Integrated Data Framework & Analytics for APCD

1. Integrated Data Framework & Analytics for APCD Presented by: Bruce Eckert, MBA, CPHIMS, FHIMSSNational Practice Director, Beacon Partners JOHN BACKHOUSEExecutive Director iWay Software (Global), Information Builders

2. Healthcare Spending Growth

3. Healthcare Expenditure in USD

4. Healthy Life Expectancy at Age 60 Developed by the World Health Organization, healthy life expectancy is based on life expectancy adjusted for time spent in poor health because of disease and/or injury

5. Healthy Lives Infant Mortality Rate Infant deaths per 1,000 live births National average and state distribution International comparison, 2007 ^ Denotes years in 2006 and 2008 National Scorecards. Data: National and state—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2003–2008; Mathews and MacDorman, 2011); international comparison—OECD Health Data 2011 (database), Version 06/2011. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2011.

6. Transitioning to Integrated Accountable Care • PQRI • Value-Based Purchasing • Healthcare Improvement Institute • LeapFrog • Beacon Challenge Grants Triple Aim ACO PCMH Primary Care Initiative Clinically Integrated Networks

7. Population Health

8. Population Health “ The use of a variety of individual, organizational and cultural interventions to help improve the illness and injury burden and the health care use behaviorof defined populations. • Dr. Michael Hillman, Marshfield Clinic “

9. ANALYTICS

10. All Payer Claims Databases Healthcare’s “Biggest” Data

11. Growing National Trend for APCD

12. Selected Data Elements in the APCD CHIA for Total Medical Expense, Cost Trends and Relative PricingNon Claims Payments, Payment Arrangement Type Connector/Risk Adjustment for ACAIndicator Purchased thru HIX, Actuarial Value, Tobacco Use Health Policy CommissionTotal Medical Expense Group Insurance Commission GIC ID Division of InsuranceNAIC Code Connector and DOIMonthly Premium, Employer ZIP, Family Size Connector, DOI and GIC Market Category Code Connector, CHIA and DOI Employer Contribution All Payer Claims Data Base Private and Public Payers

13. Consumers Employers Researchers Providers Population Health Medicaid Health Reform Insurance Payers

14. APCD Challenges

15. All Payer Claims Database, Data sets • Total Cost of Care • Total Cost of Care Trend Graph • Utilization • Utilization Trend Graphs • Inpatient Utilization • Outpatient Utilization • ER Utilization • Readmissions, Potentially Preventable (per population) • Readmissions, Potentially Preventable (per admission) • Readmissions, All Cause 30 Day (per population) • Readmissions, All Cause 30 Day (per admission) • Provider Density • Chronic Conditions • Illness Burden • Illness Burden Graph

16. Files and Selective Elements All-Payer Claims Database Product File Claims Files Provider File Member File • Service/prescribing providerName, Tax ID, Payer ID, NPI, Specialty code, City, State, Zip code • Billing ProviderName, payer ID, NPI Type of ProductHMO, POS, Indemnity Type of ContractSingle person, family Coverage TypeSelf-funded, Individual, Small group Personal Health Info (encrypted)Subscriber and member names and social security numbers Patient DemographicsAge, gender, relationship to subscriber Medical Claims Pharmacy Claims Dental Claims Service Information Service and paid dates, paid amount, admission types, diagnosis and procedure information 16

17. APCD Solution • Powerful, effective, and easy to use data analytics module with portal and self service • World class data management of claims and associated data (e.g. HIE, benchmarks, research) into a multi mastered domain and information repository • Supports industry standard (e.g. HIPAA/5010) transactions for 837 and related claims transactions. • Industry tested data model and multi-domain (Payer, Provider, Patient) mastered information repository. • Data quality, patient matching, standardization, and enrichment algorithms

18. APCD Solution - continued • Provides extensive coding data validations/cross walks including ICD9-CM, ICD-10 (GM/AM/CA), CPT-4, HCPCS, SNOMED, LOINC, DRG, RxNorm, NDC… • Data Steward Portal to support Data Governance workflows for data remediation • 360 degree view of claims, payers, patients, providers, and facilities • Scalable and extensible to handle high data volumes required by state wide APCD system • Technology agnostic solution that can operate in on-site or cloud-based solution.

19. OmniPatient™ All-Payer Claims Database

20. Omni-Patient – APCD Solution

21. Omni-Patient – APCD Solution

22. Omni-Patient – APCD Solution

23. Omni-Patient – APCD Solution

24. Omni-Patient – APCD Solution

25. Data Dictionary

26. Data Dictionary

27. Womens’ Health Categories

28. Continuity of Care Document Selection

29. CCD

30. APCD ManagementEmpower All Users to Understand APCD by any Parameter Analyze Patient Population ** Information Builders Confidential **

31. Health System Performance ScorecardIdentify Top/Bottom Performers, Alerts, Measure Performance Through Self-Service Parameterize Anything Near Real Time Alerts Broadcast metrics across dimensions to see outliers w/o knowing what to ask Personalize any gadget based on metric and dimension Determine impact of readmissions on financial metrics and population health Automatic drills/roll ups based on custom dimensions ** Information Builders Confidential **

32. Physician Cost EfficiencyDetermine Cost by Age, Time, Payer, Chronic Disease Based on service line and physician, determine by demographics, time, payer, chronic disease, what is the cost of care vs revenue Determine highest costing procedure groups and how they correlate to readmits, LOS – drill to encounter detail ** Information Builders Confidential **

33. Summary

34. Information Builders Healthcare Solutions About Us • A leading independent global software provider • Market leader in large-scale business intelligencedeployments • Market leading provider of integrationtechnology • Leading edge data integrityand governance solutions • Our top priority is Customer Success • Superior engineered software • Highest-rated customer service • Leader in solutions that enable the transformation to accountable care Fragmented Care EfficientPatientFlow 360° View of Patient Omnipatient & Enterprise Analytics ClinicalBestPractices FinancialMgt. Integrated Care

35. Information Builders Healthcare Customers

36. Information Builders’ Partnership with Beacon Partners Marrying a world-class data integration, data integrity and analytics healthcare solution with best-practice healthcare expertise to ensure we comprehensively address your needs with best-practice project management &deployment methodologies throughout the entirety of the program

37. A Leader in Strategic Healthcare Consulting Services • Exclusive focus on healthcare since its inception in 1989 • 600 successful diverse implementations • Strategic Advisory Group – Ex. CIOs, Administrators, Clinicians • Dedicated practices with deep experience in most major vendor EHRs • Deep background and experience with Accountable Care, Population Mgmt., HIE, and Analytics in many settings

38. Population Health Deployment Approach • Ensure your State’s APCD system flexes to accommodate future requirements • Focus on business drivers as the primary goal of the project • Pricing transparency • Provider utilization performance • Utilization patterns • Access disparities • Target users • Regulators • Researchers • Payers • Providers • Public

39. Comprehensive Service & Support • Project management • Carrier relationship management • Implementation services • Data file submission support • Testing and data validation • Technical Support • Analytics and report creation • Training

40. Implementation Plan With “Early CMS/SSP Visibility” • Wave 1 – High priority quick wins and immediate visibility • Pre-wave Solution Assessment to fully define business drivers and facilitate design, development, and deployment • Install OmniPatient and WebFOCUS components and establish access on all data sources • Create appropriate metadata and define cross-platform joins/drills for CMS Shared Services data sets • Configure ACO Metrics within PMF for Population Management Use Wave Investment Planning to Roll Out in Defined Waves • Wave 2 • Mastering of Data Sources by Domains (e.g., Medicare, Medicaid, Payers, HIEs, TPAs) • Registries/Datasets, KPIs • Wave 3 • Data Model extensions • Establish Data Governance • Ongoing revisions based on newly-identified business drivers • Wrap up of open “use cases”

41. Questions? ThankYou! For more information, please contact: Bruce Eckertbeckert@beaconpartners.com John Backhousejohn_backhouse@ibi.com