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Technology in Health Care Keynote Address

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Stephen McHale: Co-Founder, Chief Chairman, Executive Officer, Explorys …

Stephen McHale: Co-Founder, Chief Chairman, Executive Officer, Explorys
Missouri Health Policy Summit 2013

Published in: Health & Medicine, Business
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  • 1. Big Data + Healthcare October 8, 2013 page 1 | CONFIDENTIAL
  • 2. About Explorys page 2 | CONFIDENTIAL
  • 3. Explorys About US Formed in conjunction with Cleveland Clinic in 2009. Value-based care network and Platform for enabling the transformation of healthcare. Serve large integrated delivery networks and provider led plans. Our mission is to unlock the power of Big Data to improve healthcare for everyone. page 3 | CONFIDENTIAL 
  • 4. Explorys Member Systems Network enabling platform of 300 hospitals 17 integrated delivery networks 200,000 providers 135 billion data points Delivering over $52 billion in care annually Across 35 million patients Projected as 45 million as newly signed systems go live in coming months page 4 | CONFIDENTIAL
  • 5. Healthcare Market Dynamics page 5 | CONFIDENTIAL
  • 6. The battle is on for…  Healthcare consumers  Patient share of chart  Employer contracts  Well aligned providers page 6 | CONFIDENTIAL
  • 7. The Perfect Storm page 7 | CONFIDENTIAL
  • 8. Growing trend towards mass consolidation to compete effectively and remain financially secure. Number of M&A transactions, 2000-2011 page 8 | CONFIDENTIAL Source: The Health Care M&A Report, Irving Levin Associates, Inc., 2000-2011 and AHA Hospital Statistics
  • 9. Growing trend towards mass consolidation to compete effectively and remain financially secure. "It's a numbers game," he said. "To effectively take on the financial risk providers are being told to assume, they need a certain amount of critical mass. The bigger you are, the more the numbers work to your advantage.” - Healthcare remains highly fragmented relative to other industries Ben Rooks, founder of San Francisco-based ST Advisors Sources: Kauffman Hall - Strategic Options in a Consolidating Market Modern Healthcare’s 2011 Hospital Systems Survey 2011 AHA Hospital Statistics, iSuppli Corporation 2010 Semiconductor Suppliers Air Transport Association 2010 Economic Report. Statistics are prior to the United-Continental merger. Proforma for that transaction, the top 5 and top 15 would have made up 70.0% and 89.5%, Drug Store News Top 50 Rx Power Players, April 2012. Market size is defined as the revenues of the top 50 players page 9 | CONFIDENTIAL Top 5 Players Top 15 Players
  • 10. Growing Demand for Value Payers, patients, and employers and demanding accountability in care and outcomes. Unsustainable trajectory of costs coupled with few quality improvement in the last decade. Source: The Commonwealth Fund: The National Scorecard on U.S. Health System Performance, 2011, page 10 | CONFIDENTIAL
  • 11. Value-Based Models Developing Rapidly ACOs, Bundled Payments, PCMH, and others… page 11 | CONFIDENTIAL
  • 12. Share of Chart In Network Out of Network Is an imperative for growing revenue and managing risk Proactively manage your patient / customer or someone else will page 12 | CONFIDENTIAL
  • 13. Pick Your Initiatives Wisely How timing, share of chart, shared savings rate, and cash flow impact both valuebased-care and fee for service financials. page 13 | CONFIDENTIAL
  • 14. The Connected World Rapidly Forming A New Healthcare Economy Clinically Integrated Networks IDN 1 Employers Patients / Members Risk Models PHO Finance IDN 2 Health System Contact Center Contracting Guidelines TPA Apps & IT Tools Regulators Underwriters Payers IDN 3 page 14 | CONFIDENTIAL
  • 15. Aligning Provider Incentives and making sure those deserve it get compensated page 15 | CONFIDENTIAL
  • 16. “There is concern surrounding how reimbursement will be distributed mong the multitude of providers involved in a particular episode. This may pose considerable challenges to urologists in community practice and may further incentivize alignment with hospital systems.” Matthew J. Resnick, MD, assistant professor of urologic surgery at Vanderbilt University Medical Center page 16 | CONFIDENTIAL
  • 17. You’re Swimming in Big Data whether you know it or not page 17 | CONFIDENTIAL
  • 18. BIG DATA is Volume, Velocity, and Variety… Volume 150 exabytes of stored healthcare data across disparate care settings… Velocity 1,000 Variety /sec vital-signs capture by bedside, home, and mobile devices… 80 coding variability among diagnoses and test results… Source: “How big is 'big data' in healthcare?”, by Graham Hughes, MD “Big Data Use In Healthcare Needs Governance, Education” – Information Week, by Neil Versel “Why 'Big Data' Is a Big Deal”, Wall Street Journal, By L. GORDON CROVITZ page 18 | CONFIDENTIAL %
  • 19. Applying Big Data effectively could yield $300400 billion in healthcare costs page 19 | CONFIDENTIAL
  • 20. In a Gartner 2012 survey, 68% of health systems intend to make new investments in business intelligence and analytics in the next 2 years. Even at the height of the U.S. EHR adoption, that percentage never reach this level. page 20 | CONFIDENTIAL
  • 21. However, EMRs are not well positioned to leverage Big Data for population health…. “Early EHRs were not designed first and foremost to facilitate and improve the delivery of care; they were designed to facilitate billing. - Rob Tholemeier and John Moore, Chilmark Research, June 2013. page 21 | CONFIDENTIAL
  • 22. PCP Specialist Hospital Post acute Long term Capturing The Continuum of Care is CRITICAL page 22 | CONFIDENTIAL Home
  • 23. Payer Claims Charges, payments, Rx fills, 3rd party providers Provider Billings Part of the Picture EDI billing and payment adjudication (EDI) Healthcare System Operations Allocated costs, actual costs, labor, and materials Provider Info Physicians, nursing staff, specialists, and care coordinators page 23 | CONFIDENTIAL
  • 24. Payer Claims Ambulatory EMR (employed & affiliates) Charges, payments, Rx fills, 3rd party providers Diagnoses, findings, labs, procedures, encounters, appointments Provider Billings ED & In-Patient EMR EDI billing and payment adjudication (EDI) Diagnoses, findings, labs, procedures, encounters, appointments Patient Demographics, behaviors, and attitudes Healthcare System Operations Allocated costs, actual costs, labor, and materials Provider Info Physicians, nursing staff, specialists, and care coordinators Administrative page 24 | CONFIDENTIAL Long Term Care Diagnoses, findings, labs, procedures, encounters, appointments Homecare & Telemedicine Readings, patient reported outcomes, nursing visits, and mobile Clinical
  • 25. Big Data in the Real World Use Cases page 25 | CONFIDENTIAL
  • 26. Driving Knowledge from BIG DATA… What’s the best that can happen? Optimize Competitive Advantage What will happen next? Predict & Model What if these trends continue? Why is this happening? Forecast Analyze Alert DrillDown Query Report What actions are needed? Future-oriented and source of competitive advantage Descriptive Analytics (the “what”) What exactly is the problem? How many, how often, when? What happened? Degree of Intelligence page 26 | CONFIDENTIAL Predictive Analytics (the “so what…. And the “now what”) “Rearview mirror” – Provides foundation and insight
  • 27. Patients and Providers Creating Win-Win Opportunities Maximize Quality Identify the highest impact opportunities relative to risk-adjusted benchmarks and track progress. Maximize Margin Risk stratify populations, profile providers, predict outcomes, and direct action towards reducing unnecessary cost and optimizing reimbursement. Maximize Market Share Drive top-line revenue through provider alignment and virtually integrated networks. page 27 | CONFIDENTIAL
  • 28. Patients and Providers Creating Win-Win Opportunities Maximize Quality Identify the highest impact opportunities relative to risk-adjusted benchmarks and track progress. Maximize Margin 30% quality improvement within value-based care disease management programs Risk stratify populations, profile providers, predict outcomes, and direct action towards reducing unnecessary cost and optimizing reimbursement. Maximize Market Share Drive top-line revenue through provider alignment and virtually integrated networks. page 28 | CONFIDENTIAL
  • 29. “We saw a 51% reduction in hospital admissions, a 35% reduction in readmissions and a 37% reduction in emergency department visits” Teaera Roland, Nurse Care Coordinator, Mercy Health page 29 | CONFIDENTIAL
  • 30. “We have had improvements across all of our measures throughout the course of the year.” “Our pneumococcal vaccine rate rose from 52 percent in 2011 to 60 percent at the end of 2012; our colonoscopy rate went from 34 percent to 40 percent during that time. And our tobacco cessation counseling rate rose from 56 percent to 77 percent.” Dr. Amy Frankowski, MD, Catholic Health Partners page 30 | CONFIDENTIAL
  • 31. Patients and Providers Creating Win-Win Opportunities Maximize Quality Identify the highest impact opportunities relative to risk-adjusted benchmarks and track progress. Maximize Margin Accurately price care bundles for direct-to-employer risk-based contracts. Risk stratify populations, profile providers, predict outcomes, and direct action towards reducing unnecessary cost and optimizing reimbursement. Maximize Market Share Drive top-line revenue through provider alignment and virtually integrated networks. page 31 | CONFIDENTIAL
  • 32. Patients and Providers Creating Win-Win Opportunities Maximize Quality Identify the highest impact opportunities relative to risk-adjusted benchmarks and track progress. Maximize Margin Empowering Colorado Health Neighborhoods’ physician-led clinically integrated network across more than 2,000 providers. Risk stratify populations, profile providers, predict outcomes, and direct action towards reducing unnecessary cost and optimizing reimbursement. Maximize Market Share Drive top-line revenue through provider alignment and virtually integrated networks. page 32 | CONFIDENTIAL
  • 33. Q&A page 33 | CONFIDENTIAL

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