1.
How Northwestern Medicine is Leveraging
Epic to Enable Value-Based Care

2.
ABOUT PERFICIENT
Perficient is a leading information technology and
management consulting firm serving clients
throughout North America.
We help clients implement digital experience, business optimization,
and industry solutions that cultivate and captivate customers, drive
efficiency and productivity, integrate business processes, reduce
costs, and create a more agile enterprise.

3.
PERFICIENT PROFILE
Founded in 1997
Public, NASDAQ: PRFT
2014 revenue $456.7 million
Major market locations:
Allentown, Atlanta, Ann Arbor, Boston, Charlotte, Chicago, Cincinnati,
Columbus, Dallas, Denver, Detroit, Fairfax, Houston, Indianapolis,
Lafayette, Milwaukee, Minneapolis, New York City, Northern California,
Oxford (UK), Southern California, St. Louis, Toronto
Global delivery centers in China and India
>2,600 colleagues
Dedicated solution practices
~90% repeat business rate
Alliance partnerships with major technology vendors
Multiple vendor/industry technology and growth awards

4.
4
PERFICIENT HEALTHCARE PRACTICE

5.
SPEAKER INTRODUCTIONS
Rob Desautels, Director IT, Northwestern Medicine
Rob has more than 15 years of experience within the IT industry including 11 years
dedicated to healthcare and life sciences. Since 2013, he has served as a senior IT
leader at Northwestern Medicine (formerly Cadence Health) and helped champion
and lead the analytics effort with Epic to shape the tools that enable the population
health management program for Northwestern Medicine Physician Partners
(formerly Cadence Medical Partners).
John Ideler, Healthcare Director, Perficient
John has more than 25 years of experience in the IT industry, including more than
five years in life sciences and healthcare. He is responsible for ensuring client
satisfaction and the successful completion of large scale projects. John has
extensive experience in providing clients BI analytics capability using Epic's Cogito
data warehouse as a centralized source.

6.
6
THE TRANSFORMATION
OF HEALTHCARE
John Ideler, Healthcare Director, Perficient

7.
HEALTHCARE IN THE
UNITED STATES
U.S. is the most expensive
healthcare system in the world
Many assume we pay more
because we get better health
outcomes
The evidence, however, doesn’t
support that view

8.
THE IMPACT: SHRINKING HOSPITAL MARGINS
Studer Group, Value-Based Purchasing At A Glance – Fiscal 2015 and Your Organization
2011
2021
2.2%
-16.8%
The average hospital has a
2.2% operating margin.
Reimbursement Cuts
2.2%
WILL BE A
16.8% DEFICIT
By 2018, CMS quality-
based payment
initiatives will put more
than 11% of payments
at risk.

9.
THE SOLUTION: A NEW CARE DELIVERY MODEL
Volume Value
Fee for Service – Per Case Payment to Manage Populations
No Rewards for Quality Incentives and Penalties for Quality
Metrics (Outcomes Drive Incomes)
Collaboration/Partnerships and
Coordination of Care Not Valued
Shared Accountabilities (Healthcare
Providers, Health Plans, etc.)
No IT Investment Incentives IT Core Part of the Strategy

10.
TRANSFORMING DATA: KEY TO VALUE-BASED CARE
We have access to an
abundance of data.
The problem is not how to
get it – it’s bringing it
together and knowing what
to do with it once we have it.
Information must be
managed so it is useful,
operationally relevant,
insightful and secure.

11.
WHAT IS VALUE-BASED CARE?
Healthcare reimbursement model
based on the value of the services
provided rather than the volume.
Goal: Lower healthcare costs and
improve quality and outcomes

12.
5 MAIN FUNCTIONS CONTRIBUTING TO A VBC PROGRAM

13.
8 KEY CAPABILITIES NEEDED BY A VBC PROGRAM
1. Define, understand, engage, and track patient populations
2. The ability for clinicians to identify patients with important care considerations
3. Manage population health, outreach and care management, care
coordination and planning, and patient engagement
4. Ability to identify, categorize, and manage chronically ill patients
5. Patient attribution
6. Measures, scorecards and reports
7. Integrated analytics and reporting for clinical and business intelligence
8. Integrate claims and other external sources into the EMR, so they are visible
and actionable at the point of care

14.
LEVERAGING
THE NATIVE
CAPABILITIES
OF EPIC

15.
15
NORTHWESTERN MEDICINE
Rob Desautels, Director IT, Northwestern Medicine

16.
NORTHWESTERN MEDICINE
Total Workforce of
Over 18,000 Employees
70 Acute and
Outpatient Care Sites
National Leader in Quality and
Consumer Preference
3,700 Medical Staff Includes
1,500 Employed Physicians
600,000 Square Feet of Additional
Research Lab Space by 2018
Primary Clinical Affiliate of Northwestern University
Feinberg School of Medicine
“… Where the Patient Comes First.”

17.
GROWING TO SERVE PATIENTS CLOSER TO WHERE THEY
LIVE AND WORK
Measurement
FY
2009
FY
2014
NM
Today*
Acute Care Locations 1 2 4
Licensed Beds 854 1,011 1,517
Inpatient
Admissions
47,700 52,600 83,400
Outpatient Sites 14 29 70
Employed Physicians 111 1,185 1,502
Northwestern Medicine Growth: 2009-2015
*Pro forma FY14 combination of Cadence and NMHC

18.
ORGANIZATION TO DELIVER VALUE-BASED CARE
 Northwestern Medicine Physician Partners (NMPP) is the NM vehicle for
emerging value-based contracting, payment and care delivery
- Formerly Cadence Medical Partners (CMP)
- Network of employed and independent physicians/providers
- Payer/Employer contracting organization
- Meets legal criteria for “clinical integration”
 Common approach across all payers and physicians
- One program
- One set of measures and clinical protocols
- One set of administrative procedures
- One infrastructure for care management
- One set of incentives

19.
WHY EPIC/COGITO WAS CHOSEN
• Epic is the EMR platform at legacy Cadence Health and foundation for Northwestern Medicine
• Leveraging the tools within the system EMR allows for care management to occur in the tool
providing the analytic information (single platform)
• Expansion of the Cogito analytics platform to include the data warehouse provided:
o Ability to seamlessly load native Epic data into Cogito
o MSSP interface already written by Epic to ingest CMS file
o The development of smart data elements (SDE) to send information from the Cogito
data warehouse to Epic hyperspace
o Reports already available/used via Radar and workbench
o Scalability (Johns Hopkins risk stratification, in future release)
• Speed to market, as new platform did not have to be purchased, configured and integrated
with Epic data

20.
MAPPING REQUIREMENTS TO TECHNOLOGY
Business Requirement Technology Solution
Cohort Establishment
Identify cohorts of patients with chronic conditions, or those whom qualify for
wellness screenings, based on a specified inclusion and exclusion criteria.
Chronic Disease, Wellness, & Risk Registries
• Asthma, Diabetes, CHF, Hypertension, CAD (5)
• Wellness Registries (11)
• General Risk (1)
Clinical Quality Measures
Develop Clinical Quality Measures that help measure and track the quality of
health care services provided by eligible providers and hospitals within our health
care system.
Healthy Planet
• Develop 44 Registry-Based CQ Measures
• 25 Chronic Disease
• 19 Wellness
Care Management & Coordination
Enable care managers to actively manage health of patient population via the use
of care planning & coordination tools such as patient outreach, longitudinal care
planning, goal setting, tracking, and population health analytics.
Healthy Planet
• Care Management Workflows & Care Coordination Tools
• Patient Goals, Longitudinal Plan of Care
• Electronic Patient Outreach Tracking
• Reporting Dashboards & Workbench Reports
Risk Stratification
Stratify total patient population and identify highest risk patients based on a host
of risk criteria such as; comorbidities, walking limitations, disability, # of
ED/Inpatient stays, a discharge readmission risk factor score, living status, etc.
Healthy Planet
• Developed a risk score and applied to total patient population
based on Epic data
• Risk score made available directly in care manager workbench
reports and workflows

21.
MAPPING REQUIREMENTS TO TECHNOLOGY
Business Requirement Technology Solution
Obtaining Clinical Data for Patients seen at Non-Epic Locations
Obtain clinical information for patients not seen within our hospital network,
or employed practices.
Healthy Planet – Abstractor Navigator
• Extended Epic Access to Non-Employed Practices
• Abstractor Encounter
• Care Gap Reporting & Inbasket setup to route messages to
Care Managers
Reporting tools for Physicians
Provide physicians with an overview of the performance of their patient
population across all registry-based measures, incorporating internal and
external data.
Radar Dashboards & Reporting Workbench Reports
• Centralized view of population performance on registry-
based measures
• Drill down capability to identify non-compliant patients
• Quarterly performance & trending
Leverage External Data for Population Health
Import, Store, & Analyze claims & eligibility data from various sources;
payers, hospital quality, oncology, for population health purposes.
Cogito Data Warehouse (CDW)
• External Claims & Eligibility Data
• Hospital Quality Measures
• Physician Roster
• Oncology & CMP Measures

22.
MAPPING REQUIREMENTS TO TECHNOLOGY
Business Requirement Technology Solution
Patient to Physician Attribution (Claims-Based)
Attribute Patients to Physicians based on plurality of
outpatient visits, and store attributed PCP & Specialist
information in Hyperspace
Cogito Data Warehouse – Attribution Algorithm
• Develop custom logic to analyze claims and eligibility files to assign patients to 1 PCP &
multiple specialists based on claims activity
Primary Care Team
• Developed custom primary care team fields to store attributed PCP & Specialists
EPT Import
• Developed custom import spec to import attributed PCP & Specialist to Hyperspace &
populate primary care team fields
Patient Matching
Determine if incoming patients on a roster or claim
currently exists in Epic. Match patient to existing record,
if a patient exists. Create a new record if patient does
not exist.
Cogito Data Warehouse – Patient Matching
• Develop custom logic to identify and match records if patient exists in Epic. Send to
Identity if patient does not exist
Identity – Custom Algorithm for Patient Matching
Access
• Create new ID types and workflows to add and store unique payer IDs to patient records
Leverage external data for CQMs
Modify Clinical Quality Measures to incorporate external
claims data
Smart Data Elements
• Built in Chronicles and allow measures to look to external claims data to satisfy measure
criteria
Datalink Actions
• SQL queries that leverage grouper code sets. mine claims data, and return the required
value to the SDE

23.
THE SOLUTION

24.
LESSONS LEARNED
 Reality that not all providers (especially non-employed) will move to a single platform
 No single solution for interoperability and exchange of necessary information
- HIE
- Clearing houses
- Report writers/sniffer
- EMR/PM
- Epic Connect
- Epic Care everywhere
 How do we import external data
- Once we import how do we normalize
- Once we normalize how do we risk stratify and attribute

25.
LESSONS LEARNED
 Engage all partners early
- We don’t all speak the same language even though we think we do
 Enterprise and Executive Leadership Support is necessary but not sufficient
- Need buy-in from end users such as clinical team, tech team, analytic team
 Defining measures and program prior to developing technology solution
- A poorly thought out process is just as poor electronically as it is on paper
 Data Governance (examples of issues)
- What is the definition of a day?
- We know that we should shoot for a glyco hemoglobin of less than 8 (maybe?), but what is
a reasonable target of compliance (25th percentile, 50th percentile or 90th percentile?)
- Reporting of measures that appear to overlap across different quality programs (PQRS,
CMS ACO, MU, etc.)

26.
LESSONS LEARNED
 Frequent and intense communication within the project team, with end-users, and
stakeholders
 Creating the technology platform is only the beginning- need to plan for robust
downstream training of users
 Know your data sources
- There is a lack of consistency between payers and within a payer from month to month
(Medicaid – ACE data)
 External EMR (clinical) data
- Remains a challenge because of interoperability issues, but at the same time is the “pot of
gold” we need to get to

27.
ADDITIONAL EPIC COGITO RESOURCES
GUIDE: How to Enable Value-Based Care and Clinical
Integration with Epic Cogito - http://bit.ly/CogitoWP
CLIENT SUCCESSES:
ProHealth Care Case Study - http://bit.ly/ProHealthCS
On-Demand Webinar - http://bit.ly/ProHealthWebinar
ASSESSMENT: Value-Based Care Readiness and Cogito
Implementation Assessment - http://bit.ly/CogitoAssessment

28.
FOLLOW US ONLINE
@Perficient_HC
Blogs.Perficient.com/Healthcare
linkedin.com/company/Perficient

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