Impact Pro HMGs: Using information to further describe population health Presentation at the Ingenix Health Care Conferenc...
Agenda Topics <ul><li>Introduction and IPRO refresher </li></ul><ul><li>Self Report Domains </li></ul><ul><li>Current Self...
Impact Pro – Features <ul><li>Impact Pro is a multi-dimensional, episode-based predictive modeling suite </li></ul><ul><li...
Business Applications for Impact Pro <ul><li>Medical Management  </li></ul><ul><ul><li>Identify and manage the  right  pat...
Impact Pro Suite
<ul><ul><li>Clinical Indicators </li></ul></ul><ul><ul><ul><li>Disease prevalence </li></ul></ul></ul><ul><ul><ul><li>Dise...
<ul><ul><li>Care Teams </li></ul></ul><ul><ul><ul><li>Identify key providers for a patient based on observed interaction w...
Agenda Topics <ul><li>Introduction and IPRO refresher </li></ul><ul><li>Introduction to Self Report Domains </li></ul><ul>...
<ul><li>Introduction to  Self Reported Measurement </li></ul><ul><li>Survey Domains </li></ul>
Standardized survey tools <ul><li>HRAs </li></ul><ul><ul><li>Industry tools (dozens) and CDC’s BRFSS </li></ul></ul><ul><l...
Challenges on assessing Self Report <ul><li>Descriptive statistics (ceiling/floor effects and missing data)  </li></ul><ul...
Strength of self reported measurement <ul><li>Highly reliable instruments are used </li></ul><ul><li>Valid with clinical a...
Agenda Topics <ul><li>Introduction and IPRO refresher </li></ul><ul><li>Self Report Domains </li></ul><ul><li>Current Self...
Current Self Report IPRO incorporation <ul><li>Today self report data (examples of HRA data) is “passed through” Impact Pr...
Seeing Self Reported Data in IPRO 5.0 – member list
Seeing Self Reported Data in IPRO 5.0 – HRA tab
Filtering on HRA data <ul><li>Can also create case definitions using HRA data and Impact Pro </li></ul>
Filtering can take a few forms <ul><li>To include or exclude members with all HRA responses for a particular  survey </li>...
Case Definitions <ul><li>Rules to identify sub-sets of members who meet certain criteria </li></ul><ul><li>Allow you to se...
<ul><li>Unlike Filters which query data that has already been    processed, creating a Case Definition is creating a   Rul...
Using Impact Score to Stratify  Disease Management <ul><li>Moderate Impact Diabetes </li></ul><ul><ul><li>Risk Category = ...
Limitations of existing HRA functionality in IPRO <ul><li>No standardization of HRA data from various sources </li></ul><u...
Agenda Topics <ul><li>Introduction and IPRO refresher </li></ul><ul><li>Self Report Domains </li></ul><ul><li>Current Self...
HMGs – Making the business case <ul><li>Information tools and methodologies to support care and health management – curren...
HMGs – Making the business case <ul><li>Health care organizations and employers are increasingly interested in focusing on...
Segmenting Populations Maintain Health Manage Health Improve Health <ul><li>57%  of  population has claims under  $1,000 <...
Change of Focus and Requirements <ul><li>Support analysis of healthier populations and patients of emerging risk </li></ul...
Health Management Group Concepts and Domains <ul><li>Ingenix HMG will provide methodologies and outputs to  measure  indiv...
HMG Concepts and Domains <ul><li>Information and domains to support  identification and stratification :  </li></ul><ul><u...
HMG Concepts and Domains <ul><li>Further  segmentation  can occur with:  </li></ul><ul><ul><li>Attitudes and ratings relat...
HMG Concepts and Domains <ul><li>The HMG methodology will: </li></ul><ul><ul><li>Leverage existing Ingenix technologies (I...
Key Advance: HMG Standardizes Alternative sources  of data <ul><li>The HMG methodology will: </li></ul><ul><ul><li>Standar...
Key Advance: HMG Standardizes self-report data <ul><li>Standardized self-reported concepts include: </li></ul><ul><ul><li>...
Examples of HMGs under development  Nutrition Sleep Problems Sexual Risk Activity Obesity Alcohol Abuse Depression Stress ...
Current HMG Development <ul><li>Scope out identification and stratification algorithms for HMGs </li></ul><ul><ul><li>Soli...
Smoking-Related HMG  <ul><li>HMG Levels </li></ul><ul><ul><li>Current </li></ul></ul><ul><ul><li>Quitting </li></ul></ul><...
Smoking Results
Smoking Results by Cost and Risk
Smoking Results – Emerging Risk
Smoking Results by Health Status and Lost Work Days
Physical Activity HMG  <ul><li>HMG Levels </li></ul><ul><ul><li>Active, complete – goes beyond CDC definitions </li></ul><...
Physical Activity - Identification
Physical Activity – Cost and Risk
Physical Activity – Emerging Risk
Physical Activity – Health Status and Work Absence
Nutrition HMG  <ul><li>HMG Levels </li></ul><ul><ul><li>Severe nutrition problems </li></ul></ul><ul><ul><li>Moderate nutr...
Nutrition Problems - Identification
Nutrition Results – Cost and Risk
Nutrition Results – Emerging Risk
Nutrition Results – Health Status and Work Absence
Obesity HMG  <ul><li>HMG Levels </li></ul><ul><ul><li>Morbidly Obese </li></ul></ul><ul><ul><li>Obese </li></ul></ul><ul><...
Obesity Problems - Identification
Obesity Results – Cost and Risk
Obesity Results – Emerging Risk
Obesity Results – Health Status and Work Absence
Obesity Results – Diabetes and Obesity
HMG Summary  <ul><li>Provide a context to organize and focus information in a way that is consistent from both a clinical ...
Questions/Comments
Appendix <ul><li>HRA Input Slides from Impact Pro manual </li></ul>
Assessing and Validating HRA Inputs - appendix <ul><li>Validity and reliability of input data is key to its use not only w...
HRA Table Structure - appendix
HRA Table Structure - appendix
HRA Table Structure - appendix
HRA Table Structure - appendix
Input data steps to include HRA data  - appendix
Input and Output Data Steps – HRA considerations  - appendix
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  • If they are a stand alone client, they can request the PE to be run in between regular data runs. If BPO or ASP, must communicate new rules to Ingenix to be certain that they are processed in the next data run.
  • Ingenix Hc Conference Pres 042108

    1. 1. Impact Pro HMGs: Using information to further describe population health Presentation at the Ingenix Health Care Conference Michael Manocchia, Ph.D. Director, Outcomes and Evaluation [email_address] (work)781-419-8427 May 15, 2008 ● Orlando, FL
    2. 2. Agenda Topics <ul><li>Introduction and IPRO refresher </li></ul><ul><li>Self Report Domains </li></ul><ul><li>Current Self Report IPRO incorporation </li></ul><ul><ul><li>Impact Pro Active </li></ul></ul><ul><ul><li>Filtering </li></ul></ul><ul><ul><li>Case Definitions and Business rules </li></ul></ul><ul><ul><li>Limitations in current self report IPRO approach </li></ul></ul><ul><li>Introduction of HMG </li></ul><ul><ul><li>Making the business case </li></ul></ul><ul><ul><li>HMG introduction </li></ul></ul><ul><ul><li>Self Report standardization </li></ul></ul><ul><ul><li>HMG testing with obesity, smoking and nutrition </li></ul></ul><ul><li>Additional Questions </li></ul>
    3. 3. Impact Pro – Features <ul><li>Impact Pro is a multi-dimensional, episode-based predictive modeling suite </li></ul><ul><li>Accepts readily available information, including medical claims, pharmacy claims, and lab test results for modeling </li></ul><ul><li>Leverages Symmetry’s ETGs to build clinically homogenous markers of future risk </li></ul><ul><li>Predicts both future expenditures and calculates the probability of a hospitalization </li></ul><ul><li>Multiple predictive horizons available based upon available data and business needs </li></ul><ul><li>Transparent – allows users to easily understand the clinical and utilization factors affecting a member’s risk </li></ul><ul><li>Characterizes members along a number of dimensions, including clinical details and gaps in care </li></ul>
    4. 4. Business Applications for Impact Pro <ul><li>Medical Management </li></ul><ul><ul><li>Identify and manage the right patients, at the right time, with the right intervention </li></ul></ul><ul><ul><li>Identify members at greatest risk for future healthcare problems </li></ul></ul><ul><ul><li>Understand key clinical drivers of risk – support steerage to appropriate programs </li></ul></ul><ul><ul><li>Identify care opportunities – members with gaps in care, complications and co-morbidities </li></ul></ul><ul><li>Underwriting </li></ul><ul><ul><li>Set the right premium rate, attract and retain good business, promote stability and profit </li></ul></ul><ul><ul><li>Historically, underwriters have used experience and other factors (age/gender, geographic and industry factors) to set healthcare premiums for individuals & groups </li></ul></ul><ul><ul><li>Information on health risk for groups and individuals is used to enhance the underwriting process </li></ul></ul>
    5. 5. Impact Pro Suite
    6. 6. <ul><ul><li>Clinical Indicators </li></ul></ul><ul><ul><ul><li>Disease prevalence </li></ul></ul></ul><ul><ul><ul><li>Disease stage, advanced markers </li></ul></ul></ul><ul><ul><ul><li>Significant medical and pharmacy utilization events </li></ul></ul></ul><ul><ul><ul><li>More than 1,000 markers available </li></ul></ul></ul><ul><ul><ul><li>Rules engine to support custom rules </li></ul></ul></ul><ul><ul><li>Care Opportunities </li></ul></ul><ul><ul><ul><li>Gaps in care based on comparisons with evidence-based medicine and guidelines </li></ul></ul></ul><ul><ul><ul><li>Future – supplemented by Symmetry’s EBM Connect </li></ul></ul></ul><ul><ul><ul><li>Rules engine to support custom rules </li></ul></ul></ul>Impact ProActive – Features
    7. 7. <ul><ul><li>Care Teams </li></ul></ul><ul><ul><ul><li>Identify key providers for a patient based on observed interaction with the healthcare system </li></ul></ul></ul><ul><ul><ul><li>In addition to PCP, Team defined for selected conditions, including diabetes, cardiovascular, and cancer </li></ul></ul></ul><ul><ul><li>Case Definitions </li></ul></ul><ul><ul><ul><li>Create any cohort of patients, using all Impact Pro outputs and member attributes </li></ul></ul></ul><ul><ul><ul><li>Actionability and savings Assumptions </li></ul></ul></ul><ul><ul><li>Standard Rules and User-Defined Utilities </li></ul></ul>Impact ProActive – Features (cont)
    8. 8. Agenda Topics <ul><li>Introduction and IPRO refresher </li></ul><ul><li>Introduction to Self Report Domains </li></ul><ul><li>Current Self Report IPRO incorporation </li></ul><ul><ul><li>Impact Pro Active </li></ul></ul><ul><ul><li>Filtering </li></ul></ul><ul><ul><li>Case Definitions </li></ul></ul><ul><ul><li>Limitations in current self report IPRO approach </li></ul></ul><ul><li>Introduction of HMG </li></ul><ul><ul><li>Making the business case </li></ul></ul><ul><ul><li>HMG introduction </li></ul></ul><ul><ul><li>Self Report standardization </li></ul></ul><ul><ul><li>HMG testing with obesity, smoking and nutrition </li></ul></ul><ul><li>Additional Questions </li></ul>
    9. 9. <ul><li>Introduction to Self Reported Measurement </li></ul><ul><li>Survey Domains </li></ul>
    10. 10. Standardized survey tools <ul><li>HRAs </li></ul><ul><ul><li>Industry tools (dozens) and CDC’s BRFSS </li></ul></ul><ul><li>HRQOL </li></ul><ul><ul><li>Generic Assess the health related quality of life of a population </li></ul></ul><ul><ul><ul><li>SF-36, NHP, SIP, Dartmouth COOP charts </li></ul></ul></ul><ul><ul><li>Disease-specific HRQOL measures </li></ul></ul><ul><ul><ul><li>St. George’s Respiratory Questionnaire </li></ul></ul></ul><ul><ul><ul><li>MOS-HIV instrument </li></ul></ul></ul><ul><li>Productivity </li></ul><ul><ul><li>Gold Book (2001): covered a number of instruments </li></ul></ul><ul><ul><li>IHPM leads the way today in this regard today </li></ul></ul><ul><li>Behavioral Health </li></ul><ul><ul><li>Clinical diagnostic assessments used in behavioral health that are administered via survey </li></ul></ul><ul><ul><li>Psychological assessments, including substance use and abuse </li></ul></ul><ul><li>Patient Activation measures </li></ul><ul><ul><li>Prochaska TTM; Hibbard’s Activation measures </li></ul></ul><ul><li>Non-standardized tools </li></ul><ul><ul><li>Home-grown assessments when working with patients </li></ul></ul><ul><li>Values in health care </li></ul><ul><ul><li>CAHPS and home grown satisfaction surveys </li></ul></ul><ul><ul><li>Medical decision making surveys </li></ul></ul>
    11. 11. Challenges on assessing Self Report <ul><li>Descriptive statistics (ceiling/floor effects and missing data) </li></ul><ul><li>Test-Retest Reliability </li></ul><ul><li>Item Internal consistency </li></ul><ul><li>Equality of Item-Scale Correlations </li></ul><ul><li>Item Discriminant Validity </li></ul><ul><li>Reliability (Cronbach’s alpha) </li></ul><ul><li>Construct Validity </li></ul><ul><li>Respondent burden </li></ul><ul><li>Languages </li></ul><ul><li>Various tests based on type of items present in your self report measure database </li></ul><ul><li>MAP-R for Likert-based scales is a useful tool (Ware, Hays have versions available) </li></ul>
    12. 12. Strength of self reported measurement <ul><li>Highly reliable instruments are used </li></ul><ul><li>Valid with clinical and cost measures </li></ul><ul><li>Measure domains not accessible by administrative data </li></ul><ul><ul><li>Health behaviors and attitudes </li></ul></ul><ul><ul><li>Health states, pain and function and disease severity </li></ul></ul><ul><ul><li>Mental health indicators </li></ul></ul><ul><ul><li>Perceptions of productivity impacted by health </li></ul></ul><ul><ul><li>Values around medical decisions </li></ul></ul><ul><ul><li>Satisfaction with health care </li></ul></ul><ul><ul><li>Social Support </li></ul></ul><ul><li>Validating your measurement </li></ul><ul><ul><li>See predicted response and benchmark with norms </li></ul></ul>
    13. 13. Agenda Topics <ul><li>Introduction and IPRO refresher </li></ul><ul><li>Self Report Domains </li></ul><ul><li>Current Self Report IPRO incorporation </li></ul><ul><ul><li>Impact Pro Active </li></ul></ul><ul><ul><ul><li>Filtering </li></ul></ul></ul><ul><ul><ul><li>Case Definitions </li></ul></ul></ul><ul><ul><ul><li>Limitations in current self report IPRO approach </li></ul></ul></ul><ul><li>Introduction of HMG </li></ul><ul><ul><li>Making the business case </li></ul></ul><ul><ul><li>HMG introduction </li></ul></ul><ul><ul><li>Self Report standardization </li></ul></ul><ul><ul><li>HMG testing with obesity, smoking and nutrition </li></ul></ul><ul><li>Additional Questions </li></ul>
    14. 14. Current Self Report IPRO incorporation <ul><li>Today self report data (examples of HRA data) is “passed through” Impact Pro </li></ul><ul><li>However, IPRO can organize self report survey questions, which can then be used to </li></ul><ul><ul><li>View, select or report on a population </li></ul></ul><ul><li>There is a defined HRA or survey table structure </li></ul><ul><li>Clients have to prepare their self-report survey questions into meaningful categories to filter on or create further case definitions </li></ul><ul><li>Following key principles to validate your data – (notes validation slides) </li></ul>
    15. 15. Seeing Self Reported Data in IPRO 5.0 – member list
    16. 16. Seeing Self Reported Data in IPRO 5.0 – HRA tab
    17. 17. Filtering on HRA data <ul><li>Can also create case definitions using HRA data and Impact Pro </li></ul>
    18. 18. Filtering can take a few forms <ul><li>To include or exclude members with all HRA responses for a particular survey </li></ul><ul><ul><li>All members that also took an HRA </li></ul></ul><ul><li>To include members with a sub-set of responses to particular survey questions </li></ul><ul><ul><li>All members that reported missing work days frequently do to health </li></ul></ul><ul><li>To create AND statements within the entries within the Included or Excluded boxes, or to create a combination of AND/OR statements between selections within the Included or Excluded boxes </li></ul><ul><li>Advanced Filters allows you to create AND statements or a combination of AND/OR statements between selections within the (Included or Excluded) boxes </li></ul><ul><li>Filtered records can also be reported on through customized reports within the IPRO reporting engine. </li></ul>
    19. 19. Case Definitions <ul><li>Rules to identify sub-sets of members who meet certain criteria </li></ul><ul><li>Allow you to see how many different sets of criteria an individual member meets </li></ul><ul><li>Allow you to create a hierarchy or prioritization of criteria ( Impact Score ) </li></ul><ul><li>Allow you to pre-determine anticipated savings per criteria set ( Predicted Savings ) </li></ul>
    20. 20. <ul><li>Unlike Filters which query data that has already been processed, creating a Case Definition is creating a Rule to be run through the Processing Engine – results will not be seen until the next data run NOTE: This is true for ALL rules – Clinical Indicators, Care Opportunities and Case Definitions </li></ul><ul><li>Once the Rule has been created though, it will be persistent for every future data run AND it can be used as a Filter itself. </li></ul>Creating a Case Definition
    21. 21. Using Impact Score to Stratify Disease Management <ul><li>Moderate Impact Diabetes </li></ul><ul><ul><li>Risk Category = Diabetes…and </li></ul></ul><ul><ul><li>Risk Score = 7-24….and </li></ul></ul><ul><ul><li>Care Opportunity </li></ul></ul><ul><ul><ul><li>New Insulin Rx…..or </li></ul></ul></ul><ul><ul><ul><li>New oral Hypoglycemic Rx…..or </li></ul></ul></ul><ul><ul><ul><li>Gaps in refills or no refills for oral hypoglycemic agents…….and </li></ul></ul></ul><ul><ul><li>Case Definition </li></ul></ul><ul><ul><ul><li>Exclude members who meet Case Definition of “High Impact – Diabetes” </li></ul></ul></ul><ul><ul><ul><li>Include members with stages of change self report question related to improvement of diet </li></ul></ul></ul><ul><ul><li>37 Ingenix created Case Definitions “out of the box” for demonstration purposes only </li></ul></ul>
    22. 22. Limitations of existing HRA functionality in IPRO <ul><li>No standardization of HRA data from various sources </li></ul><ul><ul><li>Clients are left to create their own standards </li></ul></ul><ul><li>No use of national standards with some self-report concepts that are widely understood and can add further depth to understanding health (e.g. CDC definitions) </li></ul><ul><ul><li>Similar to an EBM type model </li></ul></ul><ul><li>The processing engine does not use the data for further calculation of cost and risk in a precise way </li></ul><ul><li>No current way to reconcile contradictions between administrative claims and self report data </li></ul><ul><li>No current way to build multi-dimensional variables with distinct levels that combine HRA, lab and administrative claims presently </li></ul><ul><li>Leads us to address many of these limitations </li></ul>
    23. 23. Agenda Topics <ul><li>Introduction and IPRO refresher </li></ul><ul><li>Self Report Domains </li></ul><ul><li>Current Self Report IPRO incorporation </li></ul><ul><ul><li>Impact Pro Active </li></ul></ul><ul><ul><li>Filtering </li></ul></ul><ul><ul><li>Case Definitions </li></ul></ul><ul><ul><li>Limitations in current self report IPRO approach </li></ul></ul><ul><li>Introduction of HMG </li></ul><ul><ul><li>Making the business case </li></ul></ul><ul><ul><li>Self report standardization </li></ul></ul><ul><ul><li>HMG introduction </li></ul></ul><ul><ul><li>HMG testing with smoking, physical activity, nutrition and obesity </li></ul></ul><ul><li>Additional Questions </li></ul>
    24. 24. HMGs – Making the business case <ul><li>Information tools and methodologies to support care and health management – current state: </li></ul><ul><ul><li>Primary focus is on disease populations or individuals of moderate to higher risk </li></ul></ul><ul><ul><li>Clinical information and concepts supported by administrative medical and pharmacy claims, some use clinical data </li></ul></ul><ul><ul><li>Outputs include measures of risk, some add gaps in care </li></ul></ul><ul><ul><li>Many tools add reporting and some cohort modeling capabilities </li></ul></ul><ul><ul><li>Limited use of alternative sources of data today </li></ul></ul><ul><ul><li>Include alternative sources for identification and stratification methods, prediction and risk adjustment </li></ul></ul><ul><ul><ul><li>How can data from various sources be combined into meaningful building blocks of information? </li></ul></ul></ul>
    25. 25. HMGs – Making the business case <ul><li>Health care organizations and employers are increasingly interested in focusing on healthier members in a population, or members of emerging risk </li></ul><ul><ul><li>Extend interventions to the lower end of the risk spectrum </li></ul></ul><ul><ul><li>Improve wellness, healthy behaviors and lifestyle </li></ul></ul><ul><ul><li>Improve attitudes on health </li></ul></ul><ul><ul><li>Intervene in a more pro-active way, e.g., pre-diabetes, and diabetes-risk </li></ul></ul>
    26. 26. Segmenting Populations Maintain Health Manage Health Improve Health <ul><li>57% of population has claims under $1,000 </li></ul><ul><li>8% of total medical expenses are spent by this group </li></ul><ul><li>41% of population has claims between $1,000 and $20,000 </li></ul><ul><li>59% of total medical expenses are spent by this group </li></ul><ul><li>2% of population has claims greater than $20,000 </li></ul><ul><li>33% of total medical expenses are spent by this group </li></ul>Moving Forward: Enhanced Information for Health Solutions Source: National Health Plan Fully Insured Book of Business, 2004 Current Focus Acute Conditions Moderate Risk High Risk Catastrophic Illness Low Risk Chronic Disease
    27. 27. Change of Focus and Requirements <ul><li>Support analysis of healthier populations and patients of emerging risk </li></ul><ul><li>Leverage existing and new sources of data, including HRA/self report, biometric data and socio-economic data </li></ul><ul><li>Integrate these different sources of data in innovative ways: </li></ul><ul><ul><li>Improve on existing concepts, e.g., measures of future risk </li></ul></ul><ul><ul><li>Support new domains of measurement, including behaviors, attitudes, and social context </li></ul></ul><ul><li>Accommodate different data scenarios – consistent data availability unlikely across and within populations </li></ul><ul><li>Create a useful context for analysis </li></ul><ul><ul><li>We are pulling together a larger number of concepts and variables than are currently available in Impact Pro </li></ul></ul><ul><ul><li>Add value for customers by developing a context – organize information for analysis, presentation, and operations – in a flexible way </li></ul></ul>
    28. 28. Health Management Group Concepts and Domains <ul><li>Ingenix HMG will provide methodologies and outputs to measure individuals along different domains that describe health </li></ul><ul><li>HMGs provide a context for integrating five domains of health </li></ul><ul><li>Domains support both identification/stratification and further segmentation </li></ul>Risk and Severity Health Management Groups (HMGs) Clinical Health Behaviors Social Context Health Attitudes
    29. 29. HMG Concepts and Domains <ul><li>Information and domains to support identification and stratification : </li></ul><ul><ul><li>Clinical </li></ul></ul><ul><ul><ul><li>A clinical description of an individual, based on diagnostic, drug and procedural claims available in Impact Pro and through HRA self report </li></ul></ul></ul><ul><ul><ul><li>Examples – diabetes, CHF, depression, sleep disorder, obesity </li></ul></ul></ul><ul><ul><li>Risk or Severity </li></ul></ul><ul><ul><ul><li>Impact Pro risk, ETG severity, Self report of severity </li></ul></ul></ul><ul><ul><ul><li>Examples – future risk, condition episode severity, health status </li></ul></ul></ul><ul><ul><li>Behavior (Healthy behaviors) </li></ul></ul><ul><ul><ul><li>HRA and EBM measures of behavior, behaviors inferred from consumer data (future) </li></ul></ul></ul><ul><ul><ul><li>Examples – smoking, physical activity, compliance with EBM chronic and preventive rules </li></ul></ul></ul>
    30. 30. HMG Concepts and Domains <ul><li>Further segmentation can occur with: </li></ul><ul><ul><li>Attitudes and ratings related to health </li></ul></ul><ul><ul><ul><li>Readiness to change, activation and perceived social support </li></ul></ul></ul><ul><ul><ul><li>Productivity: absenteeism and presenteeism impacted by health </li></ul></ul></ul><ul><ul><li>Social Context </li></ul></ul><ul><ul><ul><li>Ascribed and achieved status found on HRA and administrative data </li></ul></ul></ul><ul><ul><ul><li>Examples – Age, gender, race ethnicity, education, income, SES </li></ul></ul></ul><ul><li>HMGs will provide a context for organizing patient information around the five domains </li></ul><ul><li>HMGs are being built for specific conditions and behavioral concepts </li></ul><ul><ul><li>HMG Levels will be defined to support identification and stratification </li></ul></ul>
    31. 31. HMG Concepts and Domains <ul><li>The HMG methodology will: </li></ul><ul><ul><li>Leverage existing Ingenix technologies (Impact Pro, ETG, EBM Connect), but expand their focus to new populations and types of measures </li></ul></ul><ul><ul><li>Introduce new sources of data and methods to improve on existing concepts and support new concepts </li></ul></ul><ul><ul><li>Integrate data from multiple sources to describe and categorize a patient along each domain </li></ul></ul><ul><ul><li>Define key building blocks and categorizations within each HMG </li></ul></ul><ul><ul><ul><li>Includes frequency of events and actions, timing (associated with different data sources) and depth of HMG level </li></ul></ul></ul>
    32. 32. Key Advance: HMG Standardizes Alternative sources of data <ul><li>The HMG methodology will: </li></ul><ul><ul><li>Standardize self report and biometric data found on HRAs and other surveys into meaningful sets of building blocks </li></ul></ul><ul><ul><ul><li>Smokers: current, quitting, former never </li></ul></ul></ul><ul><ul><ul><li>BMI: underweight, normal weight, overweight, obese and morbidly obese </li></ul></ul></ul><ul><ul><ul><li>We call these standardized measures dimensional concepts </li></ul></ul></ul><ul><ul><li>Will require the user to map their items through a standardized common HRA map with leading HRA tools in the field </li></ul></ul><ul><ul><ul><li>Also maintain flexibility for the user to develop meaningful HRA categories or build case definitions present in Impact Pro Active </li></ul></ul></ul><ul><ul><li>We will use a scoring framework to map variable attributes into consistent scores and indicators of risk </li></ul></ul>
    33. 33. Key Advance: HMG Standardizes self-report data <ul><li>Standardized self-reported concepts include: </li></ul><ul><ul><li>Condition, treatment, utilization via self report </li></ul></ul><ul><ul><li>Health behaviors: lifestyle, preventive testing, immunizations, safety and other forms of risk aversion </li></ul></ul><ul><ul><li>Health attitudes: readiness, activation and awareness </li></ul></ul><ul><ul><li>HRQOL: physical, emotional, bodily pain, role function </li></ul></ul><ul><ul><li>Productivity: absenteeism and presenteeism </li></ul></ul><ul><ul><li>Social Support </li></ul></ul><ul><ul><li>Social Context: race, ethnicity, education, income </li></ul></ul><ul><ul><li>Biometric markers: cholesterol, BMI, BP, etc. </li></ul></ul><ul><li>This data could extend the risk spectrum for those that answer an HRA and some variables could be used to tailor communication and intervention </li></ul>
    34. 34. Examples of HMGs under development Nutrition Sleep Problems Sexual Risk Activity Obesity Alcohol Abuse Depression Stress Back Problems *preliminary results to be presented Migraine Headaches Safety Diabetes Physical Activity CAD Smoking Asthma/COPD Wellness-Related Disease Management
    35. 35. Current HMG Development <ul><li>Scope out identification and stratification algorithms for HMGs </li></ul><ul><ul><li>Solicit clinical input and review </li></ul></ul><ul><li>Apply algorithms to current analytic data warehouse that has claims, lab and HRA for seven large employers </li></ul><ul><ul><li>Interested in other clients participating in this process </li></ul></ul><ul><li>Test hypotheses related to expected levels associated with HMGs to see if levels are distinct and valid </li></ul><ul><li>Begin to look at emerging risk associated with certain behaviors or conditions </li></ul>
    36. 36. Smoking-Related HMG <ul><li>HMG Levels </li></ul><ul><ul><li>Current </li></ul></ul><ul><ul><li>Quitting </li></ul></ul><ul><ul><li>Former smoker </li></ul></ul><ul><ul><li>Never smoked </li></ul></ul><ul><li>Information used to identify and stratify </li></ul><ul><ul><li>HRA: smoking status, quantity of use, quitting stage </li></ul></ul><ul><ul><li>Medical and pharmacy: diagnoses, drug therapies, procedures indicating quit attempts, quit treatments and counseling </li></ul></ul><ul><ul><li>Map relevant clinical and family history to further define levels </li></ul></ul><ul><li>Ask ourselves: If I run a smoking cessation program what would I want to understand about my members? </li></ul><ul><ul><li>Levels of smoking use </li></ul></ul><ul><ul><li>How does smoking relate to cost and risk? </li></ul></ul><ul><ul><li>What does the emerging risk across smoking groups look like? </li></ul></ul>
    37. 37. Smoking Results
    38. 38. Smoking Results by Cost and Risk
    39. 39. Smoking Results – Emerging Risk
    40. 40. Smoking Results by Health Status and Lost Work Days
    41. 41. Physical Activity HMG <ul><li>HMG Levels </li></ul><ul><ul><li>Active, complete – goes beyond CDC definitions </li></ul></ul><ul><ul><li>Active, sufficient – meets CDC definitions </li></ul></ul><ul><ul><li>Active, light – falls below CDC definitions </li></ul></ul><ul><ul><li>Active, insufficient – falls far below CDC definitions </li></ul></ul><ul><ul><li>Inactive </li></ul></ul><ul><li>Information used to identify and stratify </li></ul><ul><ul><li>HRA: many physical, exercise items to standardize </li></ul></ul><ul><ul><li>Medical and pharmacy: limited set of procedures to increase or counsel on PA </li></ul></ul><ul><li>Ask ourselves: If I run a PA program, program what would I want to understand about my members? </li></ul><ul><ul><li>Levels of activity </li></ul></ul><ul><ul><li>How does PA relate to cost and risk? </li></ul></ul><ul><ul><li>What does the emerging risk of inactivity look like? </li></ul></ul>
    42. 42. Physical Activity - Identification
    43. 43. Physical Activity – Cost and Risk
    44. 44. Physical Activity – Emerging Risk
    45. 45. Physical Activity – Health Status and Work Absence
    46. 46. Nutrition HMG <ul><li>HMG Levels </li></ul><ul><ul><li>Severe nutrition problems </li></ul></ul><ul><ul><li>Moderate nutrition problems </li></ul></ul><ul><ul><li>Low nutrition problems </li></ul></ul><ul><ul><li>No nutrition problems </li></ul></ul><ul><li>Information used to identify and stratify </li></ul><ul><ul><li>Medical and pharmacy: nutrition and weight management counseling appointments and obesity HMG (claims and biometric data) </li></ul></ul><ul><ul><li>HRA: items related to nutrition behaviors and choices </li></ul></ul><ul><li>Ask ourselves: If I run a nutrition behavior change program what would I want to understand about my members before enacting programming? </li></ul><ul><ul><li>Levels of nutrition problems </li></ul></ul><ul><ul><li>How do nutrition problems relate to cost and risk? </li></ul></ul><ul><ul><li>What does the emerging risk across nutrition groups look like? </li></ul></ul>
    47. 47. Nutrition Problems - Identification
    48. 48. Nutrition Results – Cost and Risk
    49. 49. Nutrition Results – Emerging Risk
    50. 50. Nutrition Results – Health Status and Work Absence
    51. 51. Obesity HMG <ul><li>HMG Levels </li></ul><ul><ul><li>Morbidly Obese </li></ul></ul><ul><ul><li>Obese </li></ul></ul><ul><ul><li>Overweight </li></ul></ul><ul><ul><li>Normal weight </li></ul></ul><ul><ul><li>Underweight </li></ul></ul><ul><li>Information used to identify and stratify </li></ul><ul><ul><li>Medical and pharmacy: BMI, obesity diagnoses, obesity procedures, complications associated with obesity, obesity DCC’s. </li></ul></ul><ul><ul><li>HRA: BMI and Waist circumference </li></ul></ul>
    52. 52. Obesity Problems - Identification
    53. 53. Obesity Results – Cost and Risk
    54. 54. Obesity Results – Emerging Risk
    55. 55. Obesity Results – Health Status and Work Absence
    56. 56. Obesity Results – Diabetes and Obesity
    57. 57. HMG Summary <ul><li>Provide a context to organize and focus information in a way that is consistent from both a clinical perspective and also from a health management operational perspective </li></ul><ul><li>Describe both clinical and wellness intervention opportunities </li></ul><ul><li>Have defined levels – that map to potential cohorts for intervention – e.g., level of acuity; categories of smoking status; level of physical activity </li></ul><ul><li>Have rules and algorithms that assign an individual to a clinical or behavioral status (HMG) and levels of problems within an HMG (reconcile data sources, conflicts, timing, frequency) </li></ul><ul><ul><li>Allow users to further define or combine levels that fit program goals using Impact Pro Active </li></ul></ul><ul><li>Incorporate methods to accommodate different data availability scenarios for each individual </li></ul>
    58. 58. Questions/Comments
    59. 59. Appendix <ul><li>HRA Input Slides from Impact Pro manual </li></ul>
    60. 60. Assessing and Validating HRA Inputs - appendix <ul><li>Validity and reliability of input data is key to its use not only with claims data, but also with self report </li></ul><ul><li>With self report, you want to see key elements that are included in the input tables, pass through properly, and can be used for filtering and selecting patients </li></ul><ul><ul><li>Answer_Desc: Each answer should be unique, and should provide information about the question the answer responds to. For example, an appropriate answer description is “Yes, I am a smoker.” </li></ul></ul><ul><ul><li>Quest_Desc: Each answer should be unique, and should provide information about the question topic. For example, an appropriate question description is “Do you smoke?” An inappropriate response description is “Question 1.” </li></ul></ul><ul><ul><li>Impact Pro uses the MEMBER field to uniquely link information regarding each member to the Impact Pro output datamart. MEMBER should uniquely define an individual. Every member ID in the HRADATA table must also have an entry in the MEMBER table. </li></ul></ul><ul><li>Lastly, check to see number of questions and members is correct and duplicates and invalid records indicated in the validation output. </li></ul>
    61. 61. HRA Table Structure - appendix
    62. 62. HRA Table Structure - appendix
    63. 63. HRA Table Structure - appendix
    64. 64. HRA Table Structure - appendix
    65. 65. Input data steps to include HRA data - appendix
    66. 66. Input and Output Data Steps – HRA considerations - appendix

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