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A foundation for achieving value based healthcare
 

A foundation for achieving value based healthcare

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Richard Cramer, Informatica’s Chief Healthcare Strategist and Maury DePalo, Director of Edgewater’s Healthcare Practice, will discuss the challenges of identifying, integrating, delivering, and ...

Richard Cramer, Informatica’s Chief Healthcare Strategist and Maury DePalo, Director of Edgewater’s Healthcare Practice, will discuss the challenges of identifying, integrating, delivering, and governing the diverse sources of performance data necessary to enable and measure the shared risks and rewards of accountable care delivery models.

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    A foundation for achieving value based healthcare A foundation for achieving value based healthcare Presentation Transcript

    • Let’s Talk Healthcare with Informatica and Edgewater: A Foundation for Achieving Value-Based Healthcare Richard Cramer Maury DePalo Michelle Blackmer Chief Healthcare Strategist Director, Healthcare Practice Director, Healthcare Product Marketing Informatica Edgewater Informatica1
    • Transitioning from Current Operating Models -- An Iterative Approach for Incremental Implementation Assess the Envision the Current State Future State Process Data Needs Needs Analytic Capabilities Increasing Capabilities on Each Cycle through the Process 2
    • Use Case 1 - Reporting & Analytics Integrating Clinical & Financial Performance & Risk Management Specialty Care: Dr. RubensteinBy Practice Area, By PhysicianPrimary Care: Dr. Jamieson By Service Types PMPM / Utilization / Adherence to Std / Clinical Risk / Inpatient Financial Risk DOS Procedure Submit Amt Paid Amt Outpatient Claim Nbr: 2006-1001-00101 3/30/2006 CPT 77057 3/30/2006 CPT 88174 Claim Total Screening Mammography, Bilateral ... Cytopathology (Liquid-Based) $ $ $ 105.00 45.00 150.00 $ $ $ 95.00 55.00 150.00 Claim Nbr: 2007-1310-00322 5/19/2007 CPT 77057 Screening Mammography, Bilateral ... $ 105.00 $ 95.00 5/19/2007 CPT 88174 Cytopathology (Liquid-Based) $ 45.00 $ 55.00 Claim Total $ 150.00 $ 150.00 Claim Nbr: 2009-1561-00451 7/30/2009 CPT 77057 Screening Mammography, Bilateral ... $ 105.00 $ 95.00 7/30/2009 CPT 88174 Cytopathology (Liquid-Based) $ 45.00 $ 45.00 Claim Total $ 150.00 $ 140.00 Claim Nbr: 2010-1833-00729 12/10/2010 CPT 88174 Cytopathology (Liquid-Based) $ 45.00 $ 45.00 12/19/2010 CPT 77057 Screening Mammography, Bilateral ... $ 105.00 $ 95.00 Professional Fees Claim Total $ 150.00 $ 140.00 Normative Data Provider Radiology Specification Patient Specification Provider Peer Group Service Laboratory Specification ? Provider A Result A Location Specification Provider B Result B Other Specification Provider C Result C Provider D Result D  Year over Year, Quarterly Performance & Tracking  By Time Frame 3
    • Use Case 2 – Patient & Physician Attribution Collaborative, Patient-Centered Care Primary Hospital Care Groups Specialty SNF, LTC Groups Physical Rehab Therapy Payers Shared Accountability – Shared Risks & Rewards – Coordinated Delivery Platform 4
    • Use Case 2 – Patient & Physician Attribution• Establishing a Performance Track Record • Baseline of Effective, Efficient Patient Care & Favorable Outcomes • Which Patients, Which Services, What Outcomes, What Costs? • Quality  Efficiency  Value • Evidence-based Rationale for Components of Shared Value Proposition • Value Added at Each Step in Coordinated Process of Encounters to Outcomes• Primary Building Blocks • Models: Data, Process, Business, Populations & Practices • Technology: Data Capture, Quality Control, Integration, Transformation, Aggregation, Analytics• Defining Accountability • Who is accountable, and for what? • Shared accountability – measure team and individual performance against industry or institutional standard (structures, processes, metrics) 5
    • Learn More…….• Register for the second webinar in the series: A Foundation for Achieving Value-Based Healthcare Wednesday, November 14, 2012 11:00am PT / 2:00pm ET http://vip.informatica.com/?elqPURLPage=10576• Click here to view our first webinar, Journey to the Future of Healthcare Delivery• To join future webinars in the series, click here 6