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Integrated Data Framework & Analytics for APCD. Presented by:. Bruce Eckert, MBA, CPHIMS, FHIMSS National Practice Director, Beacon Partners. JOHN BACKHOUSE Executive Director iWay Software (Global), Information Builders. Healthcare Spending Growth. Healthcare Expenditure in USD.

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slide1

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

healthy life expectancy at age 60
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

healthy lives
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.

transitioning to integrated accountable care
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

population health1
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

all payer claims databases
All Payer Claims Databases

Healthcare’s “Biggest” Data

selected data elements in the apcd
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

slide13

Consumers

Employers

Researchers

Providers

Population Health

Medicaid

Health Reform

Insurance Payers

all payer claims database data sets
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
files and selective elements
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

apcd solution
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
apcd solution continued
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.
apcd management empower all users to understand apcd by any parameter
APCD ManagementEmpower All Users to Understand APCD by any Parameter

Analyze Patient Population

** Information Builders Confidential **

slide31
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 **

physician cost efficiency determine cost by age time payer chronic disease
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 **

information builders healthcare solutions about us
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

information builders partnership with beacon partners
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

a leader in strategic healthcare consulting services
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
population health deployment approach
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
comprehensive service support
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
implementation plan with early cms ssp visibility
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”
questions
Questions?

ThankYou!

For more information, please contact:

Bruce Eckertbeckert@beaconpartners.com

John Backhousejohn_backhouse@ibi.com