An Electronic Dashboard For Improving the Quality of Health Care and for

Decreasing the Cost of health Care

Stephen A. Kardos D.O.

Stimulus For Dashboard Development

Rising Health care expenditures Failure of existing methods to stabilize and reduce

medical expense• Insurance

• Government programs

• Doctors and hospitals

• Limited access provider networks

• Disease Management Companies

Lack of available information for precise medical interventions to improve health status improvement

HistoryHistory

Challenge Solution Challenge Solution

Disparate systems Outlier management Business block management Care determined by benefits

No leveraging of information Emphasis on process Emphasis on network

discounts

Single relational database Population management Individual client management Need for care is independent

of benefits Leveraged information Emphasis on outcome Emphasis on Care

Management

HistoryHistory

Logic derived from medical practice standards Published US standards of care (ADA, AHA,

other) Single flexible software program that allows

multiple preventive health and disease states to be managed (“Excel” spreadsheet for Health)

Technology-Driven “Dashboard”• Automated Integration of:

• Claims data• Clinical data• Pharmacy data• Laboratory data

Algorithm EvolutionAlgorithm Evolution

Care ManagementDefinition

Care ManagementDefinition

• Stratification of medical risk in each population• Clinical guidelines• Wellness• Preventive • Disease management• Case management• Utilization review• Predictive modeling• Prescription drug management• Plan design

Care Management is the convergence of multiple medical tactics properly applied to specific populations including:

DrugDoseDoctorDateCost

DiagnosisProcedureDateCost

BPHeightWeight

Hgba1-cUrine ProteinElectrolytesCost

PHARMACY CLAIM LABORATORY DATACLINICAL DATA MEDICAL CLAIM

TRIVERIS DOCTORS NURSES STATISTICIANS EPIDEMIIOLOGISTS ADVOCATES

TRIVERIS DOCTORS NURSES STATISTICIANS EPIDEMIIOLOGISTS ADVOCATES

EMPLOYERS / INSURERS

PLAN MEMBERSHEALTH CARE

PROVIDERS

Computer System Integration of Claims Payment & Care Management

Computer System Integration of Claims Payment & Care Management

Step 1 Derivation of Wellness Disease Records (WDR)

MemberMember

Clinical dataClinical data

Claims dataClaims data

Pharmacy dataPharmacy data

Test results data Test results data

WellnessWDR 1

WellnessWDR 1

Diabetes Type IWDR 2

Diabetes Type IWDR 2

Care ManagementHealth Improvement Tracking System

Care ManagementHealth Improvement Tracking System

OtherWDR 3Other

WDR 3

Eye ExamMQR

Eye ExamMQR

HgA1cMQR

HgA1cMQR

BPMQRBP

MQR

Lipid ControlMQR

Lipid ControlMQR

Step 2 Current medical care management compared to Minimum Quality Requirement (MQR)

Diabetes Type IWDR

Diabetes Type IWDR

Clinical dataClinical data

Claims dataClaims data

Pharmacy dataPharmacy data

Test results data Test results data

Care ManagementHealth Improvement Tracking System

Care ManagementHealth Improvement Tracking System

Eye ExamMQR

Eye ExamMQR

HgA1cMQR

HgA1cMQR

BPMQRBP

MQR

Control LipidsMQR

Control LipidsMQR

Doctor

Member

Care ManagementCare Management

Step 3 Sharing information for action

Diabetes Type IWDR

Diabetes Type IWDR Care

Management Staff

Care ManagementCare Management

Dashboard Activities

Preventive care Chronic disease management Acute and catastrophic case management Triveris communication to member and doctor

Dashboard Demonstration Slides

Results

Case Study

FEHBP Diabetic Patients(01/98-09/2004)

Case Study

FEHBP Diabetic Patients(01/98-09/2004)

4,8384,838

712712

61.1%

71.171.1

3.63.6

2,9902,990

2002*2002*

3,9323,932

597597

51.2%

70.370.3

3.53.5

2,8692,869

20012001

6.36.34.24.23.63.63.33.32.92.9Claim PMPMClaim PMPM

4,9844,9844,5094,5094,5714,5715,1355,1355,5945,594Bed daysBed days

per 1000 member yrper 1000 member yr

604604602602706706759759816816Hospital admissionsHospital admissions

per 1000 member yrper 1000 member yr

81.0%65.9%48.2%47.8%30.4%HgbA1c Testing

71.671.671.371.369.469.468.868.868.668.6Median AgeMedian Age

2,979 2,979 3,0783,0783,1553,1553,0903,0902,9472,947PatientsPatients

2004200420032003200020001999199919981998

* Un-immunized Influenza Epidemic

Improved Quality-Less Hospital Use-Lower ExpenseImproved Quality-Less Hospital Use-Lower Expense

Case Study

FEHBP Hypertension Patients(01/98-09/2004)

Case Study

FEHBP Hypertension Patients(01/98-09/2004)

127127127127

24242424

30303030

0.570.570.570.57

71.371.371.371.3

7,4267,4267,4267,426

2002*2002*2002*2002*

119119119119

23232323

35353535

0.560.560.560.56

70.670.670.670.6

7,2907,2907,2907,290

2001200120012001

140140140140157157157157167167167167238238238238220220220220Bed daysBed days

per 1000 member yrper 1000 member yr

Bed daysBed days

per 1000 member yrper 1000 member yr

2222222226262626393939394747474741414141Hospital admissions Hospital admissions

per 1000 member yrper 1000 member yr

Hospital admissions Hospital admissions

per 1000 member yrper 1000 member yr

3535353537373737404040403535353537373737ER visits ER visits

per 1000 member yrper 1000 member yr

ER visits ER visits

per 1000 member yrper 1000 member yr

0.620.620.620.620.560.560.560.560.640.640.640.640.590.590.590.590.540.540.540.54Office Visits PMPMOffice Visits PMPMOffice Visits PMPMOffice Visits PMPM

72.072.072.072.071.471.471.471.469.669.669.669.668.868.868.868.868.168.168.168.1Median AgeMedian AgeMedian AgeMedian Age

7,4337,4337,4337,4337,8087,8087,8087,8088,2148,2148,2148,2148,0998,0998,0998,0998,0248,0248,0248,024PatientsPatientsPatientsPatients

20042004200420042003200320032003200020002000200019991999199919991998199819981998

* Un-immunized Influenza Epidemic

Improved Quality-Less Hospital Use-Lower ExpenseImproved Quality-Less Hospital Use-Lower Expense

Case Study

Chronic Renal Failure Patients(01/98-09/2004)

Case Study

Chronic Renal Failure Patients(01/98-09/2004)

15,83015,83015,83015,830

1,9631,9631,9631,963

77.677.677.677.6

9.19.19.19.1

507507507507

2002*2002*2002*2002*

13,79713,79713,79713,797

1,6261,6261,6261,626

76.476.476.476.4

9.09.09.09.0

419419419419

2001200120012001

12.012.012.012.013.013.013.013.08.28.28.28.28.68.68.68.66.86.86.86.8Claim PMPMClaim PMPMClaim PMPMClaim PMPM

971497149714971414,46114,46114,46114,46114,00414,00414,00414,00419,32919,32919,32919,32922,55922,55922,55922,559Bed daysBed days

per 1000 members/yrper 1000 members/yr

Bed daysBed days

per 1000 members/yrper 1000 members/yr

1,5481,5481,5481,5481,5071,5071,5071,5071,7321,7321,7321,7322,0582,0582,0582,0582,0632,0632,0632,063Hospital admissionsHospital admissions

per 1000 members/ yrper 1000 members/ yr

Hospital admissionsHospital admissions

per 1000 members/ yrper 1000 members/ yr

77.477.477.477.477.577.577.577.575.675.675.675.675.575.575.575.574.474.474.474.4Median AgeMedian AgeMedian AgeMedian Age

502502502502522522522522370370370370331331331331288288288288PatientsPatientsPatientsPatients

20042004200420042003200320032003200020002000200019991999199919991998199819981998

* Un-immunized Influenza Epidemic

Improved Quality-Less Hospital Use-Lower ExpenseImproved Quality-Less Hospital Use-Lower Expense

1995

1996

1997

1998

1999

2000

2001

2002

2003

Reserves Admin Expense Claims

Reserves

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

$70,000,000

$80,000,000

$90,000,000

0

A Federal Employee Health Benefit Plan1998-2003

Conclusion

Makes care management possible Efficient Bonds doctors and patients and plan sponsors Improves health status Lowers plan expense

DashboardDashboard