Presentation Template

Report
The Path to Shared Savings With Population
Health Management Applications
Eric Just, VP Technology
Kathy Merkley, RN, VP Clinical Engagement
April 9, 2014
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© 2014 Health Catalyst
© 2014 Health Catalyst
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Accountable Care Organizations &
Shared Savings
•
Healthcare provider organizations responsible for
providing coordinated care for their patients
•
Contract with payers through some form of
shared risk payment model
•
Most payment models include downside risk to
the healthcare providers
•
Payment models reward high-quality, low-cost
care with shared savings
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Population Health Management (PHM)
The Key to Shared Savings
Four Building Blocks of
Population Health Management
1
2
developing
Provider Network
Population
3
the asset
4
Quality Outcomes
Cost Outcomes
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PHM and Accountable Care (AC)
Accountable Care
Financing and
Administration
Population Health
Management
packaging and
marketing the asset
developing
the asset
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What Does Health Catalyst Do?
Platform
●
Enterprise Data Warehouse
“single source of truth”
●
Library of data acquisition
adapters
●
Metadata repository
●
Auditing and access control
●
Supports a variety of
analytic applications
‒ Health Catalyst
‒ Client developed
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What Does Health Catalyst Do?
Applications
Platform
●
Reports & Dashboards
●
Ad-hoc query
●
Registries
●
Quality measures
●
Population health
●
Data mining
●
Clinical improvement
●
Workflow analysis
●
Modeling and predictive
analytics
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What Does Health Catalyst Do?
Services
Applications
Platform
Installation
●
Configuration
●
Data Architecture
Improvement
●
Project Management
●
Clinical Improvement
●
“Lean” Process Improvement
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Application Families
Foundational
Applications
Discovery Applications
Advanced Applications
Encourage broad use
of the data warehouse
by presenting
dashboards, reports,
and basic registries
across clinical and
departmental areas.
Allow users to discover
patterns and trends
within the data that
inform prioritization,
inspire new
hypotheses, and
define populations
for management.
Provide deep insights
into evidence-based
metrics that drive
improvement in
quality and cost
reduction through
managing populations,
workflows, and patient
injury prevention.
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Demos
Foundational Applications
Discovery Applications
Advanced Applications`
EDIT—Executive Dashboard Integration Tool (Key Performance Indicator editable collage from all app categories)
CAFE—Comparative Analytics Framework and Exchange—across Healthcare Systems and National Benchmarks
Population Explorer
Key Process Analysis (KPA)
Patient Satisfaction Explorer
Cohort Builder
General Ledger Explorer
Comorbidity Analyzer
Population Suites
e.g., Ischemic Heart Disease
Population Modules
e.g., CABG, Stent, AMI
Regulatory Explorer
Readmission Explorer
Attribution Modeler
Workflow / Operational Suites
e.g., Acute Medical
Practice Management Explorer Suite
ACO Explorer Suite
Patient Flow Explorer
Workflow/Operational Modules
e.g., ICU, MedSurg, Emergency
Readmission Predictor
Financial Management Explorer
Payment Model Analyzer
Labor Management Explorer
Metric Correlation Analyzer
Rev Cycle Explorer
Patient Flight Plan Predictor
Patient Injury Prevention Suites
e.g., Infection Prevention
Patient Injury Prevention Modules
e.g., CAUTI, CLABSI, SSI
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Demos: How Analytics Drive Shared Savings
Demo 1: Key Process Analysis (KPA). Identify areas of
greatest opportunity for quality improvement and savings
Demo 2: Population Explorer. Identify potential risk by
understanding relative size of disease populations and risk
profiles
Demo 3: Heart Failure. Achieving quality improvement and
cost reductions by directing targeted interventions to high-risk
patients
Demo 4: Community Care. Monitoring high-risk patients in
primary care to prevent expensive acute treatment
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KPA: Clinical Hierarchy
Clinical
Program
Care Process
Families
Care
Processes
CARDIOVASCULAR
Heart
Rhythm
Disorders
Vascular
Disorders
Ischemic
Heart
Disease
Heart
Failure
ACS
AMI
PCI
CABG
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KPA: Measuring Opportunity
Using provider variation to calculate the potential financial impact of
improving and standardizing care processes
Mean Cost per Case = $10,000
Dr. J.
15 Cases
$15,000 Avg. Cost Per Case
Total Opportunity = $75,000
$1,200,000
$175,000
$500,000
$4,000
x 25
cases
==
$5,000
x 15
cases
$100,000
$75,000opportunity
opportunity
Cost Per Case, Vascular Procedures
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© 2014 Health Catalyst
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Demos: How Analytics Drive Shared Savings
Demo 1: Key Process Analysis (KPA). Identify areas of
greatest opportunity for quality improvement and savings
Demo 2: Population Explorer. Identify potential risk by
understanding relative size of disease populations and risk
profiles
Demo 3: Heart Failure. Achieving quality improvement and
cost reductions by directing targeted interventions to high-risk
patients
Demo 4: Community Care. Monitoring high-risk patients in
primary care to prevent expensive acute treatment
© 2014 Health Catalyst
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Heart Failure Statistics
Heart failure (HF) is one of the most rapidly
increasing cardiovascular disorders.
●
Leading cause of hospitalization in individuals over 65
years of age.¹
●
Third leading cause of hospitalization in the U.S. in all
age groups.²
HF is the most common cause of readmission.3
Rates approach 30% within 60-90 days of
discharge.4
1Krumholz
HM, Chen YT, Wang Y et al. Am Heart J. 2000;139(1 Pt 1):72–7..
2Heart Disease and Stroke Statistics—2012 Update. Circulation. 2012;125:e2-220.
3Jencks SF, Williams MV, Coleman EA. N Engl J Med. 2009;360:1418-28.
4Gheorghiade M, Vaduganathan M, Fonarow GC et al. J Am Coll Cardiol. 2013;61:391-403.
14
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CMS and Medicare Readmission
Penalties
Nearly 25% of all patients hospitalized for heart failure
are readmitted within 30 days.
CMS has labeled HF as an area of excessive
readmission.
CMS penalties will ensue to reduce readmission rates
Penalties Will Reduce Medicare Payments
Percent of Payments
Received
101
100
99
98
97
96
95
2%
Loss
1%
Loss
FY 2012
FY 2013
FY 2014
3%
Loss
FY 2015
http://www.ama-assn.org/amednews/2012/08/27/gvsb0827.htm. American Medical Association.
Accessed online 12/28/2012.
15
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Improvement Methodology
• A goal is a desired result the workgroup
envisions, plans and commits to achieve an
organizational desired end-point by a specified
deadline.
• AIM statements are written, measurable, and
time-sensitive objectives that move the team
toward achieving the goal .
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CV Heart Failure
Goal: Decrease 30 day readmission rates of heart
failure patients
AIM #1
AIM #2
AIM #3
Establish a baseline of all cause 30
day readmission rates for HF
patients, create and validate 30 day
and 90 day readmission rates for all
HF patients.
17
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CV Heart Failure
Goal: Decrease 30 day readmission rates of heart
failure patients
AIM #1
AIM #2
AIM #3
Identify high risk heart failure
patients and extend the
identification of these patients to a
Risk Stratification Model to predict
the likelihood of all cause 30-day
readmission rates.
18
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CV Heart Failure
Goal: Decrease 30 day readmission rates of heart
failure patients
AIM #1
AIM #2
AIM #3
Schedule a follow-up appointment
for all HF patients within 24 hours of
discharge with a focus on high risk
patients being seen within 48-72
hours after discharge.
19
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CV Heart Failure
Goal: Decrease 30 day readmission rates of heart
failure patients
AIM #1
AIM #2
Establish a medication reconciliation
baseline and track compliance in
order to achieve 75% compliance by
X date.
AIM #3
AIM #4
20
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CV Heart Failure
Goal: Decrease 30 day readmission rates of heart
failure patients
AIM #2
AIM #3
AIM #4
A follow-up phone call from a nurse
post-discharge to assess whether
the patient has obtained his/her
medication and has no barriers to
making their follow-up appointment.
AIM #5
21
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Organizational Teams
It’s not just about technology
= Subject Matter Expert
= Data Capture
= Data Provisioning & Visualization
= Data Analysis
Cardiovascular Clinical Program Guidance Team
Heart
Rhythm
MD Lead
RN SME
Knowledge
Manager
Vascular
MD Lead
RN SME
Ischemic
MD Lead
RN SME
Heart Failure
MD Lead
RN SME
Guidance Team MD lead
(e.g., Heart Failure MD Lead)
RN, Clin
Ops Director
Data
Architect
Application
Administrator
• Permanent Teams
• Integrated Clinical and Technical members
• Supports Multiple Care Process Families
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Demos: How Analytics Drive Shared Savings
Demo 1: Key Process Analysis (KPA). Identify areas of
greatest opportunity for quality improvement and savings
Demo 2: Population Explorer. Identify potential risk by
understanding relative size of disease populations and risk
profiles
Demo 3: Heart Failure. Achieving quality improvement and
cost reductions by directing targeted interventions to high-risk
patients
Demo 4: Community Care. Monitoring high-risk patients in
primary care to prevent expensive acute treatment
© 2014 Health Catalyst
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www.healthcatalyst.com
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Appendix
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© 2014 Health Catalyst
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Advanced Applications
Pediatrics
Appendectomy
Asthma Acute
Asthma Chronic*
Cardiovascular
Atrial fibrillation*
Conduction disorders*
Ischemic Heart Disease*
Heart Failure
Community Care
Diabetes*
Asthma*
Primary care
General Medicine
Diabetes*
DKA (diabetic ketoacidosis)
Deep vein thrombosis*
Peripheral vascular disease*
Pulmonary
Pneumonia Community
acquired
Pulmonary embolism*
Infectious Diseases
Cellulitis*
Urinary Tract Infection*
Meningitis*
Sepsis
Gastrointestinal
Anal/rectal disorders*
Appendectomy
Inflammatory diseases*
Lower GI procedures*
Obstruction*
Neurosciences
Stroke*
- Hemorrhagic*
- Vascular*
- Transient ischemic
attack*
Oncology
Breast
Gastrointestinal
Thoracic
Orthopedics
Fractures
- Hip/pelvis*
- Lower extremity*
- Upper extremity*
Spine
Total hip*
Total knee*
Surgery - Vascular
Aortic aneurism*
Other venous disorders*
Varicose veins*
Women and Newborns
Antenatal Steroid
C-section Delivery
Elective Inductions
NTSV cesarean
Newborn
Departmental
EC (Emergency Care)*
Laboratory*
OR Workflow*
Radiology*
Nursing*
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Other
Coordinated Care
Labor & Productivity
Medication Management
OPPE (Ongoing
Professional Practice
Evaluation)
Physician Credentialing
Primary Care
Professional Billing
ACO
Patient Injury Prevention
VT/PE prevention*
CAUTI
CLABSI
Controlled substance
diversion prevention
* In Development
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Architecture Overview
Data Marts and Applications
Common Definitions and Standardization
Population Definitions, Comorbidities, Attribution,
Patients, Labs, Encounters, Diagnoses, Medications
Source Marts
EMR
Financial
Patient Sat.
HR
Administrative
Claims
EMR
Financial
Patient Sat.
HR
Administrative
Claims
e.g. API Time
Tracking
e.g. Medicare
e.g. Epic, Cerner
e.g. EPSi,
Peoplesoft,
Lawson
e.g. Lawson,
Peoplesoft,
Ultipro
26
e.g. Press Ganey,
NRC Picker
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c
Demo 1: Key Process Analysis. Identify areas of greatest
opportunity for quality improvement and savings
Demo 2: Population Explorer. Identify potential risk by
understanding relative size of disease populations and risk
profiles
Demo 3: Heart Failure. Achieving quality improvement and
cost reductions by directing targeted interventions to high-risk
patients
Demo 4: Community Care. Monitoring high-risk patients in
primary care to prevent expensive acute treatment
Follow Us on Twitter #TimeforAnalytics
© 2014 Health Catalyst
www.healthcatalyst.com27
Proprietary and Confidential
c
Demo 1: Key Process Analysis. Identify areas of greatest
opportunity for savings and quality improvement
Demo 2: Population Explorer. Identify potential risk by
understanding relative size of disease populations and risk
profiles
Demo 3: Heart Failure. Achieving quality improvement and
cost reductions by directing targeted interventions to high-risk
patients
Demo 4: Community Care. Monitoring high-risk patients in
primary care to prevent expensive acute treatment
Follow Us on Twitter #TimeforAnalytics
© 2014 Health Catalyst
www.healthcatalyst.com28
Proprietary and Confidential
c
Demo 1: Key Process Analysis. Identify areas of greatest
opportunity for savings and quality improvement
Demo 2: Population Explorer. Identify potential risk by
understanding relative size of disease populations and risk
profiles
Demo 3: Heart Failure. Achieving quality improvement and
cost reductions by directing targeted interventions to high-risk
patients
Demo 4: Community Care. Monitoring high-risk patients in
primary care to prevent expensive acute treatment
Follow Us on Twitter #TimeforAnalytics
© 2014 Health Catalyst
www.healthcatalyst.com29
Proprietary and Confidential
c
Demo 1: Key Process Analysis. Identify areas of greatest
opportunity for savings and quality improvement
Demo 2: Population Explorer. Identify potential risk by
understanding relative size of disease populations and risk
profiles
Demo 3: Heart Failure. Achieving quality improvement and
cost reductions by directing targeted interventions to high-risk
patients
Demo 4: Community Care. Monitoring high-risk patients in
primary care to prevent expensive acute treatment
Follow Us on Twitter #TimeforAnalytics
© 2014 Health Catalyst
www.healthcatalyst.com30
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Thank You
Next Educational Webinar
By Failing to Prepare, You Are Preparing to Fail
Laying the Foundation for Sustainable Change and Success
Date: Wednesday, April 16th
Time: 1:00-2:00 PM ET
Presenter: John Haughom, MD, Senior Advisor, Health Catalyst
Register at http://healthcatalyst.com/
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