Visualize Your Data with Analytics - NextGen Healthcare · Visualize Your Data with Analytics 300 CME/CNE. ... laws, including statements concerning future prospects, events, developments,

Monday – November 2, 2015 – 2:00 PM – 3:15 PM

Visualize Your Data with Analytics

Topic

Level

Presenter(s):

Bob Dichter - Senior Director, Product Mgmt, Population Health

Stephen Albuquerque – Director of Data Analytics, R&D Mirth

Visualize Your Data with Analytics

300

CME/CNE

Safe Harbor Provisions/Legal Disclaimer

This presentation may contain forward-looking statements within the meaning of the federal securities laws, including statements

concerning future prospects, events, developments, the Company’s future performance, management’s expectations, intentions,

estimates, beliefs, projections and plans, business outlook and product availability. These forward-looking statements do not

represent a commitment, promise or legal obligation to deliver any material, code or functionality. The development,

release and timing of any features or functionality described for our products remains at our sole discretion. Future

products developed beyond what is contemplated by existing maintenance agreements, will be priced separately. This

roadmap does not constitute an offer to sell any product or technology. We believe that these forward-looking statements

are reasonable and are based on reasonable assumptions and forecasts, however, undue reliance should not be placed on such

statements that speak only as of the date hereof. Moreover, these forward-looking statements are subject to a number of risks and

uncertainties, some of which are outlined below. As a result, actual results may vary materially from those anticipated by the

forward-looking statements. Among the important factors that could cause actual results to differ materially from those indicated by

such forward-looking statements are: the volume and timing of systems sales and installations; the possibility that products will not

achieve or sustain market acceptance; the impact of incentive payments under The American Recovery and Reinvestment Act on

sales and the ability of the Company to meet continued certification requirements; the development by competitors of new or

superior technologies; the timing, cost and success or failure of new product and service introductions, development and product

upgrade releases; undetected errors or bugs in software; changing economic, political or regulatory influences in the health-care

industry or applicable to our business; changes in product-pricing policies; availability of third-party products and components;

competitive pressures including product offerings, pricing and promotional activities; the Company's ability or inability to attract

and retain qualified personnel; uncertainties concerning threatened, pending and new litigation against the Company; general

economic conditions; and the risk factors detailed from time to time in the Company’s periodic reports and registration statements

filed with the Securities and Exchange Commission.

Getting to know the audience

• Where do you practice?• < 10 provider group

• 10 – 29 provider group

• 30+ provider group

• Other

• ACO?• Current

• Less than a year

• Over a year

• Not in the plans

• Bundled Payments?

What are your Analytics Needs?

• Clinical Measures

• Cohort Management

• Comparative Physician Performance

• Financial Measures

• Leakage and Referral

• Other

Healthcare Industry is Evolving

Drivers of Health Market 2.0

Rise of Value

Based Care

Acceleration of

Consumer

Powered Health

Delivery System

Restructuring

New Economic

and Clinical Models

New Customer and

Competitive

Landscape

Fundamental Shifts Resulting Market Dynamics

1

3

© Oliver Wyman Group

2

3

A

B

Value-based healthcare

Healthcare tomorrow

“Patient-centered, high value population management”

Redefine care delivery and patient

experience around clinical and financial

outcomes

1

Physicians drive shift from one-size-fits-all to

population-health approach, aligning

resources to meet patient needs

3

Care becomes adaptive process driven by

analytics that power robust decision tools to

support care team and patients

4

2 Focus on patient-focused care that is

collaborative, evidence-based and

coordinated across continuum of care

Redistributes revenues and profits amongst

incumbent and new players resulting in new

profit levers and leadership needs

5

Coaching

Medication

Management

E-health/

Web-

Based

Services

Convenience

Clinics

Weight

Management

Home

Services

Monitoring

Lifestyle/

Wellness

Social/Mobile

Physician

CaseManager

Extenders

Behavioral Health

Navigators

Social worker

Nutritionist

Pharmacist

Shifts focus from volume of services to patient outcomes achieved

Quality/Cost for Populations and Individuals

Public PolicyAway from FFS to Population Health

So…what is Population Health?

A report in 2012 by the Institute for Health Technology Transformation (iHT2)

provides a relatively good framework for the components that should be

included in a complete solution (http://ihealthtran.com/pdf/PHMReport.pdf).

It also provides a pragmatic definition of population health:

“The federal Agency for Healthcare Research and Quality (AHRQ)

has developed a concept called “practice-based population

health” (PBPH). It defines PBPH as “an approach to care that uses

information on a group of patients within a primary care practice

or group of practices to improve the care and clinical outcomes of

patients within that practice.” Other observers also define the

population as a provider’s patient panel.”

http://ihealthtran.com/pdf/PHMReport.pdf

Data & Analytics

Referrals and network management

Patient relationship Care Delivery & Coordination

Revenue and practice management

A successful independent ambulatory group of the

future will have a whole new set of capabilities

I know my patient

and own the patient

relationship

Wellness andPrevention

I provide convenient and

accessible care

I monitor my

patients

remotely and

can predict

health events

before they

happen

I enable my

patients to

engage with

their own health

I can effectively

prioritize and triage

care

I use evidence-based

medicine and guidelines

to provide care

I manage my revenue

across a wide variety of

contract types

I manage my

clinical and

administrative

workflows on my

iPad as I work

I run Smart

Care teams

with adaptive

workflow

systems

I treat hospitals as

commodities and try

to limit use of these

contracted services

I facilitate direct

patient payment and

management of

patient financial risk

I have

integrated cost,

quality and

experience

measurement

Care teams will be deployed to proactively and holistically

manage patient health based on individualized care plans

Complex Adaptive Workflow

Personalized Health Itinerary

Intuitive engagement model

Real time biometric

and daily living

information

Value based acute and

complex care services

Personalized connected

relationship

Smart care

teams partner

with consumers

to navigate and

coordinate

acute and

complex care

Smart Care

Team

A Personalized

Ecosystem

Communication

platform

Biosensors and

monitoring

Predictive

insights engine

Weight

management

Stress

management

Nutrition

management

Genomics and

advanced diagnostics

Smart

clinics

Retail

pharmacy

clinics

Coaching

Telehealth

Physical in

the community

resources

Virtual health

resource

access

Better living

programming

IT

enablement

engines

Shared longitudinal

and collaborative

health record

Care teams needed for population health

7

How Fast?

2014 2015 2016 2017 2018 2019 2020

$0.6 TNMedicare

$0.4 TN

$0.2 TN

Managed Medicaid$0

$0.8 TN

$1.2 TN

$1.0 TN

$1.4 TN

$1.6 TN

$1.8 TN

$2.0 TN

2013

U.S. Value Market Opportunity by Funding Source2013-2020, based on OW projections of choice, incentives, and access to value-based providers

$1.9 TN in 2020

(46% of total spend)

Tipping point

Innovative employers

Individuals & exchange

Duals

Value market tops

30% of the total

6

© Oliver Wyman Group

The market is projected to hit a tipping point shortly after 2016, with more than 30% of

U.S. healthcare spend linked to value-based reimbursement

ACO Landscape Today

Medicare FFS beneficiaries attributed to an ACO

Population Health

Management

Improvement Chronic Disease Mgmt

Reduction Healthcare

Waste

High Risk Patient

Mgmt

Care Standards

Compliance

Changing Reimbursement

Longitudinal Med Record

Mgmt

Top 6 Drivers shaping PHM

1.Improvement in Chronic Disease

Management

2.Reduction in Healthcare Waste

(Unnecessary Procedures, Duplicate

Tests, PAA and Ed visits)

3.Identification and Management of High

Risk Patients

4.Improvement in Compliance with

Standards of Care

5.Changing Reimbursement

• Shift from Fee-For-Service to Value-

based Reimbursement

• Managing Risk with Payers (including

ACO)

6.Improvement in Managing Patient’s

Longitudinal Medical Record (including

home monitoring)

PHM to Improve Collaborative Care

Comprehensive PHM involves:

1. Identifying patients at risk & with gaps in care

2. Managing risk thru chronic care mgmt.

3. Improving clinical outcomes & patient satisfaction

4. Engage patient for proactive care

5. Reducing cost

© eHealth Initiatives Population Health Survey – Oct 2015

Support for PHM


PHM Approach


Supporting Data % Analytics


Uses of Analytics


Analytics are …


Key Takeaways

Who are your patients and how to manage?

Range of Function for PHM

Comprehensive PHM Solution

Foundation

• Data Aggregation & Normalization

• Analytics

• Clinical

• Financial

• Operational

Rule-based Workflows

• Patient Outreach

• Care Management

• Point-of-Care (EHR)

• Referral Management

Patient Engagement

Patient Engagement

Rule-based

Workflows

Patient Outreach

Care Management

Point-of-Care (EHR)

Referral Management

Data Aggregation

Analytics

Clinical

Financial

Operational

Data Normalization

Analytics as the Catalyst

Analytics is the Catalyst for effective PHM, turning data into action:

• Clinical, Financial and Administrative analysis

• Risk stratification & identification of gaps in care

• Segmentation into appropriate cohorts – understand our panel

• Comparative analysis and benchmarking

• Network utilization – where is the leakage?

• Financial analysis – where are spending money?

• Actionable Workflows for Care Management, Outreach & Referral powered by analytics

Introducing Mirth Analytics

Part of Enterprise-wide

Collaborative Care Solution from NextGen

Architecture Overview

Sources

NextGen Ambulatory

OthersHL7, XDS, CCLF etc

CDR(Results)

Mirth ConnectClinical/Claims

Periodic Data Load

Analytics(Staging)

Analytics(Reporting)

Build Your Own BI

Computations Aggregations

Technology StackDatabase : PostgresData Integration : PentahoScheduler : RundeckUI : Angular & Node Js

Risk and Performance Management, Population Analysis,

Provider Management, Ad hoc Reporting

NG ShareClinical/Claims

AdhocReporting

Gennius - Analytics Engine

a. Powerful measures analysis engine that allows healthcare delivery organizations (HODs) to identify outliers (organizations, physicians and patients) against benchmarks and take actions at the right time to close gaps in care and improve clinical performance.

b. Versatile risk analysis engine that can use clinical and financial data to allow HODs analyze key financial indicators to identify and manage network leakage and improve financial performance.

c. Flexible population analysis engine that allows healthcare providers (physicians, nurses and care managers) to find high risk patients (frequent flyers) to proactively manage care and improve standards of care and reduce healthcare waste (readmissions and ED visits).

Provider Comparative Analysis

Initial Release Key Features

System Foundation (Data Aggregation, Centralized Data Repository, Security & User Roles, Audit , Measures Engine)

Clinical, Financial (CCLF) data processing

Clinical Performance Analysis (ACO-26) with Missed Patient List

Risk and Provider Performance Analysis (In/Out Network, Inpatient, ED, Procedure & Drugs Utilizations)

Population Analysis (Patient Categorization by Major Disease Conditions )

KPI & Trend Analysis

Ad hoc Reporting

Clinical Performance Analysis – CMO View

Mirth Group Mirth Practice

CMO

Practice Level

Compare Peers

Peer Comparison

Compare Peers for selected measure

Clinical Performance Analysis – Provider View

Physician

Select Measures

Drill-down to

Missed Patients

Sortby

% Towards Goal

Legend

Missed Patient List

ViewPatient Face-sheet

Drill-down To

Measure Met Patient List

Patient Face-sheet - 1

Continued Next Slide

Scroll down

Clinical Data



Scroll down

Patient Activity Financial Data


Pharma Charges Data

Chargesby

Care Settings

Population Analysis – Provider’s Panel

Single-click filtering

by Major Condition Category

Normalized Patient Count

In/Out NetworkSpend

View Patient Face-sheet

Claims Reveal Breath of Information

Understanding Leakage with Claims Data

Out/In Network Charges & Patient Count

Default Sortby

Out of Network $

Top 20 PCP by

Out of Network $

View Provider Synopsis

CMO

Percentage Out of Network

Default Sortby

Total Patients

Top 20 PCP by

% Out of Network


Provider Synopsis - 1


Scroll down

Normalized Financial

Data



Scroll down

Charges by

OON Service Org

Charges by

Procedure


Charges by

Patient Demographic

Charges by

Major Condition Category

Leakage by Organizations

Default Sortby

Charges

Top 20 OON Organizations

by Charges

Leakage by Providers

Default Sortby

Charges

Top 20 OON Providers

by Charges

Admissions Normalized Stats

Default Sortby

Admits Charge PMPM

Top 20 PCP by

Admits Charge PMPM


Predictive Analysis by Leveraging Milliman

Industry Leading Brand

• Known for technical acuity

• Offers intelligent, independent analysis to help clients cost-effectively manage their businesses or populations without compromising quality of care

• Expertise derives from the diverse backgrounds of their consultants, who include actuaries, clinician professionals, and information technology specialists

Access to Predictive Data

through Incremental Product Releases

Analytics Incremental Releases

Clinical Performance Analysis (Additional Quality Measures: PQRS, HEDIS, UDS, PCMH) with drill-downs

Spend & Utilization Analysis (Detail Spend & Utilization Analysis) with drill-downs

Population Analysis (Patient Cohort Builder & Risk Stratification)

Peer comparison using Blinded Benchmarking

Alerts and Role-based Home Page

Risk & Pre-visit Assessment

Network Referral Optimization Analysis

Measures Submission using Certified Submission Agent

Analytics Incremental Releases

Home-Monitoring Data Analysis

Patient Outreach Analysis

Predictive Modeling

Road Ahead: Analytics Enabled Workflows

Patient Outreach

- Letter Printing

- Voice Reminders

- Texting

- Emailing

- Patient Portal

Care Management

- Basic Workflows (CRM)

- Dashboards

- Work-lists

- Advanced Workflows

- Care Plan Documentation

Road Ahead: Analytics Enabled Workflows

Point-Of-Care Integration

- EHR Integration

- Gap-in-care Alerts

- Daily Huddle & Task Mgmt

- Referral Management

- Using HISP & EHR workflow

Patient Engagement

- Basic

- Patient Portal

- Patient Satisfaction Survey

- Advanced

- Mobile App & Multiple form factors

- Centralized Appointment Scheduling

- Patient Education

Questions?

Session Survey

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Thank You!

Documents

Visualize Your Data with Analytics - NextGen Healthcare · Visualize Your Data with Analytics 300 CME/CNE. ... laws, including statements concerning future prospects, events, developments,