The Path to Shared Savings With Population Health Management Applications

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Eric Just, Vice President of Technology and Kathleen Merkley, Clinical Engagement Executive and Vice President at Health Catalyst, will demonstrate live several advanced applications built on a Late-Binding Catalyst data warehouse. Attendees will better understand how to:

Identify variability in care
Define accurate populations
Report on key health indicators across the continuum of care
Apply flexible models for risk stratification
Measure detailed process metrics spanning transitions of care for HF patients

Next generation health systems and Accountable Care Organizations will be paid based on an evolving model that rewards healthcare providers through ‘shared savings.’ Those savings must be achieved through systematic cost reductions while still improving quality of care. For most, this dual focus will prove to be the most critical and difficult part of realizing success.

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  • Heart failure (HF) is one of the most rapidly increasing cardiovascular disorders in the United States. According to the 2012 update of Heart Disease and Stroke Statistics, it is the leading cause of hospitalization in individuals over the age of 65. This age group currently encompasses over 13% of our population, and that number will rise to 20% in the next 7 years. Unfortunately, the elderly population is not the only group that has an increased incidence of HF. Due largely to the rise in obesity, the trends are increasing in all age groups, making HF the third leading cause of hospitalization for the total U.S. population. Primary hospitalization is not the only issue with HF as it is also the most common cause of hospital readmissions, with approximately 30% of patients readmitted to the hospital within 60-90 days of discharge from their index hospitalization, the hospitalization immediately prior to readmission. This statistic has prompted CMS to make HF one of the targets for new initiatives to reduce these numbers and cut Medicare costs.
  • Nearly 25% of patients re-hospitalized for HF are readmitted within one month. As a result of this data, CMS has labeled HF as one of its target areas of excessive readmission, along with acute myocardial infarction (MI) and pneumonia. CMS has instituted initiatives that include penalties to encourage hospitals to reduce these rates. In the fiscal year 2013, hospitals with the highest rates of readmissions will receive a 1% loss in Medicare payments, an amount that can equal millions of dollars. This rate will continue to increase, raising to 2% in 2014, and 3% in 2015.
  • The Path to Shared Savings With Population Health Management Applications

    1. 1. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics © 2014 Health Catalyst www.healthcatalyst.comProprietary and Confidential Eric Just, VP Technology Kathy Merkley, RN, VP Clinical Engagement April 9, 2014 The Path to Shared Savings With Population Health Management Applications
    2. 2. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics Accountable Care Organizations & Shared Savings • Healthcare provider organizations responsible for providing coordinated care for their patients • Contract with payers through some form of shared risk payment model • Most payment models include downside risk to the healthcare providers • Payment models reward high-quality, low-cost care with shared savings
    3. 3. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics Population Health Management (PHM) The Key to Shared Savings Provider Network 1 Population 2 Cost Outcomes 4 Quality Outcomes 3 Four Building Blocks of Population Health Management developing the asset
    4. 4. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics PHM and Accountable Care (AC) Accountable Care Financing and Administration Population Health Management developing the asset packaging and marketing the asset
    5. 5. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics What Does Health Catalyst Do? ● Enterprise Data Warehouse “single source of truth” ● Library of data acquisition adapters ● Metadata repository ● Auditing and access control ● Supports a variety of analytic applications ‒ Health Catalyst ‒ Client developed 5 Platform
    6. 6. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics What Does Health Catalyst Do? ● Reports & Dashboards ● Ad-hoc query ● Registries ● Quality measures ● Population health ● Data mining ● Clinical improvement ● Workflow analysis ● Modeling and predictive analytics 6 Applications Platform
    7. 7. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics What Does Health Catalyst Do? Installation ● Configuration ● Data Architecture Improvement ● Project Management ● Clinical Improvement ● “Lean” Process Improvement 7 Applications Services Platform
    8. 8. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics Application Families 8 Foundational Applications Discovery Applications Advanced Applications Provide deep insights into evidence-based metrics that drive improvement in quality and cost reduction through managing populations, workflows, and patient injury prevention. Encourage broad use of the data warehouse by presenting dashboards, reports, and basic registries across clinical and departmental areas. Allow users to discover patterns and trends within the data that inform prioritization, inspire new hypotheses, and define populations for management.
    9. 9. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics Demos 9 Discovery ApplicationsFoundational Applications Advanced Applications` Population Suites e.g., Ischemic Heart Disease Workflow / Operational Suites e.g., Acute Medical Patient Injury Prevention Suites e.g., Infection Prevention Patient Injury Prevention Modules e.g., CAUTI, CLABSI, SSI Workflow/Operational Modules e.g., ICU, MedSurg, Emergency Population Modules e.g., CABG, Stent, AMI Labor Management Explorer Rev Cycle Explorer Patient Satisfaction Explorer General Ledger Explorer Readmission Explorer Population Explorer Patient Flow Explorer Practice Management Explorer Suite Financial Management Explorer CAFE—Comparative Analytics Framework and Exchange—across Healthcare Systems and National Benchmarks EDIT—Executive Dashboard Integration Tool (Key Performance Indicator editable collage from all app categories) Key Process Analysis (KPA) Cohort Builder Comorbidity Analyzer Payment Model Analyzer Readmission Predictor Patient Flight Plan Predictor ACO Explorer Suite Metric Correlation Analyzer Regulatory Explorer Attribution Modeler
    10. 10. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 10 Demo 1: Key Process Analysis (KPA). Identify areas of greatest opportunity for quality improvement and savings Demo 2: Population Explorer. Identify potential risk by understanding relative size of disease populations and risk profiles Demo 3: Heart Failure. Achieving quality improvement and cost reductions by directing targeted interventions to high-risk patients Demo 4: Community Care. Monitoring high-risk patients in primary care to prevent expensive acute treatment Demos: How Analytics Drive Shared Savings
    11. 11. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics Heart Rhythm Disorders Vascular Disorders Ischemic Heart Disease Heart Failure CARDIOVASCULAR Care Process Families Clinical Program CABGPCIAMIACSCare Processes KPA: Clinical Hierarchy
    12. 12. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics Dr. J. 15 Cases $15,000 Avg. Cost Per Case Mean Cost per Case = $10,000 $5,000 x 15 cases = $75,000 opportunity Total Opportunity = $75,000Total Opportunity = $175,000 $4,000 x 25 cases = $100,000 opportunity Total Opportunity = $500,000Total Opportunity = $1,200,000 Cost Per Case, Vascular Procedures KPA: Measuring Opportunity Using provider variation to calculate the potential financial impact of improving and standardizing care processes
    13. 13. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 13 Demo 1: Key Process Analysis (KPA). Identify areas of greatest opportunity for quality improvement and savings Demo 2: Population Explorer. Identify potential risk by understanding relative size of disease populations and risk profiles Demo 3: Heart Failure. Achieving quality improvement and cost reductions by directing targeted interventions to high-risk patients Demo 4: Community Care. Monitoring high-risk patients in primary care to prevent expensive acute treatment Demos: How Analytics Drive Shared Savings
    14. 14. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 14 Heart Failure Statistics Heart failure (HF) is one of the most rapidly increasing cardiovascular disorders. ● Leading cause of hospitalization in individuals over 65 years of age.¹ ● Third leading cause of hospitalization in the U.S. in all age groups.² 1Krumholz HM, Chen YT, Wang Y et al. Am Heart J. 2000;139(1 Pt 1):72–7.. 2Heart Disease and Stroke Statistics—2012 Update. Circulation. 2012;125:e2-220. 3Jencks SF, Williams MV, Coleman EA. N Engl J Med. 2009;360:1418-28. 4Gheorghiade M, Vaduganathan M, Fonarow GC et al. J Am Coll Cardiol. 2013;61:391-403. HF is the most common cause of readmission.3 Rates approach 30% within 60-90 days of discharge.4
    15. 15. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 15 CMS and Medicare Readmission Penalties Nearly 25% of all patients hospitalized for heart failure are readmitted within 30 days. CMS has labeled HF as an area of excessive readmission. CMS penalties will ensue to reduce readmission rates http://www.ama-assn.org/amednews/2012/08/27/gvsb0827.htm. American Medical Association. Accessed online 12/28/2012. 95 96 97 98 99 100 101 FY 2012 FY 2013 FY 2014 FY2015 PercentofPayments Received Penalties Will Reduce Medicare Payments 1% Loss 2% Loss 3% Loss
    16. 16. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics Improvement Methodology • A goal is a desired result the workgroup envisions, plans and commits to achieve an organizational desired end-point by a specified deadline. • AIM statements are written, measurable, and time-sensitive objectives that move the team toward achieving the goal .
    17. 17. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 17 CV Heart Failure Goal: Decrease 30 day readmission rates of heart failure patients Establish a baseline of all cause 30 day readmission rates for HF patients, create and validate 30 day and 90 day readmission rates for all HF patients. AIM #1 AIM #2 AIM #3
    18. 18. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 18 CV Heart Failure Goal: Decrease 30 day readmission rates of heart failure patients Identify high risk heart failure patients and extend the identification of these patients to a Risk Stratification Model to predict the likelihood of all cause 30-day readmission rates. AIM #1 AIM #2 AIM #3
    19. 19. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 19 CV Heart Failure Goal: Decrease 30 day readmission rates of heart failure patients Schedule a follow-up appointment for all HF patients within 24 hours of discharge with a focus on high risk patients being seen within 48-72 hours after discharge. AIM #1 AIM #2 AIM #3
    20. 20. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 20 CV Heart Failure Goal: Decrease 30 day readmission rates of heart failure patients AIM #1 AIM #2 AIM #4 AIM #3 Establish a medication reconciliation baseline and track compliance in order to achieve 75% compliance by X date.
    21. 21. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 21 CV Heart Failure Goal: Decrease 30 day readmission rates of heart failure patients AIM #2 AIM #3 AIM #5 AIM #4 A follow-up phone call from a nurse post-discharge to assess whether the patient has obtained his/her medication and has no barriers to making their follow-up appointment.
    22. 22. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics Organizational Teams It’s not just about technology Cardiovascular Clinical Program Guidance Team Heart Failure MD Lead RN SME Knowledge Manager Data Architect Application Administrator RN, Clin Ops Director Guidance Team MD lead (e.g., Heart Failure MD Lead) = Subject Matter Expert = Data Capture = Data Provisioning & Visualization = Data Analysis Ischemic MD Lead RN SME Vascular MD Lead RN SME • Permanent Teams • Integrated Clinical and Technical members • Supports Multiple Care Process Families Heart Rhythm MD Lead RN SME
    23. 23. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics 23 Demo 1: Key Process Analysis (KPA). Identify areas of greatest opportunity for quality improvement and savings Demo 2: Population Explorer. Identify potential risk by understanding relative size of disease populations and risk profiles Demo 3: Heart Failure. Achieving quality improvement and cost reductions by directing targeted interventions to high-risk patients Demo 4: Community Care. Monitoring high-risk patients in primary care to prevent expensive acute treatment Demos: How Analytics Drive Shared Savings
    24. 24. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics © 2014 Health Catalyst www.healthcatalyst.comProprietary and Confidential Appendix
    25. 25. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics Advanced Applications Pediatrics Appendectomy Asthma Acute Asthma Chronic* Cardiovascular Atrial fibrillation* Conduction disorders* Ischemic Heart Disease* Heart Failure Community Care Diabetes* Asthma* Primary care General Medicine Diabetes* DKA (diabetic ketoacidosis) Deep vein thrombosis* Peripheral vascular disease* Pulmonary Pneumonia Community acquired Pulmonary embolism* Infectious Diseases Cellulitis* Urinary Tract Infection* Meningitis* Sepsis Gastrointestinal Anal/rectal disorders* Appendectomy Inflammatory diseases* Lower GI procedures* Obstruction* Neurosciences Stroke* - Hemorrhagic* - Vascular* - Transient ischemic attack* Oncology Breast Gastrointestinal Thoracic Orthopedics Fractures - Hip/pelvis* - Lower extremity* - Upper extremity* Spine Total hip* Total knee* Surgery - Vascular Aortic aneurism* Other venous disorders* Varicose veins* Women and Newborns Antenatal Steroid C-section Delivery Elective Inductions NTSV cesarean Newborn Departmental EC (Emergency Care)* Laboratory* OR Workflow* Radiology* Nursing* Other Coordinated Care Labor & Productivity Medication Management OPPE (Ongoing Professional Practice Evaluation) Physician Credentialing Primary Care Professional Billing ACO Patient Injury Prevention VT/PE prevention* CAUTI CLABSI Controlled substance diversion prevention * In Development
    26. 26. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics26 Data Marts and Applications Common Definitions and Standardization Population Definitions, Comorbidities, Attribution, Patients, Labs, Encounters, Diagnoses, Medications Source Marts EMR EMR Financial Patient Sat. HR Administrative Claims Financial Patient Sat. HR Administrative Claims e.g. Epic, Cerner e.g. EPSi, Peoplesoft, Lawson e.g. Press Ganey, NRC Picker e.g. Lawson, Peoplesoft, Ultipro e.g. API Time Tracking e.g. Medicare Architecture Overview
    27. 27. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics c 27 Demo 1: Key Process Analysis. Identify areas of greatest opportunity for quality improvement and savings Demo 2: Population Explorer. Identify potential risk by understanding relative size of disease populations and risk profiles Demo 3: Heart Failure. Achieving quality improvement and cost reductions by directing targeted interventions to high-risk patients Demo 4: Community Care. Monitoring high-risk patients in primary care to prevent expensive acute treatment
    28. 28. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics c 28 Demo 1: Key Process Analysis. Identify areas of greatest opportunity for savings and quality improvement Demo 2: Population Explorer. Identify potential risk by understanding relative size of disease populations and risk profiles Demo 3: Heart Failure. Achieving quality improvement and cost reductions by directing targeted interventions to high-risk patients Demo 4: Community Care. Monitoring high-risk patients in primary care to prevent expensive acute treatment
    29. 29. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics c 29 Demo 1: Key Process Analysis. Identify areas of greatest opportunity for savings and quality improvement Demo 2: Population Explorer. Identify potential risk by understanding relative size of disease populations and risk profiles Demo 3: Heart Failure. Achieving quality improvement and cost reductions by directing targeted interventions to high-risk patients Demo 4: Community Care. Monitoring high-risk patients in primary care to prevent expensive acute treatment
    30. 30. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics c 30 Demo 1: Key Process Analysis. Identify areas of greatest opportunity for savings and quality improvement Demo 2: Population Explorer. Identify potential risk by understanding relative size of disease populations and risk profiles Demo 3: Heart Failure. Achieving quality improvement and cost reductions by directing targeted interventions to high-risk patients Demo 4: Community Care. Monitoring high-risk patients in primary care to prevent expensive acute treatment
    31. 31. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Follow Us on Twitter #TimeforAnalytics Thank You Next Educational Webinar By Failing to Prepare, You Are Preparing to Fail Laying the Foundation for Sustainable Change and Success Date: Wednesday, April 16th Time: 1:00-2:00 PM ET Presenter: John Haughom, MD, Senior Advisor, Health Catalyst Register at http://healthcatalyst.com/

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