meaningful analytics = higher quality, increased revenue

TIPAAA 23rd Annual Meeting | March 29, 2018

Meaningful Analytics = Higher Quality, Increased Revenue & Less Stress

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Today’s Co-presenters

Laurie Jaccard, RN | Founder and President | CI | Hilton Head, SC

Since 2001, Clinical Intelligence (CI) has partnered with over 150 healthcare organizations in 40 states to improve clinical, financial and operational performance with an emphasis on clinical outcomes. CI’s proprietary analytics platform, ClinView®, augments and amplifies the results generated through CI’s consulting services, and provides sustainable, insight-driven solutions for the long term.

Peter Leventis | Chief Executive Officer | CIMS | Columbia, SC

Founded in 2008, Community Integrated Management Services, LLC (CIMS), is a private, for profit partnership owned equally by 14 Federally Qualified Health Centers (FQHC) in South Carolina.

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Actionable analytics that allow leaders throughout

a healthcare organization to drive improvements

in clinical, financial and operational performance.

Definition: Meaningful Analytics

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Background Community Integrated Management Services, LLC

• In 2007, South Carolina announced plans to move SC Medicaid from fee for service to managed care with no limit on the number of Managed Care Organizations that could operate in the state.

• In addition, the healthcare industry was beginning the discussions of about transitioning from “Volume Based” to “Value Based” Reimbursement.

• So in 2008, CIMS was founded.

CIMS • Independent Practice Association (IPA) • Located in South Carolina • Integrated network • Offering primary care, behavioral, dental and

pharmacy services in 39 of the 46 counties in SC

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Background Community Integrated Management Services, LLC

Since inception, CIMS recognized the importance of data – but achieving meaningful data required:

• Leadership commitment

• Long term vision

• Dedication from providers and staff

• Finding the right solution partner

• Technology investment

• Believing in a process

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1. Identify: Challenges

2. Access: Current Analytics State

3. Select: Right Solution

4. Implement: Single Source of Truth

5. Measure: Return on Investment (ROI)

6. Plan: For the Future

Our Journey | 2008-2018 A Commitment To The Process

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1. Transition to Value-Based Care We recognized that value-based care is driven by data because providers must report to payors on specific metrics and demonstrate improvement.

2. Contract Negotiations with Plans These partnerships are most effective when both sides understand the benefits of the relationship and when each side is properly supported with analytics during plan negotiations.

3. Progressive Leadership We knew decisions could not be made in a vacuum if we were to maximize return.

Our Challenges | 2008

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• Data was siloed and resided in disparate systems throughput enterprise - not validated or risk segmented

• Projects were not grounded by measurable analytics to determine ROI

• Reporting was performed in isolation using multiple sources and without consensus

Our Current State | 2008

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Advisory

Predictive Analytics

Business Reporting and Analysis

Data Integration and Consolidation

Data Collection and Basic Analysis

TRANSFORMING

(81% - 100%)

OPTIMIZING (61% - 80%)

INTERACTIVE (41% - 60%)

EXPLORING (21% - 40%)

AWARE

(0 – 20%)

Our Current State | 2008 Data Maturity Level

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Care Management & Quality Provider Engagement Evidence Based Medicine Support Staff By In Workplan Driven Coding Level Financial Structure Value Focused Incentive Based Pay Shared Savings Contracts

Operations Progressive Culture Leadership Commitment System Reporting Analytics Solution

1 2 3 2 2

1 1 1

2 4 1 0

2008

33% 20/60

MATURITY LEVEL

EXPLORING

Our Current State | 2008 Meaningful Analytics Readiness Scorecard (Scale 1 – 5)

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Selecting The Right Solution | 2010 What we looked for in a partner

• Passionate about healthcare • Superior listening and communication skills • Supportive of leadership’s business decisions • Committed to understanding uniqueness of our organization • Proven track record with results

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• Security: HIPAA compliant • Access Anywhere: Cloud-based • Ease of Use: A balance of guided and self-service analytics • Focused On Actionable Data: Designed to illuminate opportunities • Customizable: Designed to meet our needs

Selecting The Right Solution | 2010 What we looked for in a platform

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Implementation Quick Example: ED Utilization

Leveraged data to shift patient behaviors to redirect patient to appropriate level of care

• Which ED? • What Day of Week? • What time of Day? • What Diagnosis? • Visits per year?

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Implementation Quick Example: Retinal Scanners

Leveraged data to validate purchasing decision

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Allowed system-wide insight on clinical performance Tracked improvements within the network Promoted data sharing with our payors

Return on Investment | 2010-2017 Transition to Value Based Care

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Leveled the playing field Improved communication and partnership Allowed us to addressed payor misconceptions

Return on Investment | 2010-2017 Contract negotiations with plans

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Quantifies results Allows for collaborative planning Visualizes data for easier comprehension

Return on Investment | 2010-2017 Progressive Leadership

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4 5 4 4

5 3 4

4 4 4 3 3



2018

80% 48/60

MATURITY LEVEL

OPTIMIZING

Return on Investment | 2018 Progressive leadership

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CIMS | Scorecard (Scale: 1 – 5)

Meaningful Analytics Readiness



1 2 3 2 2

1 1 1

2 4 1 0

2008 2018 Care Management & Quality Provider Engagement Evidence Based Medicine Support Staff By In Workplan Driven Coding Level Financial Structure Value Focused Incentive Based Pay Shared Savings Contracts


4 4 4 3 3

5 3 4

4 5 4 4

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Return on Investment | 2018 Results

• Discussions no longer subjective

• Decisions based on objective data from EMR and Claims Based Data

• Speaking same language

• Trust with leadership; staff and payors

• Prepared to adapt to the changing healthcare landscape

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Looking Ahead Platform Expansion of our strategic vision

• Empowering Physicians to Champion Patient Care Delivery

• Shift focus from Top Down to Bottom Up Strategic Alignment (Goals > Strategies)

• Physician-only sessions to include Nurse and Quality

• Continue to have lower level meetings with staff to support the needs of the providers / physicians

• We need to ensure they are armed with everything they need – EMR, good nursing staff, support staff and an analytics tool that they can access / gauge and they will self police

Senior Level / C-Suite

Mid Level Staff

Front End

Nursing

PROVIDERS

Front Line Delivery of Care

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Looking Ahead Platform Expansion of our strategic vision

• Support State Star Rating Requirements Proactive Reporting Tools to assist plans in meeting requirements for NCQA

• Improve user adoption and satisfaction

• Improve Gaps in Care Closures by incorporating into daily operations (i.e., huddles)

• Incentivize and reward qualifying practices

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Alignment of Priorities Catapult Goal Achievement

Patient Care Outcomes Better Care, Better Health

Health Centers C-Suite Responsibilities Identify Physician Champions to become experts; ensure consistent information flow to

all stakeholders/ providers

Ensure daily operations meet this goal (how well they know patient panels, which gaps

in care, better stewards of care)

Embrace that managed care organizations have access to augment what we need done

(i.e. mobile mammography scheduling across organization, vision testing)

Empower staff to do more patient education and training to take delivery to a new level

Physicians / Providers Problem Solvers – more analytically engaged

Improve Patient Engagement

Clinical Drivers are the responsibility of the providers and clinical team

Create standard orders based on evidence based medicine

Plan’s Responsibilities Stimulate incentives for better health, better care

Questions?

TIPAAA 23rd Annual Meeting | March 29, 2018

meaningful analytics = higher quality, increased revenue

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