Usable and Scalable

Glenn Tobin, Ph.D.

Chief Executive Officer, Crimson

September 16, 2013

Crimson

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Old View of the World

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Goal: Single Source of the Truth Across All Patients


Single EMR Across 90% of Sites,

HIE Connectivity at Periphery

Single Dominant Platform

Moving Away From a Single EMR

As we’ve acquired different groups, they’ve

come with different EMRs. Initially, we thought

we could change these all out—but frankly,

that’s just too expensive. Instead, we’re

importing data from disparate sources into our

data warehouse until a simpler and less

expensive solution for direct linkage of the

EMRs occurs.

William Chin, MD, Executive Medical

Director, HealthCare Partners

”

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• How do you identify patient utilization of

services occurring outside the network?

• Which patients are likely to become high

cost in the future?

• How can we pool clinical data from

different EMRs to identify patient gaps in

care?

• What steps can we take to influence

behavior when the person is not in the

physician office or hospital?

• How do we support workflow of newly

formed care teams working at the top of

their license?

• How do I manage risk contract reporting

across many payors?

Multiple IT Systems the Norm Key Challenges of Population Health

The Reality of Provider-Based Pop Health Managers


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Emerging Population Health IT Approach

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Independent Providers

Affiliated EMR Systems

Payer Claims Data

Consumer Data Patient -Entered Data


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Data and Analytics



Payer Claims Data



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Data and Analytics

Workflows—Care Team, Network Managers, and Financial Managers



Payer Claims Data



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Data and Analytics




Payer Claims Data



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Data and Analytics




Payer Claims Data



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Documents

Harnessing Data and Analytics for Population Health...Harnessing Data and Analytics for Population Health Panelists: • Jim Adams, The Advisory Board Company • Farzad Mostashari,