HealthBridge is one of the nation’s largest and most successful health information exchange organizations. An Overview of HealthBridge’s Shared Data Analytics

HealthBridge is one of the nation’s largest and most successful health

information exchange organizations.

An Overview of HealthBridge’s

Shared Data AnalyticsInfrastructure

Randy Woodward

Director, Business Intelligence Systems

March 16, 2012

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“Best of Breed” Partners

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Enterprise Master Patient Index (eMPI)

IBM’s Initiate™

Clinical & Claims Data Repository & Clinical Analytics

PluralSoft’s CareQuotient™

Semantic Data Normalization

Clinical Architecture’s Symedical™

Claims Data Grouping Engines

OPTUMInsight’s Symmetry™

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Initiate™by

IBM

Overview

Proven Patient and Provider data models

Configurable identity matching algorithms and matching thresholds, by data source

Efficient data stewardship, governance, and data quality resolution tools

Enables collaborative data stewardship

Alerts for data quality issues

Custom business rules

Tools to locate and correct duplicates

Tools to identify and resolve potential duplicates and links

Tools to identify and resolve patient data quality issues via pre-configured analytics

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IBM - Initiate

Proven standards-based integration

Integration toolkit for loading patient data

HL7 v2 and HL7 v3 support

Web Services in support of SOA environments

Support for Integrating the Healthcare Enterprise (IHE) HL7 v2 & v3 Profiles:

o Patient Identifier eXchange (PIX)

o Patient Demographic Query (PDQ)

o Audit Trail and Node Authentication (ATNA)

o Patient Admission Management (PAM)

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IBM - Initiate

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Symedical™by

Clinical Architecture

Overview

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Clinical Architecture - Symedical

Free-standing semantic normalization tool

Critical capability to improve interoperability, and enable aggregation of disparate data sources – operates across all data structures

“Out-of-the-box” mapping includes LOINC, RxNORM, CPT, ICD-9/10, NDC

Supports namespace and site specific terminologies

Maps in advance when terminologies are known

Maps terms dynamically at run-time when they're not known

Monitors and manages multiple maps remotely with powerful workflow tools

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Clinical Architecture - Symedical

Mapping algorithms that learn

Recognition of new and changed terms and workflow tools to manage

Leverage configurable algorithms to fine tune results

Role / Site based user security

Fully audited environment

“Rosetta Stone” – Enables terms to be mapped to/from standard and non-standard lexicons

Application: EPIC to EPIC translations (e.g., Hospital A lab test catalogue to or from Hospital B lab test catalogue utilizing LOINC coding as the common link)

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CareQuotient™by

PluralSoft

Overview

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Highly flexible DIMENSIONAL model for storing conformed/normalized data

Can store non-coded data and later transform that data when translation maps are available

Optimized data structure for reporting and aggregation

Extensible data model, supports the addition of future data requirements and related reporting

Platform for data marts & OLAP cubes

Data model supports clinical & claims data

PluralSoft - CareQuotient

Information Domains

People & Organizations

Lab Orders & Results

Medications & Prescription Information

Patient

Provider

Payer

Staff

Facility

Immunization

Radiology & Documents

Referrals & Authorizations

Medical Conditions (Allergies, Family-social-medical history)

Encounters

Appointments

Master Data (ICD, CPT, DRG, HCPCS, CCS, CRG …), Geography

Revenues (Charges, Grants ..)

Products

Member Enrollment

Medical & Rx Claims

Revenue (Ins. Billing)

Utilization

Provider PayerLegend:

Clinical Observations & Vital Signs (EHR Template/Flow Sheets )

Expenses (Payroll, Supplies, Infrastructure, …)

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14 chronic disease conditions and preventative care measures:

Diabetes Asthma Hypertension Ischemic Vascular Disease (IVD) Coronary Artery Disease Congestive Heart Failure Chronic Pain Depression Tobacco Use Cessation Counseling and Advice Breast Cancer Prevention Cervical Cancer Prevention Colon Cancer Prevention Childhood Immunizations Preventive Care and Screening

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264 clinical measures including HEDIS, NQF, and PQRI

Clinical measures can be customized

360 standard reports & dashboards

Standard reports & dashboards can be customized

Leverages existing investments in hardware and software infrastructure

Built on the Microsoft Business Intelligence stack

Diabetes Measures – Sample Chronic Disease - Physical health

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Diabetes Measure Drill Through - Sample

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Patient Scorecard – SampleManaging Comorbidity (physical & mental) + Preventive Care

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Provider Scorecard – SamplePerformance across physical & mental health, Chronic & Preventive Care

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Symmetry™ by

OPTUMInsight(formerly Ingenix)

Overview

Symmetry Suite

Universal language and business standard for health care analytics in the marketplace

Only product suite in the market providing comprehensive health care analytic solutions through “component” engines on an integrated platform

A complete toolkit for health care management and analytics

Clinical ResourceMeasurement

Risk Assessment andPredictive Modeling

QualityMeasurement

ERG EBMConnect

ETGPEG

PCQ Connect

Provider Measurement & Engagement

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Episode Treatment Groups

Episode Risk Groups

Procedure Episode Groups

EBM Connect

PCQ Connect

Symmetry Suite – common analytics platform for: Care quality improvement Care cost management Physician performance

ratings Minimized total cost of

ownership Industry recognized common

methods and analytics 8 of top 10 health plans 20 of top 25 health plans 24 BCBS plans

Transparent, not a Black Box Flexible for your needs

Symmetry Suite

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Episode Treatment Groups (ETGs)

Episode Treatment GroupsClaims data• Diagnosis codes• Drug codes• Procedure codes Claims data,

grouped by episode

Episode Treatment Groups Foundation for clinical resource

use and efficiency analyses analysis by episode to support:

Transparency Health care measurement Incentives for increased value and

high quality care

Organize health care data (experience) into episodes of care related to the treatment of a medical condition for a given patient

The market leading episode of care grouper

Over 200 health plans and other health care organizations covering over 160 million individuals

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Episode Risk Groups (ERGs)


grouped by episode

Episode Risk Groups Population-based health risk

assessment

Predict current and future health care usage for individuals and groups

Predicts a member's current (retrospective) and future (prospective) need for health care services and associated costs

Clinically-relevant – robustly prioritize multiple conditions and co-morbidities

Adoption Over 100 health plans and other

health care organizations covering over 115 million individuals

Episode Risk Groups

Risk score for each individual

Administrative• Age, gender

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Evidence Based Medicine (EBM Connect)

EBM Connect

Claims data• Diagnosis codes• Drug codes• Procedure codes

Administrative• Enrollment records• Laboratory results• Disease registry

Members who qualify for EBM conditions and their compliance

EBM Connect Foundation for quality measurement:

assesses compliance of delivered care with evidence-based medicine and care guidelines

Identifies gaps between clinical evidence and health care practice

Unnecessary or potentially harmful diagnostic tests or treatments

Patients with indications of poor disease control

Potentially harmful drug-to-drug or drug-to-disease interactions

Identifies both high-performing physicians and areas to recommend improved physician compliance with prescribed care

Adoption 30 Health plans and other health care

organizations covering over 100 million individuals

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Procedure Episode Groups (PEGs)


grouped by episode

Procedure Episode Groups Industry-first foundation for

enhanced analysis by procedure to support

Transparency Provider measurement Incentives for increased value

and high quality care

Analyze the cost and quality of surgical providers, procedures, and related services

Procedure Episode Groups

Risk score for each individual

Procedure codes• CPT• HCPCS• NUBC

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Provider Cost & Quality (PCQ Connect)

Episode Treatment GroupsClaims data• Diagnosis codes• Drug codes• Procedure codes

Claims data, grouped by episode

EBM Connect

Members who qualify for EBM conditions and their compliance

PCQ ConnectPeer Groups• Attributed episodes of care,

by severity group• Attributed quality measures

– EBM conditions and compliance

Administrative• Enrollment

records• Laboratory results• Disease Registry PCQ Connect

Foundation analysis for physician measurement

Network management Transparency Tiering P4P Centers of excellence

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Adjust for Severity Provides multiple methods to reflect underlying differences

in the types of cases addressed and the severity of a patient’s condition

Manage outliers Provides different methods to identify outliers, and the

ability to include, exclude, or set the cost to the threshold value to account for and treat outlier episodes appropriately

Define peer groups Provides standard methodology for creating peer groups

within the same region and specialty Attribute properly

PCQ Connect correctly attributes the right cost and quality measures to the right provide

Advantages of PCQs

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Symmetry Applications

Business Application

ETG PEG ERG EBMConnect

PCQ Connect

Provider Performance Measurement

Disease / Care Management

Member / Population Risk Assessment

Financial Performance and Trends

Providers, Employer Groups, and Consumer Information Sharing

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Thank You!