Supporting Healthcare Transformation with an Enterprise Analytics Program

Christopher Donovan, MBAExecutive Director Enterprise AnalyticsCleveland Clinic

Cleveland ClinicProfile

Industry Transformation

Advocate, Aurora Health Care to merge, create $11 billion health systemSystems say together they will form the 10th largest nonprofit integrated health system in the country

Optum to buy DaVita Group for $4.9 billion

CVS Health to acquire Aetna for $69 billion in year’s largest acquisition

Amazon, Berkshire Hathaway and JP Morgan Could Disrupt U.S. Health Care and Capitalism As We Know It

Why Apple, Amazon, and Google are making big health care movesSilicon Valley wants to disrupt your health careBy Dylan Scott

• Capturing, integrating and interpreting data from all available sources

• Predictive algorithms that surface opportunities for intervention and prevention

• Thoughtful use of augmented intelligence

• Seamless connections to patients and partners as healthcare becomes “borderless”

• New skills, knowledge and pipelines

• Mature data governance

Digital Transformation at CC

Patients - main patient-facing elements; patient portals, multichannel commerce and customer apps

Ecosystem - supports the creation of, and connection to, external ecosystems, marketplaces & communities. (API mgt, control & security)

Internet of Things (IOT) - connects physical assets for monitoring, optimization, control and monetization. Capabilities include connectivity, analytics and integration of core and IOT systems

IT Systems - supports back office and operations; such as ERP and core systems

Data & Analytics - information management and analytical capabilities. Data management programs and analytical applications fuel data-driven decision making, and algorithms automate discovery and action

Adapted from Gartner - A Digital Business Technology Platform Is Fundamental to Scaling Digital Business

Analytics is Core to a Digital Platform

Patients

Analytics

Customer Facing &

Public APIs

Partner & Supplier Analytics

PatientAnalytics

Business & Operational

Analytics

IoTAnalytics

SocialNetworksPatient Portal &

Apps

Multichannel Interaction & Commerce

Connected Things

(Customers)

Connected Things

(Partners)

OT Systems

Connected Things

(Enterprise)

EndpointComputing

CoreSystems

Back-Office Systems Employee

Collaboration and Workplace

Supplier Portal &

Apps

Enterprise Run Ecosystems

API Management Industry &

Partner-run Ecosystem

Business IntelligenceAlgorithms & AI

Engines

PATIENTS ECOSYSTEMS

THINGS IT SYSTEMS

ANALYTICS

Adapted from Gartner - A Digital Business Technology Platform Is Fundamental to Scaling Digital Business

Analytics is Core to a Digital Platform

Business Intelligence

Customer Facing &

Public APIs

Partner & Supplier Analytics

PatientAnalytics

Business & Operational

Analytics

IoTAnalytics

SocialNetworksPatient Portal &

Apps

Multichannel Interaction & Commerce

Connected Things

(Customers)

Connected Things

(Partners)

OT Systems

Connected Things

(Enterprise)

EndpointComputing

CoreSystems

Back-Office Systems Employee

Collaboration and Workplace

Supplier Portal &

Apps

Enterprise Run Ecosystems

API Management Industry &

Partner-run Ecosystem

Algorithms & AI Engines

PATIENTS ECOSYSTEMS

THINGS IT SYSTEMS

ANALYTICS

Adapted from Gartner - A Digital Business Technology Platform Is Fundamental to Scaling Digital Business

Analytics is Core to a Digital Platform

PatientAnalytics

Patient Portal & Apps

Connected Things

(Customers)

CoreSystems

Algorithms & AI Engines

Business & Operational

Analytics

IoTAnalytics

API Management

Business Intelligence

International Institute for Analytics

2.252.882.89

2.963.05

3.193.233.29

3.433.553.583.62

3.914.56

Airlines

Utilities & Telecom

Digital Natives

Grocery

Financial ServicesConsumer BrandsGeneral RetailPharma & Med DevicesManufacturing

Automotive

Healthcare - Providers

Healthcare - InsuranceInsuranceSpecialty - Retail

Industry Best In Class

Maturity Score

Medians

Com

petit

ive

Adv

anta

ge

Adapted from: Copyright © 2012, SAS Institute Inc. All rights reserved. ANALYTICS MATURITY GOAL: FROM REACTIVE TO PREDICTIVE

How do we act on it?

What’s the best that can happen?

What will happen next?

Why is this happening?

What actions are needed?

What were the key drivers?

How many, how often, where?

What Happened?

Sophistication of Analytics

StdReports

AdhocReports

DataExploration

AlertsScorecards

StatisticalAnalysis

Forecasting

PredictiveAnalysis

Optimization

Proactive Decision Making

Reactive Decision Making

Driving Analytic Maturity

Develop the ability to act on insights from all available data to

improve patient outcomes, affordable care, education and

research

DataEnhance the value of CC data assets

PeopleDevelop an analytically

capable organization

ProcessValue

analytics over instinct

TechnologyCreate a modern analytics platform

CC Enterprise Analytics Vision

Matrix Program Leadership

Executive Director Medical Director

IT

Infrastructure

CIOADMIN

Financial DSS / BI

CFOMed Ops

Clin Ops BI

CMOOEstablished new

program leadership positions with new, formalized matrix reporting to drive

alignment

Executive Steering

Committee

Operational Leadership

TeamAdvisory Council

Data Governance

Council

Operational leaders who are data

domain SME’s and recognized as

authoritative relative to their data

domains

Limited membership -core functional owners

Broad, open membership

Institute Leadership

Council

Program Governance

• Responsibilities of the data and analytics team:–Provision of trustworthy, available data –Deployment of modern, useable analytics tools–Development of enterprise scale vision, training and support–Development of expertise and “consulting” around

measurement, performance management, and “math”

• Responsibilities of the enterprise:–Become facile users of data related insight–Broadly disseminate an analytically oriented culture –Commitment to developing required skills

A Shared Effort

Dashboards

Enterprise Data Vault

Hadoop

Data Labs

External Data

Data Asset Management

Enterprise Data Views Analytic Engine

Analytics Spreadheet Reporting KPIs

Data Integration

Metadata Data Quality Business Glossary Master Data ManagementETL

Analytic Tools

CC Enterprise Analytics Platform• Enterprise data store capable of

capturing a wide variety of structured, unstructured and streaming data

• Curated data views for easy access with standard, reusable definitions and data models

• World class advanced analytics providing nuanced capability and supporting open source frameworks

• Flexible integration with external and novel internal data stores

• State of the art visualization and access capabilities to facilitate data discovery and drive analytic culture

http://sloanreview.mit.edu/article/minding-the-analytics-gap/

• Two important abilities- Ability to produce results- Ability to consume results

• As organizations mature… - How do each of these change?- How do they change relative to each other?- What are the implications for managing?

Building Analytic CapabilitySo

phist

icat

ion

Maturity

http://sloanreview.mit.edu/article/minding-the-analytics-gap/

Soph

istic

atio

n

Maturity

Ability to Produce

Ability to Consume

Make analytics easier to consume

Waste

Different growth curves produce waste

http://sloanreview.mit.edu/article/minding-the-analytics-gap/

Soph

istic

atio

n

Maturity

Ability to Produce

Ability to Consume

Make analytics easier to consume

Minding the Analytics Gap

http://sloanreview.mit.edu/article/minding-the-analytics-gap/

Soph

istic

atio

n

Maturity

Ability to Produce

Ability to Consume

Make analytics easier to consume

Increase understanding of

analytics

Minding the Analytics Gap

Addressing differentiated requirements through appropriate tool, capability and

training curriculum

Quantitative Analysts

Business Analysts

Key leaders & decision makers

Front line and operational managers

DataScientists

ExecLeaders

Driving Analytic Maturity

Developing new talent pipelines through enhanced internships and

updated job descriptions

Show Complexity

Show the Math

Workflow Integration

How do we make this easier to consume?

• Enterprise Data Platform– 1,400 + database accounts created

– Loaded 12 TB of data into environment

– Hadoop environment in prod with 90 TB of data

– 99 enterprise data labs in production

– Fully integrated analytics environment

– 638 user accounts from 37 different enterprise business units

– Over 5,100 data mappings have been promoted to our PROD environment to date–Processed 294 billon rows of data

– 10,000 distinct dashboard views published

Accomplishments – Data & Technology

Dashboards

Enterprise Data Vault

Hadoop

Data Labs

External Data

Data Asset Management

Enterprise Data Views Analytic Engine

Analytics Reporting KPIs

Data Integration

Metadata Data Quality Business Glossary Master Data ManagementETL

Analytic Tools

Leveraging the enterprise platform– Revenue cycle project driving $8.5m savings over 5 years– HIM compliance reporting – discharge audits from 1% to 100% with lower costs & FTEs ($280k

savings over 5 years)

– Cancer center pilot demonstrated an 18% reduction in manual data retrieval and 250 hrs saved per year

– Captured 2,000+ variant control files for annotation and genotypic / phenotypic analysis

Advanced analytics– International patient program pricing – projecting $6m of improved collections for 2017

– Applied Monte Carlo simulations to contract negotiations – saving 80 hours per negotiation

Population Health– HCC improvement effort – achieved 83% RAF compliance through November (vs. 2016 63%)

Accomplishments – Delivering Value

Hadoop Genomics Pilot

• Loaded 996 VCF files from GeneBank(Cardiovascular Cohort)

• Matched with EMR derived phenotypic data

61 cases with mutations in colon cancer related genes

34 cases with no clinical indication of colon cancer risk

25 cases with no noted colonoscopy

Opportunity: 15 cases with increased risk and no colonoscopy

• Connecting genomic data with traditional patient data from our EMR

• Develop differentiated care paths and treatment options

• Identify populations at risk where early intervention has preventive potential

• Historic challenges regarding size and complexity of the datasets

• Ability to blend, explore and analyze the data

Leveraging Genomic Data

Applying Analytics to Drive Value

Applying Advanced Capability

• Financial Scenario Modeling:- Planning Tool for MNS/Financial Planning- Flexible scenario analysis tool capable of

producing rolling 5 year utilization and financial projections

• 6 Scenarios developed • Charge and Rate Scenario• Encounter Movement• Payer Volume Change• Institute Volume Change• Shared Savings• Narrow Network Products

Can we understand how costs are behaving over time?

Can moving averages keep us from reacting to short-term changes?

Is there an opportunity to reduce the width of the band around the mean tech direct cost?

Changing the Discussion

Variability at lower LOS tied to variability within various resource areas

• These resource areas have the widest range of cost for encounters with LOS <= 3 days

• Can this variability be reduced?

Finding Hidden Opportunity

All Encounters APR Severity = 1 APR Severity = 2

• Expectation is that lower APR Severity generally translates to lower LOS and costs. • Encounters with lower APR Severity (1 & 2) and higher costs/LOS (clusters 2 - 4) may represent Coding or

Utilization opportunities

Visualizing Data for Insight

Excludes physicians with less than 5 encounters

Exploring Variability

Total Population

5 Selected physicians

Are We Building Analytic Maturity?

Stage 1: Analytically Impaired

Stage 2:Localized Analytics

Stage 3: Analytical

Aspirations

Stage 4: Analytical

Companies

Stage 5: Analytical

Competitors

Source: 2017 IIA Maturity Survey

3.06

2017

2.17

2014

1.91 2.25 3.21

Lowest Score

Median Highest Score

Healthcare –Providers Best in Class

Parting Thoughts

• Learn from others• Comprehensive strategy – not just a technology

problem• Recognize that this is culture change• Establish your key principles & anchor to them• Drive to demonstrable value