The Critical Role of Analytics in Managing Population...

Sean Cassidy, General Manager

Enterprise Provider Analytics and

Population Health

The Critical Role of Analytics in

Managing Population Health

2 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.

Our mission: To improve the health of communities

Premier is the nation’s largest healthcare alliance

Owned by

93,000+ Alternate sites

of care

$4.2 BILLION savings in 2011

$43 BILLION

in group

purchasing

volume

2,800 member

hospitals

Database representing

Five-time

winner

of Ethisphere’s

most Ethical

Companies

award

Award-winning

environmentally

sustainable

program

200 healthcare systems

Malcolm

Baldrige

National Quality

Award

1 in every 4 U.S.

discharges

winner

Owned by


• 55,000 covered lives

• Pioneer | Medicaid | Employees

• Pioneer data live in 44 days

Austin, TX


• Medicare Shared Savings

• MSSP data live in 55 days

Atlanta, GA


• MSSP| Aetna | Employee

• MSSP data live in 55 days

St. Joseph’s, MO


• Pioneer | Commercial | Employee

• Data Alliance member

Minneapolis, MN


• MSSP | Aetna

• Integration to IBM/Premier EDW

Roanoke, VA


• Local employer market

• Data Alliance member

Charlotte, NC

Population %

Commercial 53%

Medicare 27%

Employee 12%

Medicaid 8%

3

Our pop health solutions are covering ~1M ACO lives

http://www.rpndocs.com/index.asp


A transformative moment in healthcare

Imperative to manage

population health, impact outcomes, and provide higher quality at lower

cost

Economic and regulatory challenges

• Government, commercial and consumer pricing pressure

• Mix degradation

• Flat/declining utilization

Systemic challenges

• Fragmented care delivery

• Misaligned relationships with physicians, payers

• 30% of undefined waste

• Lack of transparency and information sharing

Transformative challenges

• Movement toward risk-based payments

• Value-based purchasing

• Readmissions/HAC penalties

• Bundled payments


FEE-FOR-SERVICE MOVING TO INTEGRATED CARE, NEW PAYMENT MODELS & RISK

The journey to high value healthcare

Value-based purchasing: HACs, quality, efficiency, cuts

HAC & readmissions

penalties Shared savings

Global payment Bundled payment

Population Management High Value Episodes High Performing Hospitals

345 QUEST members

450 Partnership for

Patients

43 Markets

21 Major DRGs

120 markets


FEE-FOR-SERVICE MOVING TO INTEGRATED CARE, NEW PAYMENT MODELS & RISK

Value-based purchasing: HACs, quality, efficiency, cuts

HAC & readmissions

penalties

Shared savings

Global payment Bundled payment

How many

physicians are

referring out of my

network?

How well do we manage episodes

of care?

How to I manage

thousands of

patients at

once?

Key

Questions

Key population health questions


29 markets | 23 systems | 100+ hospitals | 5,000+

MDs, 1.5M accountable care covered lives

86 markets | 67 systems | 300+ hospitals | 12,000+

MDs

Primary Care network development

Patient Centered Medical Home

Physician-led / professionally managed

Clinically Integrated Network

Care Management programs

Population Health Analytics

Aligned Payer arrangements

Insights from our members focused on pop health


FTC definition of a CIN

Improve

utilization/quality/costs

Implement protocols

and best practices

Furnish higher quality, more

efficient working together

Pool infrastructure, human,

and financial resources

Jointly contract with payers on

share savings/risk basis

Basic IT requirements

Interface multiple EHRs

Integrate clinical/claims

data

Apply near real time clinical

intelligence

Define patient cohorts and

aggregate patient data

Calculate performance

metrics

Capabilities to

manage populations

Risk Stratification

Patient Outreach and

Engagement

Patient Centered

Medical Home

Care Management

Performance evaluation

against benchmarks

Clinically integrated network required capabilities


EDW as a pop health data integration mechanism

Data Data Warehouse &

Analytic Engine

Medical Claims

Rx Claims

Eligibility File(s)

Other (e.g.,

HRA)

Population stratification and high-risk

patient prioritization with insight on Rx

adherence, gaps in care, likelihood of

hospitalization).

Population Health Management

e.g. Disease registry, cost distribution,

program evaluation, peer-to-peer

performance assessment

Reporting & Benchmarking

Medical Management

In/out of network utilization. Claims-

based analysis of preferred vendors,

referral and prescribing patterns, and

more)

Lab Results

Demographics

Performance Management

Risk-adjusted primary care

efficiency evaluation and network

variation assessment.

Analytics and

Clinical

Intelligence

9


So, to do pop health, we need to solve this problem…

External Data Sources

Data Data Data Data Data Data Data Data Data Data

Data Data Data Data Data Data


11

Foundational

• What happened?

• When and where?

• How much?

Operational, Tactical

• What will happen?

• What will be the impact?

• Dashboards

• Clinical data repositories

• Departmental data marts

• Enterprise data warehouse

Data integration

Data warehouse

• Enterprise analytics

• Unstructured content analytics

• Outcomes analytics

• Evidence-based medicine

Decision support

analytics

• Streaming analytics

• Similarity analytics

• Personalized healthcare

• Consumer engagement

Predictive

analytics

Advanced, Predictive

• What are potential scenarios?

• What is the best course?

• How can we pre-empt and

mitigate the crisis?

… and deliver these capabilities …

11


… on something that looks like this …

Analyze

Integrate

Manage

Business Analytics

Applications

External

Information

Sources

Cubes

Streams

Big Data

Master Data

Content

Data

Streaming

Information

Govern

Quality

Security & Privacy

Lifecycle

Warehouse

Standards

Transactional

& Collaborative

Applications

Content

Information

Governance

ODS

Data Model


… but that introduces a new challenges …

Large IT projects have a failure rate of over 28% (Gartner) and

are often delivered late and over budget

Providers are capital and resource constrained

Finding resources with advanced data analysis/integration, BI

tooling, statistical modeling, etc., skills can be a challenge

Providers often don’t have effective governance and oversight

processes, which are critical to project success

Providers often underestimate the challenges and expense

associated with data acquisition and integration

Providers often don’t have innovation oriented IT cultures

Insight is often not actionable

How do you maximize the value of your EDW/BI investments?


… which could potentially be addressed by:

Learning from the successes (and failures) of organizations

who have done it before

Avoiding re-inventing the wheel

Tapping into a community of expertise that extends outside the

boundaries of the organization

Being part of an ecosystem that innovates solutions

collaboratively

Speaking a common data language

Leveraging existing data integration investments

Focusing on delivering stakeholder value, rather than data

integration and technology/infrastructure management

Deploying BI within a social business framework


You need to be ambidextrous…

Today’s needs

• Facility, department, &

service line analysis

• Population segmentation

and analysis

• Data acquisition and

integration

• …

Tomorrow’s challenges

• Network and system level

performance analysis

• Predictive and prescriptive

modeling

• Risk management

• Big data management

• …

Develop now and share

to accelerate Collaborate to prepare,

drive and innovate


And you need to be honest about your capabilities

Problem

Instru-mentation:

Do we have the data?

Integration:

Can we access the

data?

Infor-mation:

Can we transform the

data into usable infor-

mation? Technology:

Do we have the tech to analyze the information?

Technology Skills:

Can we build the solution?

Analytical Skills:

Can we leverage the

solution?


Social Business Actions / Knowledge / Communities

Clinical

Integration

Network

Management

Identify Care

Gaps

Stratify

Risks

Segment

Population

Engage

Patients

Measure

Outcomes

Manage

Care

Population Health

Management Cost Management

Effective

Operations

Purchased

Services

Portfolio

Management

Clinical

Preference Resource

Utilization

Comparative

Effectiveness

Enterprise Data Warehouse Clinical / Financial / Supply Chain / Payer

Another way to look at it

Member

Management

Labor

Productivity

Proper Skill

Mix

Staff to

Volume


It’s not just about the data, it’s about connecting…

DATA KNOWLEDGE PEOPLE

Business

analytics &

intelligence

Integrated

data across

the continuum

Content

contribution

Role-based

content

access Collaboration Networking

Actionable Information Best Practices Communities


The value of the cloud

90% of healthcare

CIOs view IT

innovation as

critical to success

Using the cloud

could reduce IT

costs by 9% and

deliver over $11B

in savings over 3

years

Less then 25% of

healthcare CIOs

think their existing

infrastructure

supports innovation

Source: MeriTalk – “Health Check: Healthcare CIOs Prescribe Change”


“E-commerce, in particular, has exploded data

management challenges along three dimensions:

volumes, velocity, and variety.”

“Big Data” is 12 years old

Doug Laney, META Group

February 6, 2001


Are you using Big Data?

vital-signs are captured by

bedside monitoring devices

Volume Velocity Variety

1,000/sec

Recognize abnormalities

quickly with real-time

analysis of devices,

images & alerts.

Combine massive volumes

of data to form the basis of

evidence based medicine.

Enrich your population

health analytics by tapping

into unstructured data.

unstructured data in EMRs,

devices, publications, drug

structures…

80% estimated stored healthcare

data as of 2011

150exabytes

Courtesy of:


Big data needs to be complemented by big judgment

[The odds are] that

someone in your

organization is making

a poor decision on the

basis of information

that was enormously

expensive to collect

…[training is] overly

focused on the

[analytical] tool itself,

instead of on how

managers can use it to

improve their

judgment…

… data investments are

providing limited returns

because [of

underinvestment] in

understanding the

information

“Good Data Won’t Guarantee Good Decisions”

Shah, Horne and Capella

Harvard Business Review

April, 2012


“If US healthcare were to use big data creatively and

effectively to drive efficiency and quality, the sector could

create more than $300 billion in value every year.

Two-thirds of that would be in the form of reducing US

healthcare expenditure by about 8 percent. ”

But big data presents a very compelling opportunity

McKinsey Global Institute

May, 2011

Thank you

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