Data driven care the key to accountable care delivery from a physician group perspective
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Data Driven Care: The Key to Accountable Care Delivery from a Physician Group Perspective. Dr. Greg Spencer & Luke Skelley. Today’s Agenda. Why a regional physician group is heavily investing in analytics and data warehousing

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Data driven care the key to accountable care delivery from a physician group perspective

Data Driven Care: The Key to Accountable Care Delivery from a Physician Group Perspective

Dr. Greg Spencer & Luke Skelley


Today s agenda

Today’s Agenda

  • Why a regional physician group is heavily investing in analytics and data warehousing

  • Crystal Run Healthcare’s 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


Data driven care the key to accountable care delivery from a physician group perspective

POLL QUESTION #1What best describes the group you belong to?Health PlanPhysician GroupProvider OrganizationVendorOther


Crystal run healthcare

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


Crystal run healthcare1

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


Crystal run healthcare2

Crystal Run Healthcare

  • The mission of Crystal Run Healthcareis to improve the qualityand availabilityof, and satisfactionwith, 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.


The goal the triple aim

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


Crystal run strategy and objectives

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


Crystal run governance model

Crystal Run Governance Model

joint clinical and financial 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

Hal Teitelbaum, MD, JD, MBA

Managing Partner & CEO

edw executive sponsors

Greg Spencer, MD

Chief Medical &

Chief Medical Info Officer

Michelle A. Koury, MD

Chief Operating Officer

Mary DeFreitas

Chief HR Officer

Erlene Washington

Senior VP of

Finance & Accounting

edw governance

Jonathan Nasser, MD

Medical Director

Greg Spencer, MD

CMO & CMIO

Miguel HernandezTechnology Director

Lou Cervone

BI Director

EDW Steering Committee


Crystal run care management strategies

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


Crystal run quality structure

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


Why crystal run is heavily investing in analytics and data warehousing

Why Crystal Run is heavily investing in analytics and data warehousing


Data driven care the key to accountable care delivery from a physician group perspective

POLL QUESTION #2If you are a health plan, physician group, or provider organization, do you currently exchange clinical and claims data with these other constituents?


Crystal run data analytics strategy

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


Crystal run analytics current state

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


Physician dashboard

Physician Dashboard


Physician dashboard1

Physician Dashboard


Turning data into improved care ensuring financial viability in the future

Turning data into improved care & ensuring financial viability in the future


Physician variation analysis

Physician Variation Analysis

Mean Cost per Case = $20,000

Dr. J.

15 Cases

$60,000 Avg. Cost Per Case

$40,000 x 15 cases =

$600,000 opportunity

Total Opportunity = $600,000

$35,000 x 25 cases =

$875,000 opportunity

Total Opportunity = $1,475,000

Total Opportunity = $2,360,000

Total Opportunity = $3,960,000

Cost Per Case, Vascular Procedures


Crystal run results

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%.


Improved quality breast cancer screening

ImprovedQualityBreast Cancer Screening

Mammography


Outcomes avoidable admissions

Outcomes: Avoidable Admissions

Monthly Quality Trend

# Avoidable Admissions

17%


Outcomes readmissions

Outcomes: Readmissions

30 Day Readmission Rate for Medicare


Total cost difference

Total cost difference

(equalized as cost per patient treated)

PEG-filgrastim use in Breast cancer patients

2012 pre-pathway

791 patients

$595,920

2013 post-pathway

817 patients

$368,160

TOTAL COST SAVINGS

$227, 760


R educing pharmaceutical costs

Reducing Pharmaceutical Costs

PEG Filgrastrim cost per patient before and after breast cancer pathway


A culture of efficiency improving access

A Culture Of Efficiency: Improving Access

  • 41,823 fewer visits

  • 30,206 more patients

  • “Created” 12 physicians


Variation reduction spread reduction in charges

Variation ReductionSpreadReduction in Charges


Variation reduction spread improving access

Variation ReductionSpreadImproving Access


Managing patient populations across payer entities

Managing patient populations across payer entities


Crystal run s payer mix

Crystal Run’s payer mix

  • 24 Payer Entities

  • No dominant payer, so little to no leverage for discounts, etc.

  • No dominant payer, so payers need to contract with Crystal Run to effectively do business in the area

  • Complicates data analysis due to limited population/statistics by payer


Payer challenges

Payer Challenges

  • Having data-focused payer conversations about shared savings

  • Need claims data to support risk contracting

  • Multiple payers limits ability to do valid statistical modeling

  • Collaborating with multiple plans to develop shared savings model


Living in two worlds

Living in Two Worlds

  • Improvements in quality reduces costs to benefit of payer

  • Reduction in patient visits offset by increase in patient volume

  • Hospitals acquisition of physicians not based on value but to protect referrals

  • Triple Aim is a threat to hospitals

  • Hospitals have to align optimal patient care vs. optimal reimbursement


Clinician engagement challenges successes

Clinician Engagement: Challenges & Successes


Clinician engagement

Clinician Engagement

  • Data used in physician recruitment and retention

  • Data also used to support alignment and/or acquisition decisions

  • Sharing physician performance data helps affect behavior even if no penalty or not tied to a quality effort

    • Sharing physician data makes outliers come to consensus

    • Not all physician practices focus on value

    • Younger physicians sometimes avoid change more than older ones


It s all about the data

It’s All About the Data

The limitation is data.

The doctors need performance data

They have metrics to measure care

~ 80% of Business Intelligence’s time spent gathering versus analyzing data

90/10 of data capture time to analysis time.


Crystal run edw requirements

Crystal Run EDW Requirements

  • Fast to implement and fast to ROI

  • Capable of easily expanding to add new data sources

  • Library of analytical applications

  • Vendor with healthcare experience and expertise

  • Data model conducive to healthcare data

  • Ability to become self sufficient

  • Long term business partner


Adaptive data architecture turning clinician questions into actionable results

Adaptive Data Architecture: Turning clinician questions into actionable results


Provider payer collaboration

Provider-Payer Collaboration

Clinical data

Claims data

Case mix analysis

Risk stratification

Utilization review

Prior authorizations

Utilization review

Care management

Care gap notification

Prevent readmissions

Contracting

Admission notification

Physician profiling

Physician profiling

Discharge notification

Regulatory measures

Regulatory measures

Case management

Case management

Evidence based guidelines

Evidence based guidelines

Consumer transparency

Consumer transparency

Wellness programs

Wellness programs


Provider payer data sharing

Provider Payer Data Sharing

Clinical data

Case mix analysis

Risk stratification

Utilization review

Prior authorizations

Utilization review

Care management

Care gap notification

Prevent readmissions

Contracting

Admission notification

Physician profiling

Physician profiling

Discharge notification

Regulatory measures

Regulatory measures

Case management

Case management

Claims data

Evidence based guidelines

Evidence based guidelines

Consumer transparency

Consumer transparency

Wellness programs

Wellness programs


Crystal run edw architecture

Crystal Run EDW Architecture


Catalyst apps and claims data

Catalyst Apps and Claims Data

Key Process Analysis

Executive Dashboard Integration Tool

Comorbidity Analyzer

Claims Data

Population Explorer

Cohort Builder

Readmissions Explorer


Catalyst data warehouse advantages

Driven by business and clinical need

Rapid development and deployment of data sources

Built incrementally (i.e., less expensive)

Ownership transferred to client with technical support as needed

Align with access roles and data stewardship jurisdictions

Applications support Healthcare Analytics Adoption Model

Catalyst Data Warehouse Advantages


Healthcare analytic adoption model

Healthcare Analytic Adoption Model


Data driven care the key to accountable care delivery from a physician group perspective

POLL QUESTION #3On a scale of 1-5, with 5 being very advanced, how far along is your organization in using data to guide your quality and cost initiatives?


Data driven care the key to accountable care delivery from a physician group perspective

Organizational Structure Goals

SENIOR EXECUTIVELEADERSHIP TEAM

GUIDANCE TEAM

Provides overall governance and prioritization of initiatives

CONTENT ANDANALYTICSTEAM

CLINICALIMPLEMENTATIONTEAM

Provides steady state domain oversight

WORKGROUP

Supports developmentof clinical content and analytics feedback

Refines Work Group output and leads implementation

ENSURETHAT…

  • Workgroups are created with institutional priority

  • Appropriate leadership is engaged in prioritization

  • Organizational barriers between team members are removed

Provides clinical forum to develop clinical content and analytics feedback


Organizational teams

Organizational Teams

Subject Matter Expert

Data Capture

Data Provisioning & Visualization

Women & Children’s Clinical Program Guidance Team

Data Analysis

Pregnancy

MD Lead

RN SME

Normal Newborn MD Lead

RN SME

Gynecology

MD Lead

RN SME

Guidance Team MD lead

(e.g., Pregnancy MD Lead)

RN, Clinical Ops Director

Pregnancy SAM

Gynecology

SAM

Normal Newborn SAM

DataArchitect

Knowledge Manager

Application Administrator

Permanent Teams

Integrated Clinical and Technical members

Supports Multiple Care Process Families


Workgroup roles

Workgroup Roles

DATA CAPTURE

Subject MatterExpert

Application Administrators (e.g., EMR Administrators, Financial System Administrators)

  • Acquire key data elements

  • Assure data quality

  • Integrate data capture into operational workflow

Knowledge Managers

Data CaptureWorkflow Analysis

Data Provisioning

Data Analysis

DATA ANALYSIS

DATA PROVISIONING

Knowledge Managers

Data Architects(infrastructure)

  • Interpret data

  • Discover new information in the data (data mining)

  • Evaluate data quality

  • Move data from transactional systems into the EDW

  • Build visualization for use by clinicians

Data Architects

(Analysis)

Data Architects(Visualization)


Crystal run edw teams

Crystal Run EDW Teams

  • EDW data acquisition

    • Systems programmers

    • Database administrator

    • Clinical SME’s

  • EDW data architecture and integration services

    • BI director

    • Data architects

    • Business development

    • Project manager

    • Clinical SME’s


Catalyst resource deployment

Catalyst Resource Deployment

Installation

Improvement

Independence

Primary owner

Secondary owner

Technical Director

Level of Engagement

Engagement Executive

Support

SOW#1

SOW#3

SOW#2

SOW#4

SOW#5+

EngagementTime


Data driven care the key to accountable care delivery from a physician group perspective

The Analytic Organization’s Journey


Data driven care the key to accountable care delivery from a physician group perspective

http://www.healthcatalyst.com/


Ahip institute 2014

AHIP Institute 2014

June 11-13, 2014 in Seattle, WA

AHIP’s Data Analytics Forum will provide valuable insights on how stakeholders in the health care system utilize big data to enhance care quality, reduce costs, make better business decisions, and streamline operational processes.

Please join Luke Skelly and Health Catalyst at Booth #911


Questions

Questions?


Data driven care the key to accountable care delivery from a physician group perspective

Seed Questions

What are some of the barriers you’ve run across in acquiring claims from payers?

What internal challenges do you see payers or providers facing in developing a data driven culture?

How does Health Catalyst support a population health management approach using claims data from non-acute care settings (home health, skilled nursing facilities, etc.)


Contact information

Contact Information

Dr. Greg Spencer, CMO

Crystal Run Healthcare

www.crystalrunhealthcare.com

Luke Skelley, VP

Health Catalyst

[email protected]

www.healthcatalyst.com


Data driven care the key to accountable care delivery from a physician group perspective

Survey Questions

On a scale of 1-5, with 5 being the highest, how satisfied are you overall with the quality of this webinar?

What do you wish the presenter had spent less time on?

What do you the presenter had spent more time on?

What topics would you like to see in future webinars from Health Catalyst?

On a scale of 1-5, how interested are you in a demonstration of Health Catalyst Solutions?

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