DATA-DRIVEN CARE: THE KEY TO ACCOUNTABLE CARE DELIVERY FROM A PHYSICIAN GROUP PERSPECTIVE

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Hospitals, payers and physician groups alike are facing changes in healthcare that require their attention. These changes are a result of financial forces that are changing the ways healthcare services are paid, cost of care pressures, ever-changing patient population behaviors, improvements in the science of health care and federal regulations tied to incentives that are soon turning to penalties. Anyone in health care is grappling to understand these changes and chart their strategies to be prepared for the future. The presenters have proven expertise developing their strategies to care for patients in an accountable care model using data to drive their strategies. The presenting organizations will talk through their strategy including their future expectations and early results using data to identify improvement opportunities and to shift the clinical approach to health care. In addition to strategy, they will share solutions and analytic applications critical to the current and future expected results of their strategy.

Text of DATA-DRIVEN CARE: THE KEY TO ACCOUNTABLE CARE DELIVERY FROM A PHYSICIAN GROUP PERSPECTIVE

  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright 2014 Health Catalyst www.healthcatalyst.comCreative Commons Copyright Dr. Greg Spencer & Luke Skelley Data Driven Care: The Key to Accountable Care Delivery from a Physician Group Perspective
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Todays Agenda Why a regional physician group is heavily investing in analytics and data warehousing Crystal Run Healthcares strategy to turn data into improved care as well as financial viability in the future How Crystal Run manages across its patient population who are covered by 24 payer entities Some of the preliminary challenges and successes engaging clinicians in the use of data The importance of an adaptive data architecture to turn clinician questions into actionable results
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright POLL QUESTION #1 What best describes the group you belong to? Health Plan Physician Group Provider Organization Vendor Other
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Healthcare Physician owned MSG in NY State, founded 1996 300+ providers, 16 locations Joint Venture ASC, Urgent Care, Diagnostic Imaging, Sleep Center, High Complexity Lab, Pathology Early adopter EHR (NextGen) 1999 Accredited by Joint Commission 2006 Level 3 NCQA PCMH Recognition 2009, 2012
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Healthcare Single entity ACO April 2012: MSSP participant December 2012: NCQA ACO Accreditation 25,000 commercial lives at risk MSSP 10,400 attributed beneficiaries 82% primary care services within ACO
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Healthcare The mission of Crystal Run Healthcare is to improve the quality and availability of, and satisfaction with, health care services in the communities we serve. To accomplish this goal, the practice emphasizes both traditional medical excellence as well as responsiveness to consumer needs through service excellence and patient empowerment.
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright The Goal: The Triple Aim Improve the health of the population Enhance the patient experience of care Reduce, or at least control, the per capita cost of care
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Strategy and Objectives Embrace goals of Triple Aim Physicians play a crucial role in driving change in healthcare Focus on providing coordinated care Population health management is critical Competition from hospitals and health plans is occurring Coverage area is expanding, and needs to expand further Physicians and their teams need to work together for the best of their patients A strategic pillar is to be the practice of choice for physicians, patients, and employees
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Governance Model Establish data warehouse priorities Set policies for data access, information security and privacy Develop process for setting data definitions and standards Coordinate with Partners eCare leadership JOINT CLINICAL AND FINANCIAL GOVERNANCE MODEL Hal Teitelbaum, MD, JD, MBA Managing Partner & CEO MichelleA. Koury, MD Chief Operating Officer Greg Spencer, MD Chief Medical & Chief Medical Info Officer Mary DeFreitas Chief HR Officer Erlene Washington Senior VP of Finance &Accounting EDW EXECUTIVE SPONSORS Greg Spencer, MD CMO & CMIO Jonathan Nasser, MD Medical Director Miguel Hernandez Technology Director Lou Cervone BI Director EDW Steering Committee EDW GOVERNANCE
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Care Management Strategies Embedding Care Managers at different offices, medical homes and hospitals Identify high-risk patients from registries and PCP/ team referral Implement evidence based protocols Use EHR and mobile / home devices
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Quality Structure 27 divisions each headed by its own physician specialist Manage quality efforts and information Work with Best Practice Council (quality committee) to define registries Report to practice-level committee for quality and patient safety
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright 2014 Health Catalyst www.healthcatalyst.comProprietary and Confidential 12 Why Crystal Run is heavily investing in analytics and data warehousing
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright POLL QUESTION #2 If you are a health plan, physician group, or provider organization, do you currently exchange clinical and claims data with these other constituents?
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Data Analytics Strategy Implementing formal quality improvement methodology Implementing EDW with multiple data sources Implementing analytical applications Daily financial reporting Order tracking: In-house vs. Sent out Claims Data Integration RVUs Standardization
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Analytics Current State Quality improvements heavily dependent upon data Using simple analytical tools Excel, Access, Tableau Time and effort spent on manual data entry and extraction is excessive and poorly scalable Decisions about what data to use based on amount of disruption vs. value Data entry/analysis not done at Top of Licensure Reporting quality metrics resource intensive kept it simple
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Physician Dashboard
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Physician Dashboard
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright 2014 Health Catalyst www.healthcatalyst.comProprietary and Confidential Turning data into improved care & ensuring financial viability in the future
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Dr. J. 15 Cases $60,000 Avg. Cost Per Case Mean Cost per Case = $20,000 $40,000 x 15 cases = $600,000 opportunity Total Opportunity = $600,000 Total Opportunity = $1,475,000 $35,000 x 25 cases = $875,000 opportunity Total Opportunity = $2,360,000 Total Opportunity = $3,960,000 Cost Per Case, Vascular Procedures Physician Variation Analysis
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Crystal Run Results Reduced hospital admissions 4+% in one year Improved mammogram rates from 60-65% to greater than 75% Achieved less than 9% rate of A1Cs > 9 Blood pressure control in hypertensive patients improved to greater than 75%.
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Improved Quality Breast Cancer Screening Mammography 66.0% 67.0% 68.0% 69.0% 70.0% 71.0% 72.0% 73.0% 74.0% 75.0% 76.0% 1st Quarter 2011 2nd Quarter 2011 3rd Quarter 2011 4th Quarter 2011 1st Quarter 2012 2nd Quarter 2012 3rd Quarter 2012 4th Quarter 2012 1st Quarter 2013 2nd Quarter 2013 3rd Quarter 2013 CRHC Results NCQA Goal
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Outcomes: Avoidable Admissions#AvoidableAdmissions 17% 0 10 20 30 40 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Avoidable Admissions Monthly Quality Trend
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Outcomes: Readmissions 16.50% 17.00% 17.50% 18.00% 18.50% 19.00% 19.50% 20.00% Q2-2012 Q3-2012 Q4-2012 Q1-2013 Q2-2013 Q3-2013 CRHC Linear (CRHC) 30 Day Readmission Rate for Medicare
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Total cost difference 2012 pre-pathway 791 patients $595,920 2013 post-pathway 817 patients $368,160 TOTAL COST SAVINGS $227, 760 PEG-filgrastim use in Breast cancer patients (equalized as cost per patient treated)
  • 2014 Health Catalyst www.healthcatalyst.com Creative Commons Copyright Reducing Pharmaceutical Costs $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 Physician A Physician B Physician C Physician D Average PEG Filgrastrim cost per patient before and after breast cancer pathway