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Let’s Talk Healthcare with Informatica and Edgewater:Bridging the Gap: Reaching Consensus on ACO Metrics
Maury DePaloDirector, Healthcare Practice
Edgewater
Michelle BlackmerDirector, Healthcare Product Marketing
Informatica
Richard CramerChief Healthcare Strategist
Informatica
Special guest: Senthil Balasubramanian, Manager, Decision Support, Penn Medicine
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• Bridging the Gap – Achieving Better Data Alignment• Bringing Together Quality & Financial Data
• Success Factors• Aligning Quality & Financial Objectives• Targeting Defined Patient Populations• Reaching Consensus on Baseline Medical Expenditures
• Use Cases• Combining Financial and Quality Performance Analytics• Promoting Accountability across a Shared Process Model
• Q & A
Today’s Agenda
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By Time Frame
By
Ser
vice
Typ
es Inpatient
Outpatient
Professional Fees
Radiology
Laboratory
By Practice Area, By Physician
Cardiology Associates, Inc.
Specialty Care: Dr. Rubenstein
Year over Year, Quarterly, Monthly Performance Tracking
PMPM / Utilization / Adherence to Std / Clinical Risk / Financial RiskDOS 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 1: Reporting & AnalyticsIntegrating Quality & Financial Performance & Risk Management
Primary Care: Dr. Jamieson
Primary Care, Inc.
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Data Integration
Master Data Management
Information LifecycleManagement
Real-Time Events, Alerts& Decision Support
Data Quality Management
Technology Solutions & Benefits
Core Data Models Population Models
Process Models Business Models
• Primary Entity Reporting• Patients, Providers• Charges, Costs,
Payments
• Partnerships• Gain / Loss / Risk Sharing• Incentive Alignment• Inter-Enterprise Data
Architecture
• Segmentation• Patient Cohorts• Stratification Criteria
• Continuum of Care Models & Analytics
• Care Records: Diagnoses, Treatments, Outcomes
Use Case 1: Reporting & AnalyticsIntegrating Quality & Financial Performance & Risk Management
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Use Case 2: Patient & Physician Attribution
HospitalPrimary
Care Groups
Physical Therapy
Rehab
SNF, LTCSpecialty Groups
Payers
Shared Accountability – Shared Risks & Rewards – Coordinated Delivery Platform
Collaborative, Patient-Centered Care
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• Patient Navigation• Patient Access Metrics
Use Case 2: Patient & Physician Attribution
Data Integration
Master Data Management
Information LifecycleManagement
Real-Time Events, Alerts& Decision Support
Data Quality Management
Technology Solutions & Benefits
Core Data Models Population Models
Process Models Business Models
• Triple Aim:• Healthy Population• Quality & Satisfaction• Per Capita Costs of Care
• Participants / Contributors• Clinical Risk Models• Financial Risk Models
• Care Setting Analytics• PCMH / PCPCH
• Patient Engagement• Patient Experience
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Learn More…….
• Register for the third webinar in the series• Bridging the Gap: Reaching Consensus on ACO Metrics • Wednesday, January 23, 2013• 11:00am PT / 2:00pm ET
• Click here to view the other webinars in the series
• Click here to sign up for alerts for future webinars in the series