The Path to Shared Savings With Population Health Management Applications

© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary and Confidential
Follow Us on Twitter #TimeforAnalytics
www.healthcatalyst.comProprietary and Confidential
Eric Just, VP Technology
Kathy Merkley, RN, VP Clinical Engagement
April 9, 2014
The Path to Shared Savings With Population
Health Management Applications

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

Population Health Management (PHM)
The Key to Shared Savings
Provider Network
1
Population
2
Cost Outcomes
4
Quality Outcomes
3
Four Building Blocks of
Population Health Management
developing
the asset

PHM and Accountable Care (AC)
Accountable Care
Financing and
Administration
Population Health
Management developing
the asset
packaging and
marketing the asset

What Does Health Catalyst Do?
● 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
5
Platform

● Reports & Dashboards
● Ad-hoc query
● Registries
● Quality measures
● Population health
● Data mining
● Clinical improvement
● Workflow analysis
● Modeling and predictive
analytics
6
Applications
Platform

Installation
● Configuration
● Data Architecture
Improvement
● Project Management
● Clinical Improvement
● “Lean” Process Improvement
7
Applications
Services
Platform

Application Families
8
Foundational
Applications
Discovery Applications Advanced Applications
Provide deep insights
into evidence-based
metrics that drive
improvement in
quality and cost
reduction through
managing populations,
workflows, and patient
injury prevention.
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.

Demos
9
Discovery ApplicationsFoundational Applications Advanced Applications`
Population Suites
e.g., Ischemic Heart Disease
Workflow / Operational Suites
e.g., Acute Medical
Patient Injury Prevention Suites
e.g., Infection Prevention
Patient Injury Prevention Modules
e.g., CAUTI, CLABSI, SSI
Workflow/Operational Modules
e.g., ICU, MedSurg, Emergency
Population Modules
e.g., CABG, Stent, AMI
Labor Management Explorer
Rev Cycle Explorer
Patient Satisfaction Explorer
General Ledger Explorer
Readmission Explorer
Population Explorer
Patient Flow Explorer
Practice Management Explorer Suite
Financial Management Explorer
CAFE—Comparative Analytics Framework and Exchange—across Healthcare Systems and National Benchmarks
EDIT—Executive Dashboard Integration Tool (Key Performance Indicator editable collage from all app categories)
Key Process Analysis (KPA)
Cohort Builder
Comorbidity Analyzer
Payment Model Analyzer
Readmission Predictor
Patient Flight Plan Predictor
ACO Explorer Suite
Metric Correlation Analyzer
Regulatory Explorer
Attribution Modeler

Follow Us on Twitter #TimeforAnalytics 10
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
Demos: How Analytics Drive Shared Savings

Heart
Rhythm
Disorders
Vascular
Disorders
Ischemic
Heart
Disease
Heart
Failure
CARDIOVASCULAR
Care Process
Families
Clinical
Program
CABGPCIAMIACSCare
Processes
KPA: Clinical Hierarchy

Dr. J.
15 Cases
$15,000 Avg. Cost Per Case
Mean Cost per Case = $10,000
$5,000 x 15 cases =
$75,000 opportunity
Total Opportunity = $75,000Total Opportunity = $175,000
$4,000 x 25 cases =
$100,000 opportunity
Total Opportunity = $500,000Total Opportunity = $1,200,000
Cost Per Case, Vascular Procedures
KPA: Measuring Opportunity
Using provider variation to calculate the potential financial impact of
improving and standardizing care processes

profiles
patients

14
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
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.
HF is the most common cause of readmission.3
Rates approach 30% within 60-90 days of
discharge.4

15
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
http://www.ama-assn.org/amednews/2012/08/27/gvsb0827.htm. American Medical Association.
Accessed online 12/28/2012.
95
96
97
98
99
100
101
FY 2012 FY 2013 FY 2014 FY2015
PercentofPayments
Received
Penalties Will Reduce Medicare Payments
1%
Loss
2%
Loss
3%
Loss

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 .

17
CV Heart Failure
Goal: Decrease 30 day readmission rates of heart
failure patients
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.
AIM #1
AIM #2
AIM #3

18
CV Heart Failure
failure patients
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.
AIM #1
AIM #2
AIM #3

19
CV Heart Failure
failure patients
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.
AIM #1
AIM #2
AIM #3

20
CV Heart Failure
failure patients
AIM #1
AIM #2
AIM #4
AIM #3
Establish a medication reconciliation
baseline and track compliance in
order to achieve 75% compliance by
X date.

21
CV Heart Failure
failure patients
AIM #2
AIM #3
AIM #5
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.

Organizational Teams
It’s not just about technology
Cardiovascular Clinical Program Guidance Team
Heart Failure
MD Lead
RN SME
Knowledge
Manager
Data
Architect
Application
Administrator
RN, Clin
Ops Director
Guidance Team MD lead
(e.g., Heart Failure MD Lead)
= Subject Matter Expert
= Data Capture
= Data Provisioning & Visualization
= Data Analysis
Ischemic
MD Lead
RN SME
Vascular
MD Lead
RN SME
• Permanent Teams
• Integrated Clinical and Technical members
• Supports Multiple Care Process Families
Heart
Rhythm
MD Lead
RN SME

profiles
patients

www.healthcatalyst.comProprietary and Confidential
Appendix

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*
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

Follow Us on Twitter #TimeforAnalytics26
Data Marts and Applications
Common Definitions and Standardization
Population Definitions, Comorbidities, Attribution,
Patients, Labs, Encounters, Diagnoses, Medications
Source Marts
EMR
EMR Financial Patient Sat. HR Administrative Claims
Financial Patient Sat. HR Administrative Claims
e.g. Epic, Cerner e.g. EPSi,
Peoplesoft,
Lawson
e.g. Press Ganey,
NRC Picker
e.g. Lawson,
Peoplesoft,
Ultipro
e.g. API Time
Tracking
e.g. Medicare
Architecture Overview

c
27
Demo 1: Key Process Analysis. Identify areas of greatest
opportunity for quality improvement and savings
profiles
patients

c
28
opportunity for savings and quality improvement
profiles
patients

c
29
profiles
patients

c
30
profiles
patients

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/

The Path to Shared Savings With Population Health Management Applications

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Semelhante a The Path to Shared Savings With Population Health Management Applications

Semelhante a The Path to Shared Savings With Population Health Management Applications (20)

Mais de Health Catalyst

Mais de Health Catalyst (20)

Último

Último (20)

The Path to Shared Savings With Population Health Management Applications

Notas do Editor