Health Industries Practice Overview www.edgewater.com
Edgewater Technology: Background & Experience <ul><li>Strategic Technology Management Consulting Firm </li></ul><ul><ul><l...
Edgewater Technology: Background & Experience <ul><li>Core Values </li></ul><ul><ul><li>Delivery Excellence </li></ul></ul...
Edgewater Technology: Service Offerings
Edgewater Technology: Industry Experience Horizontal Offerings Increasing Value Across the Enterprise by  Delivering A Uni...
Edgewater Technology: What Customers Are Saying <ul><li>“ Imagine a ‘dream team’ of our decision support leader and Edgewa...
Healthcare Industries – Focus on the Patient Care <ul><li>Health Producers </li></ul><ul><li>Pharmaceutical </li></ul><ul>...
Health Industries Practice: Key Messages Superior Outcomes Dollars Spent =  Value to the Patient / Member <ul><li>Direct P...
Health Industries Practice: Key Messages Superior Outcomes Dollars Spent =  Value to the Patient / Member Improved Access ...
Health Industries Practice: Key Messages Superior Outcomes Dollars Spent =  Value to the Patient / Member Reduced Time / I...
Healthcare Environment <ul><li>Market Demand For Transparency </li></ul><ul><li>Increased Medical Spend on Members </li></...
Unlocking the Value of Enterprise Data Assets <ul><li>The Challenge </li></ul><ul><ul><li>Many diverse application systems...
Unlocking the Value of Enterprise Data Assets <ul><li>The Value </li></ul><ul><ul><li>Data is managed proactively as a dis...
Predictive Analytics: Focusing Corrective Actions <ul><li>Identify Segments of Interest </li></ul><ul><li>Establish Normat...
Extending Visibility into the Enterprise Executive User Functional User Power User Highly Aggregated More Detail Complete ...
Enterprise View: Across the Full Spectrum of Care Longitudinal Medical Record Ambulatory Acute Care SNF Home Care Emergenc...
Edgewater’s Health Industries Offerings <ul><li>Enterprise Data Strategy & Implementation Services </li></ul><ul><ul><li>D...
Edgewater Technology: Case Examples: Producers Clinical Trials IVR Enrollment, stratification, randomization, patient diar...
Edgewater Technology: Case Examples: Providers Total Cancer Care – Enterprise Data Warehouse (EDW) Personalized Medicine; ...
Edgewater Technology: Case Examples: Payers Web-based Inquiry Tracking Solution   Customer Service Workstation Buy vs. Bui...
Healthcare Client Successes - Carilion <ul><li>Carilion Health System </li></ul><ul><li>As the largest healthcare provider...
Healthcare Client Successes - Healthfirst <ul><li>HEALTH FIRST – Florida </li></ul><ul><li>Health First is a private, non-...
Healthcare Client Successes - Providence <ul><li>PROVIDENCE HEALTH SYSTEM </li></ul><ul><li>Based in Seattle, Washington, ...
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Edgewater Technology Healthcare 2009

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Overview of Edgewater Healthcare Practice

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Transcript of "Edgewater Technology Healthcare 2009"

  1. 1. Health Industries Practice Overview www.edgewater.com
  2. 2. Edgewater Technology: Background & Experience <ul><li>Strategic Technology Management Consulting Firm </li></ul><ul><ul><li>Enterprise Performance Mgmt, Complex Data & Systems Integration </li></ul></ul><ul><ul><li>Technical Consulting, Custom Software Design & Development </li></ul></ul><ul><ul><li>Strategy, Business Consulting Services, Industry Focus </li></ul></ul><ul><ul><li>Tailored Technology Solutions for Customer’s Business Needs </li></ul></ul><ul><li>Founded in 1992 </li></ul><ul><ul><li>Headquartered in Wakefield, MA </li></ul></ul><ul><ul><li>Offices in New Hampshire, New York, Florida, Arkansas, Colorado, California - 15 Direct Sales Staff located Nationwide </li></ul></ul><ul><ul><li>Edgewater Technology acquired Lynx in September 2007 - Certified SAP Consultants </li></ul></ul><ul><li>Delivery Track Record </li></ul><ul><ul><li>Over 1900 Projects Completed </li></ul></ul><ul><ul><li>350 Technology Consultants </li></ul></ul><ul><ul><li>Consistent and Profitable Growth </li></ul></ul><ul><ul><li>95% Customer Retention </li></ul></ul>
  3. 3. Edgewater Technology: Background & Experience <ul><li>Core Values </li></ul><ul><ul><li>Delivery Excellence </li></ul></ul><ul><ul><li>Vertical Industry Expertise </li></ul></ul><ul><ul><li>Technology Excellence </li></ul></ul><ul><ul><li>Solid Methodologies </li></ul></ul><ul><ul><li>Strong Customer References </li></ul></ul><ul><ul><li>Strong Operational Metrics </li></ul></ul><ul><li>Financials </li></ul><ul><ul><li>Revenue: FY 2007: $68.5M </li></ul></ul><ul><ul><li>Publicly Traded: NASDAQ: EDGW </li></ul></ul><ul><li>Website </li></ul><ul><ul><li>www.edgewater.com </li></ul></ul>
  4. 4. Edgewater Technology: Service Offerings
  5. 5. Edgewater Technology: Industry Experience Horizontal Offerings Increasing Value Across the Enterprise by Delivering A Unique Blend of Premium IT Services Vertical Markets Healthcare/ Life Sciences Retail Financial Services Higher Education CPG / Mfg Hospitality Emerging Information/ Media Travel / Entertainment Enterprise Architecture Services Enterprise Performance Management / Business Intelligence Data Services Mergers & Acquisitions Program / Project Management Business Strategy Services Insurance
  6. 6. Edgewater Technology: What Customers Are Saying <ul><li>“ Imagine a ‘dream team’ of our decision support leader and Edgewater’s principal consultant driving our strategy.” - VP, IT, Integrated Health Network </li></ul><ul><li>“ Edgewater is the absolute thought leader on our enterprise data strategy.” </li></ul><ul><li> - IT Director, Comprehensive Cancer Center </li></ul><ul><li>“ The other firms offer data management only. Edgewater truly understands healthcare and data management.” - Enterprise Architect, Health Provider </li></ul><ul><li>“ You are the first consultants that have given us hope that it can be done!” </li></ul><ul><li> - CIO, Integrated Health Network </li></ul><ul><li>“ We are leaps and bounds ahead of where we were because of Edgewater’s leadership.” - Chief Medical Officer, Health Network </li></ul><ul><li>“ Edgewater was instrumental in making our enterprise data warehouse a reality.” - Medical Director, Cancer Treatment & Research Institute </li></ul><ul><li>“ Our thinking is very similar on the key pieces of a viable enterprise strategy.” - Head of Medical Informatics, Leading Health Network </li></ul>
  7. 7. Healthcare Industries – Focus on the Patient Care <ul><li>Health Producers </li></ul><ul><li>Pharmaceutical </li></ul><ul><li>Biotechnology </li></ul><ul><li>Medical Device </li></ul><ul><li>Health Regulators </li></ul><ul><li>FDA </li></ul><ul><li>EMEA, ICH </li></ul><ul><li>CMS </li></ul><ul><li>JCAHO </li></ul><ul><li>NCQA </li></ul><ul><li>Health Providers </li></ul><ul><li>Hospitals </li></ul><ul><li>Integrated Health Systems </li></ul><ul><li>Cancer Centers </li></ul><ul><li>Medical Groups </li></ul><ul><li>Academic Medical </li></ul><ul><ul><li>Centers </li></ul></ul><ul><li>Health Payers </li></ul><ul><li>HMO, PPO, POS, EPO </li></ul><ul><li>Blues </li></ul><ul><li>Medicare / Medicaid </li></ul><ul><li>TPA </li></ul><ul><li>Self-Funded Employers </li></ul>
  8. 8. Health Industries Practice: Key Messages Superior Outcomes Dollars Spent = Value to the Patient / Member <ul><li>Direct Patient Outcomes </li></ul><ul><ul><li>Extended Survival / Reduced Mortality </li></ul></ul><ul><ul><li>Reduced Disease Severity / Reduced Morbidity </li></ul></ul><ul><ul><li>Improved Quality of Life </li></ul></ul><ul><ul><li>Increased Patient Satisfaction </li></ul></ul><ul><ul><li>Improved Patient Safety </li></ul></ul><ul><ul><ul><li>Reduced Adverse Events / Serious Adverse Events </li></ul></ul></ul><ul><ul><li>Time to Diagnosis </li></ul></ul><ul><ul><li>Time to Initial Definitive Treatment </li></ul></ul><ul><li>Indirect Patient Measures </li></ul><ul><ul><li>Improved Quality of Care </li></ul></ul><ul><ul><ul><li>- measured against Standard of Care </li></ul></ul></ul><ul><ul><ul><li>- measured against Base of Evidence - HQI, CMS Pay for Performance, VBP </li></ul></ul></ul><ul><ul><li>Increased Efficiency of High Quality Care </li></ul></ul><ul><ul><li>Reduced Length of Stay </li></ul></ul>
  9. 9. Health Industries Practice: Key Messages Superior Outcomes Dollars Spent = Value to the Patient / Member Improved Access to High Quality Care / Best Focused Care  Best Individual Care / Personalized Care  Improved Geographic Access, Distribution of Services  Improved Access to Matching Clinical Trials  Improved Market Share Improved Efficiency in Delivery of High Quality / Most Appropriate Care  Reduced Cost of Delivery  Better Utilization of Capacity  Getting Patients to the Most Appropriate Setting Compliance with Regulations  Regulated Best Practices  Improved Audit / Inspection Performance
  10. 10. Health Industries Practice: Key Messages Superior Outcomes Dollars Spent = Value to the Patient / Member Reduced Time / Increased Throughput / Increased Efficiency  to bring Research Findings to Patient Care  (i.e. Translational Research) Clinical Research to Standard of Care  Increased Number of Patients Enrolled in Clinical Trials  Improved Identification of Appropriate Candidates for Clinical Trials  Increased Number of New Approved Treatments Basic Research to Clinical Research  Increased Number of New Clinical Trials  Increased Number of New Investigational Compounds; New Investigational Protocols  Increased Funding for Basic Research; Clinical Research
  11. 11. Healthcare Environment <ul><li>Market Demand For Transparency </li></ul><ul><li>Increased Medical Spend on Members </li></ul><ul><li>Reduced Medicare Reimbursement </li></ul><ul><li>Regulatory Compliance (e.g. NPI) </li></ul><ul><li>Competition </li></ul><ul><li>Lack of Standard Reporting Definition </li></ul><ul><li>No Formal Business Intelligence (BI) </li></ul><ul><li>or Enterprise Data Strategy </li></ul><ul><li>Poor Data Access </li></ul><ul><li>Inconsistent Data Governance </li></ul><ul><li>Lack of Data and/or Systems Integration </li></ul>Future Goals <ul><li>Improved Patient / Member Outcomes </li></ul><ul><li>Increase Revenue, Reduced Costs </li></ul><ul><li>Reduce or Optimize Utilization </li></ul><ul><li>Membership Growth and Retention </li></ul><ul><li>New Market Opportunities </li></ul><ul><li>Increasing Medical Expenditure </li></ul><ul><li>Monitoring and Targeting Unfavorable Utilization Trends, Costs </li></ul><ul><li>Identifying Patient / Member Segments Requiring Intervention </li></ul><ul><li>Measuring Effectiveness of Outreach Programs </li></ul><ul><li>Stimulating Revenue Growth </li></ul><ul><li>Retaining and Growing Membership </li></ul><ul><li>Development of New Products and Services </li></ul>Internal Challenges Challenges, pressures and goals faced in today’s healthcare marketplace … External Pressures Technical Business
  12. 12. Unlocking the Value of Enterprise Data Assets <ul><li>The Challenge </li></ul><ul><ul><li>Many diverse application systems are required to support the various aspects of clinical and research operations </li></ul></ul><ul><ul><ul><li>Clinical, Operational, Research, Administrative, Financial </li></ul></ul></ul><ul><ul><li>Individual application systems are deployed and managed to support specific aspects of the operation </li></ul></ul><ul><ul><ul><li>EMR, OR Scheduling, Materials Mgmt, Billing & Reimbursement, CTMS, Research Admin </li></ul></ul></ul><ul><ul><li>Bringing data together from multiple points of origin leads to various integration and governance issues </li></ul></ul><ul><ul><ul><li>Differences in: definition, format, usage, intent, access controls </li></ul></ul></ul><ul><li>The Opportunity </li></ul><ul><ul><li>Data has value and utility beyond the single application or operational context where it originated </li></ul></ul><ul><ul><li>Combination of data from multiple sources increases its value </li></ul></ul><ul><ul><ul><li>E.g. Profitability of Service Lines; Clinical Trials Enrollment Matching </li></ul></ul></ul><ul><ul><li>Take definite steps now to properly manage these assets and leverage their value across the organization </li></ul></ul>
  13. 13. Unlocking the Value of Enterprise Data Assets <ul><li>The Value </li></ul><ul><ul><li>Data is managed proactively as a distinct and independent enterprise asset </li></ul></ul><ul><ul><li>Organization implements consistent policies and protections on critical data assets </li></ul></ul><ul><ul><li>Value of data grows as it is combined and reused in novel contexts </li></ul></ul><ul><ul><li>Benefits realized as improvements in outcomes, quality, utilization, cost control, and profitability </li></ul></ul><ul><li>The Future </li></ul><ul><ul><li>Business / technology initiatives designed and planned with proactive view to the data assets that will be realized </li></ul></ul><ul><ul><ul><li>Impact, overlap, integration with existing assets </li></ul></ul></ul><ul><ul><li>Policies and procedures in place to leverage the value and ensure the protection and compliance of these critical enterprise assets </li></ul></ul><ul><ul><li>Promote a culture of transparency, awareness and innovation in the effective, proactive use of data </li></ul></ul>
  14. 14. Predictive Analytics: Focusing Corrective Actions <ul><li>Identify Segments of Interest </li></ul><ul><li>Establish Normative Data </li></ul><ul><li>Identify Patterns of Interest </li></ul><ul><li>Activate Detective Conditions in </li></ul><ul><li>Business Rules to Examine Data </li></ul><ul><li>Define Action to Take Upon Recognition </li></ul><ul><li>of Condition </li></ul><ul><li>Monitor and Refine: Update to Conditions </li></ul>Expected Behavior If [ Provider X ]  [ Specialty = Pediatric ] AND [ Frequency of [ Service Type = Crown ] ] > [ 1 Std Dev ] Then [ Flag Provider X [ Fraud Review ] ]
  15. 15. Extending Visibility into the Enterprise Executive User Functional User Power User Highly Aggregated More Detail Complete Raw Data <ul><ul><ul><li>Graphical Display, Dashboards, Interactive </li></ul></ul></ul><ul><ul><ul><li>Aggregated Data, Derived, Model Execution </li></ul></ul></ul><ul><ul><ul><li>Limited Drill Down </li></ul></ul></ul><ul><ul><ul><li>Standard & Ad hoc Reporting </li></ul></ul></ul><ul><ul><ul><ul><li>Parameter-Driven by Users at Run-Time </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Sorting, Selection, Filtering, Drill-Down </li></ul></ul></ul></ul><ul><ul><ul><li>Utilizing Standard Functions and Models </li></ul></ul></ul><ul><ul><ul><li>Direct Access to Detailed Raw Data </li></ul></ul></ul><ul><ul><ul><li>Model Development & Deployment </li></ul></ul></ul><ul><li>Traceability </li></ul><ul><li>Consistency </li></ul>
  16. 16. Enterprise View: Across the Full Spectrum of Care Longitudinal Medical Record Ambulatory Acute Care SNF Home Care Emergency Long-Term EMR Materials Management Registration & Scheduling Research Billing & Reimbursements OR Scheduling Integrated EDW Lab Data Costs Labor Legacy External Data
  17. 17. Edgewater’s Health Industries Offerings <ul><li>Enterprise Data Strategy & Implementation Services </li></ul><ul><ul><li>Data Warehouse / Data Architecture </li></ul></ul><ul><ul><li>Data Quality Assessment </li></ul></ul><ul><ul><li>Complex Data Integration </li></ul></ul><ul><li>Enterprise Performance Management (EPM) </li></ul><ul><ul><li>Budgeting & Planning </li></ul></ul><ul><ul><li>Consolidations </li></ul></ul><ul><ul><li>Management Reporting </li></ul></ul><ul><li>Business Intelligence (BI) Quick Start Programs </li></ul><ul><ul><li>Management Dashboards </li></ul></ul><ul><ul><li>KPIs & Metrics Design </li></ul></ul><ul><li>Subject Area Focused Data Services </li></ul><ul><ul><li>Quality: Core Measures, Surgical Care Improvement </li></ul></ul><ul><ul><li>Utilization Review, Predictive Analytics </li></ul></ul><ul><li>Strategic Build </li></ul><ul><ul><li>Surgical Analytics, Personalized Medicine, Real-time Analytics </li></ul></ul><ul><ul><li>Auto-Adjudication, Real-Time Claims Adjudication </li></ul></ul><ul><li>Internet Commerce </li></ul><ul><ul><li>Web Analytics </li></ul></ul>
  18. 18. Edgewater Technology: Case Examples: Producers Clinical Trials IVR Enrollment, stratification, randomization, patient diaries, milestone tracking, replacement doses Quality Indicators: Clinical Data Management Ops; Business Process Redesign Data Entry, Medical-Encoding; Clinical Review; Clinical Forms Mgmt; Business Intelligence Prototype International Sales Force Mobility Platform; Insight PDA Analysis, Requirements, Implementation; Integration Research Portal Analysis & Design across several functional areas; Implementation supports surveys, workflow, tracking
  19. 19. Edgewater Technology: Case Examples: Providers Total Cancer Care – Enterprise Data Warehouse (EDW) Personalized Medicine; Integrated Clinical & Research Data; Microarray; Q&A Methodology Surgical Analytics – Integrated EDW & BI Tools Data Integration; Clinical, Operational, Financial Performance Improvement Quality Data Management System – Integrated EDW Data Integration; Surgical Care Improvement, Metrics; Q&A and Use Case Methodology Enterprise Information Management (EIM) Strategy Best Practices, Strategic Vision & Benefits, Implementation Roadmap; EDW Strategy & Tools
  20. 20. Edgewater Technology: Case Examples: Payers Web-based Inquiry Tracking Solution Customer Service Workstation Buy vs. Build and PMO Implementation Implementation of a Claims System Solution Claims Administration System Integration Business Analysis & Report Development Services Enterprise Information Management Strategy Strategic Vision, BI Tool Implementation, EDW migration
  21. 21. Healthcare Client Successes - Carilion <ul><li>Carilion Health System </li></ul><ul><li>As the largest healthcare provider and the leading employer spanning across western Virginia, Carilion Health System provides a complete healthcare network offering the latest medical technology and the highest standards of care. Because of its size, diversity and composition of ten hospitals, a level one trauma center, cancer center and other facilities, Carilion faced several challenges when it came to budgeting and management reporting. </li></ul><ul><li>CHALLENGES FACED </li></ul><ul><li>Arduous, inaccurate and time consuming budgeting process. </li></ul><ul><li>Complex healthcare calculations. </li></ul><ul><li>Limited reporting capabilities and complexities developing reports </li></ul><ul><li>BENEFITS REALIZED </li></ul><ul><li>Increased efficiency and accuracy in budget process. </li></ul><ul><li>Robust modeling environment to handle the complexities of the hospital contractual processes. </li></ul><ul><li>More intuitive and simplified reporting tools strengthening user and reporting capabilities </li></ul>
  22. 22. Healthcare Client Successes - Healthfirst <ul><li>HEALTH FIRST – Florida </li></ul><ul><li>Health First is a private, non-profit organization providing the people of its communities with quality healthcare without regard to their financial status. Together, with its provider partners, Health First strives to completely integrate all components of care into a seamless system delivered under single leadership. To accomplish this goal, their executive team needs timely access to critical information for public accountability and continuous measurement of clinical performance. </li></ul><ul><li>Health First used a system called Trendstar for their reporting and analysis. The system housed essential data like historical patient activity, cost and revenue by insurance plan, contract information and other key healthcare information. Trendstar had no flexibility, was costly to maintain, and inaccessible to a wide audience of users. If an executive needed a specific report or analysis, he or she would have to place a report request with an analyst. An analyst would then spend several days coding the report This process was slow and quite limited causing top management to wait for days to receive crucial financial information. For these reasons, Health First found it difficult to manage their business properly. </li></ul><ul><li>CHALLENGES FACED </li></ul><ul><li>Time consuming and cumbersome methods utilized to access crucial information. </li></ul><ul><li>Limited means to analyze profitability. </li></ul><ul><li>Required the ability to map patient data to the correct service lines and payors. </li></ul><ul><li>BENEFITS REALIZED </li></ul><ul><li>Easy access to data without complex reporting logic. </li></ul><ul><li>Acquiring information in minutes, not days, leaving more time for analysis. </li></ul><ul><li>High-powered, quick visibility to profitability by doctor, service line, DRG, zip code and many other analysis points. </li></ul>
  23. 23. Healthcare Client Successes - Providence <ul><li>PROVIDENCE HEALTH SYSTEM </li></ul><ul><li>Based in Seattle, Washington, Providence Health System’s commitment of caring spans throughout Alaska, Washington, Oregon and Southern California. Their 34,000 employees operate 19 acute care hospitals, 19 freestanding long-term care facilities and 15 low-income and assisted living facilities. Providence also works closely with its network of physician organizations and sponsors health plans that provide coverage for more than 606,000 members. To meet their myriad of needs, Providence offers a comprehensive array of services including acute and primary care, outpatient services, transitional, home and hospice care, substance abuse programs, mental health treatment and more. For an organization as immense as Providence, getting consistent management reporting and budgeting across the enterprise was an extremely arduous task. </li></ul><ul><li>CHALLENGES FACED </li></ul><ul><li>No single point reporting application in place to address financial, customer satisfaction, position control and daily decision making. </li></ul><ul><li>Existing budgeting solution was not designed to support their budgeting process. </li></ul><ul><li>Many stakeholders with various needs required a more flexible budgeting tool. </li></ul><ul><li>Too many disparate data sources and account structures with no access to departmental detail . </li></ul><ul><li>BENEFITS REALIZED </li></ul><ul><li>A single point reporting application with a user friendly and intuitive interface that delivered mission critical data to Providence executives to manage the business. </li></ul><ul><li>A flexible budgeting tool that conformed to the needs of their budgeting process. </li></ul><ul><li>A single system-wide structure for consolidation with detailed budgeting at the department/ sub-account level that is visible throughout the organization </li></ul>

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