How Northwestern Medicine is Leveraging

Epic to Enable Value-Based Care

ABOUT PERFICIENT

Perficient is a leading information technology and

management consulting firm serving clients

throughout North America.

We help clients implement digital experience, business optimization,

and industry solutions that cultivate and captivate customers, drive

efficiency and productivity, integrate business processes, reduce

costs, and create a more agile enterprise.

PERFICIENT PROFILEFounded in 1997

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2014 revenue $456.7 million

Major market locations:

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PERFICIENT HEALTHCARE PRACTICE

SPEAKER INTRODUCTIONS

Rob Desautels, Director IT, Northwestern Medicine

Rob has more than 15 years of experience within the IT industry including 11 years

dedicated to healthcare and life sciences. Since 2013, he has served as a senior IT

leader at Northwestern Medicine (formerly Cadence Health) and helped champion

and lead the analytics effort with Epic to shape the tools that enable the population

health management program for Northwestern Medicine Physician Partners

(formerly Cadence Medical Partners).

John Ideler, Healthcare Director, Perficient

John has more than 25 years of experience in the IT industry, including more than

five years in life sciences and healthcare. He is responsible for ensuring client

satisfaction and the successful completion of large scale projects. John has

extensive experience in providing clients BI analytics capability using Epic's Cogito

data warehouse as a centralized source.

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THE TRANSFORMATION

OF HEALTHCAREJohn Ideler, Healthcare Director, Perficient

HEALTHCARE IN THE

UNITED STATES

U.S. is the most expensive

healthcare system in the world

Many assume we pay more

because we get better health

outcomes

The evidence, however, doesn’t

support that view

THE IMPACT: SHRINKING HOSPITAL MARGINS

Studer Group, Value-Based Purchasing At A Glance – Fiscal 2015 and Your Organization

2011

2021

2.2%

-16.8%

The average hospital has a

2.2% operating margin.

Reimbursement Cuts

2.2%

WILL BE A

16.8% DEFICIT

By 2018, CMS quality-

based payment

initiatives will put more

than 11% of payments

at risk.

THE SOLUTION: A NEW CARE DELIVERY MODEL

Volume Value

Fee for Service – Per Case Payment to Manage Populations

No Rewards for Quality Incentives and Penalties for Quality

Metrics (Outcomes Drive Incomes)

Collaboration/Partnerships and

Coordination of Care Not Valued

Shared Accountabilities (Healthcare

Providers, Health Plans, etc.)

No IT Investment Incentives IT Core Part of the Strategy

TRANSFORMING DATA: KEY TO VALUE-BASED CARE

We have access to an

abundance of data.

The problem is not how to

get it – it’s bringing it

together and knowing what

to do with it once we have it.

Information must be

managed so it is useful,

operationally relevant,

insightful and secure.

WHAT IS VALUE-BASED CARE?

Healthcare reimbursement model

based on the value of the services

provided rather than the volume.

Goal: Lower healthcare costs and

improve quality and outcomes

5 MAIN FUNCTIONS CONTRIBUTING TO A VBC PROGRAM

8 KEY CAPABILITIES NEEDED BY A VBC PROGRAM

1. Define, understand, engage, and track patient populations

2. The ability for clinicians to identify patients with important care considerations

3. Manage population health, outreach and care management, care

coordination and planning, and patient engagement

4. Ability to identify, categorize, and manage chronically ill patients

5. Patient attribution

6. Measures, scorecards and reports

7. Integrated analytics and reporting for clinical and business intelligence

8. Integrate claims and other external sources into the EMR, so they are visible

and actionable at the point of care

LEVERAGING

THE NATIVE

CAPABILITIES

OF EPIC

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NORTHWESTERN MEDICINERob Desautels, Director IT, Northwestern Medicine

NORTHWESTERN MEDICINE

Total Workforce of Over 18,000 Employees

70 Acute and Outpatient Care Sites

National Leader in Quality and Consumer Preference

3,700 Medical Staff Includes 1,500 Employed Physicians

600,000 Square Feet of Additional Research Lab Space by 2018

Primary Clinical Affiliate of Northwestern University Feinberg School of Medicine

“… Where the Patient Comes First.”

GROWING TO SERVE PATIENTS CLOSER TO WHERE THEY

LIVE AND WORK

MeasurementFY

2009 FY

2014

NM Today*

Acute Care Locations 1 2 4

Licensed Beds 854 1,011 1,517

Inpatient Admissions

47,700 52,600 83,400

Outpatient Sites 14 29 70

Employed Physicians 111 1,185 1,502

Northwestern Medicine Growth: 2009-2015

*Pro forma FY14 combination of Cadence and NMHC

ORGANIZATION TO DELIVER VALUE-BASED CARE

Northwestern Medicine Physician Partners (NMPP) is the NM vehicle for

emerging value-based contracting, payment and care delivery

- Formerly Cadence Medical Partners (CMP)

- Network of employed and independent physicians/providers

- Payer/Employer contracting organization

- Meets legal criteria for “clinical integration”

Common approach across all payers and physicians - One program

- One set of measures and clinical protocols

- One set of administrative procedures

- One infrastructure for care management

- One set of incentives

WHY EPIC/COGITO WAS CHOSEN

• Epic is the EMR platform at legacy Cadence Health and foundation for Northwestern Medicine

• Leveraging the tools within the system EMR allows for care management to occur in the tool

providing the analytic information (single platform)

• Expansion of the Cogito analytics platform to include the data warehouse provided:

o Ability to seamlessly load native Epic data into Cogito

o MSSP interface already written by Epic to ingest CMS file

o The development of smart data elements (SDE) to send information from the Cogito

data warehouse to Epic hyperspace

o Reports already available/used via Radar and workbench

o Scalability (Johns Hopkins risk stratification, in future release)

• Speed to market, as new platform did not have to be purchased, configured and integrated

with Epic data

MAPPING REQUIREMENTS TO TECHNOLOGY

Business Requirement Technology Solution

Cohort EstablishmentIdentify cohorts of patients with chronic conditions, or those whom qualify for wellness screenings, based on a specified inclusion and exclusion criteria.

Chronic Disease, Wellness, & Risk Registries• Asthma, Diabetes, CHF, Hypertension, CAD (5)• Wellness Registries (11) • General Risk (1)

Clinical Quality MeasuresDevelop Clinical Quality Measures that help measure and track the quality of health care services provided by eligible providers and hospitals within our health care system.

Healthy Planet• Develop 44 Registry-Based CQ Measures• 25 Chronic Disease• 19 Wellness

Care Management & CoordinationEnable care managers to actively manage health of patient population via the use of care planning & coordination tools such as patient outreach, longitudinal care planning, goal setting, tracking, and population health analytics.

Healthy Planet • Care Management Workflows & Care Coordination Tools• Patient Goals, Longitudinal Plan of Care• Electronic Patient Outreach Tracking • Reporting Dashboards & Workbench Reports

Risk StratificationStratify total patient population and identify highest risk patients based on a host of risk criteria such as; comorbidities, walking limitations, disability, # of ED/Inpatient stays, a discharge readmission risk factor score, living status, etc.

Healthy Planet• Developed a risk score and applied to total patient population

based on Epic data• Risk score made available directly in care manager workbench

reports and workflows

MAPPING REQUIREMENTS TO TECHNOLOGY

Business Requirement Technology Solution

Obtaining Clinical Data for Patients seen at Non-Epic LocationsObtain clinical information for patients not seen within our hospital network, or employed practices.

Healthy Planet – Abstractor Navigator• Extended Epic Access to Non-Employed Practices• Abstractor Encounter• Care Gap Reporting & Inbasket setup to route messages to

Care Managers

Reporting tools for PhysiciansProvide physicians with an overview of the performance of their patient population across all registry-based measures, incorporating internal and external data.

Radar Dashboards & Reporting Workbench Reports • Centralized view of population performance on registry-

based measures• Drill down capability to identify non-compliant patients• Quarterly performance & trending

Leverage External Data for Population Health Import, Store, & Analyze claims & eligibility data from various sources; payers, hospital quality, oncology, for population health purposes.

Cogito Data Warehouse (CDW)• External Claims & Eligibility Data• Hospital Quality Measures• Physician Roster • Oncology & CMP Measures

MAPPING REQUIREMENTS TO TECHNOLOGYBusiness Requirement Technology Solution

Patient to Physician Attribution (Claims-Based)Attribute Patients to Physicians based on plurality of outpatient visits, and store attributed PCP & Specialist information in Hyperspace

Cogito Data Warehouse – Attribution Algorithm• Develop custom logic to analyze claims and eligibility files to assign patients to 1 PCP &

multiple specialists based on claims activityPrimary Care Team• Developed custom primary care team fields to store attributed PCP & SpecialistsEPT Import• Developed custom import spec to import attributed PCP & Specialist to Hyperspace &

populate primary care team fields

Patient MatchingDetermine if incoming patients on a roster or claim currently exists in Epic. Match patient to existing record, if a patient exists. Create a new record if patient does not exist.

Cogito Data Warehouse – Patient Matching• Develop custom logic to identify and match records if patient exists in Epic. Send to

Identity if patient does not existIdentity – Custom Algorithm for Patient MatchingAccess • Create new ID types and workflows to add and store unique payer IDs to patient records

Leverage external data for CQMsModify Clinical Quality Measures to incorporate external claims data

Smart Data Elements• Built in Chronicles and allow measures to look to external claims data to satisfy measure

criteria Datalink Actions• SQL queries that leverage grouper code sets. mine claims data, and return the required

value to the SDE

THE SOLUTION

LESSONS LEARNED

Reality that not all providers (especially non-employed) will move to a single platform

No single solution for interoperability and exchange of necessary information

- HIE

- Clearing houses

- Report writers/sniffer

- EMR/PM

- Epic Connect

- Epic Care everywhere

How do we import external data

- Once we import how do we normalize

- Once we normalize how do we risk stratify and attribute

LESSONS LEARNED

Engage all partners early - We don’t all speak the same language even though we think we do

Enterprise and Executive Leadership Support is necessary but not sufficient- Need buy-in from end users such as clinical team, tech team, analytic team

Defining measures and program prior to developing technology solution - A poorly thought out process is just as poor electronically as it is on paper

Data Governance (examples of issues)- What is the definition of a day?

- We know that we should shoot for a glyco hemoglobin of less than 8 (maybe?), but what is

a reasonable target of compliance (25th percentile, 50th percentile or 90th percentile?)

- Reporting of measures that appear to overlap across different quality programs (PQRS,

CMS ACO, MU, etc.)

LESSONS LEARNED

Frequent and intense communication within the project team, with end-users, and

stakeholders

Creating the technology platform is only the beginning- need to plan for robust

downstream training of users

Know your data sources- There is a lack of consistency between payers and within a payer from month to month

(Medicaid – ACE data)

External EMR (clinical) data- Remains a challenge because of interoperability issues, but at the same time is the “pot of

gold” we need to get to

ADDITIONAL EPIC COGITO RESOURCES

GUIDE: How to Enable Value-Based Care and Clinical

Integration with Epic Cogito - http://bit.ly/CogitoWP

CLIENT SUCCESSES:

ProHealth Care Case Study - http://bit.ly/ProHealthCS

On-Demand Webinar - http://bit.ly/ProHealthWebinar

ASSESSMENT: Value-Based Care Readiness and Cogito

Implementation Assessment - http://bit.ly/CogitoAssessment

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