© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
What the Leading Health Systems Do Differently with Analytics and Data Warehousing
Break All The Rules
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 2
Health Catalyst’s PhilosophyWe educate, we don’t sell. An educated person decides what’s best for them to buy.
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Overview & Context• Healthcare Data Warehousing Association
(HDWA), 2001• How do we create role models for analytic success in
healthcare?• Can we recreate it?
• Health Catalyst is the commercial manifestation of HDWA
• Today’s webinar• What are the common traits of the leaders?
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
• I was hoping for checklists, recipes and algorithms for Analytic Success
• No such luck
• It’s much squishier than that, but it’s still replicable
• Today’s discussion will be more about intangible qualities of culture, leadership, and attitude
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
It Starts With CultureFollowed closely by strategy and execution
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 6
Leaders Are Operating Consistently At Level 6.5
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 7
There Aren’t Many LeadersA Few Examples• Intermountain Health Care
• Quietly, consistently, leading for 30+ years
• Allina• Becoming the Intermountain of Minnesota
• Kaiser• Per-capita prepayment and quality baked into its DNA
• Geisinger• The mindset of Intermountain, the culture of Mayo
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Why Isn’t Everyone Doing It?Is it really that difficult or complex?
8
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Culture
9
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 10
Asked Dear Friends……What key pieces of advice should I emphasize?
• “Be brave with data.”• “The teams that try to plan everything out from the
outset fail. Agile and lean wins in data warehousing as in small businesses.”
• “I believe the most important lesson I have (and still am) learning is to let imperfect but useful things lose into the wild.”
• “…let it lose and iteratively refine…”• “…smart healthcare CIOs expect and “give
permission” to their BI leaders to evaluate rules and precedents based on risk and motives.”
Thank you Eric Just, Steve Catmull, and Mike Doyle
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 11
How Do You Identify A “Leader”? Lead Past Competing Interests
• They balance the tension of care delivery, economic risk, affordability of care, and accessibility to care… all under one CEO
Risk Takers• They take risks, on their own, with new care delivery models and population
health… no government mandates required
Consistently Principle-Driven• They do the right thing for patients and their communities, even at the risk of
financial loss in a fee-for-service environment
Data Trumps Ego & Anecdote• They have the courage to face the truth of data• Data drives their decisions, not anecdotes and hunches
Motivate people through Mastery, Autonomy, and Purpose They recognize what motivates people and organizations
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 12
What Motivates People?
Thank you, Daniel Pink
Nurture and encourage these…
Be aware to avoid stepping on them…
By accident or design, leaders practice this…
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 13
The Motives Behind BehaviorEnlightenmentPeaceJoyLoveReasonAcceptanceWillingnessNeutralityCouragePrideAngerDesireFearGriefApathyGuiltShame
The Turning Point
*-- Power vs. Force, Hawkins
Inherently positive motives as they affect behavior
Generally negative motives as they affect behavior
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
Leading Past Competing InterestsBalance is elusive… it moves… and might not always be appropriate
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 16
Leaders Are 100% Consistent On This…
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 17
Simple EquationLeaders are constantly thinking in these terms, and living in the realm of risk tolerance
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 18
Data Quality
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 19
Trust With Data
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 20
Centralized vs. Decentralized Resources and Staffing
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
Determination & Commitment
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Internal Small Business Mentality
22
Nobody has to do business with the EDW team
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Characteristics of Successful Small Businesses
23
Small Business Checklist1. Have you clearly documented your products and services AND the customers that
want/need them?
2. Do you have product line managers and teams?
3. Do you track who uses which of your products and how often?
4. Do you have a strategic product roadmap?
5. Do you have a web site that makes it easy…‒ For new customers to find you, understand your products, and consume them?‒ For existing customers to get the most out of your products and encourage those customers to collaborate?
6. Do you have a team member that leads and executes your marketing strategy to attract new clients?
7. Are you operating with financial efficiency?
8. Do you regularly poll your customers for their satisfaction and suggestions for product enhancements?
9. Do you regularly poll your team members to track their satisfaction?
10. Do you have a Board of Directors (i.e., Data Governance Committee)?
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 25
Personality Of The Analytics Leader
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 26
Personality Of The Analytics Team
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Strategy
27
Leaders Are Covering The Continuum Of Analytic Use Cases
Robert Wood Johnson Foundation, 2014
Requires a collaborative strategy between leaders in healthcare, politics, charity, education, and business
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
They Invest In Analytics• This is not an “additional duty”
• EMRs required investments in technology and people… so do enterprise data warehouses (EDW). But, luckily, a small fraction of an EMR.
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 30
The EMR Is A Means, Not The End
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 31
Where Are They Focused?
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
Aligning Strategy: Data to Monitor Variation
Range 85% - 95%
Range 94% - 98%
The Joint Commission Index Across Hospitals: Demonstrated Progress in Reducing Variation
Thank you, Lisa Shilling, Kaiser Permanente
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Analytics StrategyVertical and Horizontal… Tactical and Strategic
33
Lab
Admissions
Radiology
Registration
Pharmacy
Nursing
AR/AP
Materials M
gt
Intensive Medicine
Cardiology
Oncology
Women & Newborns
Primary Care
Step Two:Clinical Excellence Programs
Step One: Operational Excellence Programs
More complex
Less complex
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 34
Organize Your Analytics Teams
Boards and C-Levels: Let your clinical and administrative leaders establish their specific clinical and financial goals
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 35
Matrixed Collaboration
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 36
Move On Parallel Fronts
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Replacing Existing Reporting SystemsUse the EDW for its unique capabilities… stop squabbling with the Departments
37
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Analytics Tools DogmaThere’s a reason Excel is still so popular… it works
38
Give data analysts what they want; not what you want them to want
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 39
Traditional Software Engineering vs. Data Engineering
• The thickness of a requirements document is inversely related to the success of a data warehousing project
• Can you define all the use cases for the books in a library? No… same is true for a data warehouse
• As long as you gather and retain the granular data in its true form, you can repurpose that data, an infinite number of ways
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 40
The Data Warehouse Platform… It’s Not Just For AnalyticsSecondary Use of Transaction Data
Risk Takers Consistently Principle-Driven Data Trumps Ego & Anecdote Lead Past Competing Interests Mastery, Autonomy, Purpose
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Execution
41
GeisingerManaging gaps in care
42 Care Gap Examples
Advance Directives
Lipid Panel, HgbA1c
Aspirin for CAD
Depression and Asthma
BP <140/90, LDL <100Clinical Goal
Active Medication
Lab Result
Imaging Result
Scanned Document
Patient Reported Data
Mammogram, DXA
Nephrology for CKD Stage 4
Asthma Action Plan
Heart FailurePatient Education
Clinical Documentation
Referral
Diagnosis Coding HCCs
Thank you, Dr. Fred Bloom
GeisingerRedesign and Care Coordination Delivers Rapid Impact
43
Thank you, Dr. Fred Bloom
AAA Screening Malignant Melanoma
Adolescent Well Visits—Birthday Model
Medical Weight Management
Adult Preventive Care—Birthday Model
Osteoporosis Program
Colonoscopy Screening Program—Birthday Model
Peds Transition to Primary Care (after age 18)
CKD Stage 4 Sleep Medicine Outreach (BMI 35-39)
Dexa Scans Women’s Health: Annual GYN Exams—Birthday Model
Emergency Department Transition to Primary Care Provider
Influenza, Pertussis & Pneumococcal
Care Gap Programs Thank you, Dr. Fred Bloom
Proven Health Navigator Results for Medicare
45(Am J Manag Care. 2010;16(8):607-614)
Thank you, Dr. Fred Bloom
PHN Return On InvestmentThank you, Dr. Fred Bloom
Three-Year Results in 25,000 DM Patients
305 MIs Prevented
NNT to prevent one (1) MI
=82 patients
140 Strokes Prevented
NNT to prevent one (1) Stroke
=170 patients
166 Cases of Retinopathy Prevented
NNT to prevent one (1) case of
Retinopathy=
152 patients
Thank you, Dr. Fred Bloom
Kaiser’s Quality Goals Timeline – 2011 – 2013
Domain 2011 2012 2013
Population Health Self perceived health status data for 15% of members
Self perceived health status data for 20% of members
Self perceived health status data for 25% of members
Population Care Management - Chronic Conditions
Medicare Stars Part C 4 StarsHEDIS composite at 90th percentile
All CV, diabetes, and cancer screening metrics at 90th percentile
Behaviorial Health, Musculoskeletal 90%Medication Management 75%
Medicare Stars Part C 4 StarsAll CV, diabetes, and cancer screening
metrics at 90th percentileBehaviorial Health, Musculoskeletal and
respiratory @ 90%Medication Management 75%
Medicare Stars Part C 4 StarsAll CV, diabetes, and cancer screening
metrics at 90th percentileBehaviorial Health, Musculoskeletal and
respiratory @ 90%Medication Management 90%
Inpatient HSMR TJC Composite
Reduce HSMR: Below US Medicare average, crude mortality 10% from 2010
baselineTJC Composite at national 90th percentile
Readmit rate<15% of all cause readmissions
Reduce HSMR: Below US MedicareTBD - May shift to inpatient outcomes
Readmit rate<10% of all cause readmissions
TJC Composite at national 90th percentile
Reduce HSMR: Below US MedicareTJC Composite at national 90th percentile
Patient Safety Never Events 10% less events than 2010 10% less events than 2011 10% less events than 2012
Workplace Safety Per regional targets Per regional targets Per regional targets
Clinical RiskManagement
0 to 5% reduction in lawsuits with a payout from 2010
0 to 5% reduction in lawsuits with a payout from 2011
0 to 5% reduction in lawsuits with a payout from 2012
Service Hospital
Outpatient
HealthPlan
Medicare Stars
At National 75th percentile (final quarter)
75th percentile in local or national in 3 of 8 regions
75th percentile in local or national in 6 of 8 regions
4 Stars on Overall CAHPS
At national 75th percentile (rolling 12 months)
75th percentile in local or national in 5 of 8 regions
75th percentile in local or national 7 of 8 regions
4+ Stars on Overall CAHPS
Above National 75th percentile (rolling 12 months)
8 of 8 Regions at goal
8 of 8 regions at goal
4+ Stars on Overall CAHPS
Equitable Care Identify interventions to reduce the gap Decrease the gap by x% Decrease by x% more over
2012
Thank you, Lisa Shilling, Kaiser Permanente
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 49
Intermountain’s Board GoalsSix “Dimensions of Care” goal areas
1. Clinical Excellence
2. Patient Engagement
3. Operational Effectiveness
4. Employee Engagement
5. Physician Engagement
6. Community Stewardship
Thank you, Intermountain web site
Intermountain’s Clinical Excellence Board Goals1. Behavioral Health Clinical Program: Decrease inpatient psychiatric 30-day readmission rate for the Intermountain system.
2. Cardiovascular Clinical Program: Integrate the treatment of heart failure patients across the continuum to improve care and reduce hospital readmissions.
3. Intermountain Homecare: Improve care transitions to and from Homecare through effective communication, collaboration, and coordination among care providers.
4. Intensive Medicine Clinical Program: Decrease mortality in patients diagnosed during their hospital stay with severe sepsis.
5. Oncology Clinical Program: Improve the appropriate utilization of genetic screening to determine if families are at higher risk for colon and endometrial cancer.
6. Patient Safety: Reduce the system rate of catheter-associated urinary tract infections.
7. Pediatric Specialties Clinical Program: Build a care model for children with type 1 diabetes.
8. Primary Care Clinical Program: Establish an individualized approach to diabetic care by engaging patients in self-management, primary care visits, and specialty consultations.
9. SelectHealth: Increase the percentage of SelectHealth members with diabetes who meet four measures of diabetes care: blood sugar control, cholesterol control, kidney function, and eye exam.
10. Surgical Services: A three-part goal that reduces blood utilization, defines clinical outcome measures for specific development teams, and develops and implements a standardized process to decrease intracase supply utilization. Intracase utilization means the processes or units of care used within each health episode.
11. Women and Newborns: Improve care, cost efficiency, and resource utilization in the neonatal intensive care unit (NICU), and accurately estimate the number of babies with early onset bacterial infection.
12. Primary Children’s Hospital: Increase the involvement of infectious disease specialists in decisions to use outpatient antibiotic therapy via infusion, injection, or implantation.
13. Rural Facilities: Implement electronic physician orders to guide evidence-based care for patients with the primary diagnosis of pneumonia, labor induction, pancreatitis, and sepsis.
14. CMS Value-Based Purchasing: The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards hospitals with incentive payments for the quality of care they provide to people covered by Medicare. The focuses for Intermountain’s goal in this area are to:
● Attain a significant improvement in the value-based purchasing process and outcome domains for select measures.
● Sustain progress for those hospitals that already meet or exceed national benchmarks.
Thank you, Intermountain web site
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
In Conclusion
51
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 52
How Do You Become An Analytics “Leader”?
Lead Past Competing Interests• Balance the tension of care delivery, economic risk, affordability of care, and
accessibility to care… all under one CEO
Take Risk• Take risks, on their own, with new care delivery models and population
health… no government mandates required
Consistently Practice Principle-Driven Decisions• Do the right thing for patients and their communities, even at the risk of
financial loss in a fee-for-service environment
Value Data Over Ego & Anecdote• Have the courage to face the truth of data• Data drives their decisions, not anecdotes and hunches
Motivate through Mastery, Autonomy, and Purpose• Recognize what motivates people and organizations
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright
Thank YouUpcoming Educational OpportunitiesHealthcare Transformation Series: Chapter SevenDate: September 4, 1-2pm, ESTPresenter: Dr. John Haughom, Senior Advisor, Health Catalysthttp://www.healthcatalyst.com/knowledge-center/webinars-presentations
Healthcare Analytics SummitJoin top healthcare professionals for a high-powered analytics summit using analytics to drive an engaging experience with renowned leaders who are on the cutting edge of healthcare using data-driven methods to improve care and reduce costs.Date: September 24th-25th Location: Salt Lake City, UtahSave the Date: http://www.healthcatalyst.com/news/healthcare-analytics-summit-2014
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright © 2014 Health Catalyst
www.healthcatalyst.com
Transforming Healthcare Through Analytics
Provide a tangible vision of healthcare analyticsLeading keynote speakersEngage the audience with analytics in a unique wayHands-on learning experiencesInteractive audience engagement, optimized for teamsUser and special interest group follow upProvide meaningful networking opportunitiesShare Health Catalyst vision, products, roadmapsHave Fun
Access to a mobile app will be used for audience response and participation in real time. Group-wide and individual analytic insights will be shared throughout the summit, resulting in a more substantive, engaging experience while demonstrating the power of analytics.
hasummit.com
Billy BeaneGeneral ManagerOakland A’s
Glen D. Steele, MD, PhDPresident and CEOGeisinger Health System
Ray KurzweilDirector of EngineeringGoogle and Leading Futurist
James Merlino, MDChief Experience OfficerCleveland Clinic
Penny WheelerPresident and Chief Clinical OfficerAllina Health
Charles Macias, MD, MPHChief Clinical Integration Systems OfficeTexas Children’s Hospital
Governor Mike LeavittFormer Secretary of HHSFounder of Leavitt Partners
Ms. Lizette Yearwood, JPChief Executive OfficerCayman IslandsHealth Service Authority (HAS)
Keynote Speakers
© 2014 Health Catalystwww.healthcatalyst.comCreative Commons Copyright 55
Q&A, Contact [email protected]
@drsanders