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Intro of data analysis in healthcare for triple aim

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Have you ever heard of Triple Aim in healthcare? The slide briefly introduces how to turn millions of healthcare data into useful insights and predictions for Triple Aim. What aspects do we usually …

Have you ever heard of Triple Aim in healthcare? The slide briefly introduces how to turn millions of healthcare data into useful insights and predictions for Triple Aim. What aspects do we usually use data for analysis? Reports for enrollment and ED visits demonstrate the aspects you can dig into. What is the structure for claims? How to use quality measures? It also has emergency department (ED) visits as the example to show how to use the codes in claims to dig out ED visits. Lastly, it explains common diagnosis and procedure coding in healthcare, including ICD, CPT, and HCPCS.

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  • 1. 2/9/2014 INTRO OF DATA ANALYSIS IN HEALTHCARE Analysis, Reporting, Action with Triple Aim Yaxing Liu, PhD SQLROCKET.BLOGSPOT.COM 1 Todd Park, CTO,  Department of Health and Human Services Source: http://www.forbes.com/sites/nicoleperlroth/2011/11/02/tim‐oreilly‐the‐worlds‐7‐most‐powerful‐data‐scientists/ SQLROCKET.BLOGSPOT.COM 2 1
  • 2. 2/9/2014 Triple Aim  Better Care Better  Population  Health In 2011, current  estimates by World  Health Organization put  U.S. health care spending  at approximately 17.9%  of GDP.  Lower  Cost SQLROCKET.BLOGSPOT.COM 3 Healthcare Ecosystem Source: http://www.infosys.com/industries/healthcare/industry‐offerings/Pages/interface‐factory‐CoE.aspx SQLROCKET.BLOGSPOT.COM 4 2
  • 3. 2/9/2014 Data Warehouse Modeling From the book: Healthcare Risk Adjustment and Predictive Modeling SQLROCKET.BLOGSPOT.COM 5 Programs ACO: Accountable Care Organizations. HIE: Health Information Exchanges. Patient‐center care. SQLROCKET.BLOGSPOT.COM 6 3
  • 4. 2/9/2014 Reporting Chronic care reporting Utilization Quality measures Enrollments/trends Costs: PMPM HEDIS measures Prediction Priority Score ED Visits Readmission Hospital  Admissions Enrollment  Chronic Condition  Trend Development Screening/Assess ment/Care Plan Transitional  Support Costs Actions? Care Alerts Chronic Care  Management Identify high‐ risk/ high‐ opportunity patients Automated  Tracking Medication  scheduling and  reminder SQLROCKET.BLOGSPOT.COM 7 Medicaid Enrollment Source: https://www.ccwdata.org/cs/groups/public/documents/digitalmedia/a2_race_2009_image.jpg SQLROCKET.BLOGSPOT.COM 8 4
  • 5. 2/9/2014 Medicaid Enrollment Source: https://www.ccwdata.org/cs/groups/public/documents/digitalmedia/a2_age_2000_2009_image.jpg SQLROCKET.BLOGSPOT.COM 9 Track Enrollment Trends SQLROCKET.BLOGSPOT.COM 10 10 5
  • 6. 2/9/2014 Enrollment Analysis SQLROCKET.BLOGSPOT.COM 11 11 PMPM Cost Source: http://www.objectivehealth.com/our‐offerings/strategy‐solution/value‐based‐care SQLROCKET.BLOGSPOT.COM 12 12 6
  • 7. 2/9/2014 Cost and Savings State  Fiscal Year Per‐Member, Per‐Month Total Annual Savings 2007 $8.73 103,000,000 2008 $15.69 204,000,000 2009 $20.89 295,000,000 2010 $25.40 $382,000,000 $984,000,000 Source: https://www.communitycarenc.org/our-results/ccnc-saves-money/ SQLROCKET.BLOGSPOT.COM 13 13 When • Admit date • Discharge date Who • Member • Provider Why • PRIMARY_DIAGNOSIS • SECONDARY_DIAGNOSIS • DISCHARGE_STATUS_CODE_DESC SQLROCKET.BLOGSPOT.COM 14 7
  • 8. 2/9/2014 PROCEDURE_CODE • Hospital outpatient and Acute Inpatient ED claims are identified  by revenue center codes equal to ‘0450’,’0451’,’0452’,’0456’,  ‘0459’  • PROCEDURE_CODE = '450' Revenue center code: 0981. • Revenue_Codex in (450, 451, 452, 456, 459) Place of Service • [PLACE_OF_SERVICE] like '%emerg%' SQLROCKET.BLOGSPOT.COM 15 SQLROCKET.BLOGSPOT.COM 16 16 8
  • 9. 2/9/2014 SQLROCKET.BLOGSPOT.COM 17 17 ED Visits Reports  Number of visits: 129.8 million  Number of injury‐related visits: 37.9 million  Number of visits per 100 persons: 42.8  Percent of visits with patient seen in fewer than 15 minutes: 25.1%  Percent of visits resulting in hospital admission: 13.3%  Percent of visits resulting in transfer to a different (psychiatric or  other) hospital: 2.1% • Source: National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department  Summary Tables, tables 1, 4, 14, 24 SQLROCKET.BLOGSPOT.COM 18 18 9
  • 10. 2/9/2014 Claim Header + Claim Line • Claim Num • Claim Type • Claim Status: Paid, adjusted, denied, rejected • Dates • Amount Data Dictionary • Medicare:  • https://www.ccwdata.org/web/guest/data‐dictionaries Form • UB‐04 SQLROCKET.BLOGSPOT.COM 19  Inpatient  Outpatient  SNF/swing bed  Hospice  Physician encounter  DME  SQLROCKET.BLOGSPOT.COM 20 20 10
  • 11. 2/9/2014 Patient • Age • Race • Gender Provider • NPI / name / address  Diagnosis/procedure  • CPT • HCPCS • ICD9‐CM Diagnosis, ICD9‐CM Procedure, ICD10 • LOINC SQLROCKET.BLOGSPOT.COM 21 Origin • The International Classification of Diseases (ICD) is updated and maintained  by the World Health Organization (WHO) • ICD‐9‐CM developed in 1970s • WHO’s 9th revision of ICD (ICD‐9) had attained wide international recognition  by 1970s Modifiction • The U.S. National Center for Health Statistics, part of Centers for Disease  Control, modified ICD‐9 with clinical information  • Result was the International Classification of Diseases, 9th Revision, Clinical  Modification (ICD‐9‐CM), commonly referred to as ICD‐9, which precisely  delineates the clinical picture of each patient, providing exact information  beyond that needed for statistical groupings and analysis of healthcare trends SQLROCKET.BLOGSPOT.COM 22 11
  • 12. 2/9/2014 Professional (CMS‐1500) • diagnosis codes • V‐codes (V01‐V91) • E‐codes (E000‐E999) Institutional (UB‐04) • diagnosis codes • V‐codes • E‐codes • procedure codes SQLROCKET.BLOGSPOT.COM 23 Definition • 3 digits followed by a decimal, then followed by no, 1, or 2 digits,3‐5 characters in length • First digit may be alpha (E or V) or numeric; digits 2‐5 are numeric • All claims, whether CMS‐1500 or UB‐04, must have at least one ICD‐9 diagnosis code • On UB‐04, the first diagnosis code must describe the principal reason for the care provided. Guideline • Providers should code only the current condition that prompted the patient’s visit • When the diagnostic statement identifies an acute condition, providers should use the code  that specifies “acute” whenever it is available • Providers should be as specific as possible in specifying diagnosis SQLROCKET.BLOGSPOT.COM 24 12
  • 13. 2/9/2014 Include: • ICD‐10‐CM – diagnosis codes • ICD‐10‐PCS (Procedure Coding System) –procedure  codes, only for UB‐04 (primarily hospitals) Definition • 3‐7 characters in length • First digit is alpha; digits 2 and 3 are numeric; digits  4‐7 are alpha or numeric • specific SQLROCKET.BLOGSPOT.COM 25 SQLROCKET.BLOGSPOT.COM 26 26 13
  • 14. 2/9/2014 Definition • • • • 2 digits followed by a decimal, then no, 1, or 2 digits Used to document procedures performed during the encounter Ranked in priority of significance Used only on UB‐04 claims SQLROCKET.BLOGSPOT.COM 27 CMS ICD‐9 coding guidelines  Identify each service, procedure, or supply with an ICD‐9 diagnosis  code to describe the diagnosis, symptom, complaint, condition, or  problem  Identify services or visits for circumstances other than disease or  injury, such as follow‐up care after chemotherapy, with V codes  provided for this purpose  Code the principal diagnosis first, followed by the secondary, tertiary,  and so on. SQLROCKET.BLOGSPOT.COM 28 28 14
  • 15. 2/9/2014 CPT: Current Procedural Terminology • Developed and maintained by the American Medical As sociation (AMA) in 1966 • Five‐digit codes with descriptions • CPT and HCPCS codes also used to reimburse most non • ‐physician  • health professionals Six major sections • Evaluation and management (E&M) (99201‐99499) • Anesthesiology (00100‐01999) • Surgery (10040‐69990) • Radiology (70010‐79999) • Pathology and laboratory (80048‐89399) • Medicine (90281‐99199 and 99500‐99999) Subsections • Procedures are divided into subsections according to body part, service, or diagnosis SQLROCKET.BLOGSPOT.COM 29 SQLROCKET.BLOGSPOT.COM 30 15
  • 16. 2/9/2014 Definition • HCPCS means HCFA Common Procedure Coding System • Allows providers and medical suppliers to report  professional services, procedures and supplies SQLROCKET.BLOGSPOT.COM 31 SQLROCKET.BLOGSPOT.COM 32 16
  • 17. 2/9/2014 SQLROCKET.BLOGSPOT.COM 33 CMS NDC 5‐4‐2 Segmentation The first segment: the labeler code assigned by FDA.  A labeler is any firm that manufactures, repacks, or distributes a drug  product. The second segment: the product code, identifies a specific drug,  strength, and dosage form of that drug. The third segment, known as the package code, identifies the  package size.  SQLROCKET.BLOGSPOT.COM 34 34 17
  • 18. 2/9/2014 NDC Examples NDC Codes NDC Descriptions 99073070827 FreeStyle Lite Test Strips‐ 100 ct 99073070822 FreeStyle Lite Test Strips‐ 50 ct 99073070819  NFRS FreeStyle Lite Test Strips 50 ct 99073071230 NFRS FreeStyle Insulinx Test Strips 50 ct SQLROCKET.BLOGSPOT.COM 35 35 HEDIS measures SQLROCKET.BLOGSPOT.COM 36 36 18

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