the critical role of analytics in managing population...
TRANSCRIPT
Sean Cassidy, General Manager
Enterprise Provider Analytics and
Population Health
The Critical Role of Analytics in
Managing Population Health
2 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
Our mission: To improve the health of communities
Premier is the nation’s largest healthcare alliance
Owned by
93,000+ Alternate sites
of care
$4.2 BILLION savings in 2011
$43 BILLION
in group
purchasing
volume
2,800 member
hospitals
Database representing
Five-time
winner
of Ethisphere’s
most Ethical
Companies
award
Award-winning
environmentally
sustainable
program
200 healthcare systems
Malcolm
Baldrige
National Quality
Award
1 in every 4 U.S.
discharges
winner
Owned by
3 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
• 55,000 covered lives
• Pioneer | Medicaid | Employees
• Pioneer data live in 44 days
Austin, TX
• 36,000 covered lives
• Medicare Shared Savings
• MSSP data live in 55 days
Atlanta, GA
• 25,000 covered lives
• MSSP| Aetna | Employee
• MSSP data live in 55 days
St. Joseph’s, MO
• 234,000 covered lives
• Pioneer | Commercial | Employee
• Data Alliance member
Minneapolis, MN
• 72,000 covered lives
• MSSP | Aetna
• Integration to IBM/Premier EDW
Roanoke, VA
• 100,000 covered lives
• Local employer market
• Data Alliance member
Charlotte, NC
Population %
Commercial 53%
Medicare 27%
Employee 12%
Medicaid 8%
3
Our pop health solutions are covering ~1M ACO lives
4 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
A transformative moment in healthcare
Imperative to manage
population health, impact outcomes, and provide higher quality at lower
cost
Economic and regulatory challenges
• Government, commercial and consumer pricing pressure
• Mix degradation
• Flat/declining utilization
Systemic challenges
• Fragmented care delivery
• Misaligned relationships with physicians, payers
• 30% of undefined waste
• Lack of transparency and information sharing
Transformative challenges
• Movement toward risk-based payments
• Value-based purchasing
• Readmissions/HAC penalties
• Bundled payments
5 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
FEE-FOR-SERVICE MOVING TO INTEGRATED CARE, NEW PAYMENT MODELS & RISK
The journey to high value healthcare
Value-based purchasing: HACs, quality, efficiency, cuts
HAC & readmissions
penalties Shared savings
Global payment Bundled payment
Population Management High Value Episodes High Performing Hospitals
345 QUEST members
450 Partnership for
Patients
43 Markets
21 Major DRGs
120 markets
6 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
FEE-FOR-SERVICE MOVING TO INTEGRATED CARE, NEW PAYMENT MODELS & RISK
Value-based purchasing: HACs, quality, efficiency, cuts
HAC & readmissions
penalties
Shared savings
Global payment Bundled payment
How many
physicians are
referring out of my
network?
How well do we manage episodes
of care?
How to I manage
thousands of
patients at
once?
Key
Questions
Key population health questions
7 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
29 markets | 23 systems | 100+ hospitals | 5,000+
MDs, 1.5M accountable care covered lives
86 markets | 67 systems | 300+ hospitals | 12,000+
MDs
Primary Care network development
Patient Centered Medical Home
Physician-led / professionally managed
Clinically Integrated Network
Care Management programs
Population Health Analytics
Aligned Payer arrangements
Insights from our members focused on pop health
8 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
FTC definition of a CIN
Improve
utilization/quality/costs
Implement protocols
and best practices
Furnish higher quality, more
efficient working together
Pool infrastructure, human,
and financial resources
Jointly contract with payers on
share savings/risk basis
Basic IT requirements
Interface multiple EHRs
Integrate clinical/claims
data
Apply near real time clinical
intelligence
Define patient cohorts and
aggregate patient data
Calculate performance
metrics
Capabilities to
manage populations
Risk Stratification
Patient Outreach and
Engagement
Patient Centered
Medical Home
Care Management
Performance evaluation
against benchmarks
Clinically integrated network required capabilities
9 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
EDW as a pop health data integration mechanism
Data Data Warehouse &
Analytic Engine
Medical Claims
Rx Claims
Eligibility File(s)
Other (e.g.,
HRA)
Population stratification and high-risk
patient prioritization with insight on Rx
adherence, gaps in care, likelihood of
hospitalization).
Population Health Management
e.g. Disease registry, cost distribution,
program evaluation, peer-to-peer
performance assessment
Reporting & Benchmarking
Medical Management
In/out of network utilization. Claims-
based analysis of preferred vendors,
referral and prescribing patterns, and
more)
Lab Results
Demographics
Performance Management
Risk-adjusted primary care
efficiency evaluation and network
variation assessment.
Analytics and
Clinical
Intelligence
9
10 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
So, to do pop health, we need to solve this problem…
External Data Sources
Data Data Data Data Data Data Data Data Data Data
Data Data Data Data Data Data
11 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
11
Foundational
• What happened?
• When and where?
• How much?
Operational, Tactical
• What will happen?
• What will be the impact?
• Dashboards
• Clinical data repositories
• Departmental data marts
• Enterprise data warehouse
Data integration
Data warehouse
• Enterprise analytics
• Unstructured content analytics
• Outcomes analytics
• Evidence-based medicine
Decision support
analytics
• Streaming analytics
• Similarity analytics
• Personalized healthcare
• Consumer engagement
Predictive
analytics
Advanced, Predictive
• What are potential scenarios?
• What is the best course?
• How can we pre-empt and
mitigate the crisis?
… and deliver these capabilities …
11
12 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
… on something that looks like this …
Analyze
Integrate
Manage
Business Analytics
Applications
External
Information
Sources
Cubes
Streams
Big Data
Master Data
Content
Data
Streaming
Information
Govern
Quality
Security & Privacy
Lifecycle
Warehouse
Standards
Transactional
& Collaborative
Applications
Content
Information
Governance
ODS
Data Model
13 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
… but that introduces a new challenges …
Large IT projects have a failure rate of over 28% (Gartner) and
are often delivered late and over budget
Providers are capital and resource constrained
Finding resources with advanced data analysis/integration, BI
tooling, statistical modeling, etc., skills can be a challenge
Providers often don’t have effective governance and oversight
processes, which are critical to project success
Providers often underestimate the challenges and expense
associated with data acquisition and integration
Providers often don’t have innovation oriented IT cultures
Insight is often not actionable
How do you maximize the value of your EDW/BI investments?
14 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
… which could potentially be addressed by:
Learning from the successes (and failures) of organizations
who have done it before
Avoiding re-inventing the wheel
Tapping into a community of expertise that extends outside the
boundaries of the organization
Being part of an ecosystem that innovates solutions
collaboratively
Speaking a common data language
Leveraging existing data integration investments
Focusing on delivering stakeholder value, rather than data
integration and technology/infrastructure management
Deploying BI within a social business framework
15 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
You need to be ambidextrous…
Today’s needs
• Facility, department, &
service line analysis
• Population segmentation
and analysis
• Data acquisition and
integration
• …
Tomorrow’s challenges
• Network and system level
performance analysis
• Predictive and prescriptive
modeling
• Risk management
• Big data management
• …
Develop now and share
to accelerate Collaborate to prepare,
drive and innovate
16 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
And you need to be honest about your capabilities
Problem
Instru-mentation:
Do we have the data?
Integration:
Can we access the
data?
Infor-mation:
Can we transform the
data into usable infor-
mation? Technology:
Do we have the tech to analyze the information?
Technology Skills:
Can we build the solution?
Analytical Skills:
Can we leverage the
solution?
17 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
Social Business Actions / Knowledge / Communities
Clinical
Integration
Network
Management
Identify Care
Gaps
Stratify
Risks
Segment
Population
Engage
Patients
Measure
Outcomes
Manage
Care
Population Health
Management Cost Management
Effective
Operations
Purchased
Services
Portfolio
Management
Clinical
Preference Resource
Utilization
Comparative
Effectiveness
Enterprise Data Warehouse Clinical / Financial / Supply Chain / Payer
Another way to look at it
Member
Management
Labor
Productivity
Proper Skill
Mix
Staff to
Volume
18 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
It’s not just about the data, it’s about connecting…
DATA KNOWLEDGE PEOPLE
Business
analytics &
intelligence
Integrated
data across
the continuum
Content
contribution
Role-based
content
access Collaboration Networking
Actionable Information Best Practices Communities
19 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
The value of the cloud
90% of healthcare
CIOs view IT
innovation as
critical to success
Using the cloud
could reduce IT
costs by 9% and
deliver over $11B
in savings over 3
years
Less then 25% of
healthcare CIOs
think their existing
infrastructure
supports innovation
Source: MeriTalk – “Health Check: Healthcare CIOs Prescribe Change”
20 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
“E-commerce, in particular, has exploded data
management challenges along three dimensions:
volumes, velocity, and variety.”
“Big Data” is 12 years old
Doug Laney, META Group
February 6, 2001
21 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
Are you using Big Data?
vital-signs are captured by
bedside monitoring devices
Volume Velocity Variety
1,000/sec
Recognize abnormalities
quickly with real-time
analysis of devices,
images & alerts.
Combine massive volumes
of data to form the basis of
evidence based medicine.
Enrich your population
health analytics by tapping
into unstructured data.
unstructured data in EMRs,
devices, publications, drug
structures…
80% estimated stored healthcare
data as of 2011
150exabytes
Courtesy of:
22 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
Big data needs to be complemented by big judgment
[The odds are] that
someone in your
organization is making
a poor decision on the
basis of information
that was enormously
expensive to collect
…[training is] overly
focused on the
[analytical] tool itself,
instead of on how
managers can use it to
improve their
judgment…
… data investments are
providing limited returns
because [of
underinvestment] in
understanding the
information
“Good Data Won’t Guarantee Good Decisions”
Shah, Horne and Capella
Harvard Business Review
April, 2012
23 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
“If US healthcare were to use big data creatively and
effectively to drive efficiency and quality, the sector could
create more than $300 billion in value every year.
Two-thirds of that would be in the form of reducing US
healthcare expenditure by about 8 percent. ”
But big data presents a very compelling opportunity
McKinsey Global Institute
May, 2011
Thank you