Welcome

Creating cost and outcomes transparency to enable superior value-based care at Providence St. Joseph Health

Ari Robicsek

Chief Medical Analytics Officer

Providence St. Joseph Health

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Agenda

• Our burning platform

• Value Oriented Architecture

• Demo

• Outcomes

• Next Steps

829CLINICS

23kPHYSICIANS

1.9mCOVERED LIVES

90NON-ACUTESERVICES

HIGH SCHOOL, NURSING SCHOOL AND UNIVERSITY

50 HOSPITALS

106kCAREGIVERS

14SUPPORTIVE HOUSING FACILITIES

Introduction

4KCaregivers

65%Pop. Served

and 16K shared services caregivers

25KCaregivers

14%Pop. Served 15K

Caregivers

36%Pop. Served

34KCaregivers

40%Pop. Served

5KCaregivers

29%Pop. Served

Communities we serve….

Our Burning Platform

Estimate of direct cost coverage of Medicare

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Limitations of traditional unit costing

• Baseline clinician resistance to the idea of administrators ‘telling them how to practice medicine’

• DRGs often don’t define clinical cohorts in a way that makes sense to clinicians (e.g. grab-bags

like ‘SEPTICEMIA OR SEVERE SEPSIS’, ‘ESOPHAGITIS, GASTROENT & MISC DIGEST

DISORDERS’)

• Attribution is a real concern where many clinicians are involved

• “My patients are sicker”

• Services are often not organized in a way that makes sense to clinicians

• Statistical significance is often not taken into account; results easily skewed by a few patients

• Clinical outcomes are not part of the conversation (it’s about cost rather than value)

Design philosophy

1. This is about value, not just cost.

2. Platform allows rapid exploration for good and bad performance, and easy drill-down into the specific derivers of performance.

3. Statistical tools call out areas of focus.

4. Cohort selection and risk adjustment allow apples-to-apples comparisons that clinicians believe.

5. Strong data presentation helps clinicians recognize specific practices that would benefit from standardization.

Value Oriented Architecture

Better

Better

Better

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Normalizing cost

25

Cost normalization example: OR Time for elective CABG

Level 2

Level 1 (Major Activity Group)

Assembling a hierarchy

Level 3

Level 2

Level 1 (Major Activity Group)

Assembling a hierarchy

Level 3

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Value Oriented Architecture Schematic

PremierPress-

GaneyTonic

EpicRegistries w/Risk

Models

Cost

Normalization

Intuitive

Hierarchies

Statistical

Engine

Outcomes we really care about

Specialized tools: Natural Language Processing (NLP)

1 level fusion

Demo

Specialized tools: ‘Sniffer’

Reference cost

Outcomes

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$0 $100 $200 $300 $400 $500 $600 $700 $800

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Surgeon's average bone cement purchase cost / case

Bone Cement cost distribution among surgeons with 100+ casesPrimary unilateral total knee replacement, 2014-2016; n=20,000

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Surgeon's average bone cement purchase cost / case

Bone Cement cost distribution among surgeons with 100+ casesPrimary unilateral total knee replacement, 2014-2016; n=20,000

Avg cost/case: $163Infections: 0.11%

Avg cost/case: $395Infections: 0.17%

Avg cost/case: $603Infections: 0.31%

Average bone cement cost/caseElective, Unilateral, Primary Total Knee Replacement

$265

$189

Impact:

$76 /case reductionin bone cement

Sources of variation discovered

• Room and Board (range: $663 – $2,231)

• Supplies (range: <$50 – $1,510)• Aquamantys Sealer (used routinely by 6 high-volume surgeons for TKA;

$500/case)

• Implants (range: $3,279 – $5,729)• Femoral component (range: $1,600 – $2,200)• Tibial component (range: $ 825 – $1,600)• Use of antibiotic-impregnated cement• Use of stems ($1,000/case; 3 surgeons use it >20% of the time)

Total Knee Replacement, 2016, no fracture, all DRG; only included surgeons with 50+ cases in 2016

Sources of variation discovered

• OR/anesthesia (at Swedish-FH, range is $1,780 – $2,853)

• Labs (range: $10 – $307)• Use of pathology• Frequency of CBCs• Blood typing, antibody testing during hospitalization

• Medications (range: $108 – $755)• Tisseel (4 surgeons, $450/case), Tranexamic acid (among doctors who use

it routinely, its cost ranges from $7 – $249/case)• Liposomal bupivacaine (10 surgeons, $290/case), Ropivacaine infusion (16

surgeons, $280/case)

Total Knee Replacement, 2016, no fracture, all DRG; only included surgeons with 50+ cases in 2016

Average total cost/caseElective, Unilateral, Primary Total Knee Replacement

$8,907

$8,610

Impact:

$297reductionin case cost

Q1 Results by region (Providence)

Impact:

Bending thecost curve

Next Steps

Coming soon

• Tableau-R statistical integration

• Episode-of-care analytics

• Dashboard user data entry

EXTRA SLIDES

Year over year cost variation

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ari.robicsek@providence.org