Technology in Health Care Keynote Address

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Big Data + HealthcareOctober 8, 2013

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About Explorys

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Formed in conjunction with Cleveland Clinic in 2009.

Value-based care network and Platform for enabling the transformation of healthcare.

Serve large integrated delivery networks and provider led plans.

Our mission is to unlock the power of Big Data to improve healthcare for everyone.

ExplorysAbout US

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Explorys Member SystemsNetwork enabling platform of 300 hospitals

17 integrated delivery networks

200,000 providers

135 billion data points

Delivering over $52 billion in care annually

Across 35 million patients Projected as 45 million as newly signed

systems go live in coming months

Big Data Meets

Big Network

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Healthcare Market Dynamics

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The battle is on for… Healthcare consumers

Patient share of chart

Employer contracts

Well aligned providers

HEALTHCARE

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The

Perfect Storm

Decreasing reimbursement

Rising operational costs

Increasing quality transparency

Growing demand for value

Consolidating market

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Number of M&A transactions, 2000-2011

Source: The Health Care M&A Report, Irving Levin Associates, Inc., 2000-2011 and AHA Hospital Statistics

Growing trend towards mass consolidation to compete effectively and remain financially secure.

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Top 5 Players Top 15 Players

Growing trend towards mass consolidation to compete effectively and remain financially secure.

"It's a numbers game," he said. "To effectively take on the financial risk providers are being told to assume, they need a certain amount of critical mass. The bigger you are, the more the numbers work to your advantage.” - Ben Rooks, founder of San Francisco-based ST Advisors

Sources:Kauffman Hall - Strategic Options in a Consolidating MarketModern Healthcare’s 2011 Hospital Systems Survey2011 AHA Hospital Statistics, iSuppli Corporation 2010 Semiconductor SuppliersAir Transport Association 2010 Economic Report. Statistics are prior to the United-Continental merger. Proforma for that transaction, the top 5 and top 15 would have made up 70.0% and 89.5%, Drug Store News Top 50 Rx Power Players, April 2012. Market size is defined as the revenues of the top 50 players

Healthcare remains highly fragmented relative to other industries

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Growing Demand for ValuePayers, patients, and employers and demanding accountability in care and outcomes.

Unsustainable trajectory of costs coupled with few quality improvement in the last decade.

Source: The Commonwealth Fund: The National Scorecard on U.S. Health System Performance, 2011,

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Value-Based Models Developing RapidlyACOs, Bundled Payments, PCMH, and others…

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Share of Chart

Is an imperative for growing revenue and managing risk

Proactively manage your patient / customer or someone else will

In Network

Out of Network

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Pick Your Initiatives Wisely

How timing, share of chart, shared savings rate, and cash flow impact both value-based-care and fee for service financials.

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HealthSystem

IDN 1

IDN 2

PHO

IDN 3

Risk Models

Guidelines

Apps & IT Tools

Employers

Payers

Patients /Members

Contact Center

Contracting

Underwriters

TPA

Regulators

Finance

Clinically Integrated

Networks

Rapidly FormingThe Connected WorldA New Healthcare Economy

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Aligning Provider Incentivesand making sure those deserve it get

compensated

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“There is concern surrounding

how reimbursement will be distributed mong the multitude of providers involved in a particular episode. This may pose considerable challenges to urologists in community practice

and may further incentivize alignment with hospital systems.”

Matthew J. Resnick, MD, assistant professor of urologic surgery at Vanderbilt University Medical Center

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You’re Swimming in Big Datawhether you know it or not

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Source: “How big is 'big data' in healthcare?”, by Graham Hughes, MD“Big Data Use In Healthcare Needs Governance, Education” – Information Week, by Neil Versel

“Why 'Big Data' Is a Big Deal”, Wall Street Journal, By L. GORDON CROVITZ

of stored healthcare data across disparate

care settings…

150 exabytes

Volume

BIG DATA is Volume, Velocity, and Variety…

vital-signs capture by bedside, home, and

mobile devices…

1,000/sec

Velocity

coding variability among diagnoses and

test results…

80%

Variety

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Applying Big Data effectively could yield $300-400 billion in healthcare costs

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In a Gartner 2012 survey, 68% of health systems intend to make new investments in

business intelligence and analytics in the next 2 years.

Even at the height of the U.S. EHR adoption, that percentage never reach this level.

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However, EMRs are not well positioned to leverage Big Data for population health….

“Early EHRs were not designed first and foremost to facilitate and improve the delivery of care; they were

designed to facilitate billing.

- Rob Tholemeier and John Moore, Chilmark Research, June 2013.

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PCP Specialist Hospital Post acute Long term Home

Capturing The Continuum of Care is CRITICAL

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Healthcare System Operations

Allocated costs, actual costs, labor, and materials

Payer ClaimsCharges, payments, Rx fills,

3rd party providers

Provider BillingsEDI billing and payment

adjudication (EDI)

Provider InfoPhysicians, nursing staff,

specialists, and care coordinators

Partof the Picture

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Healthcare System Operations

Allocated costs, actual costs, labor, and materials

Payer ClaimsCharges, payments, Rx fills,

3rd party providers

Provider BillingsEDI billing and payment

adjudication (EDI)

Provider InfoPhysicians, nursing staff,

specialists, and care coordinators

Ambulatory EMR (employed & affiliates)Diagnoses, findings, labs, procedures, encounters, appointments

ED & In-Patient EMRDiagnoses, findings, labs, procedures, encounters, appointments

Long Term Care Diagnoses, findings, labs, procedures, encounters, appointments

Homecare & Telemedicine Readings, patient reported outcomes, nursing visits, and mobile

Patient Demographics,

behaviors, and attitudes

ClinicalAdministrative

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Big Data in the Real WorldUse Cases

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Driving Knowledge from BIG DATA…

Alert

Drill-Down

Query

Report What happened?

How many, how often, when?

What exactly is the problem?

What actions are needed?

Optimize

Predict &

ModelForecast

Analyze

What’s the best that can happen?

What will happen next?

What if these trends continue?

Why is this happening?

Predictive Analytics(the “so what….And the “now what”)

Future-oriented and source of competitive advantage

Descriptive Analytics (the “what”)

“Rearview mirror” – Provides foundation and insight

Com

peti

tive A

dvanta

ge

Degree of Intelligence

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Maximize QualityIdentify the highest impact opportunities relative to risk-adjusted benchmarks and track progress.

Maximize MarginRisk stratify populations, profile providers, predict outcomes, and direct action towards reducing unnecessary cost and optimizing reimbursement.

Maximize Market ShareDrive top-line revenue through provider alignment and virtually integrated networks.

Patients and ProvidersCreating Win-Win Opportunities

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30% quality improvement within value-based care disease management programs




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“We saw a 51% reduction in hospital admissions, a 35% reduction in readmissions and a 37% reduction

in emergency department visits”

Teaera Roland, Nurse Care Coordinator, Mercy Health

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“We have had improvements across all of our measures throughout the course of the

year.”

“Our pneumococcal vaccine rate rose from 52 percent in 2011 to 60 percent at the end of 2012; our colonoscopy rate went from 34

percent to 40 percent during that time. And our tobacco cessation counseling rate rose from 56 percent to 77 percent.”

Dr. Amy Frankowski, MD, Catholic Health Partners

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Accurately price care bundles for direct-to-employer risk-based contracts.



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Empowering Colorado Health Neighborhoods’ physician-led clinically integrated network

across more than 2,000 providers.


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Q&A

Technology in Health Care Keynote Address

Health & Medicine

Transcript of Technology in Health Care Keynote Address