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Harnessing Data and Analytics
for Population Health
Panelists:
• Jim Adams, The Advisory Board Company
• Farzad Mostashari, MD, ScM, U.S. Department of Health
and Human Services
• Christopher Lloyd, MHMD Memorial Hermann Physician Network
• Colin Ward, Greater Baltimore Health Alliance
• Glenn Tobin, Ph.D., The Advisory Board Company
Moderator:
• Aneesh Chopra, The Advisory Board Company
National Population
Health Symposium
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Today’s Panelists
2
Harnessing Data and Analytics for Population Health
Jim Adams Executive Director
The Advisory Board
Company
Farzad Mostashari, MD, ScM National Coordinator for Health
Information Technology
U.S. Department of Health and
Human Services
Colin Ward Executive Director
Greater Baltimore
Health Alliance
Aneesh Chopra Senior Advisor
The Advisory Board
Company
Glenn Tobin, Ph.D. Chief Executive Officer,
Crimson
The Advisory Board
Company
Christopher Lloyd Chief Executive Officer,
MHMD Memorial Hermann
Physician Network
Memorial Hermann
Healthcare System
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Different Capabilities for Different Question Types
3
Be Prepared and Plan for Predictive and Prescriptive Analytics
Source: Advisory Board Company research and analysis.
Beware the
False Summits!
Degree of Competitive Advantage
Deg
ree o
f Diffic
ulty
Analyze the Actions
• Mathematical models
• Linear programming
• Constraint programming
Prescriptive:
What should we do?
3
Analyze the Past
• Reports and graphs
• Dashboards
• Drill down/around
Descriptive:
What happened?
1
Analyze the Future
• Predictive modeling
• Data mining
• Forecasting
• Simulations
Predictive:
What might happen?
2
Three levels of BI maturity, with
each level more difficult and
more advantageous than the last.
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Analytics for Population Health Management
4
Be Prepared and Plan for Predictive and Prescriptive Analytics
Source: Advisory Board Company research and analysis. 1) Post-acute care.
Beware the
False Summits!
Degree of Competitive Advantage
Competencies and capabilities at
one level do not automatically
translate to the next level.
Deg
ree o
f Diffic
ulty
Analyze the Actions
• PAC1 interventions
• Performance optimization
Prescriptive:
What should we do?
3
Analyze the Past
• Readmissions
• Performance monitoring
Descriptive:
What happened?
1
Analyze the Future
• High-risk patients
• Performance under new reimbursement models
Predictive:
What might happen?
2
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Another Perspective on Analytics for PHM1
5
Examples of Tools and Processes with Analytic Underpinning
Source: Advisory Board Company research and analysis. 1) Population health management.
• Contracting (pre/post)
• Performance scorecards
Administer,
Monitor, and Report
6
• Risk segmentation
– High cost
– Rising risk
– Chronic conditions
• PCP attribution
• Registries
• Disease or PHM
dashboards
• Smart portals
Map and Track
2
• Registries
• Assisted interventions
– Clinical decision support
– Cognitive support
Deliver Care
3
Identify Population
1
• Real-time monitoring/alerts
• Registries
• Risk reassessment
• Pathway optimization
Coordinate Cross-
Continuum Care
4
• Predictive/persuasive
engagement
• Patient satisfaction
Engage Patients
5
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Cultural Change Key to Productive Use of Analytics
6
Assess Your Culture’s Readiness for BI
Fragmented Enterprise Perspective
Big Data Advanced Analytics
• Will valid data and analytics trump politics
and “gut feel”?
• Do we offer widespread training on using
data, identifying opportunities, and
instituting change?
• Will the organization support decisions that
are automated, alerted, or assisted by BI?
• Do we have an enterprise champion?
• Will the different business areas affected
cooperate?
• Can we successfully implement changes
to address high-impact opportunities?
• Have we developed a shared vision and
strategy for the use of BI?
• Do we know when we have enough data
to make a decision?
• Do we review our assumptions and
models for currency and relevance?
• Do we have a local champion?
• Will we appropriately deal with new-
found transparency or challenge
“common knowledge”?
• Will we appropriately deal with multiple
versions of the truth?
• Do we have the authority to clean up
the source system data?
Source: Advisory Board Company research and analysis.
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Insights from the National Coordinator for Health IT
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Farzad Mostashari, MD, ScM National Coordinator for Health
Information Technology
U.S. Department of Health and
Human Services
Dr. Farzad Mostashari is the National Coordinator for
Health Information Technology at the U.S. Department of
Health and Human Services. To this role, Dr. Mostashari
brings a rich body of experience to continue leading the
nation in constructing a health care system that uses
information and technology to empower individuals,
and improve both the health and health care of Americans.
Dr. Mostashari first joined ONC as its deputy national
coordinator in July 2009. During his tenure in this position,
he developed a series of grant programs to promote
electronic health record adoption, furthered the
development of health information exchange, and helped
construct the workforce development program. His vision
has been instrumental in the formulation of the ONC’s
Health IT Strategic Plan, the creation of ONC’s Authorized
Testing and Certification Bodies, and will influence future
stages of Meaningful Use.
Sources and Uses of Data in an Accountable Care World
Christopher Lloyd Chief Executive Officer MHMD - Memorial Hermann Physician Network The National Population Health Symposium September 16, 2013
Health Reform Distilled
2
QUALITY
COST
Needed to drive the Quality & Cost equation?
• Organizational Structure • Commitment to Evidence Based
Medicine • Dedication • Information • Partnership
The Fundamentals of Change – Accountable Care
• Everyone's role in care delivery must change • Data is paramount – and it exists • Industry payment must be altered with aligned incentives • Shared Accountability – patients too… • Outcomes!! • Clinical Integration of all parties is fundamental
MHMD Clinical Programs Committee Structure
MHMD Board of Directors
Clinical Programs Committee
H&V
Cardiology
CV Surgery
Neuro
Neurology
Neurosurgery
Woman/Child
Neonatal
OB/Gyn
Surgery
Anesthesia
Bariatrics
Orthopedics
ENT
Allergy
Medicine
Critical Care
Emergency
Ad hoc
Hospital Medicine
Post Acute
Oncology
Oncology
Contract
Imaging
Pathology
Primary Care
Adult PCP
Peds
Peer Review
Clinical Ethics & Palliative Care
Order Set Editorial Board
Informatics
Acute Surgery 4
The Necessary Interrelationship for Change
MHMD MHHS
The Functions of Population Management
• “New” data source for physicians and hospitals • Typically held by insurance companies • Indicates cost/quality opportunities
6
Population Dashboard
ED Utilization
Inpatient Quality & Safety Metric Results
9
50% increase
68% reduction
.5% reduction
12% reduction
13% reduction
5% increase
BASELINE Order Set
Usage e-Order Set
Usage Iatrogenic
Pneumothorax Events
PPE or DVT Events
Hospital Acquired Infections
Serious Safety Events
Order Set Results Excluding Top 5% Costs – Jan - June 2011
Overall Project Order Set No Order Set Total
Patients 1,579 1,617 3,196
Avg. Direct Costs 93% 107% 100%
LOS 4.1 4.3 4.2
Cost Variance with Order Set -15%
LOS Variance with Order Set -5%
10
Order Set Results Excluding Top 5% Costs – Jan - June 2011
Overall Project Order Set No Order Set Total
Patients 1,579 1,617 3,196
Avg. Direct Costs 93% 107% 100%
LOS 4.1 4.3 4.2
Cost Variance with Order Set -15%
LOS Variance with Order Set -5%
11
Memorial Hermann Health Insurance Quality Metrics
52%
12%
11%
BASELINE
ALO
S
ER/1
000
CT/
1000
OPS
/100
0
30da
y R
eadm
it As
thm
a M
eds
Cer
vica
l CA
Bre
ast
CA
Colo
rect
al C
A
Dia
b H
bA1c
CAD
LD
L-C
Gen
eric
Rx
Adm
its/
1000
Dia
b LD
L-C
Dia
b N
eph
7day
po
st D
/C
.9%
12%
32%
63%
43%
3.4% 11% 17% 7.1%
5.6%
4.0% 0%
2.6%
Data / Metrics / Care Management
12
Adult & Pedi ICU Ventilator Associated Pneumonias (VAP)
13
CI Performance (2011)
14
Moving Down the Road –
Driving Quality and Reducing Costs
15
1
Greater Baltimore Health Alliance 2013 National Population Health Symposium
September 16, 2013
Presenter: Colin Ward
Greater Baltimore Health Alliance
Our Community
Wellness/ Prevention
Employed Physicians (GBMA)
MSO- Primary
Care
MSO- Specialty
Physicians
GBMC Hospital
Tertiary Partners
Post-Acute Partners
Gilchrist Hospice
•100 Primary Care Providers (Employed & Aligned) &
Greater Baltimore Medical Center
•CMS Shared Savings Program (July 2012) &
Cigna CAC (April 2013)
• Multiple EMR platforms & Data analysis solutions
2
3
Real Time Data For Population Health
•Compares “real time” hospital ADT data with patient panel
provided by GBHA
•Sends notification to secure email address
•Approximately one million patients in CRISP Database with
GBHA representing nearly 10%
Our Community
Wellness/ Prevention
Employed Physicians (GBMA)
MSO- Primary
Care
MSO- Specialty
Physicians
GBMC Hospital
Tertiary Partners
Post-Acute Partners
Gilchrist Hospice
Encounter
Notification System
Patient Panel
ADT “Hit”
Real Time Data For Population Health
•10 practices daily average 37 IP Discharges & 42 ED Discharges
•47 Hospitals participate – GBHA discharges come from 32
•Identifying frequent flyers
•Preventing Admissions/ Readmissions
•Transitional Care/ Medication Reconciliation
•Activating providers
•Increasing value to patients
4
Real Time Data For Population Health
•2 Fewer People
•2 Fewer Handoffs
•3 Fewer Hours
5
Scalable Population Health
Management Making Data and Analytics Usable and Scalable
Glenn Tobin, Ph.D.
Chief Executive Officer, Crimson
September 16, 2013
Crimson
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Old View of the World
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Goal: Single Source of the Truth Across All Patients
Source: Advisory Board Company research and analysis.
Single EMR Across 90% of Sites,
HIE Connectivity at Periphery
Single Dominant Platform
Moving Away From a Single EMR
As we’ve acquired different groups, they’ve
come with different EMRs. Initially, we thought
we could change these all out—but frankly,
that’s just too expensive. Instead, we’re
importing data from disparate sources into our
data warehouse until a simpler and less
expensive solution for direct linkage of the
EMRs occurs.
William Chin, MD, Executive Medical
Director, HealthCare Partners
”
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• How do you identify patient utilization of
services occurring outside the network?
• Which patients are likely to become high
cost in the future?
• How can we pool clinical data from
different EMRs to identify patient gaps in
care?
• What steps can we take to influence
behavior when the person is not in the
physician office or hospital?
• How do we support workflow of newly
formed care teams working at the top of
their license?
• How do I manage risk contract reporting
across many payors?
Multiple IT Systems the Norm Key Challenges of Population Health
The Reality of Provider-Based Pop Health Managers
Source: Advisory Board Company research and analysis.
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Emerging Population Health IT Approach
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Independent Providers
Affiliated EMR Systems
Payer Claims Data
Consumer Data Patient -Entered Data
Source: Advisory Board Company research and analysis.
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Emerging Population Health IT Approach
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Data and Analytics
Independent Providers
Affiliated EMR Systems
Payer Claims Data
Consumer Data Patient -Entered Data
Source: Advisory Board Company research and analysis.
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Emerging Population Health IT Approach
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Data and Analytics
Workflows—Care Team, Network Managers, and Financial Managers
Independent Providers
Affiliated EMR Systems
Payer Claims Data
Consumer Data Patient -Entered Data
Source: Advisory Board Company research and analysis.
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Emerging Population Health IT Approach
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Data and Analytics
Workflows—Care Team, Network Managers, and Financial Managers
Independent Providers
Affiliated EMR Systems
Payer Claims Data
Consumer Data Patient -Entered Data
Source: Advisory Board Company research and analysis.
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Emerging Population Health IT Approach
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Data and Analytics
Workflows—Care Team, Network Managers, and Financial Managers
Independent Providers
Affiliated EMR Systems
Payer Claims Data
Consumer Data Patient -Entered Data
Source: Advisory Board Company research and analysis.
©2013 T
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Emerging Population Health IT Approach
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Data and Analytics
Workflows—Care Team, Network Managers, and Financial Managers
Independent Providers
Affiliated EMR Systems
Payer Claims Data
Consumer Data Patient -Entered Data
Source: Advisory Board Company research and analysis.
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